The impact of ADHD and autism spectrum disorders on temperament, character, and personality development

OBJECTIVE: The authors describe personality development and disorders in relation to symptoms of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorders. METHOD: Consecutive adults referred for neuropsychiatric investigation (N=240) were assessed for current and lifetime ADHD and autism spectrum disorders and completed the Temperament and Character Inventory. In a subgroup of subjects (N=174), presence of axis II personality disorders was also assessed with the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II). RESULTS: Patients with ADHD reported high novelty seeking and high harm avoidance. Patients with autism spectrum disorders reported low novelty seeking, low reward dependence, and high harm avoidance. Character scores (self-directedness and cooperativeness) were extremely low among subjects with neuropsychiatric disorders, indicating a high overall prevalence of personality disorders, which was confirmed with the SCID-II. Cluster B personality disorders were more common in subjects with ADHD, while cluster A and C disorders were more common in those with autism spectrum disorders. The overlap between DSM-IV personality disorder categories was high, and they seem less clinically useful in this context. CONCLUSIONS: ADHD and autism spectrum disorders are associated with specific temperament configurations and an increased risk of personality disorders and deficits in character maturation.     

Personality disorder and the Temperament and Character Inventory in the elderly.

OBJECTIVE: The aim of this study was to determine the prevalence of personality disorders in a group of elderly patients without an organic mental disorder and to examine the relationship between the Temperament and Character Inventory (TCI) and personality disorder symptoms in psychogeriatric clinical practice. METHOD: A total of 91 subjects completed the Structured Clinical Interview for DSM-III-R personality questionnaire and the 125-item TCI. RESULTS: Of the 91 subjects, 34 individuals (31%) had at least one DSM-III-R personality disorder diagnosis, with avoidant, dependent and paranoid personality disorder being the most common. The trends and correlations between the temperament and character dimensions and the correlations between individual personality disorder symptoms and the dimensions were similar to those in the original model. The most significant findings were the strong negative correlations of the character scores of self-directedness and co-operativeness with the total number of personality disorder symptoms, and the fact that the self-directedness scores predicted the number of personality disorder diagnoses. CONCLUSION: The reported prevalence rate is comparable to studies of both younger and older patient populations using similar methodology. The TCI provides a useful framework for further research on personality disorders in the elderly.     

Temperament and character in patients with borderline personality disorder taking gender and comorbidity into account

This study examined correlations of borderline personality disorder (BPD) symptoms with scales from Cloninger's psychobiological model taking gender and psychiatric comorbidity into consideration. Inpatients with BPD (n = 202) were compared to several control groups including psychiatrically healthy persons (n = 327), subjects with affective disorders (n = 46), alcohol use disorders (n = 47), cluster C personality disorders (n = 23) and antisocial personality disorder (n = 25). The results indicate that only males with BPD presented an 'explosive' temperament suggested by Cloninger, with simultaneously high levels of novelty seeking and harm avoidance. In contrast, women with BPD were characterized by high levels of harm avoidance, but not novelty seeking. Regarding temperament and character dimensions our analyses suggest that patients with BPD could be characterized, in particular, by a combination of high harm avoidance and very low self-directedness. The specific temperament configuration of BPD postulated by Cloninger's psychobiological model could only partially be supported. The results provide support for the importance of controlling for gender effects when investigating the applicability of dimensional models with respect to personality disorders.     

Symptomatic overlap between attention-deficit/hyperactivity disorder and borderline personality disorder in women: the role of temperament and character traits

ObjectiveThere is substantial symptomatic overlap between attention-deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD) in adults, but the nature of the relationship between these disorders needs further clarification. The role of temperament and character traits in the differentiation of classes of patients with similar ADHD and BPD symptom profiles was examined and possible pathways between early temperament and future ADHD and/or BPD were hypothesized.MethodsStructured diagnostic interviews were conducted in 103 female patients to assess current Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition symptoms of ADHD and BPD, and parent interviews were used to assess ADHD symptoms in childhood. Classes of subjects with homogeneous symptom profiles were identified using latent class analysis. Temperament and character traits were assessed using the Temperament and Character Inventory of Cloninger et al; scores were then compared across the latent classes.ResultsLatent class analysis revealed 4 mutually exclusive classes of patients: 1 with only ADHD symptoms; 1 with BPD symptoms and ADHD symptoms of hyperactivity; 1 with BPD symptoms and ADHD symptoms of inattention, hyperactivity, and impulsivity; and 1 with BPD symptoms and ADHD symptoms of inattention and hyperactivity. High Novelty Seeking was found in all classes except for the class with symptoms of BPD and only the hyperactivity aspect of ADHD. The highest Novelty Seeking temperament scores were found in that class of patients with both symptoms of BPD and symptoms in all areas of ADHD. High Harm Avoidance, low Cooperativeness, and low Self-directedness were specifically related to classes containing BPD symptoms.ConclusionsClasses of ADHD and BPD symptoms are associated with specific temperament and character configurations. Novelty Seeking was associated with the inattention symptoms of ADHD. An outspoken Novelty Seeking temperament suggests vulnerability for the development of ADHD and co-occurring BPD. Contrary to patients with combined ADHD and BPD symptoms, patients with only symptoms of ADHD showed normal character development and thus an absence of a personality disorder. Assessment of temperament and character traits can improve our understanding of the complex relationship between ADHD and BPD.     

Le modèle du tempérament et du caractère de Cloninger appliqué dans le trouble bipolaire de l’adulte : recension de la littérature d’une approche tempéramentale

Context

Although psychiatric research uses clear diagnostic criteria to describe bipolar disorders, therapists in clinical practice are often confronted with patients presenting a number of symptoms with different degrees of intensity and belonging to more than one diagnostic category. With respect to this actual clinical complexity, there is an increasing interest in a dimensional approach of psychopathological traits to gain better understanding of mental disorders. In the 1980s, Robert Cloninger elaborated on a psychobiological model to explain personality in clinical groups as well as in general population. His model was then operationalised with a questionnaire evaluating temperament (harm avoidance, novelty seeking, reward dependence and persistence) and character (self-directeness, cooperativeness, self-transcendence): the Temperament and Character Inventory (TCI).

Objective

To review all studies conducted in adult bipolar samples on temperament and character according to Cloninger's psychobiological model.

Materials and methods

A search was conducted on MedLine and PsycInfo for all articles written in English or French, between 1986 and September 2008, on temperament and character in bipolar disorder. The words bipolar disorder or mania had to be associated with the following keywords temperament, TCI, Cloninger, TPQ, harm avoidance, novelty seeking, reward dependence.

Results

Across studies, compared to the general population, bipolar subjects have significantly higher harm avoidance, higher novelty seeking and lower self-directness. Some studies have investigated differences between bipolar disorders and other psychopathologies like depression, and borderline personality disorder. Among studies on depression and bipolar disorder, there is no consensus on the findings. Compared to borderline personality disorder patients, bipolar disorder subjects have lower harm avoidance and higher self-directness and cooperativeness. This finding is consistent with Cloninger's hypothesis that all personality disorders have lower self-directness than any axis I disorder. With respect to other temperament and character traits, studies yielded results either contradictory or non-significant. No difference was found when the bipolar group was subdivided according to the clinical presentation (type I vs II) and the suicidal risk, apart from harm avoidance. Bipolar subjects with substance related disorders displayed higher novelty seeking and lower persistence, which might be explained by a low dopaminergic activity that had to be compensated with drug intake. Low persistence causes greater difficulties to overcome substance dependence. However, it is not possible to determine whether these temperament characteristics are specifically linked to bipolar disorder, substance related disorders, or both. Similar limitations apply to bipolar patients with comorbid anxiety disorders, who presented higher harm avoidance and lower self-directness.

Conclusions

Across studies, there are limitations which impede the generalization of the findings to other clinical populations. Age, gender, cultural characteristics, mood status during evaluation, group size, versions of the TCI questionnaire, suicidal risk, clinical type (BP I vs II) and comorbidity differ from one study to another. These methodological variables should be controlled in future studies. Nevertheless, adult bipolar patients appear to present a different temperamental profile than other clinical groups and general population. Therefore, Cloninger's psychobiological model of temperament remains an interesting avenue for future researches in bipolar disorder.     

Temperament, character and symptoms of anxiety and depression in the general population.

Few studies have investigated the relationship of temperament and character, as conceptualized in the Temperament and Character Inventory-Revised (TCI-R), to symptoms of depression and anxiety in the general population. In this study a random sample of subjects (20 to 70 years), in two Finnish cities, were surveyed with the TCI-R, Beck Depression and Anxiety Inventories, plus questions related to diagnosed lifetime mental disorders, health care use for psychiatric reasons during the past 12 months, and history of mental disorders in first-degree relatives. Altogether 347 subjects (38.6%) responded. Of the TCI-R dimensions, Harm Avoidance correlated with symptoms of depression (r(s)=0.555, p<0.001), anxiety (r(s)=0.560, p<0.001), self-reported lifetime mental disorder (r(s)=0.272, p<0.001), health care use for psychiatric reason during the past 12 months (r(s)=0.241, p<0.001) and family history of mental disorder (r(s)=0.202, p<0.001). Self-directedness correlated negatively with symptoms of depression (r(s)=-0.495, p<0.001), anxiety (r(s)=-0.458, p<0.001), lifetime mental disorder (r(s)=0.225, p<0.001) and health care use (r(s)=-0.135, p=0.013). Overall, Harm Avoidance and Self-directedness seem to associate moderately with depressive and anxiety symptoms, and somewhat predict self-reported use of health services for psychiatric reasons, and lifetime mental disorder. High harm avoidance may associate with a family history of mental disorder.     

Personality factors in depressive disorders: contribution of the psychobiologic model developed by Cloninger

The psychobiological model of personality developed by Cloninger, including four dimensions of temperament and three dimensions of character, allows to explore personality factors associated with depressive disorders. The three main dimensions of temperament are Novelty Seeking (NS), ie the tendency towards excitement in response to novel or rewarding stimuli, Harm Avoidance (HA) hypothesized to represent the tendency to respond intensely to signals of adverse stimuli, and Reward Dependence reflecting the tendency to respond intensely to signals of reward and to maintain behavior previously associated with reward. These personality traits are hypothetically related to underlying neurotransmetter systems (especially NS to dopaminergic function and HA to serotonergic function). The two main dimensions of character are Self-Directedness (SD) and Cooperativeness (C), measuring maturity traits respectively concerning individual and social adaptation; thus they are negatively correlated with the risk of personality disorder for a given patient. Many studies have been carried out with the Temperament and Character Inventory (TCI), or with the previous Tridimensional Personality Questionnaire (TPQ), in depressive disorders with cross-sectional but also with short-term and long-term longitudinal designs. They show primarily that patients with history of depressive disorders, even in euthymic phase, have very high Harm Avoidance scores. In prospective studies conducted in depressive patients, even after remission of the depressive episodes, the Harm Avoidance scores are lower than before treatment, but still elevated compared to the general population. The patients who fail to respond to antidepressant treatments have generally higher Harm Avoidance scores before treatment than the others. Overall, various results support four types of potent relationships between Harm Avoidance and depression: an influence of state on trait measure, a pathoplastic effect of Harm Avoidance on depressive expression, a vulnerability model (Harm Avoidance representing a susceptibility factor for depression), and a scar model with elevated Harm Avoidance scores even after remission of acute depressive symptoms. Other temperament dimensions, Novelty Seeking and Reward Dependence, are not consistently associated with depression characteristics nor affected by state effects, but Self-Directedness character dimension is often low when compared to subjects without depressive disorders, reflecting maladaptive personalities frequently associated to depressive disorders. Some studies suggest that low Self-Directedness scores can be predictive of suicidal behaviors. In cross-sectional studies, Harm Avoidance scores are highly positively correlated with depression intensity (r=0.23 to 0.67) and Self-Directedness scores are highly negatively correlated with depression (r=- 0.37 to - 0.60). Some studies suggest that the temperamental dimensions assessed by the TCI could have a predictive value for the response to antidepressants treatments, but this result is controversial and needs further research. For example, a study conducted in 84 patients with major depressive disorder showed that temperament type based on TPQ traits explained 25% of the response to treatment variance: patients with high scores on both Harm Avoidance and Reward Dependence had a favourable response to either clomipramine or desipramine. Studies of the relationship of temperament dimensions to biological markers of depression have also been published. It has been shown for example that Reward Dependence and Harm Avoidance scores are significantly predictive of morning hypercortisolemia in depressed subjects. More specifically, correlations have been obtained between platelet serotonergic markers (5-HT2a receptors) and Harm Avoidance scores also in depressed patients. In conclusion, Harm Avoidance seems to be a vulnerability factor or at least an associated factor to depressive disorders. This temperament dimension is supposed to be highly heritable, and to be linked to the serotonergic system variations.     

Application of the seven-factor model of personality to early childhood

The seven-factor model of personality developed by Cloninger and colleagues describes personality as a function of developmental aspects of character superimposed on heritable dimensions of temperament. The objective of this study was to determine whether this model could be applied to early childhood. We tested a preschool version of the Temperament and Character Inventory (the preschool TCI) in 305 children aged 2-5 years. Exploratory factor analysis provided support for the presence of distinct domains of temperament (comprising four factors) and character (comprising three factors). The preschool TCI demonstrated high internal consistency for each of the seven factors (Cronbach's alpha values: 0.70-0.93). Inter-individual differences in novelty seeking, reward dependence and cooperativeness were highly preserved (Pearson's r values 0.75, 0.64 and 0.80, respectively) in 29 subjects who were studied over a 3-year period from toddlerhood to early school age. Future studies are warranted to test the extent to which early childhood measurements of the seven factors might predict the development of personality disorders.     

Relationship of dissociation to temperament and character in men and women.

OBJECTIVE: This study approaches the question of nature and nurture of dissociative phenomena. Within Cloninger's concept of personality, character traits are thought to develop in response to environmental stimuli and conditions during childhood and adolescence, whereas temperament traits are considered to be genetically predisposed. The hypothesis is tested that dissociative symptoms are associated with distinct character traits but not with temperament dimensions. METHOD: Psychiatric patients (N = 191) and healthy subjects (N = 41) were evaluated for dissociative symptoms (Dissociative Experience Scale), temperament and character (Temperament and Character Inventory), and current psychopathology (SCL-90-R). Regression analyses for women and men were calculated separately. RESULTS: For both genders, the character traits of self-transcendence and self-directedness were significant and independent predictors for dissociation. CONCLUSIONS: These results support the hypothesis that dissociative symptoms are caused by environmental factors and point against a genetic predisposition in the development of dissociative symptoms.     

Reliability and validity of the Italian version of the Temperament and Character Inventory-Revised in an outpatient sample

OBJECTIVE: The aim of this study was to evaluate the reliability and validity of the Temperament and Character Inventory-Revised (TCI-R) in an outpatient sample. METHOD: The TCI-R was administered to 404 consecutively admitted subjects. The TCI-R scale 1-month test-retest reliability and TCI-R/TCI convergent validity were assessed in 2 independent subsamples. RESULTS: The TCI-R scales showed adequate Cronbach alpha values and acceptable 1-month test-retest reliability coefficients. Although many TCI-R facets showed factorial complexity, factor analysis results were consistent with the 7-factor structure of the TCI-R scales. The predictive validity of TCI-R profiles for personality disorder diagnoses was confirmed, with different combinations of temperament dimensions being associated with specific personality disorders. CONCLUSIONS: The TCI-R was a reliable and valid instrument for assessing temperament and character features, at least among Italian outpatients. The TCI-R psychometric properties support its clinical usefulness in the assessing of personality psychopathology.     

Temperament and character in patients with classical myotonic dystrophy type 1 (DM-1)

This study was designed to investigate personality in classical Myotonic Dystrophy (DM-1). Forty-six patients with DM-1 (25 women and 21 men), 31 healthy controls and 37 subjects in a contrast group, consisting of patients with other muscle disorders (spinal muscular atrophy, facioscapulohumeral dystrophy and limb girdle muscular dystrophy), completed the Temperament and Character Inventory (TCI) (Cloninger, 1994). We aimed to establish whether CTG triplet repeat size correlated with ratings of personality dimensions in the TCI. The DM-1 patients scored significantly higher on the TCI dimension Harm avoidance and lower on Persistence, Self-directedness and Cooperativeness. Signs of a personality disorder were found in 20% of the DM-1 patients. No correlation was found between the number of CTG repeats and scores in the TCI. This study indicates deviant personality in classical DM-1 regarding temperament and character, both in comparison to healthy controls and to patients with other muscle disorders with no known brain disorder.     

Personality disorder diagnosis by means of the Temperament and Character Inventory

Personality disorders (PDs) criteria are still in development. Cloninger's biosocial theory of personality contributed to this discussion. The aim of the study was to explore the relationships between extreme expressions on temperament and an immature character according to Cloninger's assumptions. Eight hundred healthy volunteers and 200 psychiatric inpatients were consecutively recruited each from Sweden and Germany, and were asked to complete the Temperament and Character Inventory, which measures 4 temperament and 3 character dimensions. Patients differed from controls on temperament and character dimensions. The combination of low and very low character scores with extreme scores in either novelty seeking, harm avoidance, or reward dependence was found more often among patients with PD compared with patients without PD and controls; this is more pronounced with an increasing number of extreme temperament scores. The Temperament and Character Inventory represents a useful tool in the diagnostic process of personality disorders.     

Patterns of temperament and character in subjects with obsessive-compulsive disorder

BACKGROUND: The purpose of this study was to assess the temperament and character patterns of obsessive-compulsive disorder (OCD) patients and to investigate the relationship between patterns of temperament and character and the severity of obsessive-compulsive symptoms. METHOD: The subjects were 40 patients who met DSM-IV criteria for OCD and 40 age-, sex-, and IQ-matched healthy controls. All subjects completed Cloninger's Temperament and Character Inventory. Other instruments included the Yale-Brown Obsessive Compulsive Scale, the Beck Depression Inventory, and the Beck Anxiety Inventory. RESULTS: OCD patients showed significantly higher scores of harm avoidance and lower scores of novelty seeking and self-directedness compared with healthy comparison subjects. In addition, the high harm avoidance and low self-directedness scores are correlated with a greater severity of obsessive-compulsive symptoms in OCD subjects (multiple regression analysis, beta = 0.39, t = 2.54, df = 34, p = .016; beta = -0.41, t = 2.46, df = 34, p = .019, respectively). CONCLUSION: OCD patients had distinct patterns of temperament and character compared with healthy comparison subjects. In addition, these patterns are specifically related to the severity of obsessive-compulsive symptoms.     

Relation of temperament and character properties with clinical presentation of bipolar disorder

OBJECTIVES: The purpose of this study was to examine the underlying temperament and character properties of patients with bipolar disorder and explore the possible connections between these properties and clinical presentation of the illness. METHODS: The sociodemographic and clinical properties of 90 patients with bipolar disorder, who were euthymic according to Young Mania Rating Scale and Hamilton Depression Scale scores, were recorded. Their temperament and character features were evaluated by using Temperament and Character Inventory and results were compared with 90 age- and sex-matched healthy controls and between patients with different clinical properties. RESULTS: Patients' scores on subscales of self-directedness and cooperativeness were significantly lower compared with controls. Significant associations were found between Temperament and Character Inventory subtitles and comorbid personality disorder, number of episodes, subtype of the first episode, rapid cycling, and previous suicide attempt. CONCLUSIONS: Temperament and character features of patients with euthymic bipolar disorder show some significant differences compared to the healthy population and may vary according to different clinical presentations.     

Temperament profiles in personality disorders among a young adult population

The objective of this study was to describe the temperament dimension profiles assessed by the Temperament and Character Inventory (TCI) among young adults with the DSM-III-R personality disorder (PD). Our hypothesis was that PD clusters and separate PDs can be distinguished from one another by their specific temperament profiles. As a part of the 31-year follow-up survey of the prospective Northern Finland 1966 Birth Cohort, the cohort members living in the city of Oulu at the age of 31 years (n=1609) were invited to participate in a two-phase field study. The Structured Clinical Interview for DSM-III-R for PDs (SCID-II) was used as diagnostic instrument. The final study sample consisted of the 1311 subjects who had completed the Hopkins Symptom Check List-25 questionnaire for screening and had given a written informed consent. Of the 321 SCID interviewed subjects, 74 met the criteria for at least one PD and had completed the TCI. The mean TCI scores of subjects with PD and control subjects without PD (n=910) were compared. Low Novelty Seeking, high Harm Avoidance and low Reward Dependence characterized cluster A and C PDs. Subjects with a cluster B PD did not differ from controls, except for Novelty Seeking, which was high. The temperament dimensions could not distinguish different PDs very well, with the only exception of persons with obsessive-compulsive PD. PD clusters were associated with different profiles of temperament, lending some support for Cloninger's typology.     

Temperament and disruptive behavior disorders

In several studies on children with conduct disorder, difficult temperament in infancy was one of the major variables in the explanation of later aggressive behavior. According to these studies, subjects with a combination of high novelty seeking, low harm avoidance and low reward dependence (NS high, HA + RD low) should be most at risk for the development of disruptive behavior disorders. The Junior Temperament and Character Inventory was given to a clinical sample of 65 adolescent patients of both sexes with the diagnoses of conduct disorder (with and without attention deficit hyperactivity disorder), emotional disorder (anxiety disorder, obsessive-compulsive disorder, depressive disorder), eating disorder (anorexia, bulimia) or personality disorder (borderline and narcissistic personality disorder). High novelty seeking and low harm avoidance were significantly correlated with externalizing symptoms like aggression and delinquency. In conduct-disordered children and adolescents, we found significantly higher scores of NS compared to the other clinical groups and the normative population, and significantly lower scores of harm avoidance compared to the other clinical groups, but not compared to the normative population. The relative risk of having a conduct disorder was markedly higher in those children and adolescents with elevated scores of novelty seeking.     

Exploring personality clusters among parents of ED subjects. Relationship with parents' psychopathology,attachment, and family dynamics

Background

Eating disorders are some of the most difficult mental disorders to treat and manage. Family interacts with genetic dispositions and other pathogenic factors, and may influence the outburst, development and outcome of EDs. The present study explores with a cluster analysis the personality traits of parents of ED subjects.

Methods

One-hundred-eight mothers and 104 fathers were tested with Temperament Character Inventory (TCI), Eating Disorder Inventory-2 (EDI-2), State–Trait Anger Expression Inventory (STAX), Family Assessment Device (FAD), Attachment Style Questionnaire (ASQ), Symptom Questionnaire (SQ), Psychological Well-Being scales (PWB). The cluster distribution of parents based on personality traits was explored. Parents' clusters TCI scores were compared as regards personality, psychopathology, attachment and family features. Cross distribution of temperament and character clusters in mothers and fathers, among couples and ED diagnoses of the daughters was explored.

Results

Two clusters of mothers and fathers were identified with temperament clustering. Character traits led to two mothers and three fathers clusters. Mothers temperament cluster 1 (MTC1) correspond to a explosive/adventurous profile, MTC2 to a cautious/passive-dependent profile. Fathers temperament cluster 1 (FTC1) was explosive/methodic, FTC2 was independent/methodic. Character clustering distinguished very immature mothers (MCC1) and majority (65%) of character mature mothers with low self-transcendence (MCC2). A third of fathers was severely immature (FCC1), a third impaired as regards relationships (poor cooperativeness and self-transcendence; FCC2), and one third character mature fathers with low self-transcendence (FCC3). Each cluster evidences specific psychopathology and attachment characteristics. FTC1 was more frequently associated with character immaturity. No significant clusters' cross correlation was found in parental couples.

Conclusion

Parents' clusters analyze in depth the univocal picture of prototypical mothers and fathers of EDs. Parents not disturbed as regards personality traits are not exceptions. Since EDs are multifactor disorders family dynamics related to parents' personality may be very relevant or even marginal in their pathogenesis. Conversely, parenting may be negatively influenced by relatively marginal personality malfunctions of parents. The clustering approach to the complexity of personality-related dynamics of ED families improves the picture of ED parents. Psychoeducational, counseling and psychotherapeutic family interventions should consider the specific underlying personality of parents.     

Towards an understanding of defense style in terms of temperament and character

The aim was to investigate the relationships between a model of personality based on the concept of defense mechanisms, as articulated by Vaillant, with the psychobiological model of personality, as developed by Cloninger. A total of 128 adults from 11 family pedigrees with at least two alcohol-dependent members completed the self-report Defense Style Questionnaire and the Temperament and Character Inventory. Immature defenses were largely explained by low character scores, while neurotic defenses were part temperament and part character. Cluster A, B and C defenses were related to low reward dependence, high novelty-seeking and high harm avoidance respectively. In a regression analysis, cluster B and C defenses were more related to low character scores than to temperament but, for cluster A defenses, temperament and character both contributed. The results suggest that it is possible to integrate an ego defense model of personality with a psychobiological model of personality, thereby enriching both approaches.     

Temperament profiles in personality disorders among a young adult population

The objective of this study was to describe the temperament dimension profiles assessed by the Temperament and Character Inventory (TCI) among young adults with the DSM-III-R personality disorder (PD). Our hypothesis was that PD clusters and separate PDs can be distinguished from one another by their specific temperament profiles. As a part of the 31-year follow-up survey of the prospective Northern Finland 1966 Birth Cohort, the cohort members living in the city of Oulu at the age of 31 years (n=1609) were invited to participate in a two-phase field study. The Structured Clinical Interview for DSM-III-R for PDs (SCID–II) was used as diagnostic instrument. The final study sample consisted of the 1311 subjects who had completed the Hopkins Symptom Check List-25 questionnaire for screening and had given a written informed consent. Of the 321 SCID interviewed subjects, 74 met the criteria for at least one PD and had completed the TCI. The mean TCI scores of subjects with PD and control subjects without PD (n=910) were compared. Low Novelty Seeking, high Harm Avoidance and low Reward Dependence characterized cluster A and C PDs. Subjects with a cluster B PD did not differ from controls, except for Novelty Seeking, which was high. The temperament dimensions could not distinguish different PDs very well, with the only exception of persons with obsessive–compulsive PD. PD clusters were associated with different profiles of temperament, lending some support for Cloninger's typology.     

Polymorphisms of DRD4 and DRD3 and risk of avoidant and obsessive personality traits and disorders

We investigated whether polymorphisms of the dopamine D4 receptor (DRD4) and polymorphisms of the dopamine D3 receptor (DRD3) were associated with personality disorder symptomatology rather than with personality traits such as novelty seeking. DNA was obtained from 145 depressed patients in a clinical trial. These patients were assessed for the presence of personality disorder symptoms and disorders. The 2-repeat allele of the DRD4 exon III polymorphism was associated with increased rates of avoidant and obsessive personality disorder symptomatology. The T,T genotype of the DRD4 -521 C>T polymorphism was also associated with increased rates of avoidant and obsessive personality disorder symptomatology. The Gly9,Gly9 genotype of the DRD3 Ser9Gly polymorphism was associated with increased rates of obsessive personality disorder symptomatology. None of these three polymorphisms were associated with novelty seeking or other temperament traits on the Temperament and Character Inventory. Our results suggest that genetic polymorphisms of DRD4 and DRD3 may well be associated with personality traits, and that conflicting findings to date may arise from the problem of phenotype definition.