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Temperament and character during the course of unipolar depression among inpatients.

Cloninger has developed a novel approach concerning relationships between psychopathological syndromes and personality by his biosocial theory. Increased levels of harm avoidance (HA) were consistently found in unipolar disorders. The present study was conducted to cross-validate, in part, previous findings that high harm avoidance (HA) persisted in the course of disorder and to explore the distinct role of character dimensions. One hundred and twenty-six inpatients with an unipolar depressive disorder and 126 healthy controls, strictly matched for age and gender have been included in the study. Our findings underline that higher harm avoidance among unipolar depressives compared to healthy controls persisted after treatment even if a significant reduction could be observed. Recurrent disorders and comorbidity with anxiety disorders seem to be related to a relatively immature character in terms of consistently lower scores for the character dimensions (e.g. self-directedness and cooperativeness) of the patients classified into these groups both at admission and at discharge compared with their healthy counterparts.

Adult↗

[Temperament- and character traits as well as trait patterns in alcoholic men and controls].

This study is on the personality of alcoholics, an empirical investigation based on Cloninger's biopsychological temperament- and character-traits. His Temperament and Character Inventory (TCI) was applied to 94 detoxified men suffering from primary alcohol dependence as well as to controls matched for sex and sociodemographic data. The following questions were the matter of interest: (1) Do alcoholics and controls differ in their personality as reflected by the TCI and (2) are there indicators based on personality with potential relevance for differential therapies? A multiple univariate statistical comparison yielded significant differences between alcoholics and controls on only 2 subscales (Sentimentality, Resourcefulness). A multivariate analysis of the TCI temperament traits using two-sample configural frequency analysis revealed no statistically significant difference between the two groups. Temperament patterns associated with Cloninger's Type-I/Type-II alcoholics could not be demonstrated. Analyzing the temperament and character traits of the alcohol dependent subjects with a log-linear model revealed two bivariate temperament-/character classifications on the scales "Harm Avoidance" and "Self-Directedness" as well as "Reward Dependence" and "Self Transcendence"-both making it possible to define subgroups which may be relevant for different therapeutical approaches. Taken together, the results of this study suggest that it may be useful to closer investigate the personality of alcoholics even if it is not principally different from that of control subjects.

Adult↗

The subaffective-character spectrum subtyping distinction in primary early-onset dysthymia: a clinical and family study.

In 1983, Akiskal proposed that primary early-onset dysthymia should be divided into two subtypes: subaffective dysthymia, which is a subsyndromal form of major mood disorder; and character spectrum disorder, which is a form of personality disorder with secondary dysphoria. The present study attempted to validate this distinction. Akiskal's (1983) criteria were applied to a sample of 97 early-onset dysthymic outpatients, yielding groups of 41 subaffective and 56 character spectrum patients. Patients were evaluated using structured interviews for Axis I and II disorders, family history of psychopathology, and the early home environment, and a comprehensive battery of questionnaires. In addition, direct and family history interviews were conducted with their first-degree relatives. There was mixed support for Akiskal's typology. Consistent with the model, subaffectives exhibited higher rates of major depression, depressive symptoms, and a number of depressive personality and cognitive features. In addition, there was a higher rate of alcoholism among the relatives of character spectrum patients. However, contrary to Akiskal's model, the groups did not differ on gender, unstable personality disorders, family history of mood disorders, or the early home environment.

Adult↗

Social anxiety and posttraumatic stress in combat veterans: relations to well-being and character strengths.

There are few studies examining the relationship between psychopathology and positive experiences and traits. Although initial studies suggest persons with posttraumatic stress disorder (PTSD) are at increased risk for excessive social anxiety, there have been no studies to date evaluating how these conditions might interact to affect positive experiences and traits. Using self-report scales, informant ratings, and experience-sampling methodologies, we examined the association of social anxiety with well-being and character strengths in veterans with and without PTSD. Controlling for PTSD and trait negative affect, social anxiety was negatively related to global ratings of well-being and character strengths. Social anxiety also accounted for incremental variance in day-to-day well-being (i.e., daily affect balance, percentage of pleasant days, positive social activity, self-esteem, gratitude) over a 14-day assessment period. Although veterans with PTSD reported lower levels of global and daily well-being and character strengths than veterans without PTSD, a diagnosis of PTSD failed to exhibit unique relationships with these constructs. Building on a growing body of work, these data suggest that social anxiety is uniquely associated with disturbances in positive experiences, events, and traits. Our findings support the value of directly addressing social anxiety in the study and treatment of PTSD.

Anxiety Disorders↗

The effect of inpatient cognitive-behavioral therapy for eating disorders on temperament and character.

Personality traits seem to have an important role in the development, clinical expression, course, and treatment response in eating disorders (EDs). We investigated the effects of an inpatient cognitive-behavioral treatment (CBT) on the measures of temperament and character (Temperament and Character Inventory (TCI)) in 149 consecutive patients with EDs. Baseline assessment included anthropometry, the Eating Disorder Examination (EDE), the Beck Depression Inventory (BDI), and the TCI. Treatment was based on the transdiagnostic cognitive behavior theory and treatment of ED, adapted for an inpatient setting. Treatment effects were tested by paired ANOVA, adjusted for covariates. No effects were found on Novelty Seeking, Reward Dependence, and Cooperativeness. Harm Avoidance (F=18.17, p<0.001), Persistence (F=7.71, p=0.006), Self-Directedness (F=27.55, p<0.001), and Self Transcendence (F=16.38, p<0.001) significantly changed after treatment. Changes in TCI scores were wholly dependent on the changes in BDI and EDE, and independent of ED diagnosis and behavior and of BMI changes. We conclude that in ED, a few scales of both temperament and character are significantly modified by CBT, in relation to changes in psychopathology and depression, independently of nutrition. These results are relevant for future studies based on TCI.

Adolescent↗

An alternative view of psychological well-being in cardiac rehabilitation: Considering temperament and character.

BACKGROUND: Research suggests that personality is related to recovery from cardiac events, yet few conceptions of personality provide hope or possibility of improvement for patients with the least adaptive personality types. Psychobiological theory of personality has potential in this regard, but, to date, no research has investigated temperament and character in cardiac settings. AIM: To explore relationships between temperament, character and psychological well-being among cardiac patients. METHOD: Self-report questionnaires were distributed to a convenience sample of 81 cardiac patients to obtain data on personality (TCI [Cloninger CR, Przybeck T, Svrakic D, & Wetzel RD. The Temperament and Character Inventory (TCI): A guide to its development and use. St Louis (MO), Center for Psychobiology of Personality, Washington University;1994]), anxiety and depression (HADS [Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983;67(6): 361-70]) and satisfaction with life [Diener E, Emmons RA, Larsen RJ, Griffin S. The satisfaction with life scale. J Pers Assess 1985;49(1):71-5]. RESULTS: The interaction of two personality dimensions (harm avoidance and self-directedness) was significantly related to measures of psychological well-being. Patients with low self-directedness combined with high harm avoidance reported significantly higher levels of anxiety, depression and lower levels of satisfaction with life. CONCLUSION: This exploratory study suggests that psychobiological theory of personality may be useful for practitioners in cardiac rehabilitation seeking to identify patients at risk of poor psychological well-being.

Adaptation, Psychological↗

Temperament and character in primary insomnia.

Recent studies by Cloninger suggest that the temperament dimension of harm avoidance might be related to serotonergic activity. Since serotonergic mechanisms equally play a major role in sleep regulation, we decided to use Cloninger's psychobiological model of temperament and character to assess whether there is a link between psychophysiologic insomnia and specific personality traits. Chronic insomnia is a common complaint in modern society, and it is still controversial whether insomniacs share specific personality traits. Thirty-two chronic insomniacs (< 50 years) were studied. They underwent polysomnography for two consecutive nights and filled out the 226-item self-questionnaire of Temperament and Character Inventory as well as the Hospital Anxiety and Depression scale. (1) Harm avoidance for all subscores was significantly higher in insomniac patients when compared with controls; (2) self-directedness scores were lower in insomniacs; (3) sleep latency was positively correlated to harm avoidance; (4) HA1 (anticipatory worry) was negatively correlated to REM latency. Temperament and Character Inventory is a useful tool in the investigation of chronic insomnia. Serotonergic mechanisms might explain the high incidence of harm avoidance as personality trait in psychophysiologic insomniac patients. Further studies are needed to see whether harm avoidance could be a psychological vulnerability marker for primary insomnia and be used as predictor of SSRI treatment responders.

Adult↗

Temperament and character dimensions of the relatives of schizophrenia patients and controls: the relationship between schizotypal features and personality.

PURPOSE: Previous findings indicated that schizophrenia patients might have a different personality structure from the general population on several dimensions of temperament and character. Some authors proposed that HA might be a marker of underlying genetic vulnerability to schizophrenia. Studies on high-risk subjects and first degree relatives of patients is essential to test the value of a measure as a marker of genetic vulnerability to a disease. Few studies tested the biopsychosocial model of personality on unaffected relatives of schizophrenia. SUBJECTS AND METHODS: We compared the Temperament and Character (TCI) profiles of 94 first degree relatives of schizophrenia and 75 controls. We also investigated the relationship between schizotypy and TCI dimensions in the study sample. RESULTS: The harm avoidance scores of the relatives of schizophrenia patients with schizotypal features were significantly higher. Self transcendence scores were also significantly higher among relatives with schizotypal features. In contrast, the relatives of the patients with schizophrenia who did not have schizotypal features had higher SD and C scores than the control group. DISCUSSION AND CONCLUSION: This finding is consistent with the previous findings which suggested harm avoidance as a vulnerability indicator of schizophrenia. Some character features like self transcendence might be also associated with schizotypal features.

Adult↗

Sex hormones and biogenic amine turnover of sex offenders in relation to their temperament and character dimensions.

Relationships between Cloninger's temperament and character dimensions and plasma sex hormone levels and biogenic amine turnover were studied in male prison inmates convicted of rape (n=61) or child molestation (n=24) and normal male controls (n=25). The participants completed the Temperament and Character Inventory (TCI), which includes the temperament dimensions Novelty Seeking, Harm Avoidance, Reward Dependence and Persistence as well as the character dimensions Self-Directedness, Cooperativeness and Self-Transcendence. Plasma levels of testosterone, dihydrotestosterone, sex hormone binding globulin, luteinizing hormone (LH) and follicle-stimulating hormone were estimated in plasma samples and 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA), and 3-methoxy-4-hydroxyphenylglycol (MHPG) in urine samples. Both sex offender groups had higher Novelty, Seeking and lower Reward Dependence, Self-Directedness and Cooperativeness scores compared with the controls. Plasma levels of testosterone and dihydrotestosterone were significantly higher in rapists than in controls. Novelty Seeking scores were positively correlated with LH levels in rapists, and with testosterone levels in child molesters. Harm Avoidance scores were negatively correlated with 5-HIAA levels in rapists and with HVA levels in child molesters. In rapists, the calculated free androgen index showed a negative correlation with 5-HIAA. For the sex offender sample as a whole, the subgroup with high testosterone levels had higher Harm Avoidance scores, the subgroup with low HVA levels had lower Cooperativeness scores, and the subgroups with high 5HIAA or MHPG levels had lower Persistence scores. The results indicate that Novelty Seeking behavior in the group of rapists is associated with a hyperactive hypothalamic-pituitary-gonadal axis. In addition, low serotonin turnover and low dopamine turnover seem to be associated with a passive-avoidant behavioral style in rapists and child molesters, respectively.

Adult↗

Interrelations between temperament, character, and parental rearing in male delinquent adolescents in northern Russia.

A comparison between 192 male delinquent adolescents and 121 controls from Northern Russia using the Temperament and Character Inventory (TCI) and Own Memories of Parental Rearing (EMBU) questionnaire on perceived parental rearing showed significant differences. The delinquent group had a higher level of Novelty Seeking, Harm Avoidance, and Self-transcendence, and also scored lower on Self-directedness. Delinquents who committed nonviolent crimes (thefts) appeared to have a higher level of Harm Avoidance compared with those who committed violent crimes (hooliganism, robbery, rape, and murder). As concerns perceived parental rearing practices, delinquents experienced more parental rejection and overprotection. Most of the personality dimensions were found to be highly correlated with the level of parental emotional warmth. Furthermore, both temperament traits and maternal rearing practices predicted the development of character dimensions. Findings are discussed in light of the interactive nature of parent-child relationships and of character development.

Adolescent↗

Temperament and character inventory (TCI) and depression.

Although several studies have assessed the relationships between the temperament dimensions of the Cloninger model of personality and depression, little is known about the role played by the character dimensions proposed by the seven-factor model of Cloninger in depression. In this study, the relationships between the Temperament and Character Inventory (TCI) and depression were examined in a sample of 40 major depressive patients and 40 healthy controls. Depressed patients exhibit higher harm avoidance and self-transcendence scores as well as lower self-directedness and cooperativeness scores as compared to healthy controls. However, the three other dimensions do not differ between depressive patients and controls. Among the depressive group, harm avoidance, self-directedness and cooperativeness dimensions are related to the severity of depression as assessed by the Hamilton scale. This study confirms the state dependence of the harm avoidance dimension and suggests a relationship between the character dimensions of the Cloninger model and depression.

Adult↗

Correlations between trait anxiety, personality and fatigue: study based on the Temperament and Character Inventory.

OBJECTIVE: In our study, we explored the associations among anxiety, the dimensions of Cloninger's theoretically based and empirically validated psychobiological model of personality (Temperament and Character Inventory, TCI) and fatigue in order to clarify the personality risk factors for fatigue. METHODS: Fifth-year students (n=89) and freshmen (n=162) at Saga Medical School and psychiatric outpatients of Saga Medical School Hospital (n=101) were investigated with the State-Trait Anxiety Inventory (STAI, Japanese version), the TCI (Japanese version), the General Health Questionnaire (GHQ-30) and the self-rating Fatigue Symptom Checklist (FSC), which describe fatigue along three subscales (general, physical and psychological fatigue). Correlation and ANOVA analyses were performed in this study. RESULTS: The analysis identified a significant relation (P<.0005) between trait anxiety and fatigue. The TCI dimension of harm avoidance (HA) is positively correlated with both trait anxiety and fatigue (general fatigue, psychological fatigue and physical fatigue). The character dimension of self-directedness is negatively correlated with both trait anxiety and fatigue. CONCLUSIONS: There is an inherent relationship among trait anxiety, the temperament dimension of harm avoidance, character dimension of self-directedness and fatigue. The TCI dimensions, harm avoidance and self-directedness, might be considered as predictors for fatigue-related disorders.

Adult↗

Character change in group therapy.

The treatment of character pathology in group therapy becomes ever more relevant in the current climate of health care delivery with the mounting awareness of the importance of the long-term treatment needed for such problems. This article reviews the psychodynamic meanings of character pathology and addresses the specific ways that psychodynamic group therapy is suited to its treatment. Clinical examples are offered to illustrate how the resolution of character difficulties occurs in group therapy.

Character↗

The relationship of suicide attempt history with childhood abuse and neglect, alexithymia and temperament and character dimensions of personality in substance dependents.

The aim of this study was to evaluate the prevalence of suicide in Turkish male substance dependents, and to investigate the relationship of suicide attempt history with childhood abuse and neglect, alexithymia, and temperament and character dimensions of personality. Participants were 154 consecutively admitted male substance dependents. Patients were investigated with the Childhood Abuse and Neglect Questionnaire, Toronto Alexithymia Scale (TAS-20) and Temperament and Character Inventory (TCI). Among substance-dependent patients, 28.6% was considered a group with suicide attempt history (SAH). Current age was lower and rate of being single was higher in the group with SAH. There were no significant differences between groups in terms of employment, educational status and duration of education. Rates of physical, emotional abuse and neglect, self-mutilation and being alexithymic were higher and ages at first substance use and regular substance use were lower in the group with SAH. Mean scores of "difficulty in identifying feelings" (DIF) and "difficulty in describing feelings" (DDF) subscale EOT of the TAS-20 were higher in the SAH group. Among temperament and character dimensions of the TCI, only "Self-directedness" and "Cooperativeness" were lower in SAH and there were no significant differences between groups in terms of other subscales. Age and Self-directedness score of TCI were determinants for suicide attempt. In particular, young drug users with low Self-directedness scores could be the target population in order to prevent suicidal behavior. This study also suggests that in substance-dependent patients, in the background of all suicidal behavior, childhood abuse and neglect must be evaluated.

Adult↗

The relationship between temperament and character and psychopathology in community children with overweight.

This study investigated the relationship between temperament and character and psychopathology in at risk of overweight and overweight children. The Child Behavior Checklist (CBCL) and the Junior Temperament and Character Inventory (JTCI) questionnaires were administered to 453 children (10-12 years of age, 203 boys and 250 girls) in Kimpo, South Korea. Subjects were divided into three groups; (1) nonoverweight children (n = 345), (2) children at risk of overweight (n = 72), and (3) overweight children (n = 36). CBCL and the JTCI scores were compared among three groups. In addition, the relationships between subscales of the CBCL and the JTCI were evaluated. On the CBCL, overweight children had higher scores in social problems, delinquent problems, and total problems compared to nonoverweight children. Children at risk of overweight showed higher scores only in social problems compared to nonoverweight children. On the JTCI, lower persistence and tendency of higher novelty seeking was observed in overweight children compared to nonoverweight children. Persistence scores were negatively correlated with scores of delinquent problems, externalizing problems, and total problems in overweight children. Compared to nonoverweight and children at risk of overweight, overweight children had distinct patterns of temperament and character that were related to the specific psychopathology.

Body Mass Index↗

Clinical holistic medicine: induction of spontaneous remission of cancer by recovery of the human character and the purpose of life (the life mission).

The recovery of the human character and purpose of life with consciousness-based medicine seems to be able to induce spontaneous remissions in several diseases. On two different occasions, we observed breast tumors reduced to less than half their original diameters (clinically judged) during a holistic session, when working with the patients in accordance with the holistic process theory of healing, the life mission theory, and the theory of human character. One tumor was histologically diagnosed as malign breast cancer prior to the session, while the other was under examination. As both patients had the affected regions of the breast surgically removed immediately after the session, we are unable to determine if they were actually healed by the holistic treatment. We find it extremely interesting that the size of a tumor can be reduced dramatically within a few hours of holistic treatment, when the patient is highly motivated for personal development. The reduction of tumor size is in accordance with the holistic view that many types of cancer are caused by emotional and existential disturbances. From a holistic perspective, cancer can be understood as a simple disturbance of the cells, arising from the tissue holding on to a trauma with strong emotional content. This is called "a blockage", where the function of the cells is changed from their original function in the tissue to a function of holding emotions. The reduction of the tumor in the two cases happened when old painful emotions were identified in the tissues, in and around the tumor, and processed into understanding; when the patients finally did let go of negative beliefs and attitudes that had kept the feeling(s) repressed to that part of the body, the tumor first softened and then disappeared, presumably by apoptosis. We believe that the consciousness-based/holistic medical toolbox has a serious additional offer to cancer patients, and we will therefore strongly encourage the scientific society to explore these new possibilities. Our holistic medical research meets both ethical dilemmas and practical difficulties, as it obviously is important for the research in induced spontaneous remissions that surgery and chemotherapy is not used before it is absolutely necessary. On the other hand, is it important for the patient"s survival that they receive any well-documented treatment as soon as possible. An additional aspect for the patient who is able to cure her own cancer is that she is much less likely to get cancer again and much better prepared to deal with other diseases and challenges in life. Knowing that one can fight even cancer gives a strong belief in life and the need to improve quality of life. The high incidence of secondary cancers and the physical and emotional wounds from the biomedical treatment seem to justify a focus on prevention and additional holistic treatment modules. To support the patient in learning the mastery of coherence of body and life, using the crisis of cancer to recover the human character and the purpose of life, seems turning a personal potential disaster into the greatest gift of all. When it comes down to it, life is not just about surviving; what is more important is to live fully, to learn from the great challenges of life, and to obtain the optimal quality of life while being here.

Character↗

The genetic structure of Cloninger's seven-factor model of temperament and character in a Japanese sample.

Theoretical assumptions regarding the genetic and environmental structure of personality proposed in Cloninger's seven-factor model of temperament and character were verified in a Japanese sample by using the twin method. The Temperament and Character Inventory (TCI) was administered to 296 twin pairs ranging in age from 14 to 28 years old. Among four temperament dimensions (novelty seeking [NS], harm avoidance [HA], reward dependence [RD], and persistence [PS]), HA and PS showed significant additive genetic contributions and no shared environmental effect, supporting the original theoretical assumption. NS and RD could be explained by either genetic or shared environmental factors with nonshared environment. All three character dimensions (cooperativeness [CO], self-directedness [SD], and self-transcendence [ST]) could be explained exclusively by additive contributions and no shared environmental effect. Multivariate genetic analysis indicated that there were no significant associations between NS, HA, and RD, as the theory predicts, and the genetic components of PS, SD, and CO were derived from those of the temperament dimensions. The fourth genetic component, which had a substantial load specifically on ST and overlapped with PS, was identified. Although most of the nonshared environmental effects were trait-specific, the phenotypic correlation between NS and HA could be explained by nonshared environmental overlap.

Adolescent↗

Temperament and character dimensions in patients with atopic dermatitis.

The aim of this study was to assess the personality traits of young male patients with atopic dermatitis (AD), and to examine the correlations between temperament and character dimensions with clinical and other psychological factors. Fifty young adult male AD patients and 83 healthy controls were examined using the temperament and character inventory, the Beck depression inventory and the state-trait anxiety inventory. The AD patients scored higher on harm avoidance and lower on reward dependence, self-directedness and cooperativeness than the healthy controls. The illness duration and anxiety correlated negatively with the self-directedness score, and depression correlated negatively with reward dependence and the persistence scores in AD patients. These results suggest that AD patients have distinctive temperament and character dimensions compared to healthy controls. Moreover, illness duration and anxiety might be associated with some personality problems, and some temperament dimensions (e.g. reward dependence, persistence) may be linked to depressive symptoms in AD patients.

Adolescent↗