Book Review: Antisocial, Narcissistic, and Borderline Personality Disorders – A New Conceptualization Of Development, Reinforcement, Expression, and Treatment – By Daniel Fox

March 22, 2025 Hannah Moller 0 Book Reviews, Civil Rights, Equality, Health, Media and Communication, Morality and Ethics, SI Communities, Staten Island Families, Staten Islander Exclusive

Book Review: Antisocial, Narcissistic, and Borderline Personality Disorders – A New Conceptualization Of Development, Reinforcement, Expression, and Treatment – By Daniel Fox

This excellent book, by Daniel Fox, whom we interviewed previously, serves as a primer for these three disorders, as well as providing details on treatment options that have been shown to be effective for the four different personality disorders.

Each of the sections begins with a description of the personality disorder, followed by a detailed explanation of how the current understanding was arrived at. You are led through the timelines of its evolution through the years, in most cases starting back in the 1950s when psychiatry and psychology were in their infancy but growing fast. With each subsequent release of the Diagnostic and Statistical Manual of Psychiatric Disorders, known as the DSM, you can see the current definition come into focus. As each edition unfolds, and as the definitions are applied to real patients in the real world, you see the evolution to the present day.

However, as the author points out, in most cases the DSM, even up to the latest version, has its drawbacks and limitations. And even as they edit and refine the definitions, there are still major weaknesses. This is why the author brings in additional models and methods for explanation and expansion of each of the disorders, informing the reader of the most current and effective understandings that are available today.

Using something called the CAPS model (Cognitive-Affective Processing System), consisting of various units and how they interact with each other, known as CAUs (Cognitive Affective Units), the reader can start to see how these interactions come together to form the disorder. So, for example, in Narcissistic Personality Disorder, the DSM model provides a number of different criteria that must be present to make a diagnosis. When the other methods are added to the diagnostic toolbox, a clearer picture and, more importantly, a clear treatment strategy to manage the disorder comes into view.

While an individual with NPD may have several elements as described in the DSM, adding the other models can help expand the clinicians’ understanding. There are also subtypes of NPD, such as the amorous subtype (which is histrionic in nature), where the way in which the disorder manifests itself is very different from another subtype, such as the compensatory type (which is avoidant or negativistic in presentation), but they are both still suffering from NPD. Without the additional information, the patient in one of the subtypes may be misdiagnosed.

For clinicians working with these populations of patients, this will be a valuable resource. It can also be useful when determining the severity of each patient’s disorder, as it provides suggestions for questionnaires and worksheets to use to assist in determining the severity. This can be helpful, as at some levels of severity, treatment won’t be effective. The book also guides you on what to look out for. For example, with ASPD, the most severe and resistant to treatment disorder, environment is critical. In many instances, the individual is part of a small or large community where this personality disorder is not only essential for functioning, it is seen as necessary and the norm. In such instances, the patient may respond to treatment, but it is unlikely to last. This is particularly so in a prison environment, where it is seen quite frequently.

For instance, a patient who is in prison for doing something severe may be responsive to treatment. They may want to get their life back in order. However, if they are released from prison, they have the same friends and family on the outside. When they rejoin their family, it is often the case that they are encouraged to express their disordered personality – usually the reason they ended up in prison in the first place – more thoroughly once again, or they may face ostracization. This then serves to put them back in line with their family or social circle members, and they often go back to their criminal ways. This is something the clinician should be aware of and prepared for.

Each of the sections also provides at least one case study of an individual with the most severe form of the condition. This helps you to visualize the traits just discussed into the form of an actual person performing the behaviors and demonstrating what it looks like in real life. This helps expand your understanding past the traits and descriptions, and can help you recognize what to look for in a patient.

The treatment strategies and options sections helps the clinician to understand exactly what they’re dealing with, as well as how likely it is that their patient will get better. The likelihood increases the lower on the scale or less severe the condition is. A patient suffering from mild to moderate degrees of each disorder is much more likely to improve with treatment.

The book also progresses in order of least treatable to most treatable personality disorders. ASPD is the most difficult for a patient to recover from and change, and it is, in fact, a management disorder. The patient will never be ‘cured,’ but they can learn coping strategies and methods to manage the condition so it doesn’t adversely affect their life as much. NPD is second, as it’s in between easiest and hardest to treat. And it can be treated. While not curable in the usual sense, people with mild to moderate severity can lead normal lives, and they can learn to have better relationships with others. These can be home, work, or school relationships, but they are able to interact normally. BPD is the most treatable, and is also the disorder for which someone is most likely to seek help on their own. And there are people with this condition for whom the symptoms don’t return after treatment and follow up after multiple years. The same is not the case for the other two.

Therapists treating patients with these conditions will find this book to be a helpful resource. It contains a great deal of helpful information, and it is very encouraging to those working with patients who suffer with these disorders. It is a bit technical and not as much geared toward the layperson or individual diagnosed with one of these disorders.

For those who are patients seeking treatment without a therapist, this author’s workbooks will be much more helpful. For NPD, this workbook is specific to that condition. This is the workbook for BPD. And the workbook for multiple disorders, including the previous two, can be found here.

But for those working directly with these populations, you will learn a lot about how to best help your patients, and it can be encouraging to know how much of a chance they have to get better. This book will give you a great outlook and useful tools to add to your arsenal of treatment offerings for patients with these conditions.

It is also helpful to see why someone may seek help, along with things that may stand in their way, such as the stigma associated with particular conditions. If you work with these populations, you will definitely find this book informative and helpful. I would highly recommend it, and I give it five stars.