Descriptive Psychopathology: The Signs and Symptoms of ...

347 Chapter 14: PersonalityCombat, torture, and terrorist attackSevere stress elicits a stress response in normal persons. A third to 50% of victimsexperience persistent symptoms up to 18months post-trauma. 77 Alcoholism iscommon among combat veterans with persistent stress response symptoms, andthis may contribute to the smaller hippocampal volumes reported in thesepersons. 78 Dissociative experiences during and immediately after the trauma areassociated with intense panic during the event, 79 and may predict chronicsymptoms, as does previous psychiatric illness, 80 persistent memory difficulties, 81and brain injury from the event. 82SummaryNormal personality represents a complex interaction between maturational environmentfactors (e.g. parental care, nutrition and general medical health, uniqueexperience early in life) and substantial genetic influences (e.g. multiple smallgenes with an additive effect 83 ) that lead to characteristic individualized responsepatterns. The maturation process mostly occurs during the first two decades oflife, and after that personality changes little.Personality represents a pattern of behavioral traits that are dimensional andthere is no precise cut-off point for a low or high trait. Personality traits arealso hierarchical. Several broad, more easily described traits (e.g. behavioralinhibition) are each composed of a number of more behaviorally refined traits(e.g. restraint, pessimism). The refined traits are used as descriptors in theexamination of personality.NOTES1 Phillippe Pinel, appointed in 1793 as the director of the Bicêtre, Paris’ asylum for the insane,is famous for his reforms and humane treatment of the mentally ill, literally releasing themfrom their chains. He cited this quote from a well-known encyclopedist of that era in a 1791monograph (Pinel, 1791) decrying the knee-jerk responses to the mentally ill. It could easilyapply to the diagnostic approach of present classifications.Pinel introduced the procedure of daily rounds and careful note taking. He may have beenthe first physician caring for the mentally ill to require psychiatric case histories and thekeeping of hospital records.2 Kolb and Whishaw (1996), pages 6–8.3 Kretschmer (1925); Sheldon and Stevens (1942). Sheldon’s ectomorph (lanky and fragile)was associated with low energy, schizoid traits and schizophrenia. His endomorph (roundand soft) was associated with good humor and manic-depressive illness. Mesomorphs(muscular) were associated with antisocial personality.