Affiliation: Washington University School of Medicine, Department of Psychiatry, St Louis, MO 63110, USA.
Modern psychobiological theory conceptualizes personality as a self-organizing, complex adaptive system involving a bi-directional interaction between heritable neurobiological dispositions to behavior (temperament) and developing concepts about self and external objects (character). Since its introduction in 1993, the Psychobiological Model of Temperament and Character (aka the Seven Factor model) has become one of the most popular, world-wide recognized models of personality structure and development. In the previous version of this review, published in this journal in 2012, we described the model in detail, especially its neurophysiological underpinnings, psychometric properties, cross cultural applicability, and clinical use in the diagnosis and treatment planning of personality disorder (PD). The Temperament and Character Inventory (TCI), a self-report test, has been developed for psychometric quantification of theoretically postulated personality traits, i.e., bio-genetic (temperament) and adaptive (character) aspects of personality. Diagnosis of PD is a 2-step process that involves both character and temperament assessment. As the first step, character is assessed to establish the severity of mal-adaptation, the core impairment shared by all subtypes of PD. As the second step, after the presence vs absence of a PD ( “casesness”) is established based on character, temperament is used for differential diagnosis. More precisely, various configurations of temperament traits distinguish specific symptomatic presentations of PD subtypes. We argue that the Seven Factor Psychobiological Model of Temperament and Character provides a theoretical framework to advance research and assessment of normal personality as well as clinical diagnosis and treatment of PD. In the original version of this review in 2012, we pointed to the correspondence between the 2-step diagnosis of PD described above and the DSM5 proposal to classify and diagnose PD. Unfortunately, due to widespread criticism of its dimensional-categorical hybrid approach, the DSM5 proposal for PDs was eliminated altogether. Instead, the DSM IV categorical approach was kept unchanged in DSM5. Here, we review the basic theoretical and clinical postulates of the Seven Factor Model and describe its application in PD. Pharmacotherapy and psychotherapy of PD are adiscussed again in some detail, including clinical management of temperament and character based on TCI scores.