Anger and personality in eating disorders

Objective: This study was designed to examine how anger, temperament and character profiles differ across subtypes of eating disorders (EDs) in comparison to healthy controls and to analyze the relationship between anger expression, eating attitudes and personality dimensions. Method: One hundred and thirty-five outpatients (50 of whom suffered from anorexia nervosa restrictor type [AN-R], 40 from anorexia nervosa binge/purging [AN-BP] and 45 from bulimia nervosa [BN]) and 50 control subjects were recruited and administered State-Trait Anger Expression Inventory (STAXI), Temperament and Character Inventory (TCI) and Eating Disorder Inventory II (EDI-II). Results: STAXI showed greater levels of anger in patients with BN than in those with AN. TCI showed different personality profiles, in accordance with previous studies. Correlations were found between the management of anger feelings and psychological and personality traits typical of patients with EDs. Conclusions: Clinically, impulsivity seems to be the psychopathologic element most strongly correlated to anger. Moreover, it appears clear that anger is better managed by individuals with greater character strength.     

Temperament, character and suicide attempts in anorexia nervosa, bulimia nervosa and major depression.

OBJECTIVE: We examined the relation between personality traits as measured by the Temperament and Character Inventory (TCI) and a reported history of suicide attempts in women with anorexia nervosa, bulimia nervosa and major depression. METHOD: We compared the prevalence and severity of suicide attempts in women with anorexia nervosa (n = 68), bulimia nervosa (n = 152) and major depression with no history of an eating disorder (n = 59), and we examined the relation between the TCI scales and suicide attempts. RESULTS: Comparable numbers of women across the three groups had attempted suicide. The temperament dimension of high persistence and the character dimensions of low self-directedness and high self-transcendence were associated with a reported history of suicide attempts. CONCLUSION: Suicide attempts are equally common in women with eating disorders and women with depression. Whether the observed association between temperament and suicide attempts reflects correlates, causal factors or sequelae of suicide attempts is unknown.     

Bulimic family dynamics: role of parents' personality--a controlled study with the Temperament and Character Inventory

The numbers of studies on the familial environment and personality of bulimic women have increased in recent years and results have revealed interesting features. In this study, we evaluated the temperament and character traits of patients with bulimia nervosa (BN) and their mothers and fathers, and we analyzed the correlation of temperament and character traits among members of these bulimic families. Finally, we tested the ability of the Temperament and Character Inventory (TCI) to discriminate between normal controls and bulimic subjects, their parents, and their families. Using the TCI, temperament and character features of 28 bulimic patients and their parents (23 fathers and 28 mothers) were analyzed and then compared with a control group of 29 women and their 27 fathers and 29 mothers. Data suggest that both temperament and character factors are involved in BN. Bulimic individuals were high in harm avoidance and low in self-directedness. Their mothers were distinguished by low self-directedness. The fathers were low in persistence. Harm avoidance of bulimic women positively correlated with harm avoidance and negatively with self-directedness of their mothers. The bulimic family had low self-directedness as a common denominator observed in all family members. The observation that both temperament and character have important roles in the etiopathogenesis of bulimia nervosa has important treatment ramifications. The TCI was useful in discriminating between normal controls and bulimic subjects, their parents, and the whole family.     

Correlations between trait anxiety, personality and fatigue: study based on the Temperament and Character Inventory

OBJECTIVE: In our study, we explored the associations among anxiety, the dimensions of Cloninger's theoretically based and empirically validated psychobiological model of personality (Temperament and Character Inventory, TCI) and fatigue in order to clarify the personality risk factors for fatigue. METHODS: Fifth-year students (n=89) and freshmen (n=162) at Saga Medical School and psychiatric outpatients of Saga Medical School Hospital (n=101) were investigated with the State-Trait Anxiety Inventory (STAI, Japanese version), the TCI (Japanese version), the General Health Questionnaire (GHQ-30) and the self-rating Fatigue Symptom Checklist (FSC), which describe fatigue along three subscales (general, physical and psychological fatigue). Correlation and ANOVA analyses were performed in this study. RESULTS: The analysis identified a significant relation (P<.0005) between trait anxiety and fatigue. The TCI dimension of harm avoidance (HA) is positively correlated with both trait anxiety and fatigue (general fatigue, psychological fatigue and physical fatigue). The character dimension of self-directedness is negatively correlated with both trait anxiety and fatigue. CONCLUSIONS: There is an inherent relationship among trait anxiety, the temperament dimension of harm avoidance, character dimension of self-directedness and fatigue. The TCI dimensions, harm avoidance and self-directedness, might be considered as predictors for fatigue-related disorders.     

Estrogen receptor gene 1 variants are not associated with suicidal behavior

Estrogen is thought to be involved in the pathophysiology of depression and suicidal behaviors. We studied gene variants of estrogen receptor alpha (rs827421, rs1913474, rs1801132, rs722207, rs974276 and rs910416) in 167 German suicide attempters (affective spectrum n=107, schizophrenia spectrum n=35, borderline personality disorder n=25), 92 German individuals who committed suicide and 312 German healthy subjects. Single markers and haplotype analysis in relation to suicidal behaviors (suicide attempters/completers) did not reveal any significant association. These were also not associated with related features, such as violence or impulsivity of suicide attempt, State-Trait Anger Expression Inventory (STAXI) and Questionnaire for Measuring Factors of Aggression (FAF) scores. In conclusion, our study does not support the hypothesis that estrogen receptor alpha gene variants are major contributors to suicide or to anger- or aggression-related behaviors.     

Psychometric characteristic of the Italian version of the Temperament and Character Inventory--revised, personality, psychopathology, and attachment styles

In this article, we described the psychometric characteristics of the revised version of the Cloninger's personality Temperament and Character Inventory (TCI-R), Italian translation. Two independent samples, which were composed of 355 and 385 nonclinical mother-language Italian subjects, respectively, completed the TCI-R. A further sample of psychiatric outpatients was compared with community samples. We analyzed the internal consistency of each dimension, the test-retest reliability and the factorial structure of the questionnaire. Furthermore, we explored the potential association between personality, psychopathologic indicators (evaluated by the Symptom Checklist-90), behavior dyscontrol measures, and adaptive and maladaptive interpersonal styles. As a whole, the internal consistency of the TCI-R scales was adequate, although some differences in Cronbach alpha values were observed between the 2 samples in some TCI-R subfacets. The factorial structure was consistent with the original hypothesis of Cloninger and test-retest showed a good stability of the scores over the time. Normal data for the Italian population were also calculated. Furthermore, the character dimensions of self-directedness and cooperativeness were related with some psychopathologic domains in our sample and negatively with impulsiveness, anger, and hostility. Novelty seeking was associated with impulsiveness, whereas harm avoidance was associated with anger and hostility. On the contrary, persistence and reward dependence were inversely correlated with such traits. Harm avoidance, reward dependence, self-directedness, and cooperativeness were strongly related with measures of attachment. Finally, significant differences were observed in both temperament and character traits between community subjects and psychiatric outpatients. In the present study, the validity of the Italian translation of the TCI-R is therefore supported. Personality features are also confirmed as risk factors for specific psychopathologic domains, impulsivity, anger, and hostility. Furthermore, we found attachment styles of nonclinical subjects correlated with personality features.     

Influences of parenting on normal personality traits

There is a considerable literature linking aspects of experienced parenting to later personality disorders. Because dimensionally measured personality disorders are associated with variations in normal personality traits, it is important to understand the contribution of parenting experienced in childhood to later normal personality traits. In this report, 742 community-based individuals, subjects from the Hopkins Epidemiology of Personality Disorders Study, were assessed for normal personality traits, as measured by the Revised NEO Personality Inventory (NEO-PI-R) and the Temperament and Character Inventory (TCI), and for parental behavior experienced as children, as measured by the Parental Bonding Instrument (PBI). The PBI dimensions were significantly, but moderately, correlate with measures of normal personality, the strongest associations being with the NEO-PI-R factors, neuroticism and conscientiousness, and with the TCI factors, self-directedness and harm avoidance. Subjects who reported lower parental care and higher parental intrusiveness were more likely to be higher in neuroticism, lower in conscientiousness, lower in self-directedness, and higher in harm avoidance. Also, trends emerged suggesting both parent-specific and gender-specific differences in the relationship between the PBI dimensions and normal adult personality traits. As variations in normal personality traits are associated with dimensionally measured personality disorders, it is conceivable that the role of parenting in later personality disorder may be mediated by associations between parenting and normal personality traits.     

Temperament and character as schizophrenia-related endophenotypes in non-psychotic siblings

BACKGROUND: Quantitative endophenotypes are needed to better understand the pathogenesis of schizophrenia. The psychobiological model of temperament and character suggests that personality traits are heritable and regulated by brain systems influencing schizophrenia susceptibility. Thus, measures of temperament and character may serve as schizophrenia-related endophenotypes in individuals with schizophrenia and their non-psychotic siblings. METHODS: Individuals with schizophrenia (n=35), their non-psychotic siblings (n=34), controls (n=63), and their siblings (n=56) participated in a study of the clinical, neurocognitive and neuromorphological characteristics of schizophrenia. A mixed-model approach assessed group differences on the Temperament and Character Inventory (TCI). Neurocognitive deficits and psychopathology were correlated with the TCI. Configurations of TCI domains were examined using a generalized linear model. RESULTS: Individuals with schizophrenia and their non-psychotic siblings had higher harm avoidance than controls and their siblings. Individuals with schizophrenia had lower self-directedness and cooperativeness, and higher self-transcendence than their non-psychotic siblings, controls, and the siblings of controls. Neurocognition was not related to temperament and character in individuals with schizophrenia or either control group. In non-psychotic siblings, self-directedness and cooperativeness were correlated with working memory and crystallized IQ. CONCLUSION: Evidence supports harm avoidance as a schizophrenia-related endophenotype. An increased risk of schizophrenia may be associated with asociality (configured as high harm avoidance and low reward dependence), schizotypy (configured as low self-directedness, low cooperativeness, and high self-transcendence), and neurocognitive deficits (poor executive functioning, working/episodic memory, attention, and low IQ). The non-psychotic siblings demonstrated features of a mature character profile including strong crystallized IQ, which may confer protection against psychopathology.     

Personality trait interactions in parents of patients with borderline personality disorder: A controlled study using the Temperament and Character Inventory

Family environment is a pathogenic factor of borderline personality disorder (BPD). However, the personality traits of patients with BPD and their parents have never been assessed using the same instrument and then examined for relationships. In the present study, we explored the temperament and character traits of BPD patients and their parents to investigate possible interactions. In total, 56 patients with BPD and their parents were evaluated with the Temperament and Character Inventory (TCI) and compared with 53 control families. Discriminant and correlation analyses indicated that subjects with BPD displayed higher levels of novelty seeking, harm avoidance, and self-transcendence and lower levels of self-directedness than control subjects. Their fathers displayed higher levels of novelty seeking and lower levels of persistence and self-directedness, and their mothers displayed lower levels of self-directedness compared with levels in control parents. In BPD families, temperament and character traits displayed high levels of discriminatory power. Novelty seeking in offspring with borderline personality disorder was significantly correlated with their mothers' novelty seeking and their fathers' self-transcendence. Self-directedness in borderline offspring was significantly correlated with both their mothers' and fathers' novelty seeking, and their self-transcendence was significantly correlated with their mothers' novelty seeking and harm avoidance. The different correlational pattern for borderline and control families is discussed. Characteristic personality patterns were found in BPD offspring and in both parents. The relationship between personality traits of borderline offspring and those of their parents may be related to both genetic transmission and family dynamics. Ramifications for treatment are discussed.     

Temperament and character in women with anorexia nervosa

The present study examined temperament differences among anorexia nervosa (AN) subtypes and community controls, as well as the effect of body weight on personality traits in women with AN. Temperament and Character Inventory (TCI) scores were compared between 146 women with restrictor-type AN (RAN), 117 women with purging-type AN (PAN), 60 women with binge/purge-type AN (BAN), and 827 community control women (CW) obtained from an archival normative database. Women with AN scored significantly higher on harm avoidance and significantly lower on cooperativeness than CW. Subtype analyses revealed that women with RAN and PAN reported the lowest novelty seeking, RAN women the highest persistence and self-directedness, and PAN women the highest harm avoidance. Body mass index had a nominal effect on subgroup differences, suggesting that personality disturbances are independent of body weight. Findings suggest that certain facets of temperament differ markedly between women with AN, regardless of diagnostic subtype, and controls. More subtle temperament and character differences that were independent of body weight emerged that distinguish among subtypes of AN.     

The effect of cognitive-behavioral therapy for bulimia nervosa on temperament and character as measured by the temperament and character inventory

Cognitive-behavioral therapy (CBT) is a successful treatment method for reducing symptomatology associated with bulimia nervosa (BN). Less is known regarding the impact of CBT on measures of temperament and character across treatment. We explore changes on the Temperament and Character Inventory (TCI) from pretreatment to 1-year follow-up in a sample of women with bulimia nervosa (BN). Ninety-one women who met DSM-III-R criteria for BN, completed pretreatment measures, and participated in a randomized clinical trial with a core treatment of CBT were available for follow-up at 1 year. Participants were assessed at pretreatment using the TCI as part of a larger assessment battery, and received eight sessions of CBT and eight sessions of exposure with response prevention or relaxation training. The TCI was readministered at the 1-year follow-up point. We compared TCI scores across the two administrations and explored the relation between clinical status at 1 year and TCI scores. Significant decreases in the TCI temperament scale of harm avoidance and increases in the character scale of self-directedness were observed between pretreatment and 1-year follow-up. Observed differences in these scales were independent of change in depression scores as well as other measures of therapeutic change (i.e., binge and purge frequency). We conclude that self-directedness and harm avoidance scores are positively affected by CBT. Higher scores on self-directedness not only predict treatment outcome for BN, but overall self-directedness is improved with CBT in women with BN. These results suggest that the elements of CBT affecting self-directedness may hold promise for enhancing the effectiveness of treatment for BN.     

Interrelations between temperament, character, and parental rearing among delinquent adolescents: a cross-validation

We performed a cross-validation of results from investigations in juvenile delinquents in Russia and Germany concerning relationships of personality characteristics in terms of temperament and character with parental rearing. Both studies used the Temperament and Character Inventory (TCI) based on Cloninger's psychobiological theory, and the Own Memories on Parenting (Egna Minnen Betr?ffande Uppfostran-Swedish [EMBU]) questionnaire on parental rearing based on Perris' vulnerability model. The inter-relatedness of parental rearing, temperament, and character traits in socially normally integrated adolescents, as well as in delinquent adolescents, implying direct and indirect pathways from personality and parental rearing to delinquency, could be cross-validated. Differences between delinquents and socially normally integrated adolescents are rather based on different levels of expressions of various temperament traits, harm avoidance and novelty seeking in particular, and the character trait self-directedness, as well as on parental rearing behavior (predominantly parental rejection and emotional warmth) than on different structures within related developmental processes.     

Temperament and character inventory (TCI) and depression

Although several studies have assessed the relationships between the temperament dimensions of the Cloninger model of personality and depression, little is known about the role played by the character dimensions proposed by the seven-factor model of Cloninger in depression. In this study, the relationships between the Temperament and Character Inventory (TCI) and depression were examined in a sample of 40 major depressive patients and 40 healthy controls. Depressed patients exhibit higher harm avoidance and self-transcendence scores as well as lower self-directedness and cooperativeness scores as compared to healthy controls. However, the three other dimensions do not differ between depressive patients and controls. Among the depressive group, harm avoidance, self-directedness and cooperativeness dimensions are related to the severity of depression as assessed by the Hamilton scale. This study confirms the state dependence of the harm avoidance dimension and suggests a relationship between the character dimensions of the Cloninger model and depression.     

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.     

MAOA and MAOB polymorphisms and anger-related traits in suicidal participants and controls

MAOA and, to a lesser extent, MAOB polymorphisms have been related to aggression traits and suicidality. We aimed to investigate the role of MAOA and MAOB in suicidal versus non-suicidal participants and interactions between genetic variation and suicidal status on aggression and anger-related traits. The sample was composed of three groups: one group of suicide attempters (n = 171, males 35.1 %), one group of suicide completers (n = 90, males 57.8 %) and a healthy control group (n = 317, males 43.8 %). We examined the following markers: MAOA rs909525, rs6323, and rs2064070, and MAOB rs1799836. Anger traits were measured with the state-trait anger expression inventory (STAXI) and aggression traits with the questionnaire for measuring factors of aggression (FAF). Associations were separately examined for males and females. Variation in the three MAOA variants was associated with higher levels of anger expressed outwards (STAXI “anger-out” subscale) in male suicidal patients compared to controls (p < 0.001). In females, the C allele of rs6323 showed higher scores on the same subscale (“anger out”) (p = 0.002). Allele frequencies of the MAOA rs909525 were associated with suicidality (p < 0.007). Our findings show an association between genetic variation in three polymorphisms of the MAOA and anger traits in suicidal males and one replication for the functional variant rs6323 in females. This relationship was stronger than a direct genetic association with suicide status. Future studies incorporating endophenotypic measures of anger and aggression in suicidal participants are warranted.     

Relationships of personality dimensions with impulsivity in alcohol-dependent inpatient men

Abstract

Background: Impulsivity is closely related to substance use and abuse, both as a contributor to use and as a consequence of use. Particular dimensions of temperament and character were reported to be associated with trait impulsivity in different populations. Aim: The aim of the present study was to evaluate the relationship of personality dimensions with impulsivity among men with alcohol dependence. Also we wanted to control the effect of depression and anxiety symptoms on this relationship. Methods: Participants were consecutively admitted male alcohol-dependent inpatients (n = 94) and healthy controls (n = 63). Patients were investigated with the Barratt Impulsiveness Scale, version 11 (BIS-11), the Temperament and Character Inventory (TCI) and the Symptom Checklist-Revised (SCL-90-R). Results: Severity of impulsivity and dimensions of impulsivity were higher in alcohol-dependent inpatients than in healthy controls. Impulsivity was negatively correlated with reward dependence, persistence, self-directedness and cooperativeness, but positively correlated with novelty seeking, harm avoidance, depression and anxiety. Although high depression and temperament dimensions (high novelty seeking, harm avoidance and low reward dependence) predicted impulsivity, combinations of personality dimensions that predict dimensions of impulsivity differed. Conclusions: Results may suggest that together with depression when impulsivity is the problem, both dimensions of impulsivity and personality must be evaluated and the treatment should be shaped accordingly for alcohol-dependent inpatients.     

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

Objective

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

Methods

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

Results

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

Conclusion

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

Typus melancholicus and the Temperament and Character Inventory personality dimensions in patients with major depression

Although many clinical studies have been conducted to determine the etiological role and clinical implications of typus melancholicus for unipolar depression, maladaptive personality features in depressive patients have not been well described. This study explores typus melancholicus, as measured by the rigidity subscale of the Munich Personality Test, and maladaptive personality features, as measured by the Temperament and Character Inventory (TCI), in 131 remitted patients with DSM-IV major depression and 154 normal controls. The patients reported significantly higher scores on rigidity and harm avoidance and significantly lower scores on self-directedness and cooperativeness. Only 23.6% of the variance of the rigidity scale was explained by the variance of the seven TCI scales, in which only persistence was significantly correlated positively to rigidity. Cluster analysis identified four subgroups, two of which were characterized by a high rigidity score. One of these two subgroups showed no maladaptive personality features, as measured by the TCI, while the other showed high harm avoidance and low self-directedness. These results indicate that the personality of depressive patients is characterized not only by typus melancholicus but also by maladaptive personality features, that typus melancholicus is not well represented by any TCI scale, and that typus melancholicus and maladaptive personality features can coexist in some depressive patients.     

Temperament and character personality profile in relation to suicide attempts in patients with schizophrenia

Introduction

Schizophrenia is associated with a significant risk of suicide, and suicide still remains one of the main causes of death in schizophrenic patients. Beside classic risk factors for suicidality, temperament and character traits have been researched and considered as risk factors for suicidal behavior in recent years.

Method

Subjects were 94 patients with schizophrenia who were under treatment. All patients were in a stable phase of the illness. Patients with lifetime suicide attempt (n = 46) and without suicidal attempt (n = 48) were compared with each other in terms of temperament and character traits by using the Temperament and Character Inventory.

Results

Harm avoidance and persistence scores were higher in suicidal schizophrenic patients compared with nonsuicidal schizophrenic patients. The scores of self-directedness and cooperativeness were lower in suicidal schizophrenic patients compared with nonsuicidal schizophrenic patients. These 4 variables remained significant predictors of lifetime suicidal attempts in a logistic regression model.

Conclusion

To the best of our knowledge, the present study is the first that specifically compares schizophrenic patients with and without suicidal behavior by the Cloninger temperament and character model. Our data indicate that schizophrenic patients will show a greater risk for suicide according to certain personality configurations. However, to establish causal relationships between personality and suicidality in schizophrenia, longitudinal studies are warranted within a multifactorial interactive framework of biologic and clinical variables.     

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

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