Pharmacotherapy and the Psychobiological Model of Personality: Implications for DSM-5

Dragan      M. Svrakic; C.      Robert Cloninger

Abstract

The Psychobiological Model of Temperament and Character (also known as the Seven Factor model) is described in detail in this review, in terms of its neurophysiological underpinnings, psychometric properties, and clinical applications in the diagnosis and treatment planning of personality disorder (PD). The Temperament and Character Inventory (TCI), a self-report test developed to assess temperament and character traits, is used to evaluate bio-genetic (temperament) and adaptive (character) aspects of personality. Diagnosis of PD is a 2-step process that involves both character assessment (character is essential to assess mal-adaptation, as the core impairment shared by all subtypes of PD) and temperament assessment (temperament is used to distinguish specific symptomatic presentations in differential diagnosis of PD). We advocate that the Seven Factor Model of Temperament and Character provides a theoretical framework for more productive research, assessment, and treatment of normal personality and PD. In addition, pharmacotherapy and psychotherapy of PD are discussed in some detail, including pharmacological management of temperament and psychotherapy of character based on TCI scores. Finally, congruence between the Seven Factor model and the expected DSM-5 classification of and approach to PD are discussed in some detail.

Keywords: Personality, personality disorder, pharmacotherapy, diagnosis, temperament, character, DSM-5, Psychobiological, Dysregulation, diagnosing maladaptation, narcissistic, egosyntonic, agoraphobia, paranoid, vascular dementia