The Five Factor Theory was first introduced by McCrae and Costa (1984) and is based on the assumption that personality is relatively stable in adulthood. Generally, the traits that we show at the age of 30 would remain essentially unchanged into old age. (McCrae & Costa, Personality in Adulthood) Therefore, assessing personality based on the core traits what will not change through adult life seemed like a reliable method. There have been a lot of multi-cultural, cross-sectional and longitudinal studies throughout the past two decades. All of this research has confirmed the reliability and validity in the NEO Personality Inventory, or NEO-PI (Costa & McCrae, 1985, 1989a) and has postulated there are indeed universal personality traits that characterize people all over the world.

Based on this extensive research and years of observing and interviewing people, McCrae and Costa identified the five core traits what describe a personality: Neuroticism, Extraversion, Openness (to experience), Agreeableness and Consciousness. These are the basic dispositions that endure through adulthood and shape our behavior and lives.

Neuroticism
Calm – Worrying
Even-tempered – Temperamental
Self-satisfied – Self-pitying
Comfortable – Self-conscious
Unemotional – Emotional
Hardy – Vulnerable

Extraversion
Reserved – Affectionate
Loner – Joiner
Quiet – Talkative
Passive – Active
Sober – Fun-loving
Unfeeling – Passionate

Openness to Experience

Down-to-earth – Imaginative
Uncreative – Creative
Conventional – Original
Prefer routine – Prefer variety
Uncurious – Curious
Conservative – Liberal

Agreeableness                                           Conscientiousness

Ruthless – Softhearted                                 Negligent – Conscientious
Suspicious – Trusting                                   Lazy – Hardworking
Stingy – Generous                                        Disorganized -Well-organized
Antagonistic – Acquiescent                        Late – Punctual
Critical – Lenient                                          Aimless – Ambitious
Irritable – Good-natured                             Quitting – Persevering

Axis II in DSM-IV versus the Five Factor Model

While it is true that both Axis II in DSM-IV and the Five Factor Model measure similar constructs, the main focus being one’s personality, they tend to investigate different aspects of personality. The use of DSM-IV and Axis II implicates the diagnosis of a particular personality disorder. Axis II has no interest in studying healthy individuals. Its main focus is identifying the real rigid traits that do not allow ‘normal’ functioning in life. DSM-IV, as a whole, provides the tools and the perspective required to diagnose psychological disorders, but it is not adapted to describing the wide spectrum of traits and qualities of a ‘healthy personality’.

The Five Factor Model, on the other hand, attempts to recognize and analyze all of the major traits that build up a person. This model is equally interested in studying healthy individuals as well as personality disorders (which is by no means the case with DSM-IV).

Axis II in DSM-IV provides a very detailed description of the disorders and informs abut their specific coding. The specific checkpoints and guidance make a diagnosis easier and, allegedly, more accurate.

The Five Factor model certainly has many advantages, as it is the one inventory that provides a full, very specific and realistic description of a personality, with all its nuances. Based on this description of traits, a lot can be effectively predicted about the behavior of the individual. The Five Factor Model is not limited to psychopathology, but investigates the whole continuum of a trait and so, sees subjects in every part of the belt curve. As the model is very precise in describing the big five traits (Openness, Conscientiousness, Extaversion, Agreeableness and Neuroticism), it can be of great help in therapeutic setting, revealing the areas that need ‘improvement’. After all, this is the most important part of any helping profession – how exactly do we help the individual? Not to underestimate, the Five Factor Model has an enormous body or research behind it, which has proven it is both a valid and reliable technique.

Many studies have focused on investigating the physiological characteristics and the neurobiology of borderline patients in attempt to relate these symptoms with the purely psychological characteristics.

A study with 30 young women with Borderline personality disorder that used structural magnetic resonance imaging (3D-MRI) showed that the borderline patients had significantly smaller hippocampus (-17%) and a smaller right parietal cortex (-11%) than the control group. This significantly leftward asymmetry in borderline patients was associated with stronger psychotic symptoms and some signs of schizoid personality traits while the smaller hippocampal size was related to trauma-related clinical symptoms and neuropsychological deficits (Irlea E, 2005).

Another study of 21 female borderline patients and a similar group of healthy control subjects took magnetic resonance imaging volumetric measurements of subjects’ hippocampus, amygdala, temporal lobes and prosencephalon. The results showed that patients with BPD had approximately 16% smaller hippocampus and about 8% smaller volumes of the amygdala (Driessen M, 2000).

Studies show that suicide victims, that are often borderline personality patients, have certain neurobiological abnormalities and hyperactivity of the hypothalamic-pituitary-adrenal axis (HPA-axis) (Lopez JF, 1997). Also, it has been discussed that severe anxiety associated with elevated corticotrophin-releasing factor is related to suicidal tendencies and depression (Fawcett J, 1997) that are traits of Borderline personality disorder.

Many studies have investigated the childhood experiences of patients with BPD and revealed that physical and sexual abuse, early separation, inconsistent treatment of a caretaker and neglect are all part of the etiology of BPD. A study of Mary C. Zanarini and others was determined to investigate pathological childhood experience in patients with Borderline Personality Disorder and compare the results to those of patients suffering other Personality Disorders. In the study, of the 358 patients with BPD, 91% reported having been abused (emotionally, sexually or physically) and 92% reported neglect before the age of 18.

More specifically, between 10% and 73% of borderline patients reported having been physically abused by either caretaker or other adult.

Other 16% to 71% reported having been sexually abused, usually by noncaretaker (Zanarini M, 1997). Since such great percentage of patients meeting the criteria for BPD, it may be hypothesized that they also suffer some chronic form of posttraumatic stress disorder (Herman JL, 1987). It was also revealed that it was much more common for BPD patients to report some type of abuse in childhood than patients with other Personality disorders.

Probably the most striking difference in the study between Borderline patients and other Personality disorder patients was observed when sexual abuse was considered. 61.5% of borderline patients reported sexual abuse versus 32.1% of patient suffering other personality disorders. However, it was observed that sexual abuse did not occur isolated from other forms of abuse or neglect. On the contrary, it was just another part of an already disrupted family atmosphere of chaos where series of traumatic events were part of the child’s everyday life (Zanarini MC, 1997).

As a result of the studies of Borderline patients, four variables were clearly distinguished: female gender, male noncaretaker sexual abuse, male caretaker’s neglect and denial of a patient’s feelings, and female caretaker’s inconsistent treatment. All of these are generally associated with the diagnosis of BPD (Zanarini MC, 1997). The fact that most individuals with Borderline diagnoses are women is probably related to the fact that most victims of sexual abuse as children are females, as well. Therefore, there must be some correlation between such stress provoking experiences in early childhood and Borderline Personality adults that is imbedded in stress and neurotransmitter dysregulation (Halgin R, Whitbourne S, 2003).

Borderline Personality Disorder is identified in Cluster B of Axis II of the Multiaxial system. As all personality disorders, it is characterized as a pervasive and inflexible pattern of inner experiences and behavior that cause distress and certain impairment in a person’s life (DSM-IV-R).

Being a mental illness, BPD implies instability in moods, self-image, and behavior, as well as in interpersonal relationships. People suffering from BPD have a hard time regulating their emotions and often have to deal with their impaired sense of self-identity (Linehan M, 2006). Frequently, BPD involves intense outbursts of anger, depression and anxiety that can last for only hours, or a day (Zanarini MC, 1998).

There is a hypothesis that BPD is a trauma-related disorder or a variant of Post Traumatic Stress Disorder (PTSD). A research indicated that people with BPD had significantly higher rates of PTSD when compared to subjects suffering other Personality Disorders (25% versus 13.0%) (Golier J, 2003).

People with BPD have critically unstable patterns of social relationships. This includes intense attachments and attitudes towards friends, family or loved ones that can change rapidly. Strong feelings of love and admiration can be suddenly replaced by anger or dislike. These intense emotional reactions in daily life are out of proportion and often may cause conflicts. Also, people with BPD tend to be extremely sensitive to rejection and separation, reacting with distress, outbursts of anger, episodes of anxiety, depression, and feelings of helplessness, worthlessness, suicide threats and attempts (Golier J, 2003). In addition, subjects with BPD may be at a greater risk of exposure to new traumas, substance abuse and risky behaviors due to their instability and impulsivity (Golier J, 2003).

Research shows that BPD is affecting up to two percent of adults in the United Stated (approximately 5.8 to 8.7 million Americans, mostly young women) (Swartz M, 1990). Since self-harm is very common in borderline patients (cutting, burning, suicide attempts), up to nine percent of subjects suffering BPD ultimately kill themselves (Linehan M, 2006). Patients of BPD stand for about 20% of psychiatric hospitalizations (Zanarini MC, Frankenburg FR. Treatment histories of borderline inpatients. Comprehensive Psychiatry, in press).