Descriptive Psychopathology: The Signs and Symptoms of ...

357 Chapter 15: Abnormal trait behaviorssexually frigid, dependent, and suggestible. 30 Other authors added impulsive,impressionistic, reckless, and attention-seeking, including self-injurious behaviorand “wishing to be ill”. 31 The validity of these observations is unclear. The personsdescribed are invariably women and the physicians offering the descriptionsmostly men. In dismissing the sexist implications of this demographic, Trimblewrites of the descriptors of hysterical personality:In its florid form this style is easily recognized (the essence of femininity – hence the feminists’revolt!), but some authors have revealed these trait patterns as identifiable factors usingpersonality questionnaires in population studies.Antisocial and histrionic personality disorders reflect similar temperamentpatterns (high novelty seeking/behavioral activation and low harm avoidance/behavioral inhibition), but expressed differently by gender. Both categories arefound in members of the same pedigrees, indicating a familial if not a geneticshared disposition. Both are co-morbid with about 25% of persons with eachpersonality disorder also meeting criteria for the other. Persons placed in thesecategories are at greater risk for somatization and conversion disorder diagnoses.32 Cluster B traits are also associated with bulimic symptoms. 33 In the scantreports of serial killers, most meet criteria for antisocial personality. 34Borderline personality is a heterogeneous class. Many such persons suffer froman early onset, chronic and less episodic mood disorder. Biologic markers andtreatment studies support this view. 35 Other patients with the label have traitsof high behavioral activation (novelty seeking) and low behavioral inhibition(harm avoidance) that encourages taking high risks resulting in brain dysfunctionfrom illicit drug use 36 or traumatic brain injury. 37 These conditions in turnexaggerate their other personality traits of impulsiveness and aggressiveness,resulting in a combination of state and trait behaviors. 38 The end result is thattreatments for traits (cognitive and dialectic behavior therapy) are unsuccessfullyapplied to illness.The borderline criteria also include psychological interpretations (e.g. avoidingimagined abandonment, alternating idealization and devaluation) and symptomsof illness (e.g. “paranoid ideation or severe dissociative symptoms”). The term isa remnant of psychoanalytic theorizing of a relationship between neurosis andpsychosis. It should be eliminated.Cluster CCluster C personality disorders also represent two groupings: avoidant/dependentand obsessive–compulsive. The cluster is associated with the anxiety disordersand non-melancholic depressions. 39 Almost all criteria are the consequences ofimplied, but never detailed, temperament traits. A common temperament theme