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Akhtar's aim is to take two distinct clinical frameworks—descriptive psychiatry and psychoanalysis—and construct a synthesis that will “confirm, consolidate, and enhance” (p. 277) the contributions made by each to diagnosis, evaluation, and treatment of the severe personality disorders. Broken Structures has been well received by prominent analysts and critics (Kernberg wrote the laudatory Foreword) who agree on its merits: Akhtar has assembled, combined, and integrated a very large body of information, and thus has provided a highly useful reference source to clinicians.
The book is in four parts. Part I presents a brief history and summary of the meanings and uses that the terms “identity” and “identity diffusion” have had in psychoanalysis.
Part II, the longest section (about two-thirds of the book), describes and discusses eight personality disorders. Each chapter is devoted to a single disorder (except for the last, which considers both histrionic and schizotypal disorders), and each presents an historical overview of the conceptual development of the disorder, discusses its place in DSM-III and III-R, synthesizes descriptive and analytic perceptions in terms of clinical features, considers