Descriptive Psychopathology: The Signs and Symptoms of ...

337 Chapter 14: Personalitya new situation (novelty), praise, affection, monetary compensation (rewards), andpunishment, criticism, or disappointment (non-reward). The pattern is individuallycharacteristic and is formed during the person’s formative years and then changeslittle, except when altered by traumatic brain injury or disease (stroke, epilepsy,chronic mood disorder, degenerative brain disease, and chronic illicit drug use). 27Personality patterns are composed of quantified trait dimensions. The dimensionshave low and high poles, indicating the strength of expression. These“higher-order” dimensions are in turn composed of a number of “lower-order”subtraits, accounting for the many subtle differences among individuals. 28A person can have a score anywhere on a dimension, most persons scoring inthe middle or normal range for that trait. Low and high scores are by definitionabnormal, reflecting deviation from the norm, not pathology. A score on one traitdoes not predict scores on other traits. Persons with several abnormal traits aredefined as having abnormal personalities.Deviance, however, does not imply disease or dysfunction. Firefighters andpolice officers score very high (i.e. abnormal or deviant) on dimensions thatmeasure exploratory behaviors in novel situations, traits needed to do their jobs.Similarly, missionaries and relief workers are abnormally high on dimensions ofsentimentality and cooperativeness. 29Personality structure refers to the big traits and their component subtraits. Thisstructure is shared by all humans as are other body structures, such as the humanface and hand. Males and females have the same basic “floor plan”, and personalitytraits are normally distributed in both genders. Women, however, tend toscore higher on traits that measure cooperativeness and the tendency to maintainbehaviors that elicit external reward. 30The number of personality traits and subtraits delineated by research groupsvaries, but there is substantial overlap on subtraits and unanimity on the hierarchicalbig picture. Eysenck introduced the dimensional construct of personalityto psychiatric diagnosis over 40years ago, defining neuroticism, extraversion, andpsychoticism. 31 The traditional factor analytic studies of personality generated“The 5-factor model” that describes neuroticism, extraversion, openness toexperience, agreeableness, and conscientiousness. 32 Cloninger and colleaguesoffer a combination of temperaments and character traits. The temperamentsare harm avoidance, novelty seeking, reward dependence, and persistence. Thecharacter traits are self-directedness, cooperativeness, and self-transcendence. 33Siever and Davis and colleagues define four dimensions: emotional dysregulation,dissocial behavior, anxiety/inhibition, and compulsivity. 34 Bedside testing forpersonality simplifies this array of overlapping views of trait dimensions.The neural systems for emotion and personality overlap and personality traitsmodulate emotional expression, but emotional expression is also independent of