Validation par analyse factorielle du Big Five Inventory français (BFI-Fr). Analyse convergente avec le NEO-PI-R

Background

After five decades of research, an initial consensus on a general taxonomy of personality traits, the “Big Five” personality dimensions, is nowadays largely accepted. These dimensions do not represent a particular theoretical perspective but were derived from factor analyses of the natural-language terms people use to describe themselves and others. The Big Five Inventory (BFI) does not use single adjectives as items because such items are answered less consistently than when they are accompanied by definitions or elaboration. It uses 44 short phrases based on the trait adjectives known to be prototypical markers of the Big Five. The Big Five have been most typically labeled E (Extraversion, Energy, Enthusiasm), A (Agreeableness, Altruism, Affection), C (Conscientiousness, Constraint, Control of impulse), N (Neuroticism, Negative affectivity, Nervousness), and O (Openness, Originality, Open-mindedness). The BFI has been translated and validated in different languages. The development was done in such a way that they resembled as closely as possible the original English version, both in psychological meanings and psychometric properties.

Objectives

The goal of this paper is to present the validation process of the French BFI (BFI-Fr) on a large student sample to verify psychometric properties, including factor structure and internal reliability and to show that the scales possess the necessary convergent and discriminant validity with the NEO personality inventory, revised (NEO-PI-R).Study 1: Internal consistency and intercultural comparison.

Materials and method

Two thousand four hundred and ninety-nine students were included (women 69%; mean age 20.2 years old, S.D. = 2.21, between 15 and 46 years). The 45 items of the BFI-Fr were filled out anonymously by the students at the university.

Results and discussion

A factorial analysis using principal components was performed on the student answers (raw data) and resulted in a five-factor varimax-rotated solution that was easily verified as the expected five dimensions E, A, C, N, and O, which explained 42% of the total variance. Cronbach's alpha coefficients which measure the internal coherence were respectively: 0.82, 0.75, 0.80, 0.82, and 0.74. This factorial analysis represents a very good replication of the American BFI. The mean internal consistency (0.79) is excellent, providing clear evidence of the psychometric qualities of the tool (internal validity). Normality of the distribution factors was verified before comparing the scores of French students with those of American and Spanish students. Mean scores and standard deviations were very similar in the three countries. As in previous research, gender differences in personality were found: females had higher scores (p < 0.001) for N, A, and C.Study 2: convergent and discriminant validation with the NEO-PI-R.The goal of study 2 was to compare the BFI-Fr with the NEO-PI-R.

Materials and method

Three hundred and sixty students (women 55%, mean age 21.1 years, S.D. = 2.30, between 18.3 and 45.5) were included. In the same session, they completed both the BFI-Fr and the French NEO-PI-R.

Results and discussion

Internal consistencies of the five personality dimensions were comparable for the BFI and the NEO-PI-R. Correlations between the corresponding pairs were all high (mean = 0.74) and significant (p < 0.001). These results provide evidence of the convergent validity of the BFI-Fr. Discriminant validity was excellent, with correlations between the other scales much lower than the convergent correlations, averaging only 0.14.

General discussion and conclusion

All three studies demonstrate that the BFI-Fr is a valid, powerful yet very efficient tool, as are the original English version and the other translations. The much longer NEO-PI-R remains the instrument of choice. Psychiatrists, psychologists, and researchers can now make use of another inventory in French to measure the Big Five which has the advantages of being simple, robust, reliable, and economical (5 to 10 min to complete).     

Utilisation du modèle de personnalité à cinq facteurs (FFM) dans l’évaluation des troubles de la personnalité du DSM-IV

Introduction

Widespread and long-standing dissatisfaction with the current DSM-IV diagnostic system for the personality disorders (PDs) revolves around five specific issues: use of a dichotomous, categorical model; extremely high rates of comorbidity within the PDs, as well as with Axis I disorders; excessive heterogeneity within the PDs; nonempirically derived diagnostic cut-offs and limited coverage of the personality pathology seen by clinicians. Many critics have suggested that the personality pathology might be better characterized using a dimensional trait model of general or pathological personality. Much research documents support relations between the PDs and the five-factor model of personality (FFM), a prominent model of general personality functioning. Recent research has examined the ability of FFM trait configurations to assess the DSM-IV PDs. Initial work focused on matching individual FFM profiles to prototypical PD profiles derived from expert ratings. Although this initial work showed that these FFM-assessed PDs performed like explicit PD assessments, the prototype matching approach was deemed cumbersome and a simpler, alternative count technique derived from the expert profiles was developed. The FFM PD counts sum the facets rated as being particularly prototypic (high or low) of a PD.

The current study

The current study tests the FFM PD counts by examining their convergent and discriminant validity correlations with explicit measures of DSM-IV PD symptomatology in two clinical samples (one French; one Belgian). In addition, “receiver operator characteristics” (ROC) analyses are used to provide information on the clinical utility of the FFM PD counts.

Method

The French clinical sample consisted of 100 female inpatients hospitalized for treatment of an eating disorder, whereas the Belgian clinical sample consisted of 130 psychiatric inpatients (47% women) with diverse presenting problems. Translated versions of the NEO PI-R were used to assess the FFM in each sample and to generate the FFM PD counts. DSM-IV PD symptom counts and diagnoses were obtained via structured interview in the French sample and via self-reports in the Belgian sample.

Results

In the French sample, convergent validity correlations between the FFM PD counts and DSM symptom counts ranged from 0.20 to 0.65 with a median r of 0.47. In the Belgian sample, these correlations ranged from 0.17 to 0.61 with a median r of 0.45. For the French sample, the median discriminant correlations for each FFM PD ranged from −0.23 to 0.35; for the Belgian sample they ranged from −0.13 to 0.28. Finally, ROC analyses were conducted for the PDs in which 10 or more individuals met the DSM diagnosis. ROC analyses provide “areas under the curve” (AUC), as well as other diagnostic efficiency statistics. An AUC of 0.50 indicates that the FFM PD count is no better at distinguishing between those with and without a given PD diagnosis than chance. AUCs were significant for all PDs examined except for the OCPD, ranging from 0.57 to 0.94 with a mean of 0.75. Average diagnostic efficiency statistics were also generally good.

Discussion

The FFM PD counts adequately assess the majority of extant DSM PDs. With the recent development of normative data and scoring sheets, these FFM counts can be applied in most clinical settings. Importantly, FFM data can be used flexibly with a focus either on the role of specific domains and facets or on specific trait configurations. Additionally, there are theoretical benefits to conceiving of PDs as constellations of FFM trait. Comorbidity is to be expected to the degree that the PDs include the same traits. The FFM PD counts are inherently dimensional, representing approximations to a prototype; thus, concerns surrounding the PDs as categories are rendered inert. Using the FFM to conceptualize the PDs allows basic research on personality to inform research on the etiology, course and treatment of the PDs.     

Relations entre le Big Five Inventory français et le manuel diagnostique des troubles mentaux dans un échantillon clinique français

The Big Five Inventory (BFI) was designed to provide researchers and clinicians with an efficient measure of individual differences on the so-called Big Five factors of normal personality: Extraversion, Agreeableness, Conscientiousness, Neuroticism, and Openness to Experience. The present article has two objectives: a) to introduce the BFI-Français, a French language version of the BFI; and b) to use the BFI-Français to study the relations between normal personality traits and the DSM classification of psychiatric disorders. Three French samples (161 medical students, 200 hospital employees, 106 psychiatric inpatients) completed the 44-item BFI-Français. DSM-IV diagnoses were made for each inpatient. The psychometric data obtained from the combined French samples were compared to US and Spanish samples. Means, standard deviations, internal consistency reliabilities, and factor structure were similar in all samples; thus, the BFI-Français provides an efficient, psychometrically sound way to measure the five personality factors in French samples. As expected, scores on the BFI-Français were related systematically to DSM diagnoses on both Axis I and II. Findings were consistent with the recent literature; since past research has relied primarily on Anglo-American and non-clinical samples, the present findings contribute importantly to establishing the generality of the links between personality traits and DSM.     

L' « Ouverture émotionnelle » dans les Troubles de la dépendance et les Troubles de la personnalité

Emotion processing is supposed to play an important role in psychological dysfunctions in alcohol and drug dependency disorders (DD), as well as in personality disorders (PD). The model of “Emotional Openness” (“Ouverture émotionnelle”) provides a multidimensional framework to analyze problematic patterns of emotion processing. Within this framework, it is suggested that drug- and alcohol-dependent patients as well as borderline and antisocial patients show reduced a) “cognitive/conceptual representation” of affective states; b) “emotion regulation”; and c) “expression and communication of emotion”; but d) increased “awareness of body internal indicators” of affectivity; and e) appropriate psychological treatment is supposed to improve these patterns. Drug-dependent patients with PD comorbidity (in particular borderline or antisocial) are supposed to present even stronger deficits in (a) and (b). The hypotheses are tested with the 36-item DOE questionnaire (“Dimensions of Openness to Emotional experiences”, trait version; [19]), assessing six main dimensions of emotion processing as represented by the subject (French and Italian version). The instrument presents satisfying reliability coefficients (mean alphas of the scales in two recent studies (N = 251; N = 435) vary between 0.74 and 0.82) and good factorial validity (6-factor PCA solutions with varimax rotation solutions in the two samples are highly coherent; the mean of Tucker's congruence coefficients is 0.93). Results of two clinical studies are presented, comparing N = 71 patients (21 drug-dependent without personality disorder; 30 drug-dependent with borderline or antisocial personality; 20 dependent in-patients receiving psychological therapy) with normal control subjects (N = 51 matched; N = 50 reference group), including one pre-post treatment comparison. Results confirm marked deficits of DD patients concerning “conceptual representation” and “emotion regulation”, as well as a reduction of “communication/expression of emotion” but an increased “awareness of body internal indicators” of affectivity. Differences of patients with a double diagnosis correspond to effect sizes of d = -1.33 for cognitive/conceptual representation of emotions and d = -1.25 for emotion regulation; differences in emotion communication and expression are also significant but less important d = -0.44. Awareness of body internal emotion indicators is increased (d = +0.27) but does not differ significantly from the control group. As supposed, patients with a double diagnosis (DD and PD) described significantly stronger deficits in conceptual representation and emotion regulation than the patients with dependency disorder only. In the second study, a group of DD patients receiving multi-component treatment, including individual and group therapeutic intervention, according to the client-centered approach, and working on emotion processing, showed marked differences from the reference group at the beginning of the treatment (d = -0.91 for cognitive/conceptual representation, d = -0.82 for emotion regulation and d = +0.46 for awareness of bodily internal indicators). As supposed, pre-post comparisons indicate improvement with change effect sizes of d = 0.99 for conceptual representation, d = 0.97 for emotion regulation, as well as d = 0.88 for emotion communication and expression. Furthermore, the changes following treatment are highly significant and substantial, except for the awareness of internal bodily indicators, which only slightly decreased. Patients “normalize” their emotion processing following treatment, describing increased conceptual representation and emotion regulation, as well as emotion communication and expression. Results underline the importance of dysfunctional modes of emotion processing in both pathologies, and underline the validity of applying the model and the DOE instrument. They are discussed with reference to the model of alexithymia.     

Les troubles de la personnalité dans le DSM-5

This presentation summarizes the revision process in preparing DSM-5 for personality disorders. The preliminary steps were The Research Agenda for DSM-5 published by D Kupfer et al. in 2002 and the APA/NIH Conference on Dimensional Models of Personality Disorders (Arlington, 12.01.2004) published in 2006 by T Widiger et al. DSM-IV categories showed excessive comorbidities and within- diagnosis heterogeneity, temporal instability and poor convergent and discriminant validity. The workgroup on personality and personality disorders chaired by Andrew Skodol has been working since 2007. The initial recommendations were published online on February 10, 2010. A major reconceptualization of personality disorders has been proposed by the workgroup with five severity levels of personality functioning based on degrees of impairment in core self and interpersonal capacities. A reduction in the number of categories (5) was expected to reduce the comorbidities and the replacement of some behavioral criteria by traits in 6 broad domains was expected to result in a better coverage and temporal stability. This new model did not receive a real approval from the American Psychiatric Association. The final decisions consist in the removal of the multiaxial perspective and the maintenance of DSM-IV personality disorders categories and criteria in DSM-5 Section II. The alternative hybrid model was placed in Section III with five domains and 25 trait facets. More validation studies are needed for the Personality Inventory for DSM-5 (PID-5) from R. Krueger (stability of factorial structure in psychiatric samples and concurrent validity with the new version of NEO PI-R (NEO 3).     

Big five-factor contributions to addiction to alcohol

Introduction

Personality in the field of addiction has been the subject of many studies. The purpose of this article is to synthesize the data obtained with the Neuroticism Extraversion Openness – Personality Inventory – Revised (NEO-PI-R) and the NEO – Five-Factor Inventory (NEO-FFI) among the persons who drink and suffer from addiction to alcohol.

Background

These tools, based on the theory of “The Big Five Factors”, assess the personality from a dimensional point of view. The five big dimensions addressed by these tools, are “Neuroticism” (general tendency to experience negative feelings), “Extraversion” (sociability, positive feelings, activity and self-confidence), “Openness” (imagination, intellectual curiosity, aesthetic sensitivity, attention paid to one's own feelings and no dogmatic behavior), “Agreeableness” (interpersonal tendencies) and “Conscientiousness” (forward planning, organization and task carrying out). According to Diagnostic and Statistical Manual of mental disorders (DSM-IV-TR), alcohol consumption is based on three dissimilar behaviors: utilization (alcohol consumption not leading to complications or damage), abuse (regular consumption likely to cause somatic, psycho-emotional or social damage for the individual or for his/her family circle) and dependency (excessive utilization leading to deterioration in functioning or clinically significant suffering).

Literature findings

Alcohol consumption among young adults can thus be predicted through a high level of “Neuroticism” associated with a low level of “Agreeableness”. Persons having been addicted to alcohol (present or past) have a high level of “Neuroticism”, a low “Agreeableness” and a low level of “Conscientiousness”, contrary to patients who have never been addicted to alcohol. The NEO-PI-R also enables a more accurate analysis of the personality, since each of these five big dimensions is divided into six facets. Among the patients with a past or present diagnosis of alcohol abuse, we found a low score on facets “trust”, “achievement striving”, “self-discipline” and “dutifulness” and a high score on “impulsiveness”, “vulnerability”, and “excitement-seeking”. Although dimension and facet results measured by this tool can differ according to craving level or according to gender, the studies agree in that there are common aspects among the patients.     

Étude de l’influence des troubles mentaux sur les difficultés de réinsertion sociale

The psychiatric problems of the “homeless” population are now recognized. The aim of this article is to focus the study on a sample of this population (n = 999) asking for help in their social insertion. The results on clinical disorders (Axis I of the DSM-IV) and personality disorders (Axis II of the DSM-IV) are compared to estimations on general population and to other studies on “homeless” in France. These comparisons show the prevalences of some disorders whose symptoms involve problems in social rehabilitation. At last, measures of interaction and impact (multiplicative interactions, odd ratio, etiologic fractions) shows that these morbid associations increase the problems in the attempts to social rehabilitation.     

« Drapeaux rouges » : quand s’alarmer, quel examens demander ?

The diagnosis of Parkinson's disease (PD) requires ruling out other causes of parkinsonism. Among various “other” causes of parkinsonism, neurodegenerative causes or “atypical parkinsonism” are the most difficult to diagnose. Most common diseases are “synucleinopathies”: multiple system atrophy and dementia with Lewy bodies and “tauopathies”: progressive supranuclear palsy and corticobasal degeneration. Unexpected or atypical signs and symptoms for PD, also called “red flags” along with absent or poor or short-lived levodopa response may be a clue for the diagnosis. Some tests may also support the diagnosis, among them, structural (MRI) and functional brain imaging, autonomic function tests and urodynamics, oculographic recordings and neuropsychological work-up, are the most useful.     

Heritability estimates of the Big Five personality traits based on common genetic variants

According to twin studies, the Big Five personality traits have substantial heritable components explaining 40–60% of the variance, but identification of associated genetic variants has remained elusive. Consequently, knowledge regarding the molecular genetic architecture of personality and to what extent it is shared across the different personality traits is limited. Using genomic-relatedness-matrix residual maximum likelihood analysis (GREML), we here estimated the heritability of the Big Five personality factors (extraversion, agreeableness, conscientiousness, neuroticism and openness for experience) in a sample of 5011 European adults from 527 469 single-nucleotide polymorphisms across the genome. We tested for the heritability of each personality trait, as well as for the genetic overlap between the personality factors. We found significant and substantial heritability estimates for neuroticism (15%, s.e.=0.08, P=0.04) and openness (21%, s.e.=0.08, P<0.01), but not for extraversion, agreeableness and conscientiousness. The bivariate analyses showed that the variance explained by common variants entirely overlapped between neuroticism and openness (rG=1.00, P <0.001), despite low phenotypic correlation (r=−0.09, P <0.001), suggesting that the remaining unique heritability may be determined by rare or structural variants. As far as we are aware of, this is the first study estimating the shared and unique heritability of all Big Five personality traits using the GREML approach. Findings should be considered exploratory and suggest that detectable heritability estimates based on common variants is shared between neuroticism and openness to experiences.     

L'apport d'une classification internationale des troubles mentaux dans la compréhension de la psychopathologie de Wolfgang Amadeus Mozart (1756-1791)

The ICD-10 (International classification of diseases, 10th revision), in its chapter dealing with mental disorders, has been constructed in a way that allows it to be used in various cultural settings. This classification can also provide a tool for diagnosing people who lived before the conceptualization of modern psychiatric nosology. Mozart (1756-1791) is perhaps one of the most famous composers, due to the genius of his music but also as a result of his controversial "temperament". Beyond the reputation that arises from these sources, the exact personality and psychiatric disorder(s) from which Mozart may have suffered are still not sufficiently understood. The study of Mozart's letters and his biography leads us to consider the psychiatric disorders from which he may have suffered. We detail some elements of his biography in connection with plausible psychopathological episodes, thus drawing new conclusions about the disorders from which he suffered. Mozart was born in Salzburg in 1756 to a musician father and a mother who had already given birth to six other infants, only one of whom was still living at the time, a four-year-old sister. He became a talented composer but was described as unpretentious, kind, cheerful and extraverted. During his adolescence, there is no indication of the presence of any mental disorder. But later, in accordance with previous literature, it seems that he demonstrated depressive episodes, some of which were severe and correspond to the criteria of the international classification ICD-10. In June 1788 for example, Mozart wrote: "… if such black thoughts did not come to me so often, thoughts which I banish by a tremendous effort, things would be even better." This remark constitutes a relatively specific element in favor of a depressive episode, even if no other clues appear in his letters from this period. In 1790, Mozart's words then explicitly indicate that he suffered from a severe depressive episode: he mentioned a depressed mood, a markedly diminished interest in his activities (e.g. in composing), a diminished ability to concentrate, loss of energy and feelings of excessive guilt. Thus, Mozart described five criteria for the diagnosis of a major depressive episode. "If people could see into my heart, I should almost feel ashamed - to me everything is cold - cold as ice." However, others have claimed the occurrence of some depressive episodes (for instance after the death of his mother) that are excluded by this nosological conception. Also, the arguments put forward by other authors supporting the occurrence of manic or hypomanic episodes (thus constituting a bipolar disorder diagnosis) are not supported by sufficient historic proof. He wrote letters which were incoherent in some parts; but hypomanic episodes can be excluded, as letters written the days before and after these above-mentioned ones are clearly and adequately conceived. This excludes the likelihood of a hypomanic state of duration of more than four days, as required by ICD-10 criteria. Thus, there are no diagnostic criteria for a bipolar II disorder (i.e. the presence of depressive and hypomanic episodes). The diagnosis of a cyclothymic disorder is more difficult to exclude: the length of hypomanic periods is not specified in classifications, but the symptoms must cause clinically significant distress or impairment in social functioning. Mozart suffered social and interpersonal difficulties (i.e. lack of security, affective loneliness), which are at least partially related to some of his behaviors and/or mood instability. This could be due to the presence of a personality disorder. Mozart featured personality traits which correspond to the criteria for dependent personality: difficulties acting on his own (for instance with regard to his relationship with his father); need to be nurtured and supported by others (i.e. his wife); feeling uneasy or helpless when alone. Traits of the borderline personality disorder can also be drawn from his correspondence: efforts to avoid real or imagined abandonment; impulsiveness (also described in some of his biographies); affective instability due to a marked reactivity of mood (which may account for some clinical situations having been described as depressive episodes); and a feeling of emptiness. The current conceptualization of psychiatric disorders allows us to conclude that Mozart suffered from depressive episodes in the background of a personality disorder characterized by dependent as well as borderline traits. Nevertheless, this conclusion may be challenged by authors who consider that the mood lability and brief hypomanic-like episodes that Mozart featured represent core characteristics of the so-called "soft bipolar spectrum" rather than a personality disorder feature. Indeed, there is a growing trend to lower the time criterion for hypomania and even to include hyperthymic traits (which are indisputably present in Mozart) as a constitutive element of a bipolar II disorder in the presence of depressive episodes. Thus, the psychiatric history of Mozart exemplifies nosological uncertainties that are still a source of debate in today's psychiatric research.     

L’« hyperdatation » et sa fonction défensive dans la psychose

The question of time in psychoses has been studied more often as lived time (perceived) than as discursive time (abstract). The specificity of lived time in psychosis can disturb the modes of “intrigue setting” (‘mise en intrigue’ according to Ricœur seems to translate lived time into a narrative process), particularly as concerns lack of dating or excess of dating. In this paper, the authors study the phenomenon they have named “hyperdating” and its defensive function in psychosis. “Hyperdating” would be a function of overdating, illustrating the distance between the patient who “hyperdates” and the affective charge he feels. “Hyperdating” would then consist in a radical lack of the dating function. The purpose of dating would not be to tag events temporally in order to organize the narrative chronologically, but to proceed to evacuate the meaning out of the event by designating only its date. In fact, we suppose that the affect would be shifted onto this date, and thus disconnected with the representation of the event for which there are representational deficiencies and probably a very intensive original affective load. Dating is a vehicle of chronology, and is the manifestation of a faculty for the narrative of self to become an autobiography as temporal experience. We suppose that in psychosis, this process is inefficient. In fact, there is either a lack of dating of narrative events, or a “hyperdating” which overloads narrative with temporal pseudo-indicators, in particular through quasi-sacred dates. “Hyperdating” would therefore be a defensive psychic process against the traumatic load connected to the remembrance of the event, transferring the central characteristics to the date itself, which would then be exterior to any meaningful chronology. The authors propose to define this “hyperdating” phenomenon, and to investigate its psychic function. The methodology is qualitative, and based on two clinical cases, one of schizophrenia, the other of mania.

A single case of schizophrenia

We think that in schizophrenia the “hyperdating” phenomenon could be underlain by a schism between affect and representation. This is an isolating process which fits into a psychotic dissociation, recalling the break characterising schizophrenic temporality. The speech is centred on a time-based accuracy to the detriment of experience narration and its affective expression. It then seems that “hyperdating” enables the person to avoid the huge traumatic load related to the factual content in order to shift the affective load on the dating itself.

A single case of mania

Here “hyderdating” would be the expression of a game with dates in an omnipotent process. This game appears as a mosaic, a disjointed and blurred control attempt lacking a linear temporal trajectory. In mania, a cumulated series of dates does not ensure either temporal links or any necessary “temporalisation” for “intrigue setting”. Time is one of the forms of “discontinuity and hopping” frozen in instantaneity. “Hyperdating” reveals a need to control the temporal flux which can only fail and it is, under a chronological appearance, an expression of a temporality frozen on the return of the same. The lack of temporal succession and of alternatives to “temporalisation” of events by means of a date which freezes them and removes their affective dimension can only render the reflexive capture of an identity through a biographic narrative problematic.

Conclusion

Thus, other than the discrepancies related to the specificity of the “hyperdating” process in the psychic economy of psychotic patients, there would be some similarities concerning “hyperdatation” in psychoses such as abortive attempts of intrigue restoration, deadlock of the chronological function of dating, but also freezing of temporalisation on a number. These illustrate the schism or the instantaneity, devoid of any temporal flux and therefore of any link with “withholding” (apprehension of what has just occurred) and with “protention” (intuition of the immediate future), which characterise time experience according to Husserl. The limits of our study are rooted in the difficulty of identifying this phenomenon as it seems to occur less often than those concerning forgetting or lack of dating. Furthermore the links between “hyperdating” and the affect management process as well as the differences of those links within the different types of psychosis will need to be investigated more thoroughly. That is why the prospects of this study could be the following ones: interrogating the links between “hyperdating” and memory in psychoses. (Is the “hyperdating” phenomenon a failed attempt to recover memories, and/or an attempt to shape raw mnesic traces?); further investigations of the psychotic temporality issue; therapeutic contributions in the management of time and affects could be based on these previous points as far as it seems that it is only through the flexibility of such a defence that the patient will reach the affects and integrate them in an intersubjective relationship with the therapist.     

« L'expertise » de fin d'hospitalisation d'office médicolégale (article L 3213-8 du code de la santé publique)

The “expertise” required by article L. 3213.8 of the Code of Public Health is exceptional within the statute of “compulsory hospitalization” (Police-instructed compulsory hospitalisation in France corresponds to the juridical or court-ordered hospitalisation in Anglo-Saxon law). This paper proposes a critical analysis of this “expertise” and of the ensuing situation of pathological criminals based on an extended practice of expertise and taking into consideration the recent evolution of the concept of dangerousness.     

Recherche de sensations, désinhibition et pratique de sports à risque : quelques pistes de réflexion

Sensation seeking is at the root of different behaviours. Skydivers, artists, drug addicts and criminals somehow share the same need for stimulation. But are there drug-addicted skydivers? Are there different ways to seek sensations? Studies on risky sport practices and disinhibition are contradictory. While some find risk-taking athletes do not consume substances, others maintain these athletes are indeed the most uninhibited of all. Diversity and the type of activities supposedly depend on what exactly an athlete seeks from a psychological point of view. The analysis of different sensation seekers’ personality traits helps to better understand the choice and role of one or several sources of activation. Based on a review of studies, we will discuss three sensation seeker profiles. Depressed “escapists” primarily seek sensations through substance use in order to regulate their negative affects. This “passive” stimulation mode seems better suited than practising risky sports for these individuals lacking in energy. Conversely, extraverted “hedonists” comfort their positive affectivity by seeking multi-faceted pleasure in risky sports or the “social” use of substances. They are not characterized by negative affects but by alexithymia. Some probably bypass their difficulty to understand their feelings by seeking various readily available sensations that need not be mentally interiorised (purportedly found in disinhibition or risky sports). Finally, “compensatory” types are adventurers who seek sensations in high-risk sports only. They are not characterized by depression, anxiety, disinhibition, extraversion or alexithymia. They seek to enhance and build up their personality by confronting the natural environment and danger. While all athletes seek sensations, these might not be essential to escapist and compensatory types who use them only as a mere means to escape and compensate. Extraverted hedonists seem to be the “true” sensation seekers inasmuch as stimulations are worthwhile in themselves. This strong need for hedonistic sensations might lead to an addictive process, a common answer to psychic sufferings that may also derive from boredom or a need for sensations and pleasure.     

Approche neurobiologique des traits tempéramentaux associés aux troubles de personnalité

Recent publications in the field of neurobiology related to personality disorders allow some consideration on the bidirectional relationship between genetically determined temperamental traits and environment, interactions observed in the normal development of personality during childhood and adolescence or on the contrary in the building of a disordered personality revealed at adulthood. Based on the review of studies about development of personality disorders in children, adolescents and adults, this article puts forward the interactive quality of relations between genetic background and environmental factors and proposes hypotheses concerning the role of temperament in the development of personality. Correlations between genes and environment (rGE) and interactions gene-environment (GxE) are examined. Bidirectional feedback between temperament and environment where individual temperamental characteristics determine environment selection or adjustment and not the opposite is an example of an interaction of evocative type. However, actual research designs face difficulties in the establishment of a causal link due to the multitude and complexity of involved factors linking personality traits with temperamental genetic markers. This might explain the emergence of an endophenotype concept as it has been used with autism. An endophenotype consists in a mesurable cognitive, neurophysiological or neurochemical variable expressing the genetic defect present before the onset of the illness. Some studies put forward possible endophenotypes for borderline, antisocial and schizotypal personality disorders. Longitudinal research has shown the predictive quality of externalized conduct disorders of childhood leading to antisocial and to a lesser extent borderline personality disorders in adulthood. Impulsivity and affective lability might be based on minor neurocognitive abnormalities, subclinical attention deficits and/or marked neuropsychological dimensions such as strong extraversion. Suboptimal serotoninergic regulation has been established in destructive impulsivity and suicidability. Abnormalities in the dopaminergic and noradrenergic systems might also be implicated but it remains unclear to what extent repeated trauma and abuse during childhood might modify the hypothalamic-pituitary-corticotropic axis in response to chronic stress and transform permanently the modulation of physiological and psychological reactions of these children to their perturbed environment. Researches on conduct disorders have also demonstrated the evocative interaction of a particular temperament with the environment responding to marked novelty seeking behaviour, hyperactivity, impulsivity and lack of proper physiological reaction to extreme stimuli. Lack of behaviour inhibition found in antisocial individuals is attributed to noradrenergic and serotoninergic abnormalities and neurocognitive deficits. The dimensional continuity of schizotypal personality to schizophrenia is well established and electrophysiological markers such as abnormal eye tracking movements, P300 evoked potentials, prolonged electrodermal reactions with cognitive disorganization and deficits in inhibition of attention to usual stimuli might be the future endophenotypical markers to schizophrenia susceptibility. Further studies on temperamental traits might lead to the identification of genetic markers as precursors to personality disorders.     

Adhésion au traitement prescrit et traits de personnalité dans une population de patients atteints de schizophrénie

Schizophrenia is one of the most important public health problems. It is a common, tragic and devastating mental illness that typically strikes young people when they are maturing into adulthood. Among schizophrenic out-patients, 24-63% of patients are non compliant as they failed to take the correct drug in the correct dosage. Clinical experience had demonstrated the existence of several groups of patients, some who comply with the medical regimen and others who do not adhere to treatment. Some of the factors that had been linked to poor compliance included low socio-economic status, unstable lifestyle, general negative attitudes towards one’s predicament, cognitive strategies and patient’s personal and psychological characteristics. As such, several studies have shown that three personality dimensions are particularly important for understanding schizophrenia which are extraversion, neuroticism and peculiarity. The aim of this study is to search for the possible association between personality traits or cognitive strategies and compliance to treatment in a sample of adult patients with schizophrenia. Eighty-three patients were screened for suitability for inclusion into the study. Patients who fulfilled the following criteria were recruited: aged 18 and more, who received a diagnosis of schizophrenia (Axis I DSM-IV), without severe cognitive impairment, without a diagnosis of personality disorder (Axis II DSM-IV), consulting their psychiatrist for a period of one year after dismissal of their psychiatric ward and having given their written informed consent. The final study sample consisted of 50 out-patients adults, 35 males and 15 females, age 19-59 years. After inclusion, patients were divided into two groups (Compliant-C and Non Compliant-NC) on the basis of their compliance to treatment. Mean age for the two groups is, respectively, 34.59 ± 9.62 and 27.29 ± 7.93. Compliance to treatment was measured by indirect methods such as the impression of the treating psychiatrist, interviewing patients, therapeutic outcome, counting the number of tablets remaining in a patient’s supply and objective criteria such as presence to medical and staff appointments or ending the follow-up. Personality traits were measured by the Rorschach Test, scored and interpreted according to Exner’s Comprehensive System. This psychological measure was selected for its ability to differentiate state and trait personality variables and its sound validity when used in the manner for which it was designed and intended. The selected trait variables in the Rorschach are: P < a + 1, which identifies tendencies to be passive and deferential in social situations; HVI index, which indicates a cautious, distant and mistrustful orientation to people ; EB which shows a cognitive style of decision making; Lambda > 0.99 which identifies a lack of adequate openness to experience and tendencies to view one’s world with an overly narrow focus of attention; and Fr + rF, associated with narcissistic marked tendencies to overvalue personal worth. The selected defense mechanisms in the Rorschach are: the intellectualization index (2AB + Art + Ay) used to keep emotion at a distance and minimize their impact. Denial (MP > MA) defines a predilection for escapist fantasy and prevents the impact of an unpleasant reality. Patients were contacted during their hospitalization period by the medical chief of staff who described the study in details. After they had consented, participants received the Rorschach test, before leaving the hospital. The Rorschach protocols have been scored by two Senior Rorschach practitioners. On the selected variables their scoring agreement percentage was 100%. Rorschach protocols were assigned to the C and NC groups by the end of the scoring process and once the medical team had finished the inclusion into the two groups (C and NC). The two Rorschach practitioners had worked single-blind on the set of Rorschach protocols. Group differences in Rorschach variables at the end of one year of medical follow-up were examined by using the χ² test. The significance level was set at P < 0.05. Results have shown that the C and NC groups differ significantly on the basis of schizophrenia subtypes. The Paranoid type (295.30) is more frequent in the C group whether the Disorganized type (295.10) is more frequent in the NC group (χ²= 12.16, P < 0.001). Compliant schizophrenic patients use significantly, more frequently the intellectualization defense mechanism (χ² = 6.17, P < 0.012). Non compliant patients appear to have significantly more marked narcissistic traits and tendencies to overvalue personal worth (χ² = 8.79, P < 0,003). These observations support the idea that paranoid delusions, even if persecutory, do not alter pervasively the ability of maintaining genuine relationships with some others, such as the treating psychiatrist, for instance. In Disorganized type patients, the orientation to people is overall disturbed, the interest in the therapeutic alliance more superficial and fragile. Due to narcissistic traits and tendencies to overvalue personal worth, non compliant patients display a sense of grandiosity and entitlement which distort the genuine perception of personal needs and that of their psychological states. Intellectualization acts as cognitive coping strategy aiming to mute the intensity of emotions and safeguard against distress. Shifting emotional experience to a cognitive level allows the schizophrenic patient to acknowledge his needs for medical therapy even if he does not recognize himself as being ill. The research presented here comprises a 1-year prospective study designed to test some associations between personality factors and compliance to treatment. The degree to which schizophrenic patients comply with the advice of health workers depends, among other factors, on their stable personality traits and coping mechanisms. Continued study of the links between personality traits and compliance to treatment in this population as well as regular psychological assessment of these patients may identify which therapeutic approaches are best for which patients. There is increasing interest in the role of psychological mechanisms in compliance behavior formation after the onset of illness and these models may also be useful in thinking about events before onset.