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The idea that enduring personality traits are closely related to various disease states or behavioral disorders can be traced back to initial speculation by the early Greeks. Hippocrates believed that all disease stemmed from imbalances in four bodily humors: yellow bile, black bile, blood, and phlegm. While Hippocrates’ early ideas bear a rudimentary resemblance to some recent approaches to personality, most contemporary theories of the relationship between personality and psychopathology are considerably more complex, and sensitive to both endogenous and environmental variables. Before the personality– psychopathology relationship can be understood clearly, the concept of personality must be deﬁned.
1. The Concept Of Personality
The word personality is derived from the Greek persona, which referred to masks used in the early theater. Over time, the term has come to refer not only to the exterior presentation of an individual, but the integrated internal systems which allow individuals to adapt to their environment. For example, Allport (1937) deﬁned personality as ‘the dynamic organization within the individual of those psychophysical systems that determine his unique adjustments to his environment.’ This deﬁnition highlights the idea that personality reﬂects both psychological and biological processes that are used in coping with the everyday world. These points are made more clearly by Millon (1996, p. 4), who deﬁnes personality as ‘a complex pattern of deeply embedded psychological characteristics that are largely nonconscious and not easily altered, expressing themselves automatically in almost every facet of functioning. Intrinsic and pervasive, these traits emerge from a completed matrix of biological dispositions and experiential learnings and ultimately comprise the individuals distinctive pattern of perceiving, feeling, thinking, coping, and behaving.’
Another important characteristic of personality is that it pertains to long-standing patterns of behavior which are relatively stable over time and are typically referred to as traits. The American Psychiatric Association has deﬁned personality in the Diagnostic and Statistical Manual of Mental Disorders (4th edn.) as ‘enduring patterns of perceiving, relating to, and thinking about the environment and oneself.’ Taken together, the many deﬁnitions of personality which have emerged over the years highlight several consistent features: the integration of biological and psychological systems, which results in trait-like behavioral stability and function to promote environmental adaptation.
2. Conceptual Debates Related To Personality
Numerous conceptual debates have characterized the evolution of the study of personality. Pervin (1990) outlines several of these issues: ‘Is personality primarily governed by internal factors of the person or environmental eﬀects?’; ‘Is personality determined primarily by nature or nurture?’; ‘Is personality inﬂuenced by past experiences, present factors, or future expectations?’; and ‘To what degree is personality modiﬁable?’
While each of these topics is signiﬁcant in and of itself, this research paper will highlight several other key issues regarding the nature of personality which have generated considerable discussion.
3. Trait-Like Stability vs. Situational Determinism
As noted previously, personality has historically referred to trait-like behavioral patterns which are stable across situations and time. However, a series of empirical studies in the 1920s and 1930s raised serious doubts about the trait-like stability of behavior and highlighted the signiﬁcance of situational factors in determining variability in behavior. Classic studies by Columbia University Teachers College (1928) suggested that children’s level of honesty did not follow a trait-like pattern of predictability, but was signiﬁcantly inﬂuenced by the child’s immediate environmental situation. Furthermore, numerous other studies emerged suggesting that speciﬁc behaviors measured across situations and time were quite variable, further calling into question the idea of trait like stability of behavior (Mischel 1968). Consequently, this era was characterized by a polemic atmosphere in which person vs. situation debates were common.
Ultimately, this criticism of trait constructs was followed by a period of greater integration of situational and trait theories of personality. For example, work by Epstein highlighted that personality traits may not be accurate predictors of speciﬁc individual acts, but may be excellent predictors of aggregated behavior across time and situations (Epstein 1979, Epstein and O’Brien 1985). In other words, traits may be good predictors of a person’s behavior ‘over the long haul.’ Furthermore, theories emphasizing person–situation interactionism evolved and brought into greater focus the ways in which personality traits may interact with particular situational variables. The interactionist solution to the person–situation debate was to consider which personality and situational factors interact to produce consistent behaviors vs. those which interact to produce variable behavior (Ekehammer 1974). Behavior within this approach is considered to ﬂow from transactions between a person and the environment, each of which inﬂuences the other.
4. Should Disturbances In Personality Be Conceptualized As Categories Or Dimensions?
Personality researchers frequently debate about whether personality can best be understood in categorical or dimensional terms. That is, is it more useful to determine what ‘type’ of personality an individual displays rather than what proﬁle of various personality ‘traits’ best describes the individual? This becomes particularly signiﬁcant for the study of disorders of personality, given that the primary classiﬁcation schemes for psychiatric disorders (e.g., Diagnostic and Statistical Manual of Mental Disorders, International Classiﬁcation of Diseases) rely on categorical models. Categorical models parallel traditional, medical disease-based practices in which a person is considered either to have a given disease entity or not. Such an approach has a long history in psychiatry and psychology and oﬀers several advantages: (a) clinicians are generally familiar with the descriptive and clinical terminology and can apply it easily; (b) predictions can be made about a person based on the description of the category; for example, if a person is categorized as sociopathic, we may assume that rule violation or criminal activity is likely; (c) personality types have clear and vivid descriptions which facilitate communication; (d) a disease based approach is appropriate to the extent that personality disturbances are discrete and homogeneous diagnostic entities with minimal overlap between categories.
Unfortunately, the empirical literature has not supported this idea. People generally do not have a particular personality type that can be easily categorized. Rather, personality appears to be better described as an amalgam of traits, and most empirical studies suggest that personality is best conceptualized in such terms. Categorical models of personality have also been criticized because diﬀerent measures of the same personality category show relatively low concordance or agreement (i.e., poor convergent validity) and also individuals who meet diagnostic criteria for a given personality type often meet criteria for several other types (i.e., poor discriminant validity). Indeed, if personality could be best understood in terms of unique and nonoverlapping categories, such problems with construct validity would not be so prominent. Furthermore, setting the minimum threshold for determining the presence of a personality disorder is a fairly arbitrary procedure and confusion regarding normality vs. abnormality is common. Finally, many personality disorder categories have not shown substantial stability over time, which would be anticipated with a true trait oriented personality disorder.
In contrast, the dimensional personality trait perspective has received considerable support in empirical studies. For example, when individuals with personality disorders are compared with individuals with normal personality, the distribution of personality scores does not show an ‘either–or’ pattern, suggesting that personality disordered individuals diﬀer from normals only in the magnitude of certain key personality traits. Furthermore, a large number of factor analytic studies of personality traits in both normal samples and personality disordered samples yield the same basic factor structure for each population, most often implying that four or ﬁve broad personality traits, or factors, may account for variations in both normal and disordered personality. These ﬁve factors are frequently referred to as the Five Factor Model (FFM) and they are traditionally labeled in the following manner: Factor 1, surgency or extroversion; Factor 2, agreeableness; Factor 3, conscientiousness; Factor 4, emotional stability or neuroticism; and Factor 5, culture or openness to experience.
From a clinical perspective, the lack of empirical support for categorical distinctions between normal and abnormal personality and diﬀerent personality types has led some researchers to suggest that personality disorders do not ﬁt the medical model, and consequently personality ‘diagnoses’ should not be made. Rather, personality should be ‘assessed’ along core dimensions, such as the FFM or other clinical dimensions, (e.g., Minnesota Multiphasic Personality Inventory, see Helmes and Reddon (1993) for a review). Livesley et al. (1994) suggest that the simple presence of a personality disorder be determined on the basis of a behavioral pattern that results in personal or interpersonal dysfunction, but is then assessed, or described, on the basis of a dimensional system (e.g., FFM). Such an approach acknowledges that certain personality styles indeed cause distress (i.e., disorder), but retains the comprehensive assessment aﬀorded by the dimensional approach. Whether or not such a system will ever be employed in psychiatric or psychological practice is likely to be determined more by political than by scientiﬁc forces.
5. Relationship Between Personality And Psychopathology
The idea that personality displays an important relationship to various forms of psychopathology has a long-standing history in psychopathology research. Conceptual understandings of the nature of this relationship have varied and generally represent one of several perspectives (Klein et al. 1993, Lyons et al. 1997, see Fig. 1). First, the predispositional hypothesis implies that personality variables precede and increase the risk of developing psychopathology. Also, personality and psychopathology are considered to be independent entities in terms of underlying causes or pathophysiology. An example of this perspective can be seen in early speculation that particular personality traits such as compliance, perfectionism, and dependence increase the risk of developing anorexia nervosa. Similarly, one may speculate that in some people, dependency may precede and increase the chances of developing depression. A second perspective, frequently called the complication or scar hypothesis, implies the opposite relationship between personality and psychopathology. From this view, psychopathology precedes and inﬂuences the development of particular personality traits which are considered the residue of the more active psychopathological syndrome. For example, research suggests that personality variables such as interpersonal dependence or obsessionality may increase after the onset of a major psychiatric syndrome such as depression, but then decrease as the syndrome resolves. The ‘personality trait’ may not be a true trait, but instead a complication of the depression.
A third perspective posits that both personality and psychopathology arise from the same underlying causal process. From such a spectrum or common cause hypothesis, a third variable is thought to increase the risk of both entities. From a spectrum perspective, personality and psychopathology are considered to be quantitative variations of the same underlying process. For example, it could be hypothesized that schizotypal personality traits and schizophrenia each are ‘caused,’ in part, by a particular genetic pattern. Here, schizotypal personality is not thought to cause, or be caused, by schizophrenia. Rather, it reﬂects variations of the same fundamental disturbance. This ‘spectrum disorder’ may ﬂuctuate from periods of schizotypal personality to more active schizophrenic episodes. Common cause models are similar to spectrum approaches in specifying a common causal variable, but diﬀer because they suggest that personality traits and speciﬁc forms of psychopathology are independent entities and not quantitative variations of one particular disorder or psychopathology. For example, obsessive personality traits and certain forms of depression may be posited to be independent entities which both arise from the same early experiences in a family, but they would not be considered variations of the same disorder. Finally, the pathoplasty hypothesis refers to the eﬀect that personality may have on the clinical presentation and course of a particular form of psychopathology. This model does not stipulate any speciﬁc causal signiﬁcance to personality, but simply implies that variations in personality will aﬀect the psychopathology after it emerges. For example, an individual with high degrees of the personality trait of extroversion may behave diﬀerently when depressed than an individual with very low degrees of extroversion (i.e., introversion). Here personality ‘colors’ the way the disorder is manifest.
Unfortunately, there is a general lack of empirical data to clarify which of these models best characterizes the complex relationship between various forms of psychopathology and a myriad of personality traits. However, it is likely that speciﬁc personality traits will show diﬀerent types of relationships to diﬀerent forms of psychopathology and furthermore that a given personality trait may relate to psychopathology in a variety of ways. For example, in the study of neuroticism and depression there is evidence to suggest that neuroticism predisposes an individual to develop depression (predisposition hypothesis), predicts the course of depression (pathoplasty hypothesis), and may be exacerbated by the presence of depression (complication hypothesis). Clearly, the study of the relationship between personality and psychopathology is in its infancy and additional empirical studies are needed.
6. Methodological Considerations
Disentangling the relationship between speciﬁc personality traits and various forms of psychopathology will require complex research designs and statistical procedures. Clearly, longitudinal studies of individuals will be necessary to examine which facets of personality increase the risk of which disorders. Such research will also clarify which personality dimensions will reﬂect complications of speciﬁc psychopathologies. Additionally, family history studies and behavior genetic designs employing twin studies or adoption paradigms may help to determine more precisely how various forms of personality and psychopathology are transmitted in families and the extent to which they represent variations of the same process.
The study of personality has revealed that in spite of the power of environmental situations to determine behavior, people tend to be relatively consistent across time and situations in terms of their general patterns of behavior. Furthermore, it seems that people tend to diﬀer along a few primary personality dimensions, or factors, which underlie the concept of personality. While personality traits may increase the risk of developing certain disorders or illnesses, the experience of an illness or disorder may also modify personality. Furthermore, people’s personality styles will inﬂuence the way in which their disorders develop, change over time, and also respond to treatment. Powerful scientiﬁc studies which follow individuals over time will ultimately help us to clarify how personality increases the risk of disorder and furthermore how disorder may modify personality.
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