Personality is a fascinating aspect of our patients, and it really does highlight how people are different--not in a good or bad way, but in a way that has inherent strengths in one situation and inherent vulnerabilities or weaknesses in another situation. And so, when we’re talking about personality, we are trying to engage people’s strengths, and to help them not succumb to their vulnerabilities. The personality traits that people are most familiar with are introversion and extroversion. There are many facets to those two personality traits, but for example, introverts tend to like to be by themselves, get their energy from solitary or internal focus, and also tend to be more punishment-averse. They will do things to avoid a bad outcome in contrast to the extrovert who likes to live in the moment, who likes to look into the external world for their stimulation and their energy, and who is driven by the promise of reward, so they will work hard to get something that they really want and they will have less salience in their life for the fear of punishment.
I think the most important thing for the practitioner is to have a sense for what type of personality traits characterize your patient and where are they in the extremes. Are you treating somebody who’s a very unstable extrovert or do you have a more stable introvert? Each patient will be a better fit with a different care strategy and the trick is to try and match the way in which you interact with that person, give them information and prescribe treatments with a sense of how they’re likely to respond to being in that situation. And I think it’s important to remember that the actual prevalence of personality disorders in the psychiatric sense is much less than you might expect. Patients are sometimes difficult, sometimes frustrating, sometimes very unhappy, but that does not necessarily mean that they have a personality disorder. All of us have traits and all of us are unique, and one of the pleasures of taking care of patients is appreciating those unique compositions and tailoring your interactions with them to bring out their strengths.