Relationship of trait impulsivity with clinical presentation in euthymic bipolar disorder patients

The purpose of this study was to examine trait impulsivity in patients with bipolar disorder and explore the possible connections between impulsivity and clinical presentation of the illness. Diagnoses were based on the Structured Clinical Interview for DSM-IV. The sociodemographic and clinical properties of 71 patients with bipolar disorder, who were euthymic according to Young Mania Rating Scale and Hamilton Depression Scale scores, were recorded. Their trait impulsivity was evaluated by using the Barratt Impulsiveness Scale (BIS) and impulsivity subscale of the Temperament and Character Inventory, and the results were compared with 50 age- and sex-matched healthy controls and among patients with different clinical properties. All BIS-11 subscale scores were higher in bipolar than in comparison subjects. There were no effects of education and age. Elevated BIS-11 scores were associated with predominant depressive polarity, longer duration of illness and a history of psychotic mood episodes and suicide attempts. These relationships persisted when age, gender, and education were taken into account. These results show that after accounting for common confounding factors, trait-like impulsivity was substantially higher in subjects with bipolar disorder than in nonbipolar comparison subjects and may vary according to different clinical presentations.     

Temperament and character traits in patients with bipolar disorder and associations with attempted suicide

Objective

This study was intended to investigate temperament and character traits in bipolar disorder patients with or without a history of attempted suicide.

Methods

One hundred nineteen patients diagnosed with euthymic bipolar disorder based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, and with no accompanying Axis I and II comorbidity, and 103 healthy controls were included. Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I and II disorders were used to exclude Axis I and II comorbidity. Temperament and character traits of bipolar patients with a history attempted suicide (25.2%, n = 30) or without (74.8%, n = 89) and of the healthy volunteers were determined using the Temperament and Character Inventory. The association between current suicide ideation and temperament and character traits was also examined.

Results

Bipolar patients with or without a history of attempted suicide had higher harm avoidance (HA) scores compared with the healthy controls. Persistence scores of bipolar patients with no history of attempted suicide were lower than those of the healthy controls. Self-directedness (SD) scores of the bipolar patients with a history of attempted suicide were lower than those of patients with no such history. Self-transcendence scores of bipolar patients with no history of attempted suicide were lower than those of both the healthy controls and of those patients with a history of attempted suicide. A positive correlation was determined between current suicidal ideation scale scores and HA, and a negative correlation between SD and cooperativeness was determined.

Conclusions

High harm avoidance may be a temperament trait specific to bipolar disorder patients. However, it may not be correlated with attempted suicide in such patients. These may have low persistence, high SD and low self-transcendence temperament and character traits that protect against attempted suicide. Harm avoidance, SD, and cooperativeness may be correlated with current suicidal ideation.     

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.     

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.     

Hypomanic, cyclothymic and hostile personality traits in bipolar spectrum illness: a family-based study

OBJECTIVES: To examine hypomanic, cyclothymic and hostile personality traits in a large, euthymic, family-based group of individuals with bipolar disorder (BPD) and their affectively ill and healthy relatives. To test whether these traits follow a distribution with the most "pathological" scores in the bipolar disorder I (BPD I) group and the least "pathological" scores in the unaffected relatives. METHODS: Two-hundred and ninety-six individuals from 47 bipolar disorder families were administered a battery of personality questionnaires (Temperament Evaluation of Memphis, Pisa, Paris, and San Diego; Temperament and Character Inventory; Affective Neuroscience Personality Scale; Hypomanic Personality Scale; Borderline Traits Questionnaire) as well as a self-rating depression (Beck Depression Inventory) and mania (Altman Self-Rating Mania) scale. Out of the 296 participants, 57 were diagnosed with BPD I, 24 with bipolar disorder II (BPD II), 58 with recurrent major depression (MDE-R), 45 had one previous depressive episode (MDE-S), and 86 were unaffected. Twenty six individuals had another DSM-IV diagnosis. RESULTS: The BPD I group displayed elevated hypomanic, cyclothymic and hostile traits. These traits were also characteristic of the BPD II group but were less salient in the MDE-R group. The MDE-S group did not differ significantly from unaffected relatives. Hypomanic personality characteristics were clearly elevated in both BPD groups and differentiated BPD from major depressive disorder (MDD) individuals. CONCLUSIONS: Our results provide preliminary support for the hypothesis that temperament is a genetically quantitative trait.     

Temperament and character dimensions in bipolar I disorder: a comparison to healthy controls

Research on phenotypic markers of vulnerability to bipolar disorder has focused on the identification of personality traits uniquely associated with the illness. To expand knowledge in this area, we compared Cloninger's seven temperament and character dimensions in 85 euthymic/subsyndromal bipolar I inpatients and outpatients and 85 age and sex matched community controls. We also examined associations between Cloninger's personality traits and mood state in the patient group. Bipolar subjects were administered the Structured Clinical Interview for DSM-IV (SCID), Hamilton Rating Scale for Depression, and Clinician-Administered Rating Scale for Mania. Controls received the SCID, a family psychiatric history questionnaire, and urine toxicology screen to confirm healthy status. Both groups competed the 240-item Temperament and Character Inventory (TCI). A multivariate analysis of covariance, accounting for demographic factors, was conducted to compare the groups on the TCI. Bipolar I patients scored higher on harm avoidance, lower on self-directedness, and higher on self-transcendence compared to controls. Harm avoidance and self-directedness were correlated with residual depressive symptoms positively and negatively, respectively; persistence was correlated with residual manic symptoms; and selftranscendence was correlated with residual psychotic symptoms in patients. The results indicate that bipolar I subjects do possess personality traits that are significantly different from non-ill individuals. However, only a prospective, longitudinal study may determine whether these traits mark a vulnerability to the disorder, or represent the scarring effect of affective episodes and chronic subsyndromal symptoms.     

Temperament and character in euthymic major depressive disorder patients: the effect of previous suicide attempts and psychotic mood episodes

Objective

The purpose of this study was to examine personality traits of patients with major depressive disorder and explore the possible connections between personality and clinical and sociodemographic variables.

Methods

The sociodemographic and clinical properties of 80 patients with major depression, who were euthymic according to Hamilton Depression Scale scores, were recorded. Their personality was evaluated by using Temperament and Character Inventory and results were compared with 80 age- and sex-matched healthy controls. We used general linear model analysis to evaluate the manner in which the variables contributed to TCI scores.

Results

Remitted depressive patients scored significantly lower on on self-directedness and higher on harm avoidance than HC. Previous suicide attempts had a main effect only on harm avoidance while previous psychotic mood episodes were significantly associated with novelty seeking, self-directedness and cooperativeness. With respect to numeric clinical variables, only duration of illness was significantly and negatively correlated with NS and RD scores.

Conclusion

Patients with euthymic major depressive disorder may have significantly different personality traits than the normal population, and patients with different clinical and sociodemographic characteristics may show different personality patterns. In addition, assessment of major depressed patients by means of the Temperament and Character Inventory may be helpful to get a deeper insight into those personality traits underlying suicidality and the emergence of psychotic mood episode.     

Patterns of temperament and character in patients with posttraumatic stress disorder and their association with symptom severity

Objectives

The aim of this study was to identify the patterns of temperament and character of patients with posttraumatic stress disorder (PTSD) and to explore the relationship between the patterns of temperament and character and PTSD symptoms severity.

Methods

Temperament and character features of 130 patients with PTSD (n = 65) and age and sex-matched healthy controls (n = 65) were evaluated using the Temperament and Character Inventory. Severity of PTSD symptoms and general anxiety symptoms was measured with the Impact of Events Scale-Revised (IES-R) and the Hamilton Anxiety Rating Scale (HARS).

Results

Patients with PTSD showed significantly higher scores on subscales of harm avoidance and self-transcendence and lower scores on self-directedness and cooperativeness compared to controls. Harm avoidance and self-transcendence scores were significantly associated with PTSD symptom severity as measured by IES-R but not with general anxiety symptom severity as measured by HARS.

Conclusions

Patterns of temperament and character of patients with PTSD were significantly different from those of healthy controls. In addition, these patterns are specifically associated with the PTSD symptom severity.     

Impulsivity in euthymic patients with major depressive disorder: the relation to sociodemographic and clinical properties

The purpose of this study was to examine the trait impulsivity of patients with a major depressive disorder and to explore the possible connections between impulsivity and clinical and sociodemographic variables. The sociodemographic and clinical properties of 60 patients with major depression, who were euthymic according to Hamilton Depression Scale scores, were recorded. Their trait impulsivity was evaluated using the Barratt Impulsiveness Scale (BIS-11) and the impulsivity subscale of the Temperament and Character Inventory, and the results were compared with those of 50 age- and sex-matched healthy controls. We used general linear model analysis to evaluate the manner in which the variables contributed to BIS-11 scores. Some impulsivity scores were higher in those with a major depressive disorder than in comparison subjects. There were significant effects of education and sex in these differences. Elevated BIS-11 scores were associated with a history of psychotic mood episode and suicide attempts. These relationships persisted when age, sex, and education were taken into account. These results show that, after accounting for common confounding factors, trait-like impulsivity was substantially higher in subjects with major depressive disorder than in comparison subjects and may be associated with sociodemographic and clinical properties.     

Patterns of temperament and character in a clinical sample of Korean children with attention-deficit hyperactivity disorder

Aims:  The purpose of the present study was to assess patterns of temperament and character in a clinical sample of Korean children with attention-deficit hyperactivity disorder (ADHD) and to investigate the relationship between patterns of temperament and character and the severity of ADHD symptoms.
Methods:  Fifty-one children who met DSM-IV criteria for ADHD and 51 age- and sex-matched healthy comparison subjects completed the Junior Temperament and Character Inventory (JTCI) and the DuPaul's ADHD Rating Scale (ARS-IV).
Results:  Children with ADHD had significantly higher scores of Novelty Seeking and lower scores of Self-directedness in both parents' rating and children's self-rating. In addition, low Self-directedness scores predicted higher total scores of ARS-IV.
Conclusions:  In a clinical sample of Korean children with ADHD, a distinct pattern of temperament and character was found. The current findings suggest that low Self-directedness may be related to the severity of ADHD symptoms.     

Patterns of changes in temperament and character inventory scales in subjects with obsessive-compulsive disorder following a 4-month treatment

OBJECTIVE: The purpose of this study was to assess changes in the temperament and character patterns in subjects with obsessive-compulsive disorder (OCD) following the treatment for obsessive/compulsive and accompanying depressive symptoms. METHOD: Study subjects were 35 patients who met the DSM-IV criteria for OCD. All subjects were assessed with the Temperament and Character Inventory (TCI), the Yale-Brown Obsessive-Compulsive Scale, the Beck Depression Inventory, and the Beck Anxiety Inventory before and after a 4-month treatment. RESULTS: Harm Avoidance (HA) scores in OCD subjects before treatment significantly decreased after treatment. However, the Self-Directedness scores, which were significantly lower than healthy comparison subjects before treatment, did not change. In addition, Reward Dependence scores in OCD subjects, which were not significantly different from healthy comparison subjects before treatment, significantly increased after treatment. CONCLUSION: The TCI pattern of untreated OCD subjects (high HA and low Self-Directedness, relative to healthy comparison subjects) and the decrease of HA scores and no change in Self-Directedness scores following a successful treatment suggest that temperaments are more amenable to treatment than characters.     

Evaluation of Temperament and Character Features as Risk Factors for Depressive Symptoms in Patients with Restless Legs Syndrome

Background and Purpose

Restless legs syndrome (RLS) is a common sleep-related movement disorder that is frequently associated with psychological disturbances. Personality traits are of considerable importance with respect to coping with chronic illness and disease vulnerability. This study assessed the temperament and character traits of RLS patients using an approach that involves the psychobiological model of personality.

Methods

The personality features of 65 newly diagnosed and untreated RLS patients with no neurological or psychiatric diseases and 109 healthy controls were determined using the Temperament and Character Inventory and compared using covariance analyses. The International RLS Study Group Severity Scale was used to assess the severity of the RLS symptoms, and the Beck Depression Inventory was used to assess the presence and severity of depressive symptoms.

Results

RLS patients scored significantly higher than healthy controls on the temperament dimension of harm avoidance (HA, p=0.02) and significantly lower on self-directedness (SD, p=0.001). No significant difference was observed in terms of the temperament dimension of novelty seeking (p=0.435). HA scores were significantly correlated with the BDI score but not with the RLS severity or duration.

Conclusions

High HA and low SD scores are the main characterizing personality features of RLS patients. These personality dimensions may be among the factors predisposing patients to development of the depressive symptoms that are frequently associated with RLS.     

Character and temperament in major depressive disorder and a highly anxious-retarded subtype derived from melancholia

BACKGROUND: An anxious-retarded subtype of major depressive disorder, defined by high scores for both anxiety and retardation, has been derived from melancholia and appeared to have higher external validity in terms of poor outcome and vasopressinergic stress hormone regulation. A specific personality could enhance the validity of this subtype, and the association with melancholia suggested the absence of a personality disorder. As 2 character dimensions of the Temperament and Character Inventory (TCI), self-directedness (SD) and cooperativeness, parsimoniously predict the presence of a personality disorder, the primary aim was to test whether patients with the highly anxious-retarded subtype of depression have both normal SD and normal cooperativeness. A secondary aim was to optimally account for the general personality characteristics of patients with a major depressive disorder. METHODS: Eighty-six patients with major depressive disorder and matched healthy controls were selected. Seventy patients were eventually recruited for a 2-year follow-up encompassing 5 assessments of personality (TCI) and psychopathology (Comprehensive Psychopathological Rating Scale). Full remission of depression was defined by the presence of less than 3 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition items of depression during 2 weeks. RESULTS: State-dependent changes of SD and harm avoidance (HA) scores were found in all depressed patients. Fully remitted patients had only high HA compared with healthy controls. Unexpectedly, fully remitted patients with the highly anxious-retarded subtype, in addition, had low SD. CONCLUSION: The temperament of high HA may be the predisposing TCI trait for major depressive disorder in general. Low SD may be a specific presumably premorbid character trait for the highly anxious-retarded subtype derived from melancholia.     

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.     

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.     

Increase in harm avoidance by genetic loading of schizophrenia

BackgroundSchizophrenia is highly familial neuropsychiatric disorder with heritability estimated at 60% to 90%. Even unaffected first-degree relatives of schizophrenia manifested some neuropsychologic abnormalities, neurologic soft sign, and morphologic anomalies. Because personality traits are under genetic influence and considerable heritability, we intended to evaluate temperament and character of first-degree relatives of schizophrenia and the influence of schizophrenia genetic loading on their temperament and character.MethodsTemperament and Character Inventory was completed by 97 first-degree relatives of schizophrenia or schizoaffective disorder, 48 schizophrenic probands (44 patients with schizophrenia and 4 patients with schizoaffective disorder), and 106 control subjects. Within first-degree relatives, parents who have additional probands with schizophrenia spectrum disorder in their ascendant or collateral pedigree and siblings who have offspring with schizophrenia spectrum disorder were defined as presumed carriers (n = 20). Group differences in Temperament and Character Inventory scores were compared using a mixed-model analysis of variance with family as a random effect and age as a covariate.ResultsHarm avoidance (HA) scores increased in the order of control subjects, the first-degree relatives, and probands. Among the relatives, presumed carriers, but not presumed noncarriers, had higher HA compared with control subjects. In addition, probands showed significantly low reward dependence, low self-directedness, and low cooperativeness scores compared with the first-degree relatives and control subjects. Probands had also higher self-transcendence scores than the first-degree relatives and had lower persistence scores than control subjects.ConclusionsOur findings that HA increases in proportion to the genetic loading of schizophrenia suggest that it may be a potential endophenotype of schizophrenia.     

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.     

Temperament, character, and quality of life in patients with schizophrenia and their first-degree relatives

The aim of this study was to investigate the associations between the temperament, character dimensions, and quality of life (QOL) of patients with schizophrenia; their first-degree, nonaffected relatives; and healthy control subjects. One hundred twenty patients, the same number of first-degree relatives, and the same number of control subjects were assessed using the Temperament and Character Inventory and the Quality of Life Enjoyment and Satisfaction Questionnaire. Patients were also assessed using the Positive and Negative Syndrome Scale. Patients and relatives had a significantly lower QOL than control subjects, controlled for temperament and character dimensions. Patients scored significantly higher than control subjects in harm avoidance and self-transcendence and lower in novelty seeking and self-directedness. First-degree relatives had lower results for novelty seeking and scored higher on self-transcendence than control subjects. Harm avoidance, self-directedness, and self-transcendence were the dimensions of Temperament and Character Inventory shown to be the most significant predictors of QOL. Psychopathology and age were also significant predictors of QOL. Our understanding of an individual patient's QOL must include personality evaluation.     

Temperament and character traits in patients with bipolar disorder and associations with comorbid alcoholism or anxiety disorders

Temperament and character traits may determine differences in clinical presentations and outcome of bipolar disorder. We compared personality traits in bipolar patients and healthy individuals using the Temperament and Character Inventory (TCI) and sought to verify whether comorbidity with alcoholism or anxiety disorders is associated with specific personality traits. Seventy-three DSM-IV bipolar patients were compared to 63 healthy individuals using the TCI. In a second step, the bipolar sample was subgrouped according to the presence of psychiatric comorbidity (alcoholism, n=10; anxiety disorders; n=23; alcoholism plus anxiety disorders, n=21; no comorbidity, n=19). Bipolar patients scored statistically higher than the healthy individuals on novelty seeking, harm avoidance and self-transcendence and lower on self-directedness and cooperativeness. Bipolar patients with only comorbid alcoholism scored statistically lower than bipolar patients without any comorbidity on persistence. Bipolar patients with only comorbid anxiety disorders scored statistically higher on harm avoidance and lower on self-directedness than bipolar patients without any comorbidity. Limitations of this study include the cross-sectional design and the small sample size, specifically in the analysis of the subgroups. However, our results suggest that bipolar patients exhibit a different personality structure than healthy individuals and that presence of psychiatric comorbidity in bipolar disorder is associated with specific personality traits. These findings suggest that personality, at least to some extent, mediates the comorbidity phenomena in bipolar disorder.     

Bipolar disorder. II: personality and age of onset

Objectives: The aim of this study was to examine whether personality i.e. temperament and character interacts with age of onset in bipolar disorder.
Methods: Bipolar patients were recruited among in- and outpatients from lithium dispensaries of northern Sweden. Patients were diagnosed according to DSM-IV criteria for bipolar disorder type I and II. Temperament and Character Inventory (TCI) was used for measuring personality. TCI was administered to 100 lithium treated bipolar patients and 100 controls.
Results: Treatment response was significantly lower (p = 0.005) in patients with early onset compared with late onset. Family history (p = 0.013) and suicide attempts (p = 0.001) were also significantly more common in patients with early onset. Further, patients with early onset were significantly higher (p = 0.045) in the temperament factor harm avoidance (HA) than patients with late onset, but the difference was weak. Patients with early onset had more fear of uncertainty (HA2; p = 0.022) and were more shy (HA3; p = 0.030). Bipolar I patients showed similar results as those in the total bipolar group (I and II), with significantly higher HA (p = 0.019, moderate difference), HA2 (p = 0.015) and HA3 (p = 0.043) in patients with early onset compared with late onset. Bipolar II patients showed no differences between early and late age of onset but the groups are small and the results are therefore uncertain.
Conclusions: Early age of onset in bipolar disorder was correlated to an increase in severity, family history, poorer treatment response and poorer prognosis. Early onset was also correlated to personality.