The effect of temperament and character on response to selective serotonin reuptake inhibitors in panic disorder

OBJECTIVE: In this prospective study, temperament and character were evaluated in patients with panic disorder (PD), before 1 year of medication therapy, to verify whether these factors influenced the outcome of treatment. METHOD: Seventy-one PD patients were evaluated with the SCID-IV, the Temperament and Character Inventory (TCI), the SCL-90, the Ham-A and the Ham-D. Patients were treated with pharmacotherapy and were evaluated monthly over 1 year. RESULTS: Before treatment, non-remitted patients showed higher levels of harm avoidance (HA) and lower levels of persistence (P), self-directedness (SD) and cooperativeness (C), whereas remitted patients showed only higher levels of HA. After controlling the effect of the confounding variables, the likelihood to achieve remission was positively related to SD score (OR = 1.12; P = 0.002), particularly 'self-acceptance' SD dimension (OR = 1.30; P = 0.02). CONCLUSIONS: Our data suggest that in PD: i) the evaluation of personality, using the Cloninger's model, confirms the presence of personality pathology as one predictor of non-response to treatment; ii) in patients with low SD a combination of medication and cognitive-behaviour therapy should be the most effective treatment.     

An Australian validation study of the temperament and character inventory

OBJECTIVE: To assess the validity of the temperament and character inventory (TCI) measure in an Australian sample. METHOD: A sample of depressed subjects completed the TCI and a measure assessing personality disorder constructs (PDCs), while family members and psychiatrists also returned PDC ratings. RESULTS: Factor analyses generally supported the TCI constructs, when the temperament and character scales were analysed separately. Self-reported PDC scores were validated against corroborative witness ratings and used to assess the TCIs concurrent validity. Validation analyses supported all TCI temperament scales, but the Self-transcendence Character scale was unassociated with PDC scores. The remaining two character scales (i.e. cooperativeness and self-directedness) were non-specifically associated with all PDC scores. CONCLUSION: Study results support the validity of the TCI scales, but question the best model for conceptualizing the TCI. It is suggested that two character scales quantify disordered functioning, while temperament scales quantify style, constructs that may be inter-related or independent in individual subjects.     

Personality traits and schizophrenia: evidence from a case-control study and meta-analysis

Personality is considered to be an important aspect of schizophrenia, primarily because it may influence patients' symptoms and social functioning. Specific personality traits are related to schizophrenia. The Temperament and Character Inventory (TCI) measures four traits of temperament - novelty seeking (NS), harm avoidance (HA), reward dependence (RD) and persistence (PS) - and three traits of character - self-directedness (SD), cooperativeness (CO) and self-transcendence (ST). We investigated associations between schizophrenia and personality traits using the TCI in a Japanese case-control sample (99 patients and 179 controls). Patients with schizophrenia scored higher on HA and ST and lower on NS, RD, SD and CO compared with controls in our case-control sample. We then performed a meta-analysis of samples from the published literature and our sample (384 patients and 656 controls). We found no evidence of heterogeneity among studies, except for NS in the overall population. Possible associations between personality traits (HA, RD, PS, SD, CO and ST) and schizophrenia were revealed. The effect sizes (Hedges' g) of the temperament traits were 0.98 for HA, -0.43 for RD and -0.23 for PS, and those of the character traits were -0.96 for SD, -0.47 for CO and 0.61 for ST. These findings suggest that patients with schizophrenia have a unique temperament and character profile compared with the general population.     

Anorectic family dynamics: temperament and character data

Modern psychobiologic research conceptualizes personality as a complex adaptive system involving a bidirectional interaction between heritable neurobiologic dispositions (temperament) and social learning (character). In this study, we evaluated temperament and character traits of patients with anorexia nervosa and their mothers and fathers, and we analyzed the correlation of temperament and character traits among family members in anorectic families. Finally, we tested the ability of the Temperament and Character Inventory (TCI) to discriminate between normal controls and anorectic subjects, their parents, and their families. Temperament and character features of 50 restricter anorectic patients and their parents (23 fathers and 25 mothers) were analyzed and then compared with a control group of 60 women and their 20 fathers and 20 mothers using the TCI. Data suggest that both temperament and character factors are involved in anorexia nervosa (AN). Anorectic individuals were high in harm avoidance (HA), low in novelty seeking (NS), and high in persistence (P) ("obsessive temperament type"). Their character was remarkable for low self-directedness (SD). Their mothers were distinguished by low SD. The fathers were high in HA, but also low in P, and high in reward dependence (RD). Again, they were low in SD. The anorectic family had low SD as a common denominator observed in all family members. This finding indicates that the psychopathology of AN extends beyond obsessiveness, but combines obsessiveness with low character development. None of the above temperament and character profiles is pathognomic of restricter anorectics. The observation that both temperament and character have an important role in the etiopathogenesis of AN has important treatment ramifications. The TCI was useful in discriminating between normal controls and anorectic subjects, their parents, and the whole anorectic family.     

Comparison of Clinical Features and Personality Dimensions between Patients with Major Depressive Disorder and Normal Control

Objective

Personality dimension is considered as a risk factor of depression. This study was to compare aggression, impulsivity, hopelessness, and TCI (temperament and character dimensions) between patients with major depressive disorder (MDD) and normal controls.

Methods

A total of 56 MDD patients and the same number of normal controls who were matched for age, gender, and education were recruited. All subjects completed the following questionnaires; Aggression Questionnaire (AQ), Beck Hopelessness Scale (BHS), Barratt Impulsiveness Scale, 11th Version (BIS-11), and Temperament and Character Inventory (TCI).

Results

MDD patients were significantly higher scores in anger, hostility of AQ, BHS, motor impulsivity of BIS-11, and Harm Avoidances (HA) of TCI with all subscales of HA than normal controls, whereas novelty seeking 1 (NS1) (Exploratory of NS), Reward Dependence (RD) with RD3 (Attachment) · RD4 (Dependence), Self-Directedness (SD) with most subscales of SD, Cooperativeness (CO), and ST3 (Spiritual Acceptance) showed lower scores than normal controls. Moreover, BHS and HA, BIS and NS showed moderate positive correlation in MDD patients, while BHS and SD, HA and SD were negatively correlated.

Conclusion

The present study showed unique clinical features, especially personality dimensions of patients with MDD. Our results could be applicable to suggest treatment process and to predict one''s prognosis for depression in that psychological properties are important for drug compliance and treatment response.     

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.     

Effect of serotonergic antidepressant therapy on temperament and character scales in patients with chronic tension-type headache

The purpose of the present study was to assess a group of patients with chronic tension-type headache (CTTH) and control subjects using the personality questionnaire proposed by Cloninger and to determine possible changes in the Temperament and Character Inventory (TCI) patterns of CTTH patients after therapy with serotonergic antidepressants. Forty-five patients with CTTH filled out the TCI and Beck Depression Inventory (BDI) before and after 4-month prophylactic therapy with serotonergic antidepressants. A total of 50 age-, sex- and education level-matched healthy subjects were selected as a control group. During the pretreatment period patients were found to have higher harm avoidance and lower self-directedness scores than healthy comparison subjects. During the post-treatment period, although harm avoidance scores decreased and self-directedness scores increased, harm avoidance scores were still significantly higher and self-directedness scores significantly lower in CTTH patients than in controls. After using BDI score and age as covariates at the post-treatment period, harm avoidance scores were still higher in patients with CTTH while self-directedness scores did not differ between CTTH patients and controls. These findings suggest state and trait dependence of harm avoidance, and strong state dependence of self-directedness scores in CTTH patients. When interpreting data regarding personality measured by the TCI in CTTH patients, the effects of depressive symptomatology should be taken into account.     

Personality dimensions in social phobics with or without depression

OBJECTIVE: This study investigated the personality traits of social phobics using the Temperament and Character Inventory (TCI). METHOD: A sample of 178 social phobics was assessed with the TCI, and compared with controls. The patients were classified into two groups, according to the absence (SP group) or to the presence (SP+D group) of depression. RESULTS: We found significant elevated scores for harm avoidance (HA) in social phobics when compared with controls (16.2 +/- 2.7), in both the SP (26.2 +/- 3.5), and the SP+D (28.9 +/- 4.7), groups. Lower self-directedness scores were found in the SP and in the SP+D groups when compared with the controls. Patients with the generalized type of social phobia had higher HA scores as compared with other social phobics. CONCLUSION: The personality profile obtained in these social phobics, whatever their depressive symptomatology, reflects a dramatically anxious and avoidant temperament associated to an immature character.     

Classification of adult patients with type 2 diabetes using the Temperament and Character Inventory

Aim:  Adult patients with type 2 diabetes were classified using the Temperament and Character Inventory (TCI). This classification was used to propose effective therapeutic approaches based on subtypes of psychological characteristics.
Methods:  The TCI and various psychological tests were administered to 89 patients (54 men and 35 women). Cluster analysis was performed using three temperament factors of the TCI as variables for subclassification: novelty seeking (NS), harm avoidance (HA) and reward dependence (RD).
Results:  The patients were divided into two clusters based on the TCI results. Cluster 1 had a low NS/high HA/low RD pattern, which indicated resistance to change and lack of cooperativeness, and results of other tests indicated that patients in cluster 1 were obsessional and had weak intention and personality disorder symptoms. In contrast, cluster 2 had a high NS/low HA/high RD pattern, indicating a socially active person who easily becomes dependent on others, and results of other tests indicated that these patients were histrionic and less anxious. In cluster 1 there was a significant negative correlation between hemoglobin A1c (HbA1c) and SD-1 (TCI self-directedness) 'responsibility' and a significant positive correlation between HbA1c and State anxiety of State–Trait Anxiety Inventory. In cluster 2 there was a significant positive correlation between HbA1c and HA-2 'fear of uncertainty'.
Conclusions:  Patients with type 2 diabetes were classified using the TCI into two subgroups. These two groups differed in psychological characteristics and had a different pattern in correlation with glycemic control.     

Psychometric properties of the Temperament and Character Inventory-Revised (TCI-R) in Czech adolescent sample

The psychometric properties of the TCI-R method were investigated in a cohort of 15-year-old adolescents (n = 787). This is the lowest recommended age for using the adult version of the method. A factor analysis of the temperament and character scales was carried out on the basis of Principal Component Analysis with Varimax rotation. We compared our results with a previous TCI version which was used in the pilot study of 15-year-olds (n = 171), with established norms for the Czech adolescents and adults, and in regard to gender differences. The principal component analyses for all scales with eigenvalues ≥ 1 resulted in only a 6 factor structure, in contrast to the 7 factor structure postulated by Cloninger. But the factor solution, computed separately for temperament (4F) and character (3F), approximately reflected the Cloninger's model except for the temperament subscales NS1 (Exploration Excitability), RD1 (Sentimentality) and RD4 (Dependence), which load multiple factors, and the character subscale SD 4 (Self-acceptance), which loads the Cooperativeness factor. The internal consistency of the main TCI-R scales was excellent; the Cronbach's alpha varied from .83 (NS) to .89 (HA). However, for some subscales (NS4, RD4, and CO5) the consistency was rather weak. In our research, the previous version of TCI showed less satisfying psychometric properties than TCI-R did. In terms of gender differences, girls scored higher in NS, RD, HA, CO and ST, whereas boys scored higher in PS; no statistically significant differences for SD were found. In general, our results support the Cloninger's postulated 7 factor personality structure and the appropriateness of the TCI-R usage for 15-year-old adolescents.     

Relationship between personality disorder symptoms and temperament in the young male general population of South Korea

The aim of the present study was to identify the characteristics of temperament and character in personality disorder symptoms in the young male general population. A total of 585 male subjects from the same community were included in the study (mean age, 19.06 +/- 0.26 years). There was no difference in socioeconomic and educational background. Subjects completed the Personality Disorder Questionnaire-IV+ (PDQ-IV+) and Temperament and Character Inventory (TCI). There were unique correlations between each personality disorder symptom and four temperament profiles. When classification was done through three cluster symptoms by DSM-IV, cluster A symptoms were most strongly associated with low reward dependence (r = -0.46), cluster B with high novelty seeking (r = 0.33), and cluster C with high harm avoidance (r = 0.47). The character dimension, self-directedness was the most powerful predictor of the presence of any personality disorders. In homogenous male general population, unique combinations were found between temperament and each personality disorders. Although the subjects were relatively young and therefore their characters had not yet fully matured, character played an important role in the presence of personality disorder. Temperament can be used to differentiate the personality symptoms and characters used to predict the presence of personality 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.     

Harm avoidance and self-directedness as essential features of panic disorder patients

ObjectiveThe purpose of the study is to compare the personality traits assessed with the Temperament and Character Inventory (TCI) between patients with panic disorder (PD) and a control group in a Brazilian sample.MethodsOne hundred thirty-five patients with PD paired according to sex and age with 135 controls without any psychiatric disorders were assessed with the Mini International Neuropsychiatric Interview (MINI), a structured interview. Temperament and character were assessed with the TCI.ResultsConsistently, patients with PD presented higher scores on the harm avoidance (HA) temperament scale (23.20 ± 5.41 vs 15.21 ± 4.92; P < .001) and lower scores on the self-directedness (SD) (27.81 ± 7.25 vs 35.16 ± 5.47; P < .001) if compared to the control group and has been associated independently from other TCI scales and confounders with PD. The multivariate logistic model containing HA and SD explains 38.6% to 51.4% of the differences between PD and controls.ConclusionsHarm avoidance could be a good candidate to be heritable because it appears to be a consistent finding across current literature in anxious and depressed patients independent of their cultural context. Also, SD seems to be a key character characteristic of PD patients. The dimensional assessment is an interesting alternative for understanding the relationship between the psychobiologic bases of temperament and character and is highly related to the development of psychiatric syndromes.     

The relationship between temperament and character and subclinical psychotic-like experiences in healthy adults

BackgroundConsiderable data support phenomenological and temporal continuity between psychotic disorders and subclinical psychotic-like experiences (PLE's). Although numerous studies have found similar personality correlates for schizophrenia and schizotypal personality disorder patients, their unaffected first-degree relatives, and healthy adults characterized for schizotypal traits, no study has yet investigated personality correlates of PLE's measured by the Community Assessment of Psychic Experiences (CAPE). Our study sought to examine personality correlates of PLE's using the CAPE in healthy adults.MethodThe CAPE and temperament and character inventory (TCI) were administered to 415 healthy adults. Regressions examined links between TCI traits and overall PLE levels as well as positive and negative PLE's separately.ResultsConsistent with past studies, lower self-directedness (SD) and reward dependence (RD) and higher self-transcendence (ST) and harm avoidance (HA) significantly predicted overall PLE levels. Higher ST and persistence (P) and lower SD significantly predicted higher levels of positive PLE's while lower SD and RD and higher HA, ST, and cooperativeness (C) predicted higher levels of negative PLE's.ConclusionsAssociations between TCI and PLE's using the CAPE are strikingly similar to past work in non-clinical and patient samples and provide additional support for phenomenological continuity between psychotic disorders and sub-syndromal psychotic symptoms.     

Relationship of alexithymia and temperament and character dimensions with lifetime post‐traumatic stress disorder in male alcohol‐dependent inpatients

Aims: The purpose of the present study was to evaluate the prevalence of lifetime post‐traumatic stress disorder (PTSD) in male alcohol‐dependent inpatients and to investigate the relationship of PTSD with alexithymia and temperament and character dimensions. Methods: Participants were 156 consecutively admitted male alcohol‐dependent subjects. Patients were investigated using the Clinician‐Administered PTSD Scale (CAPS), the Toronto Alexithymia Scale (TAS‐20) and the Temperament and Character Inventory (TCI). Results: Among alcohol‐dependent inpatients 32.1% were considered as having lifetime PTSD. Mean scores of alexithymia, novelty seeking (NS), harm avoidance (HA) and self‐transcendence (ST) were higher in the PTSD group, whereas age and self‐directedness (S) were lower. Among age and other factors of TAS‐20, ‘difficulty in identifying feelings (DIF)’ predicted PTSD in a logistic regression model. When age and personality dimensions of TCI were taken as independent variables, S predicted PTSD in the logistic regression model. Finally, among subscales of TCI, ‘impulsiveness versus reflection’ (NS2) and ‘congruent second nature versus bad habits’ (S5) predicted PTSD. Conclusions: Alexithymia and personality traits, particularly high DIF and S scores are related with lifetime PTSD diagnosis, even when controlling for age among alcohol‐dependent inpatients. Causal relationships between alexithymia, personality dimensions and PTSD, and their implications on treatment are not clear and should be evaluated in longitudinal studies.     

Personality dimensions measured using the Temperament and Character Inventory (TCI) and NEO-FFI on a Polish sample

The results of two self-administered, paper-and-pencil tests based on biosocial theory of personality have been compared simultaneously: the Temperament and Character Inventory (TCI) and NEO Five Factor Inventory (NEO-FFI). The stability of the personality dimensions was assessed across age, sex and education level samples in a group of 406 Polish adults with major mental diseases excluded by use of PRIME-MD questionnaire. Significant effects of age, sex, and education have been found while comparing personality dimensions in both temperamental (novelty seeking, NS; harm avoidance, HA; reward dependence, RD; persistence, P) and character scales (cooperativeness, C; self-transcendence, ST) in TCI. Among subscales of temperament only NS1, RD4 were stable according to concerning factors. All converted to their age and sex norms NEO-FFI dimensions were stable according to sex. Extraversion scale was changeable depending on age (p = 0.04). Neuroticism dimension was a little higher in lower educated group (p = 0.035).To sum up, it was concluded that sex- and age-specific norms for the dimensions of the Polish version of TCI are necessary considering the established significant differences. Particular personality genetic studies should account for age, sex and also educational differences in their methods of associative studies. CONCLUSIONS: In the exploration of personality dimensions on healthy volunteers the Polish version of NEO-FFI corresponds better than TCI to theory of stability and genetic determinants of human personality. As the study included persons with excluded major mental diseases, the sample is appropriate to provide a control group in the research of psychiatric patients using both TCI and NEO-FFI. SIGNIFICANT OUTCOMES: TCI scores for persons with excluded mental disease are highly changeable depending on age, sex and education. Adjusted to sex and age scores NEO-FFI corresponded better than TCI to stability and genetic determinants of human personality.     

An interaction between the serotonin transporter promoter region and dopamine transporter polymorphisms contributes to harm avoidance and reward dependence traits in normal healthy subjects

Summary. There is evidence for an association between polymorphisms of serotonin- and dopamine-related genes and temperamental personality traits. Recent findings have shown that interactions between allelic variants of the different genes may contribute to personality traits. We examined the effects of serotonin transporter-linked promoter region (5-HTTLPR) and dopamine transporter (DAT1) gene polymorphisms for associations with the Temperament and Character Inventory (TCI) temperament subscales in 209 Koreans. We found that the variants of 5-HTTLPR interacted with the DAT1 gene polymorphism to influence the HA and RD temperament subscales of TCI. Neither of these two genes affected any subscales of TCI alone. Controlling for the effects of gender and age, we found significant interactions between 5-HTTLPR and DAT1 genes on Harm Avoidance (HA) and Reward Dependence (RD) as measured by the TCI (Hotelling’s Trace = 3.0, P = 0.02). In the presence of the DAT1 10/10 genotype, subjects of group L of 5-HTTLPR had a significantly higher HA score and significantly lower RD score than those of group S (F = 5.04, df = 1, p = 0.03 and F = 8.35, df = 1, p = 0.004, respectively). These findings suggest that the variants of 5-HTTLPR interacted with the DAT1 gene polymorphism to influence the HA and RD temperament subscales of TCI.     

Electrophysiological indication for a link between serotonergic neurotransmission and personality in alcoholism

The serotonergic neurotransmission seems to be involved in the neuropsychobiology of alcoholism. The intensity dependence of the N1/P2 component of auditory-evoked potentials is discussed as an indicator of the central serotonergic neurotransmission in healthy subjects. The aim of this study was to verify this correlation between intensity dependence and serotonergic neurotransmission, as indicated by the personality trait "harm avoidance" (HA) within the Temperament and Character Inventory (TCI) in alcohol-dependent patients. The intensity dependence was measured in 25 alcohol-dependent patients, 10 and 40 days after detoxification. The personality trait HA was assessed, which is supposed to reflect the serotonergic neurotransmission. The intensity dependence was negatively correlated with the temperament trait HA of the TCI (r = - .55, P<.01) at Day 40, but neither on Day 10 nor with the other personality dimensions. We conclude, that the intensity dependence reflects the serotonergic neurotransmission in withdrawn alcohol-dependent patients.     

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.     

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.