Personality and Psychopathology
In this 500-page research compilation, more than 30 investigators detail the state of the art of research on the relationship between personality and psychopathology. They address all aspects of the topic: heritability of personality traits, developmental influences, the relationship between personality traits and DSM axis I and axis II disorders, and treatment.
The book is organized into five sections. The first deals with the overlap between personality traits and DSM-IV disorders. In one chapter, Dr. Cloninger and associates present his temperament and character inventory (TCI) model of personality and distinguish four basic traits: harm avoidance, novelty seeking, reward dependence, and persistence. Character is defined in this model as the result of individual development based on temperament and environment; it is represented by self-directedness, cooperativeness, and self-transcendence. This model was tested on both general and psychiatric populations and supports the hypothesis that there is a continuity between normal emotions and disorders of mood and personality.
The second section addresses the development of normal personality from childhood to adulthood, reviewing the use of five to seven factors to describe personality traits that develop during childhood and adolescence and are fairly stable in adulthood. The chapters in the third section discuss the categorical versus the dimensional approaches to personality disorders. Dr. Cloninger's TCI model is applied to further illuminate how emotions or mood states are related to both normal and deviant personality.
Section 4 explores genetic and psychosocial factors to address the etiology of personality. An extended twin kinship study of the "Virginia 30,000" compares the inheritance of height with that of what one would expect to be a more culturally determined trait: conservatism. Next, some very complex and difficult-to-follow models are proposed to relate psychodynamic concepts to adult personality and psychopathology. In one chapter, path analysis is used in a large twin study to address the nature-nurture issue. After these chapters, a chapter on using the PET imaging to study the neurology of cognition, emotion, and behavior was actually relatively easy to read and understand.
As my summaries may have revealed, this book covers sophisticated research, models, and statistics; frankly, my 20-year-old graduate-level mathematical genetics and statistics weren't really up to the task. I had hoped that the section on treatment would offer the same rigorous approach that the rest of the book has, but with the advantage of easy comprehension. However, two of the chapters are general and unsubstantiated, and another is not up-to-date clinically. Only a chapter reporting a study of patients with depression and personality disorder, which indicates that temperament is a possible predictor of response to antidepressant therapy, turned out to be what I had hoped for.
In my opinion, Personality and Psychopathology is an excellent book for someone working on the topics the book addresses or someone trying to understand the state of current knowledge or investigation in the field. Almost any chapter would serve well as the basis for a classroom discussion for psychiatric residents or psychology graduate students. Although some of the research reported here may not ultimately lead to clinically useful findings, the work as a whole provides a serious investigative approach to personality and emotional traits, states, and behavior that may one day allow psychiatric treatment, including psychotherapy, to be based on testable and verifiable hypotheses.
Dr. Szeeley is associate professor of psychiatry at the University of Medicine and Dentistry of New Jersey in Camden.
