Kernberg O F
New York Hospital-Cornell Medical Center, New York, New York.
Psychiatr Clin North Am. 1989 Sep;12(3):553-70.
This article describes a dimension of antisocial behavior that links the narcissistic personality disorder with the antisocial personality disorder, with the syndrome of malignant narcissism as intermediate between the two. Starting with a critique of the DSM-III-R description of the antisocial personality disorder, the author reviews some salient contributions to the concept of the antisocial personality disorder derived from descriptive, sociologic, and psychoanalytic viewpoints. Cleckley's classic description forms the historical background for an updated description of the key characteristics of the antisocial personality disorder. What follows is a summary of the differential diagnosis of antisocial behavior as found in the antisocial personality disorder, the syndrome of malignant narcissism, the narcissistic personality disorders with antisocial behaviors, other severe personality disorders with antisocial features, neurotic personality disorders with antisocial features, symptomatic neuroses, and, finally, dissocial reactions. Prognostic and therapeutic considerations regarding the treatment of antisocial behavior are briefly summarized in the light of this differential diagnosis. A final section describes the psychodynamics of the syndrome of malignant narcissism and of the antisocial personality disorder.
本文描述了一种反社会行为的维度，它将自恋型人格障碍与反社会型人格障碍联系起来，恶性自恋综合征介于两者之间。作者从对《精神疾病诊断与统计手册第三版修订本》（DSM-III-R）中反社会型人格障碍描述的批判入手，回顾了从描述性、社会学和精神分析学观点对反社会型人格障碍概念所做的一些突出贡献。克莱克利的经典描述构成了对反社会型人格障碍关键特征进行更新描述的历史背景。接下来是对反社会型人格障碍、恶性自恋综合征、具有反社会行为的自恋型人格障碍、其他具有反社会特征的严重人格障碍、具有反社会特征的神经症性人格障碍、症状性神经症以及最后失调性反应中反社会行为鉴别诊断的总结。鉴于这种鉴别诊断，简要总结了关于反社会行为治疗的预后和治疗考量。最后一部分描述了恶性自恋综合征和反社会型人格障碍的心理动力学。
