Variants of premorbid personality and personality disorder: a taxonomic model of their relationships

Abstract

From a biographical analysis of approximately 500 case records of patients with various kinds of mental state (in particular mood, anxiety and schizophrenic) disorders, a typology of premorbid personality variants was derived. It comprises three "affective types" dominating in patients with major affective disorders and three "neurotoid types" prevailing in other, above all anxiety and schizophrenic, disorders. These types were operationalized so that they could be assessed by means of a diagnostically "blind" rating of biographical case reports or of interview protocols concerning the premorbid development of clinically remitted patients. The material for the present analysis consisted of ratings regarding 120 subjects (100 patients and 20 healthy controls) who had been interviewed within a project primarily aiming at the development of a novel assessment tool, the Biographical Personality Interview (BPI). This data was used for constructing a comprehensive taxonomic model of premorbid personality variants and their relationships to personality disorders. The intercorrelation of type-scores representing the six premorbid personality types suggests a circular order of these types, opposing the "neurotoid types" on one side to the "affective types" on the other side of the circle (circumplex) along a dimension of mental abnormality vs. normality. Two types, the ("neurotoid") nervous, tense type, and the ("affective") manic type are contrasted with the ("affective") melancholic and the ("neurotoid") anxious, insecure types along an orthogonal dimension of rather changeable vs. rather constant habitual behaviour. This order is confirmed by the correlation of type-scores with factor scores of the two main dimensions of BPI-item scores. It is also concordant with the correlation of type-scores and scores on questionnaire scales of personality. Personality disorders as maladapted extreme variants of personality can be located outside the circle according to their similarity or dissimilarity with the six premorbid personality types. They are necessarily distributed almost exclusively along the "neurotoid" side of the circumplex. This two-dimensional model of variants of premorbid personality and personality disorders is in basic agreement with models derived from dimensions of personality in mentally healthy subjects and with findings concerning the comorbidity among personality disorders. Further empirical studies are required for choosing or developing the most appropriate model of the relationships between personality variants and personality disorders.