Abstract
This book is primarily a reference text, produced by the same people who brought us the DSM-IV-TR. It is at its most useful when called on to flesh-out a DSM-IV-TR category, but is a difficult cover-to-cover read, partly because it follows the format and chapter order of the DSM-IV-TR. Despite the didactic nature of the parent text, cautious statements in the introduction warn against premature diagnostic closure and emphasize the overriding importance of clinical judgement rather than any external set of criteria.
The case studies themselves are interesting and well-chosen in general. Each is followed by a multiaxial diagnosis and the DSM-IV-TR diagnostic criteria for the primary diagnosis illustrated, some dry but useful guidelines for differential diagnosis, concise guidelines on treatment planning and a brief summary. Generally, the more common diagnoses in any diagnostic category are illustrated.
The text is at its most interesting and valuable when discussing controversial and rare diagnoses. The section on Dissociative Identity Disorder [p.220–223] is very readable and the discussion of iatrogenic risks in this area and the concept of ‘fad diagnoses’ was brief, but balanced and informative. The Sexual and Gender Identity Disorders section gave priority to regarding normality as the first differential diagnosis to consider, gave an overview of the CBT and psychodynamic considerations in treatment, and added an important rider that a diagnosis of paraphilia in no way absolves a person of criminal responsibility – all common sense, but clearly presented and easy to read.
Personality Disorders are covered very well in descriptive terms. Attention is drawn to sexual stereotyping, using the characters of Blanche Dubois and Stanley Kowalski from A Streetcar Named Desire, who could both meet criteria for Histrionic Personality Disorder. The treatment-planning sections are generally briefer and slightly baffled in tone, with the exception of the rather authoritarian section on Borderline Personality Disorder. The coverage of Antisocial Personality Disorder ends with the candid statement ‘If this discussion of the treatment of Antisocial Personality Disorder sounds pessimistic, it is meant to.’
Most of the case study titles verge on the banal, however, some have an edge of humour, ranging from the possibly unintended (‘An Old Bird with an Empty Nest’ – Adjustment Disorder with Depressed Mood) to an unexpected reference either to The Caine Mutiny or to Red Dwarf (Principal ‘Queeg’ – Paranoid Personality Disorder).
The Test Yourself section (Chapter 17) provides a selection of more complicated cases, with the diagnosis followed by a discussion that is at times not uncritical of the DSM-IV and DSM-IV-TR.
The most frustrating aspect of this book was its failure to satisfy my curiosity about how these well-described and easily visualized patients responded to treatment. Only briefly does one get a glimpse of this (the phobic doctor who learned to overcome his dread of fingernails, and the avoidant man who surprised his treating doctor by going to the YMCA) and after reading several cases in a row it can get annoying. However, having said that, it is a good reference text to have on hand, is readable and chatty in a way the DSM could never be, and really provides a sense of the person in the vignettes. It would make a useful addition to the bookshelf and would be a good reference for preclinical trainees.