Descriptive Psychopathology: The Signs and Symptoms of ...

339 Chapter 14: Personalitywhat others might think can provide a picture of the temperament pattern. Forpatients with chronic illness, the task is more difficult and may only succeed withinformation from family members. Using collateral information is standard in theassessment of children and adolescents and for patients with cognitive difficulties,and should not be thought a burden when assessing the patient’s personality.Because personality traits represent tendencies to behave in circumstances ofreward (e.g. praise, affection, money, and position), or non-reward (e.g. criticism,coldness, and non-recognition), these kinds of situations become the focus ofquestions, rather than the social consequences of the behavior. Asking a personwho grew up in a gang-infested urban area about fighting and using a weaponmay not provide a reliable measure of how aggressive they are. Learning about thepatient’s response to meeting new persons will reveal more about their temperamentthan just determining the number of their friends. More specific temperamentquestions also focus on the person’s tendency to be irritable, impulsive, andphysical. Three broadly defined behavior areas frame the examination.Behavioral inhibition. The tendency toward behavioral inhibition with avoidanceof situations that are novel, unrewarding or socially difficult is associatedwith shyness and anxious–fearfulness (cluster C in Axis II of the DSM). Substantialtendencies toward behavioral inhibition also associates with low assertiveness,low impulsivity, low physicality and wellbeing, and high constraint and harmavoidance. It is assessed with questions such as:“Do you think you’re a nervous person? Are you high-strung?”“Are you the kind of person who worries a lot ... who usually worries about all the thingsthat can go wrong with a plan or activity?”“Are you an overly cautious person? Do you think about things too much rather than acting?Are you a timid or shy person?”“Do others think of you as a nervous/shy/worrying/cautious person?”“Do you prefer activities that are quiet with little physical activity? Do you get tired easily?”Behavioral activation. The tendency toward behavioral approach and actionis associated with high risk-taking, novelty seeking, assertiveness and aggressiveness,leadership, sociability and being physical. It also associates with low constraintand harm avoidance. Persons in the DSM Axis II cluster B category tend tobe high on behavioral activation. It is assessed with questions such as:“Are you the kind of a person who always likes to be busy ... to be doing new and excitingactivities, even if there is some risk?”“Are you a high-energy, enthusiastic person?”“Are you the kind of person who acts first and thinks about it afterward?”“Are you quick-tempered and excitable? Do others think of you as an impulsive, excitable,risk-taking person?”