Book excerpt: In this important new book, Dr. Otto F. Kernberg, one of the world's foremost psychoanalysts, explores the role of aggression in severe personality disorders and in normal and perverse sexuality, integrating new developments in psychoanalytic theory with findings from clinical work with severely regressed patients. The book also integrates Dr. Kernberg's recent studies of the descriptive, structural, and psychodynamic features of problems stemming from pathological aggression with the vicissitudes of their psychoanalytic treatment. Finally, Dr. Kernberg demonstrates the importance of differential diagnosis for effective psychoanalytically inspired treatment of these disorders, providing a rich variety of clinical illustrations. The book begins by relating the dual-drive theory of libido and aggression to contemporary developments in affect theory. Dr. Kernberg then applies this general theory of affects to aggression, which in its pathological form centers on the affect of hatred. He analyzes sado-masochistic, hysterical-hysteroid, and narcissistic-antisocial spectrums of personality disorders, emphasizing how aggression is structured in each group. Dr. Kernberg next describes and updates the theoretical frame underlying his approach to the treatment of these disorders, outlines their clinical manifestations, and illustrates their diagnosis and treatment, ranging from standard psychoanalysis with infantile personalities, to psychoanalytic psychotherapy with borderline personalities, to the psychotherapeutic approach to the treatment of psychosis and hospital milieu treatment in the management of highly regressed patients. In the final section, Dr. Kernberg links the findings from psychoanalytic approaches to personality disorders with those from the psychoanalytic study of sexual perversions.