The anguish and rage of children with severe personality disorders as-sail clinicians with uncanny power. Like no other patients, these chil-dren challenge the clinician’s skill and sensitivity. Although they strainthe resources of schools and caregivers, their remarkable determinationto survive can be both touching and endearing. Yet they excel at defeat-ing the efforts to help them. The means these children use to ensure their emotional survival can inflict enormous pain on themselves and their families, and canevoke responses from others that reinforce their maladaptation. Indeed,treatment often fails as clinicians succumb to their own inability tomanage the emotional reactions elicited by these children. On closer examination, these children’s disruptive behavior ap- pears to be the manifestation of severe personality disorders that surfacein the process of becoming organized and structured. Such patterns ofmaladjustment span a cluster of conditions encompassing the border-line, histrionic, narcissistic, and antisocial personality disorders, whichthe fourth edition of the Diagnostic and Statistical Manual of Mental Dis-orders (DSM-IV; American Psychiatric Association, 1994) groups to-gether as the Cluster B, or the “dramatic,” personality disorders. I referto this cluster of disorders as the severe personality disorders because ofthe enormous personal, social, and financial cost associated with them. In this book, I examine the processes by which youngsters affected by various combinations of constitutional vulnerability, maltreatment,and specific developmental difficulties generate and organize “dra-matic” or severe personality disorders. These personality organizations

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