Personality traits in early phases of panic disorder: implications on the presence of agoraphobia, clinical severity and short-term outcome

OBJECTIVE: To explore the relations between personality traits using the Big Five model and presence of agoraphobia, clinical severity and short-term outcome in an unbiased clinical sample of never-treated panic disorder patients. METHOD: Panic disorder (PD) patients (n = 103) in the first stages of their illness were evaluated using the Neuroticism-Extraversion-Openness Five Factor Inventory of Personality (NEO-FFI) and were compared with a sample of healthy subjects. Severity was assessed by the Panic Disorder Severity Scale and the Clinical Global Impression Scales. Patients were evaluated after 8 weeks of naturalistic pharmacologic treatment with Selective Serotonin Reuptake Inhibitors. RESULTS: Panic disorder patients show more neuroticism than healthy subjects. Patients suffering from agoraphobia are more introverted than controls. Extraversion, in addition to gender and distress, during panic attacks allows to correctly classifying 72% of the cases of agoraphobia. CONCLUSION: Low scores in extraversion contribute to explain the presence of agoraphobia in panic disorder. Personality traits are neither related to clinical severity nor to short-term response to pharmacological treatment.     

Using Implicit Association Tests for the assessment of implicit personality self-concepts of extraversion and neuroticism in schizophrenia

There is evidence from research based on self-report personality measures that schizophrenia patients tend to be lower in extraversion and higher in neuroticism than healthy individuals. Self-report personality measures assess aspects of the explicit self-concept. The Implicit Association Test (IAT) has been developed to assess aspects of implicit cognition such as implicit attitudes and implicit personality traits. The present study was conducted to investigate the applicability and reliability of the IAT in schizophrenia patients and test whether they differ from healthy individuals on implicitly measured extraversion and neuroticism. The IAT and the NEO-FFI were administered as implicit and explicit measures of extraversion and neuroticism to 34 schizophrenia patients and 45 healthy subjects. For all IAT scores satisfactory to good reliabilities were observed in the patient sample. In both study groups, IAT scores were not related to NEO-FFI scores. Schizophrenia patients were lower in implicit and explicit extraversion and higher in implicit and explicit neuroticism than healthy individuals. Our data show that the IAT can be reliably applied to schizophrenia patients and suggest that they differ from healthy individuals not only in their conscious representation but also in their implicit representation of the self with regard to neuroticism and extraversion-related characteristics.     

Adult attention-deficit/hyperactivity disorder in major depressed and bipolar subjects: role of personality traits and clinical implications

A significant comorbidity between attention-deficit/hyperactivity disorder (ADHD) and affective disorders has been consistently reported in adults. Less data regarding the role of personality traits and the influence of ADHD co-occurrence on clinical characteristics and outcome of mood disorders are currently available. One hundred and six remitted major depressed, 102 euthymic bipolar subjects, and 120 healthy controls, homogeneous with respect to demographic characteristics, were included in the study. ADHD diagnosis was based on DSM-IV-TR criteria. Childhood and adult ADHD features were measured with the Wender Utah Rating Scale, the Adult ADHD Self-rating Scale, and the Brown Attention-Deficit Disorder Scale. The Revised NEO Personality Inventory was also administered to the clinical groups, in order to investigate personality dimensions. The occurrence of adult ADHD in subjects with bipolar disorders (BD) or major depressive disorder (MDD) was 15.7 and 7.5 %, respectively, compared to 3.3 % in healthy controls (HC). Significant associations (p < .001) between personality traits (neuroticism, conscientiousness, and extraversion) and ADHD features were observed. Logistic regression analysis of all clinical subjects (n = 208) showed that those with lower levels of neuroticism (OR = 1.031; p = .025) had a lower frequency of ADHD comorbidity. The present study emphasizes the close relationship between affective disorders, especially BD, and ADHD in adults. Our findings support the need to assess subjects with mood disorders in the clinical setting for possible coexisting ADHD and to further investigate personality traits to better understand the etiology of affective disorders and ADHD co-occurrence.     

Genetic variation in the schizophrenia-risk gene neuregulin1 correlates with personality traits in healthy individuals

BACKGROUND: Differences in personality traits have long been acknowledged as potential risk factors in developing psychiatric disorders. Lately, several susceptibility genes of different psychiatric disorders have been linked to personality traits. This has not been done for schizophrenia yet. Neuregulin1 has been repeatedly shown to be associated with schizophrenia and is involved in numerous neurodevelopmental functions such as neuronal migration and myelination. The impact of this gene might also modulate personality traits in healthy subjects. METHODS: The NRG1 status of 523 healthy subjects was determined with a single nucleotide polymorphism (SNP8NRG221533) which has been described as a tagging marker being part of the core at-risk haplotype for schizophrenia. Genotype was correlated with personality traits using the NEO-FFI questionnaire. RESULTS: Subjects with the NRG1 risk allele scored higher on neuroticism (p<.05) and lower on conscientiousness (p<.05). Further, interactions of genotype by gender for extraversion (p<.05), openness (p<.05) and conscientiousness (p<.05) were found with men carrying the risk allele scoring the lowest. CONCLUSIONS: The data indicate that the NRG1 gene which has found to be associated with schizophrenia may also influence personality differences in healthy subjects.     

Personality traits of patients with mood and anxiety disorders

Although it is well established that personality traits of patients with mental disorder differ significantly from the traits of other persons, differences in personality characteristics between different mental disorders have not been examined very thoroughly. In this study, we examine personality traits in a large sample of outpatients (N=640) with mood and anxiety disorders in differing patterns of comorbidity, using the five-factor model of personality. Mood and anxiety disorders were assessed using the Composite International Diagnostic Inventory, and personality traits were assessed with the NEO Five-Factor Inventory (NEO-FFI). Most of the mean scores on the NEO-FFI scales of the study population were found to be significantly different from the scale scores of the general population. Few differences between NEO-FFI scores for differing patterns of mood and anxiety disorders were found. However, clear differences were found for subjects with one (mood or anxiety) disorder, subjects with two, and subjects with three or more disorders. Neuroticism and agreeableness differed considerably in subjects with one disorder compared with subjects with two or more disorders. The main conclusion is that personality traits appear to be associated with comorbidity and less so with any specific disorder.     

Regional cerebral brain metabolism correlates of neuroticism and extraversion

Factor-analytic approaches to human personality have consistently identified several core personality traits, such as Extraversion/Introversion, Neuroticism, Agreeableness, Consciousness, and Openness. There is an increasing recognition that certain personality traits may render individuals vulnerable to psychiatric disorders, including anxiety disorders and depression. Our purpose in this study was to explore correlates between the personality dimensions neuroticism and extraversion as assessed by the NEO Five-Factor Inventory (NEO-FFI) and resting regional cerebral glucose metabolism (rCMRglu) in healthy control subjects. Based on the anxiety and depression literatures, we predicted correlations with a network of brain structures, including ventral and medial prefrontal cortex (encompassing anterior cingulate cortex and orbitofrontal cortex), insular cortex, anterior temporal pole, ventral striatum, and the amygdala. Twenty healthy women completed an (18F)FDG (18F-fluorodeoxyglucose) positron emission tomography (PET) scan at rest and the NEO-FFI inventory. We investigated correlations between scores on NEO-FFI Neuroticism and Extraversion and rCMRglu using statistical parametric mapping (SPM99). Within a priori search territories, we found significant negative correlations between Neuroticism and rCMRglu in the insular cortex and positive correlations between Extraversion and rCMRglu in the orbitofrontal cortex. No significant correlations were found involving anterior cingulate, amygdala, or ventral striatum. Neuroticism and Extraversion are associated with activity in insular cortex and orbitofrontal cortex, respectively.     

Use of the five-factory inventory in characterizing patients with major depressive disorder

Research on personality traits has suggested an association between depression and certain personality traits, such as neuroticism and extraversion. Costa and McCrae's five-factor personality inventory (NEO) has been shown to measure personality traits in a nonclinical population, but its use has not been fully explored in clinical populations. This study aims to compare NEO results in a sample of depressed outpatients with published test norms, and determine if different levels of neuroticism and extraversion are associated with differences in certain psychosocial and clinical characteristics. Seventy-six depressed outpatients participating in antidepressant clinical trials completed this self-report questionnaire before beginning pharmacological treatment. Diagnosis of major depressive disorder (MDD) was made using the Structured Clinical Interview for DSM-III-R or DSM-IV and the severity of depression was measured with the 17-item Hamilton Depression Rating Scale (HAM-D). The three analyses conducted were as follows: (1) NEO factor scores were compared with published normative means; (2) three groups, based on level of neuroticism, were compared on certain psychosocial and clinical characteristics; and (3) three groups, based on level of extraversion, were compared on the same psychosocial and clinical characteristics. Both the males and females obtained T score values for the Neuroticism Scale 1.5 SD above the mean, for the Extraversion Scale 1.5 SD below the mean, and for the Conscientiousness Scale 1.5 SD below the mean. No significant differences were found between subjects with different levels of neuroticism and extraversion, although a trend did exist indicating a positive relationship between neuroticism and severity of depression. Depressed outpatients experience frequent negative affects, have irrational thought processes, cope with stress poorly, have difficulty controlling impulses, prefer to be alone, and have difficulty carrying out tasks. Future studies should examine how such personality factors affect response to treatment and course of illness.     

Neuroticism may be associated with history of depression in the elderly

The relationships between geriatric depression and various personality traits have never been fully clarified, and their clinical significance is uncertain. Depression in geriatric patients may differ from the disorder found in younger individuals, and may also have distinctive personality antecedents or consequences. In this study 16 elderly subjects who had recovered from depression and 14 elderly control completed the Eysenck Personality Inventory (EPI) and the Personality Disorder Examination (PDE). On the EPI, neuroticism subscale scores were significantly higher for patients than controls, while mean extraversion scores were not significantly different. On the PDE, recovered depressives had higher dimensional scores than controls in each DSM-III-R personality disorder except antisocial. Neuroticism scores correlated significantly with PDE dimensional scores for all but two of the DSM-III-R personality disorders, while extraversion scores correlated significantly with only two PDE categories. Together, these findings suggest that neuroticism and criteria for most DSM-III-R personality disorders may be associated with history of depression in a geriatric population.     

The genetic association between personality and major depression or bipolar disorder. A polygenic score analysis using genome-wide association data

The relationship between major depressive disorder (MDD) and bipolar disorder (BD) remains controversial. Previous research has reported differences and similarities in risk factors for MDD and BD, such as predisposing personality traits. For example, high neuroticism is related to both disorders, whereas openness to experience is specific for BD. This study examined the genetic association between personality and MDD and BD by applying polygenic scores for neuroticism, extraversion, openness to experience, agreeableness and conscientiousness to both disorders. Polygenic scores reflect the weighted sum of multiple single-nucleotide polymorphism alleles associated with the trait for an individual and were based on a meta-analysis of genome-wide association studies for personality traits including 13 835 subjects. Polygenic scores were tested for MDD in the combined Genetic Association Information Network (GAIN-MDD) and MDD2000+ samples (N=8921) and for BD in the combined Systematic Treatment Enhancement Program for Bipolar Disorder and Wellcome Trust Case–Control Consortium samples (N=6329) using logistic regression analyses. At the phenotypic level, personality dimensions were associated with MDD and BD. Polygenic neuroticism scores were significantly positively associated with MDD, whereas polygenic extraversion scores were significantly positively associated with BD. The explained variance of MDD and BD, ∼0.1%, was highly comparable to the variance explained by the polygenic personality scores in the corresponding personality traits themselves (between 0.1 and 0.4%). This indicates that the proportions of variance explained in mood disorders are at the upper limit of what could have been expected. This study suggests shared genetic risk factors for neuroticism and MDD on the one hand and for extraversion and BD on the other.     

Normal personality traits and comorbidity among phobic, panic and major depressive disorders

High comorbidity among anxiety and depressive conditions is a consistent but not well-understood finding. The current study examines how normal personality traits relate to this comorbidity. In the Baltimore Epidemiologic Catchment Area Follow-up Study, psychiatrists administered the full Schedules for Clinical Assessment in Neuropsychiatry to 320 subjects, all of whom completed the Revised NEO Personality Inventory. The disorders of interest were simple phobia, social phobia, agoraphobia, panic disorder, and major depression. Analyses were carried out with second-order generalized estimating equations. The unadjusted summary odds ratio (SOR - or weighted mean odds ratio) for all five disorders was 1.72 (95% confidence interval=1.21-2.46). Neuroticism, introversion, younger age, and female gender were all significant predictors of prevalence of disorders. After adjustment for the relationships between these personality and demographic predictors and prevalence, the association among disorders was much weaker (SOR=1.11, 95% CI=0.79-1.56). However, subjects with high extraversion had a SOR 213% as high (95% CI=102-444%) as those with low extraversion (1.60 vs. 0.75). Therefore, neuroticism and introversion are associated with increased comorbidity due to relationships in common with the prevalence of the different disorders. In contrast, extraversion is associated with increased comorbidity per se.     

Delusionality and response to open-label fluvoxamine in body dysmorphic disorder

BACKGROUND: Available data suggest that the delusional variant of body dysmorphic disorder (BDD), a type of delusional disorder, may respond to serotonin reuptake inhibitors (SRIs) and that delusionality (lack of insight) in BDD may improve with SRI treatment. However, this research has been hampered by the lack of a reliable and valid scale to assess delusionality. METHOD: Thirty subjects (21 women, 9 men; mean age = 33.3 +/- 9.0 years) with DSM-IV BDD were prospectively treated with open-label fluvoxamine for 16 weeks. Subjects were assessed at regular intervals with the Brown Assessment of Beliefs Scale (BABS), the Yale-Brown Obsessive Compulsive Scale Modified for BDD (BDD-YBOCS; a measure of BDD severity), and other instruments. The BABS is a reliable and valid 7-item, semistructured, clinician-administered scale that assesses current delusionality. RESULTS: In this prospective, open-label study, 63% of BDD subjects responded to fluvoxamine. Delusional and nondelusional subjects had similar improvement in BDD symptoms. In addition, insight significantly improved in both delusional and nondelusional subjects. Baseline BABS scores did not contribute significantly to endpoint BDD-YBOCS scores in a regression analysis. CONCLUSION: Degree of delusionality did not predict fluvoxamine response, and delusionality significantly improved. These findings are preliminary and require confirmation in controlled trials. The implications of these findings for other types of delusions requires investigation.     

Phobic, panic, and major depressive disorders and the five-factor model of personality

This study investigated five-factor model personality traits in anxiety (simple phobia, social phobia, agoraphobia, and panic disorder) and major depressive disorders in a population-based sample. In the Baltimore Epidemiologic Catchment Area Follow-up Study, psychiatrists administered the Schedules for Clinical Assessment in Neuropsychiatry to 333 adult subjects who also completed the Revised NEO Personality Inventory. All of the disorders except simple phobia were associated with high neuroticism. Social phobia and agoraphobia were associated with low extraversion. In addition, lower-order facets of extraversion, agreeableness, and conscientiousness were associated with certain disorders (i.e., low positive emotions in panic disorder; low trust and compliance in certain phobias; and low competence, achievement striving, and self-discipline in several disorders). This study emphasizes the utility of lower-order personality assessments and underscores the need for further research on personality/psychopathology etiologic relationships.     

Anxiety and depressive disorders and the five-factor model of personality: a higher- and lower-order personality trait investigation in a community sample

We describe in detail normal personality traits in persons with psychiatrist-ascertained anxiety and depressive disorders in a general population sample. We investigated Revised NEO Personality Inventory traits in 731 community subjects examined by psychiatrists with the Schedules for Clinical Assessment in Neuropsychiatry. All of the lifetime disorders of interest (simple phobia, social phobia, agoraphobia, panic disorder, obsessive-compulsive disorder (OCD), generalized anxiety disorder, major depressive disorder (MDD), and dysthymia) were associated with high neuroticism. Social phobia, agoraphobia, and dysthymia were associated with low extraversion, and OCD was associated with high openness to experience. In addition, lower-order facets of extraversion (E), openness (O), agreeableness (A), and conscientiousness (C) were associated with certain disorders (specifically, low assertiveness (E) and high openness to feelings (O) with MDD, low trust (A) with social phobia and agoraphobia, low self-discipline (C) with several of the disorders, and low competence and achievement striving (C) with social phobia). Neuroticism in particular was related to acuity of disorder. Longitudinal study is necessary to differentiate state versus pathoplastic effects.     

Personality and social interactions in patients with acute brief psychoses

Although a particularly vulnerable personality has been postulated by some authors as a pathogenetic factor in acute and transient psychotic disorders (ATPD) as introduced with ICD-10, little empirical work has been done on the subject. We therefore evaluated personality features and social interactions in a comparative study of patients with ATPD. We recruited all consecutive inpatients fulfilling the ICD-10 criteria of ATPD (F23) during a 5-year period, as well as control groups with "positive" schizophrenia (PS) and bipolar schizoaffective disorder (BSAD) matched for gender and age at index episode. For assessment of personality features and premorbid social contacts, we administered the NEO Five-Factor Inventory and a semi-structured interview. The assessment of the "Big Five" personality dimensions (neuroticism, extraversion, openness to experience, agreeableness, conscientiousness) with the NEO-FFI did not show any significant difference between ATPD patients and healthy controls. BSAD patients differed from mentally healthy controls on 2 of 5 subscales of the NEO-FFI (neuroticism, extraversion), but were otherwise indiscernible from ATPD patients and mentally healthy controls. In contrast, PS patients showed the most pronounced differences from the mentally healthy controls on the NEO-FFI, and had significantly less premorbid social interaction than the clinical controls. Within the limits of retrospective assessment, the present findings indicate that (1) patients with ATPD do not share the premorbid social impairment characteristic of schizophrenic patients and (2) the personality of patients with ATPD does not differ substantially from the general population.     

La théorie des cinq facteurs. Profils de personnalité selon la théorie des cinq facteurs et troubles de la personnalité chez des patients déprimés

ObjectivesThe aim of this study was to investigate in a clinical sample the relationships between the specific personality disorders (PD) and the personality traits as defined by the Big Five Model.Patients and methodsFifty-eight patients with major depressive disorder without psychotic symptoms were administered the NEO Personality Inventory Revised and the Structured Interview for DSM-IV Personality Disorders.ResultsAbout the two thirds of them presented at last one PD, the most frequent being obsessive-compulsive, avoidant, paranoid and borderline PDs. These four PDs exhibited a common Five Factor profile characterized by high neuroticism (domain and four facets), and low warmth, positive emotions, openness to values and trust. Three of them showed specific traits in addition: low extraversion and especially gregariousness and activity among paranoid, and low extraversion (especially gregariousness, assertiveness, and activity), openness to actions, competence, achievement striving and self-discipline but high straightforwardness among avoidant, and low extraversion (gregariousness and activity), openness to actions, and self-discipline among obsessive-compulsive patients.ConclusionsThese findings are fundamentally similar to the literature, with the exception of the relatively low conscientiousness among obsessive-compulsive patients. This discrepancy might be due to the fact that our patients were clinically depressed, while most previous research paradoxically studied the PD/FFM relationships among healthy non-consulting participants.     

Personality traits in schizophrenia and related personality disorders

We investigated whether schizophrenia spectrum disorders share common personality characteristics or traits. Participants with a diagnosis of schizophrenia or schizoaffective disorder (SZ) or with a schizophrenia spectrum personality disorder (schizophrenia spectrum PD: schizoid, paranoid, and schizotypal personality disorder) were compared with non-psychiatric control subjects on the five-factor model of personality and the psychosis-proneness scales. On the five-factor personality scales, SZ subjects showed higher levels of neuroticism, and lower levels of openness, agreeableness, extraversion, and conscientiousness than control subjects. Higher scores on openness and lower scores on neuroticism distinguished schizophrenia spectrum PD from SZ. On the psychosis-proneness scales, both PD and SZ participants scored high relative to non-psychiatric control participants on magical ideation and perceptual aberration, while PD participants scored intermediate between non-psychiatric control participants and SZ on social anhedonia. Discriminant analysis indicated that schizophrenia spectrum patients could be distinguished from PDs by more severe social withdrawal and maladjustment, while subjects with PDs could be best distinguished from control subjects on the basis of odd or novel ideation and decreased conscientiousness.     

Personality traits in social phobia.

The purpose was to assess personality traits in subjects with a DSM-IV diagnosis of social phobia. Thirty-two subjects were administered the Structured Clinical Interview for DSM-IV for Axes I and II disorders (SCID I and II). Personality traits were assessed by means of the Karolinska Scales of Personality (KSP). Current and lifetime axis I co-morbidity was diagnosed in 28% and 53% of the subjects, respectively. In total, 59% had at least one personality disorder and 47% were diagnosed with an avoidant personality disorder. The social phobics scored significantly higher than a Swedish normative sample on the KSP measuring anxiety proneness, irritability, detachment, and indirect aggression but lower on the scales for socialisation and social desirability. The presence as compared to absence of avoidant personality disorder in the social phobics was associated with significantly higher psychic anxiety and inhibition of aggression. In addition, symptom severity was higher in social phobics with an avoidant personality disorder. Generally, the results support the view that social phobia and avoidant personality disorder reflect different aspects of a social anxiety spectrum.     

Personality and anxiety disorders

Personality traits and most anxiety disorders are strongly related. In this article, we review existing evidence for ways in which personality traits may relate to anxiety disorders: 1) as predisposing factors, 2) as consequences, 3) as results of common etiologies, and 4) as pathoplastic factors. Based on current information, we conclude the following: 1) Personality traits such as high neuroticism, low extraversion, and personality disorder traits (particularly those from Cluster C) are at least markers of risk for certain anxiety disorders; 2) Remission from panic disorder is generally associated with partial “normalization” of personality traits; 3) Anxiety disorders in early life may influence personality development; 4) Anxiety disorders and personality traits are usefully thought of as spectra of common genetic etiologies; and 5) Extremes of personality traits indicate greater dysfunction in patients with anxiety disorders.     

Personality dimensions in schizophrenia: associations with symptoms and coping concurrently and 12 months later

BACKGROUND: Research has indicated that stable individual differences in personality exist among persons with schizophrenia, and that they likely predate the onset of illness. Less is known about whether individual differences in personality are related to levels of psychopathology and function. SAMPLING AND METHODS: This study tested the hypotheses that levels of neuroticism, extraversion and agreeableness are associated with symptomatology and coping in schizophrenia both concurrently and as measured 12 months later for 46 participants with schizophrenia or schizoaffective disorder. Baseline assessments were conducted, which included measurements of the personality dimensions of neuroticism, extraversion and agreeableness measured using the NEO, coping preferences using the Ways of Coping Questionnaire and symptoms using the Positive and Negative Syndrome Scale. The symptom and coping measures were repeated 12 months after the date of the baseline assessment. RESULTS: Univariate correlations comparing baseline assessments suggested that higher neuroticism and lower extraversion were concurrently linked to more emotional discomfort and avoidant coping. Agreeableness was linked only to positive symptoms. Correlations controlling for baseline levels revealed greater levels of neuroticism at baseline, predicted a preference for resigning when under stress and higher emotional discomfort 12 months later. Lesser levels of agreeableness continued to predict greater positive symptoms 12 months later. No long-term associations were found between coping and symptoms at 12 months with levels of extraversion. CONCLUSIONS: The results suggest individual differences in personality are associated with psychopathology in schizophrenia and may affect function over time. More research is needed with broader samples and with more frequent follow-up assessments.     

卷入欺负行为初中生的自杀意念与个性特征的关系

目的 探讨初中生卷入欺负行为者的自杀意念与个性特征的关系。方法 整群抽取山东省两所中学的初中生,采用初中生欺负问卷、自杀意念自评量表（SIOSS）和艾森克个性问卷（EPQ）进行问卷调查,回收有效问卷830份。结果不同类型欺负卷入者自杀意念检出率和自杀意念得分均存在明显差异（P〈0.05）;欺负卷入者EPQ各因子中神经质、精神质总体评分自杀意念组均高于无自杀意念组（P〈0.05）,内外向、掩饰性均低于无自杀意念组（P〈0.05）;有无自杀意念与EPQ各因子中内外向和掩饰性均成负相关（P〈0.05）,与神经质和精神质均成正相关（P〈0.05）。结论 个性特点是初中生不同类型欺负卷入者自杀意念的内在易感因素,个性内倾和高神经质等与卷入欺负的初中生自杀意念密切相关。