In order to assess something it is crucial to have a good understanding of what it is and what it is not. People differ markedly from one another in their outlook on life, in the way they interpret their experiences, and in their emotional and behavioral responses to those experiences. These differences in outlook, thoughts, emotions, and are what actions characterize an individual’s personality. More generally, personality can be defined as the dynamic organization within the individual of the psychobiological systems that modulate his or her unique adaptations to a changing internal and external environment.⁽⁴⁾ Each part of this definition is important for a clinician to appreciate. Personality is ‘dynamic’, meaning, it is constantly changing and adapting in response to experience, rather than being a set of fixed traits. Inflexibility of personality is actually an indicator of personality disorder. Personality is regulated by ‘psychobiological’ systems, meaning, personality is influenced by both biological and psychological variables. Consequently, treatment of personality disorders requires growth in psychological self-understanding and not just treatment with medications, although these can be helpful adjuncts to therapy.(5,6) These systems involve interactions among many internal processes, so that each person’s pattern of adjustment is ‘unique’ to them, even though they follow general rules and principles of development as complex adaptive systems.⁽⁷⁾ Finally, to understand personality and its development, we must pay attention to both the ‘internal’ and ‘external’ processes by which an individual interacts with and adapts to his own internal milieu and external situation. For example, when a person is under stress, he is likely to think and feel differently about himself and other people. On the other hand, when he is calm and encouraged, he may act more maturely and happily. Everyone has personal sensitivities or ‘rough spots’ that surface when they are under stress. Everyone has ‘good days’ and ‘bad days’, and this pattern of variability over time is what characterizes a person’s unique personality configuration.

An individual’s personality can only be adequately characterized in terms of interactions among different internal and external forces that influence a person’s emotions, thoughts, and behaviour. A person may feel and act differently on a date, at work, with trusted friends, at school, or in church. His personality doesn’t change, rather his personality can only be adequately assessed when the psychosocial context is specified. Some traits are strong and pervasive regardless of the situation, but other aspects of personality may be markedly affected by the situation. Furthermore, the internal processes may modify a person’s outlook, as when his outlook is influenced by prior or anticipated events, or when his goals and values allow him to change his outlook in ways that are not predictable by what he has previously done. Human beings have an amazing ability to change their outlook for the better or the worse in ways that are unpredicted by their past or present circumstances. Personality traits can be described in ways that are moderately stable over time and situations, but a prudent clinician must never mistake average probabilities with predictive certainty.

Five major types of situations are useful to distinguish for human beings: Sexual situations involving reproduction and sexuality; Material situations involving the quest for material possessions and power; Emotional situations involving emotions and social attachments; Intellectual situations involving communication and culture; Spiritual situations involving the quest for what is beyond individual human existence. The average person is concerned with material situations most of the time—obtaining food, clothing, shelter, transportation, and striving for power and wealth. However, to understand a person fully it is essential to recognize his feelings, thoughts, and intuitions in other types of situations ranging from the sexual to the spiritual. The way a person adapts to these five different types of situations correspond to layers of an individual’s personality. The treatment of psychopathology can be viewed as a working-through of problems and blind spots in these five layers of everyone’s personality, enabling the development of self-awareness in the full range of life situations.(8)

Personality involves much more than the description of a fixed set of traits that allow the prediction of a person’s behavior. Personality involves the interaction of internal and external forces that influence the development of a person’s behavior, but nevertheless allow for the potential of a person to grow in self-awareness and thereby change in ways that cannot be predicted from his past behavior.(9)

Personality refers to the motivational systems within a person, not between individuals. In other words, to understand what motivates a person we need to recognize empathically what he is thinking and feeling within his own being. We need a model of the dynamic psychobiological processes within a human being. Unfortunately, the people who have developed most personality tests often treat each person as a black box that emits self-reports. As a result, most personality psychologists have failed to understand the internal dynamics underlying the thoughts and feelings of the people they assess. However, it is possible to describe a person’s internal processes, which interact with his or her external situations. In order to account for both the internal and the external influences on personality, it is essential to distinguish the dimensions of a person’s temperament and those of his character.⁽⁴⁾

The temperament traits are biases in emotional responses that are fully developed early in life and relatively stable thereafter. On the other hand, character involves higher cognitive processes that develop in a stepwise manner over the life course to enable a person to regulate his emotions, achieve certain goals, and maintain particular values and virtues. Initially, it was thought that character was less heritable than temperament, but empirical studies have shown that both are moderately heritable. The key difference is the difference in the pattern of learning and memory: the procedural learning of habits and skills influences the conditioning of temperament, whereas propositional learning of goals and values influences the development of character. Both procedural and propositional learning interact with one another in self-aware consciousness so that a person can maintain a personal sense of continuity throughout many episodes of experience as the story of his life unfolds.

Temperament can be assessed in terms of four quantifiable dimensions, as measured by the Temperament and Character Inventory.⁽⁴⁾ These are described in Table 1.8.2.1, which shows that each trait is manifested in slightly different ways depending on the situation. A situation necessarily depends on both the person’s outlook and the external circumstances themselves. For example, a person is described as high in Harm Avoidance if he is easily fatigued, fearful, shy, pessimistic, and inhibited. On the other hand, a person is described as low in Harm Avoidance if he is vigorous, risk-taking, beguiling, optimistic, and uninhibited.

However, the level of Harm Avoidance varies moderately between situations. For example, some people who are shy are not easily fatigued, and some people who are shy meeting strangers are risktakers when driving an automobile. The components of Harm Avoidance that are manifested in different situations are moderately correlated, and so it is useful to consider all these as part of a higher order trait that is moderately heritable and moderately stable across time and situations. Likewise, Novelty Seeking, Reward Dependence, Persistence are also moderately heritable and stable dimensions of temperament.

Likewise, there are three dimensions of character, which quantify the nature of a person’s goals and values (Table 1.8.2.2). Each of these character traits is comprised of components that are expressed in different situations. The character dimensions also correspond to key functions of a person’s mental self-government. As a result, character traits provide a rich description of key features of the mental status examination, including insight and judgment.

Insight refers to the depth of a person’s ability to recognize and understand the inner nature of things, rather than basing opinions on superficial appearances. Insight is quantifiable as the character trait of Self-transcendence. A person with deep insight is respectful, mindful, and holistic in perspective, whereas one with little insight is unrealistic, shallow, and fragmented in perspective.

Judgment refers to a person’s legislative ability to cooperate and get along with others in ways that are appropriate and flexible, and can be quantified as the character trait of Cooperativeness. A person with good judgment is cooperative and principled, whereas a person who has poor judgment is uncooperative and opportunistic.

Foresight refers to a person’s executive ability to anticipate what will be satisfying in the long-term or in the future. This executive function allows a person to follow a life path that maintains well-being. A person who is far-sighted is responsible, purposeful, resilient, and resourceful, whereas one who learns from hindsight only is irresponsible, aimless, fragile, and inadequate. In addition, foresight leads to cheerfulness and spontaneity, whereas reliance on hindsight is associated with moodiness and conventionality. Accordingly, the degree of a person’s foresight provides important clinical information about a person’s ability to appreciate what is real, meaningful, and satisfying. As a result, a person’s self-directedness is an important indicator of reality testing, maturity, and vulnerability to mood disturbance. Self-directedness is high
in people who are mature and happy, whereas it is low in people with personality disorders and in those vulnerable to psychoses and mood disorders.

A wide variety of psychometric tests can be used to describe personality traits, so it is useful for a clinician to understand the relationships among alternative measures. The number and content of traits describing personality vary but there is actually extensive overlap among the traits measured. Hans Eysenck popularized tests that measured three factors called Neuroticism, Extraversion, and Psychoticism.⁽¹⁰⁾ The Eysenck Personality Questionnaire also includes validity measure called ‘Lie’. Nearly all tests subsequently developed include factors corresponding closely to Neuroticism and Extraversion at least. Later, Jeffrey Gray showed that individual differences in rates of learning corresponded to weighted combinations of Neuroticism and Extraversion.⁽¹¹⁾ In other words, people who are most prone to anxiety and respond most sensitively to punishment are neurotic introverts (that is, they are high in Neuroticism and low in Extraversion). On the other hand, people who are most impulsive and respond most sensitively to rewards are stable extraverts (that is, they are low in Neuroticism and high in Extraversion). As a result, both Zuckerman and Cloninger developed tests that correspond to these individual differences in learning and vulnerability to psychopathology, as summarized in Table 1.8.2.3. Essentially, people who are most prone to anxiety are those who are described as neurotic introverts by Eysenck, neurotic or anxiety-prone by Zuckerman and Gray, and harm-avoidant by Cloninger. On the other hand, people who are most prone to impulsivity, anger, and substance abuse are called stable extraverts by Eysenck, impulsive sensation-seekers by Zuckerman and Gray, and Novelty seekers by Cloninger.