Conclusion a complex approach to the aetiopathogenesis of personality disorders

Although the evidence discussed so far is only preliminary, it could have a major impact on the reconceptualizing of the approach that has been applied in psychiatry to the detection and categorization of the elusive profiles of normal and abnormal personalities. (7) It is clear that anchoring some temperamental traits to a strong genetic or biodevelopmental base will not provide a complete, or even improved, solution to the problems encountered in the aetiology and diagnosis of personality disorders. Many additional steps will have to be worked out and the task ahead is hard. But in view of the increasing links that are being established between core personality traits and some genetic/developmental mechanisms, the task of building a framework which would allow improved identification and differentiation of abnormal personalities no longer seems hopeless. In fact, such research is opening up many new avenues for understanding the effects of different factors (innate dispositions, neurodevelopmental organization, neurocognitive architecture, critical social transitions, and repeated stress episodes) on an individual's vulnerability to developing a personality disorder.

Hence, the use of behaviourally well-defined and biologically well-established personality dimensions must be the starting point for achieving the fine-tuned diagnoses increasingly required in modern medicine. Complexity in measurement will increase, but there is no other way of obtaining data that are sufficiently valid to allow understanding of the classical personality disorders. It is hoped that advances in the psychometric detection of the more salient 'clinical' profiles within each of the personality subspaces (at the level of either traits or dimensions), together with a refinement of the neurocognitive and neurohormonal data, will produce much better solutions.

Some of the old-established and very consistent categories of personality disorders will be confirmed, but it is possible that unexpected 'types' of abnormal personalities, with clinical relevance, will emerge. In this new framework it may be easier to detect at an early stage those 'exceptional' and 'charismatic', although pathological, personalities who often impose great social costs and dramatic consequences not only for themselves but also for the group or the society in which they live. (67)

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