Take our Agreeableness Test

Find a therapist near me

Personality can be framed as levels intersecting with traits, rather than fixed categories.

Neurosis is one level of personality organization shaped by triangular conflict, guilt, and competition.

Neuroticism can be expressed through obsessionality.

This post is part 1 of a series.

This is the first of a three-part series on analytic approaches to personality organization and how we can use this framework to develop a psychoanalytic formulation of our patients. It contrasts with how the DSM is currently organized, and apparently how it will be organized in future editions. I personally find the use of levels of personality organization incredibly useful in conceptualizing complicated clinical presentations, and I’ll refer back to this series frequently in other writings.

The DSM categorizes symptom clusters into syndromes, which it then mislabels “diagnoses.” These symptom clusters are thought to aggregate in ways that provide useful pathophysiological or prognostic information. See here for one of my critiques of this approach.

Many analysts, by contrast, categorize people and their symptomatic presentations along two separate axes: the level of personality organization and their characterological traits. Nancy McWilliams, in her book Psychoanalytic Diagnosis,1 does a wonderful job reviewing this approach to case construction. The seminal works on personality organization come from Otto Kernberg, which I highly recommend.2,3 In this post, I focus primarily on levels of personality organization, using the characterological trait of obsessionality as a clinical illustration across levels.

Levels of Personality Organization

The three levels of personality organization in patient populations are neurotic, borderline, and psychotic. Kernberg also describes a........

© Psychology Today