Descriptive Psychopathology: The Signs and Symptoms of ...

364 Section 3: Examination domainsNo unusual stress events were identified, either at home or at school. Hewas not found to be depressed or psychotic. His parents described him as aquiet, shy person, a perfectionist and a pessimist. Until the emergency roomvisit the patient had never been seen by a psychiatrist or psychologist. He didhave a long history of allergies, mild asthmatic-like episodes, and multiplecomplaints including headaches, ear aches, rashes, breathing problems, andURIs resulting in over 30 physician office visits in the previous 3years. Hisfather accompanied him for most of the visits. No health problem wasconsidered serious and for many visits no pathology was identified. Thepatient’s parents were said to be extremely attentive and involved with thepatient’s school activities, but the father’s work frequently kept him awayfrom home.The clinical importance of assessing personalityPersonality disorders are medical diagnoses, and about 10% of persons meetDSM criteria for personality disorder. These deviant trait patterns are associatedwith other conditions. For example, 40–60% of individuals with anxiety disorder,non-melancholic depression, eating disorder, and adjustment disorder have apre-existing personality disorder, complicating treatment.Personality dimensions also predict the likelihood that a person will usetobacco, 73 abuse alcohol early in life, or use illicit drugs. Such use compromiseshealth and is associated with non-compliance to treatment. The same traits predicthigh-risk or criminal behaviors. 74In addition, all patients and their family members have personalities. The successin educating the patient and family members about the patient’s condition andtreatments, how the family can help, and how the patient needs to comply withtreatment depends on the clinician’s ability to influence others. Recognizing thepersonality traits of the patient and of family members guides that influence.SummaryMost deviant personality traits reflect variability in maturation. The determinantsof deviant personality are similar to those for normal personality. Disease, injury,and toxicity, however, can affect the neural networks subserving personalityaltering trait behavior. The conditions that elicit such change tend to occur afterpersonality is formed and a substantial personality change after age 35 is almostalways the result of brain disease or dysfunction.The DSM and ICD categorical approach to personality disorder is inconsistentwith the modern understanding of personality structure, and requires replacement