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

Objective

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

Methods

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

Results

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

Conclusion

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

Temperament profiles, 5-HT2A genotype, and response to treatment with SSRIs in major depression

Variation in antidepressive medication response according to 5-HT2A genotype has been reported in several studies. Temperament has been proposed to be one of the vulnerability factors in mood and anxiety disorders. We studied temperament profiles of 98 patients with major depression and explored the interaction between Temperament and Character Inventory (TCI) temperament dimensions, 5-HT2A genotype (SNPs rs6311, rs6313 and rs7997012) and treatment response. No interactive effects for TCI temperament dimensions and 5-HT2A genotypes on antidepressive treatment response were found.     

A Cluster Model of Temperament as an Indicator of Antidepressant Response and Symptom Severity in Major Depression

Objective

Not enough is known about which patients suffering from major depressive disorder benefit from antidepressant drug treatment. Individual temperament is relatively stable over a person''s lifespan and is thought to be largely biologically predefined. We assessed how temperament profiles are related to depression and predict the efficacy of antidepressant treatment.

Methods

We recruited one hundred Finnish outpatients (aged 19 to 72) suffering from major depressive disorder, of whom 86 completed the 6-week study. We assessed their temperament features with the Temperament and Character Inventory and used cluster analysis to determine the patient''s temperament profile. We also categorized the patients according to the vegetative symptoms of major depressive disorder.

Results

There was an association between skewed temperament profile and severity of major depressive disorder, but the temperament profiles alone did not predict antidepressant treatment response. Those with higher baseline vegetative symptoms score had modest treatment response. Our model with baseline Montgomery Åsberg Depression Rating Scale (MADRS) vegetative symptoms, age and temperament clusters as explanatory variables explained 20% of the variance in the endpoint MADRS scores.

Conclusion

The temperament clusters were associated both with severity of depression and antidepressive treatment response of depression. The effect of the temperament profile alone was modest but, combined with vegetative symptoms of depression, their explanatory power was more marked suggesting that there could be an association of these two in the biological basis of MDD.     

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

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

Temperament,character and personality disorders

ObjectiveTo study, whether temperament and character remain stable over time and whether they differ between patients with and without personality disorder (PD) and between patients with specific PDs.MethodsPatients with (n = 225) or without (n = 285) PD from Jorvi Bipolar Study, Vantaa Depression Study (VDS) and Vantaa Primary Care Depression Study were interviewed at baseline and at 18 months, and in the VDS also at 5 years. A general population comparison group (n = 264) was surveyed by mail.ResultsCompared with non-PD patients, PD patients scored lower on self-directedness and cooperativeness. Cluster B and C PDs associated with high Novelty Seeking and Harm Avoidance, respectively. In logistic regression models, sensitivity and specificity of Temperament and Character Inventory (TCI) dimensions for presence of any PD were 53% and 75%, and for specific PDs from 11% to 41% and from 92% to 100%, respectively. The 18-month test-retest correlations of TCI-R dimensions ranged from 0.58 to 0.82.ConclusionsMedium-term temporal stability of TCI in a clinical population appears good. Character scores differ markedly between PD and non-PD patients, whereas temperament scores differ only somewhat between the specific PDs. However, the TCI dimensions capture only a portion of the differences between PD and non-PD patients.     

Temperament and character profiles of patients with tension-type headache and migraine

The aim of this present study was to evaluate the temperament and character profiles of persons with tension-type headache (TTH) and migraine, and to compare the results with those of healthy controls. The study population consisted of 81 patients with TTH (60 female, 21 male) and 56 patients with migraine (34 female, 17 male) aged 18-50 years, according to the criteria of the International Headache Society with age and gender - matched healthy control subjects (54 female, 28 male). All participants were instructed to complete a self-administered 240-item temperament and character inventory (TCI) questionnaire and Beck Depression Inventory (BDI). The TCI assesses four dimensions of temperament, namely, novelty seeking (NS), harm avoidance (HA), reward dependence (RD), and persistence (P), and three dimensions of character, being self-directedness (SD), cooperativeness (C) and self-transcendence (ST). According to the TCI biosocial model, the temperament dimension HA is suggested to indicate central serotonergic turnover, which is further correlated with depressive state. It was found that mean BDI scores were significantly higher in patients with TTH and migraine than in those of the controls. The BDI scores were positively correlated with HA scores (r = 0.295, P < 0.001) and negatively correlated with SD (r = -0.386, P < 0.001) and C scores (r = -0.164, P= 0.016). Multivariate analysis showed that BDI scores had significant covariation for HA, SD and C. Despite using the BDI score as a covariate, TTH patients had higher HA scores (P = 0.01) than did the control subjects. No significant differences were found between the groups regarding main NS, RD, P, SD, C and ST scores. Based on the main results of this study, it is suggested that higher serotonergic activity related to HA scores in TTH patients and their relationship with depressive symptomatology supports the role of central serotonergic involvement in TTH.     

Are there temperament differences between major depression and dysthymic disorder in adolescent clinical outpatients?

AimsThe aim of the study was to explore possible differences in temperament and character dimensions between 2 monodiagnostic adolescent groups of depression, namely, one with a present episode of major depression and subjects with the other being their dysthymic peers.SampleFrom a multisite Western Hungarian sample of consecutively referred 14- to 18-year-old new psychiatric adolescent outpatients, 2 groups were compared: group I, n = 56 (9 males, 47 females), with major depressive disorder (MDD) and group II, n = 27 (6 males, 21 females), with a diagnosis of dysthymic disorder (DD). All other comorbid diagnoses including bipolar and double depression (MDD + DD) cases were excluded. Present suicide events, if the attempter had an underlying diagnosis of depression, were not causes for exclusion. Assessment methods used were the adapted Hungarian versions of the Mini International Neuropsychiatric Interview and the Junior Temperament (Cloninger) Character Inventory.ResultsThe only difference between the major depressive and dysthymic adolescents was harm avoidance, adolescents with major depression having a higher level practice of harm avoidance, whereas the temperament type of MDD vs DD seems to differ only in the aspect of avoiding painful stress. Expectations regarding a worse degree of self-directedness and lower levels of persistence and cooperativeness in the MDD sample were not proved.ConclusionsNo essential temperament differences were found between the 2 adolescent depressive groups. Scarce differences between temperament qualities of MDD and DD may support Akiskal's continuum theory of depressive disorders. More research and the use of closer clinical personality typologies are warranted to explore possible personality trait differences (if they exist) between clinical diagnostic groups of adolescent patients.     

The influence of temperament on symptoms and functional outcome in people with psychosis in the Northern Finland 1966 Birth Cohort

ObjectiveTo describe symptom expression and functional outcome in psychotic disorders in relation with temperament traits assessed with the Temperament and Character Inventory (TCI) in a population-based sample.MethodAs part of the 31-year follow-up survey of the Northern Finland 1966 Birth Cohort, TCI temperament items were filled in by 4349 members of the cohort. In individuals with psychotic disorders, also positive and negative symptoms and outcome variables were assessed in a 35-year follow-up. Information of TCI and outcomes were available for altogether 41 individuals with psychosis.ResultReward dependence (RD) (rho = ?0.45) and Persistence (P) (rho = ?0.52) were significantly correlated with Positive and Negative Syndrome Scale (PANSS) negative symptoms. Higher P scores predicted higher social and occupational functioning (as measured by Social and Occupational Functioning Assessment Scale [SOFAS]), and higher Harm avoidance (HA) predicted a higher likelihood of being on a disability pension.ConclusionResults indicate that understanding of personality dimensions support better understanding of outcome and symptom expressions in psychotic disorders.     

Temperament and character profiles are associated with depression outcome in psychiatric secondary care patients with harmful drinking

BackgroundTemperament and character profiles have been associated with depression outcome and alcohol abuse comorbidity in depressed patients. How harmful alcohol use modifies the effects of temperament and character on depression outcome is not well known. Knowledge of these associations could provide a method for enhancing more individualized treatment strategies for these patients.MethodsWe screened 242 depressed patients with at least moderate level of depressive symptoms. The Alcohol Use Disorders Identification Test (AUDIT) was used for identifying patients with marked alcohol use problems (AUP, AUDIT≥11). After 6 weeks of antidepressive treatment 173 patients were assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS), and the Temperament and Character Inventory (TCI-R). Outcome of depression (MADRS scores across three follow-up points at 6 weeks, 6 months and 24 months) was predicted with AUP, gender, and AUP x Gender and AUP x Time interactions together with temperament and character dimension scores in a linear mixed effects model.ResultsPoorer outcome of depression (MADRS scores at 6 weeks, 6 months and 24 months) was predicted by AUP × Time interaction (p = 0.0002) together with low Reward Dependence (p = 0.003). Gender and all other temperament and character traits were non-significant predictors of the depression outcome in the mixed effects model.ConclusionsPossibly due to the modifying effect of alcohol use problems, high Reward Dependence was associated with better depression treatment outcome at 6 months. Harm Avoidance and Self-Directedness did not predict depression outcome when alcohol use problems were controlled.     

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

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

Temperament and character model of personality profile of alcohol- and drug-dependent inpatients

The aims of this study were to evaluate the differences in dimensions of temperament and character in Turkish alcohol- and drug-dependent inpatients, and to examine which dimensions would predict drug dependency. The subjects consisted of 111 alcohol-dependent and 93 drug-dependent inpatients according to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Subjects were tested using Cloninger's Temperament and Character Inventory (TCI). Among the temperament dimensions, novelty seeking score was higher and reward dependency score was lower in drug-dependent patients than in alcohol-dependent patients. Among the character dimensions, self-directedness and cooperativeness scores were lower in drug-dependent patients. Low age and novelty seeking predicted drug dependency in forward logistic regression model. Subscales that predicted drug dependency other than young age were lower scores on compassion vs revengefulness (C4) and helpfulness (C3), and higher score on spiritual acceptance vs rational materialism (ST3). As in previous studies, which indicate an association between personality and substance choice, in the present study, TCI was shown to be an efficient tool in discriminating alcohol and drug dependents; thus, it seems to be important to consider TCI dimensions in planning the treatment of substance dependency.     

Genetic and environmental influences underlying the relationship between autistic traits and temperament and character dimensions in adulthood

BackgroundIn recent years, several twin studies adopted a dimensional approach to Autism Spectrum Disorders (ASD) and estimated the contribution of genetic and environmental influences to variation in autistic traits. However, no study was performed on adults over 18 years of age and all but two studies were based on parent or teacher ratings. Also, the genetic and environmental contributions to the interplay between autistic traits and adult personality dimensions have not been investigated.MethodsA sample of 266 complete twin pairs (30% males, mean age 40 ± 12 years) drawn from the population-based Italian Twin Register was administered the Autism-Spectrum Quotient, Temperament and Character Inventory (TCI-125), and General Health Questionnaire (GHQ-12). Genetic structural equation modelling was performed with the Mx program. Estimates were adjusted for gender, age, and GHQ-12 score.ResultsGenetic factors accounted for 44% and 20%–49% of individual differences in autistic traits and TCI dimensions, respectively. Unshared environmental factors explained the remaining proportion of variance. Consistently with the notion of a personality profile in ASD characterised by obsessive temperament, autistic traits showed significant phenotypic correlations with several TCI dimensions (positive: HA; negative: NS, RD, SD, C). Genetic and unshared environmental correlations between AQ and these TCI dimensions were significant. The degree of genetic overlap was generally greater than the degree of environmental overlap.ConclusionsDespite some limitations, this study suggests that genetic factors contribute substantially to individual differences in autistic traits in adults, with unshared environmental influences also playing an important role. It also suggests that autistic traits and the majority of temperament and character dimensions share common genetic and environmental aetiological factors.     

Personality, anxiety and mood traits in patients with sleep-related breathing disorders: effect of reduced daytime alertness

OBJECTIVE: The etiology of depression and personality disorders in patients with sleep-disordered breathing (SDB) is not well defined and it is still unclear if they are directly related to the severity of the disease. In this study we test the hypothesis as to whether daytime sleepiness largely contributes to appearance of mood disorders. METHODS: Sixty patients diagnosed as having snoring (n=16) or OSA (n=44) were examined. Daytime sleepiness was assessed by the administration of the Epworth Sleepiness Scale (ESS) and by the Maintenance Wakefulness Test (MWT). The Hospital Anxiety (HAD-A) and Depression (HAD-D) Scale and the Temperament and Character Inventory (TCI) questionnaires were used for psychopathological evaluation. RESULTS: The mean HAD-A score was 6.9+/-0.45 and the average HAD-D score was 4.6+/-0.48, with no significant difference between snorers and OSA patients. Anxiety was present in 16% of cases and depression in 7%. The HAD-D score was related to the ESS score (R=0.37, P=0.003), the mean sleep latency at the MWT (R=-0.34, P=0.04), and the mean low SaO(2), ESS score alone explaining the 17% of variance in the HAD-D score. Compared to controls, there were no differences in almost all TCI scores, with novelty-seeking temperament score higher in patients. No relationships were found between HAD or TCI scores and apnea density. CONCLUSIONS: We conclude that among patients evaluated for SDB, higher depression scores show an association with reduced daytime alertness, which therefore may have important effects on mood.     

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

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

Temperament and character dimensions of the relatives of schizophrenia patients and controls: the relationship between schizotypal features and personality.

PURPOSE: Previous findings indicated that schizophrenia patients might have a different personality structure from the general population on several dimensions of temperament and character. Some authors proposed that HA might be a marker of underlying genetic vulnerability to schizophrenia. Studies on high-risk subjects and first degree relatives of patients is essential to test the value of a measure as a marker of genetic vulnerability to a disease. Few studies tested the biopsychosocial model of personality on unaffected relatives of schizophrenia. SUBJECTS AND METHODS: We compared the Temperament and Character (TCI) profiles of 94 first degree relatives of schizophrenia and 75 controls. We also investigated the relationship between schizotypy and TCI dimensions in the study sample. RESULTS: The harm avoidance scores of the relatives of schizophrenia patients with schizotypal features were significantly higher. Self transcendence scores were also significantly higher among relatives with schizotypal features. In contrast, the relatives of the patients with schizophrenia who did not have schizotypal features had higher SD and C scores than the control group. DISCUSSION AND CONCLUSION: This finding is consistent with the previous findings which suggested harm avoidance as a vulnerability indicator of schizophrenia. Some character features like self transcendence might be also associated with schizotypal features.     

The Effect of Temperament on the Association Between Pre-treatment Anxiety and Chemotherapy-Related Symptoms in Patients With Breast Cancer

Objective Pre-treatment anxiety (PA) before chemotherapy increases complaints of chemotherapy-related symptoms (CRS). The results on the association have been inconsistent, and the effect of temperament remains unclear. We aimed to determine whether PA is a risk factor for CRS and the effect of differing temperaments on CRS. Methods This prospective study comprised 176 breast cancer patients awaiting adjuvant chemotherapy post-surgery. We assessed CRS, PA, and temperament using the MD Anderson Symptom Inventory (MDASI), the Hospital Anxiety and Depression Scale, and the short form of the Temperament and Character Inventory-Revised, respectively. The MDASI was re-administered three weeks after the first chemo-cycle. Results PA showed weak positive correlation with several CRS after the first cycle; no CRS was significantly associated with PA when pre-treatment depressive symptoms and baseline CRS were adjusted in multiple regression analysis. Moderation model analysis indicated that the PA effect on several CRS, including pain, insomnia, anorexia, dry mouth, and vomiting, was moderated by harm avoidance (HA) but not by other temperament dimensions. In particular, PA was positively associated with CRS in patients with low HA. Conclusion The results in patients with low HA indicate that more attention to PA in patients with confident and optimistic temperaments is necessary.     

Personality factors in depressive disorders: contribution of the psychobiologic model developed by Cloninger

The psychobiological model of personality developed by Cloninger, including four dimensions of temperament and three dimensions of character, allows to explore personality factors associated with depressive disorders. The three main dimensions of temperament are Novelty Seeking (NS), ie the tendency towards excitement in response to novel or rewarding stimuli, Harm Avoidance (HA) hypothesized to represent the tendency to respond intensely to signals of adverse stimuli, and Reward Dependence reflecting the tendency to respond intensely to signals of reward and to maintain behavior previously associated with reward. These personality traits are hypothetically related to underlying neurotransmetter systems (especially NS to dopaminergic function and HA to serotonergic function). The two main dimensions of character are Self-Directedness (SD) and Cooperativeness (C), measuring maturity traits respectively concerning individual and social adaptation; thus they are negatively correlated with the risk of personality disorder for a given patient. Many studies have been carried out with the Temperament and Character Inventory (TCI), or with the previous Tridimensional Personality Questionnaire (TPQ), in depressive disorders with cross-sectional but also with short-term and long-term longitudinal designs. They show primarily that patients with history of depressive disorders, even in euthymic phase, have very high Harm Avoidance scores. In prospective studies conducted in depressive patients, even after remission of the depressive episodes, the Harm Avoidance scores are lower than before treatment, but still elevated compared to the general population. The patients who fail to respond to antidepressant treatments have generally higher Harm Avoidance scores before treatment than the others. Overall, various results support four types of potent relationships between Harm Avoidance and depression: an influence of state on trait measure, a pathoplastic effect of Harm Avoidance on depressive expression, a vulnerability model (Harm Avoidance representing a susceptibility factor for depression), and a scar model with elevated Harm Avoidance scores even after remission of acute depressive symptoms. Other temperament dimensions, Novelty Seeking and Reward Dependence, are not consistently associated with depression characteristics nor affected by state effects, but Self-Directedness character dimension is often low when compared to subjects without depressive disorders, reflecting maladaptive personalities frequently associated to depressive disorders. Some studies suggest that low Self-Directedness scores can be predictive of suicidal behaviors. In cross-sectional studies, Harm Avoidance scores are highly positively correlated with depression intensity (r=0.23 to 0.67) and Self-Directedness scores are highly negatively correlated with depression (r=- 0.37 to - 0.60). Some studies suggest that the temperamental dimensions assessed by the TCI could have a predictive value for the response to antidepressants treatments, but this result is controversial and needs further research. For example, a study conducted in 84 patients with major depressive disorder showed that temperament type based on TPQ traits explained 25% of the response to treatment variance: patients with high scores on both Harm Avoidance and Reward Dependence had a favourable response to either clomipramine or desipramine. Studies of the relationship of temperament dimensions to biological markers of depression have also been published. It has been shown for example that Reward Dependence and Harm Avoidance scores are significantly predictive of morning hypercortisolemia in depressed subjects. More specifically, correlations have been obtained between platelet serotonergic markers (5-HT2a receptors) and Harm Avoidance scores also in depressed patients. In conclusion, Harm Avoidance seems to be a vulnerability factor or at least an associated factor to depressive disorders. This temperament dimension is supposed to be highly heritable, and to be linked to the serotonergic system variations.     

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.     

Relationships of affective temperament ratings to diagnosis and morbidity measures in major affective disorders

BackgroundRatings of affective temperament types show promise in helping to differentiate diagnostic groups among major affective disorders as well as to predict associations with important aspects of morbidity including suicidal risk.MethodsThe Temperament Evaluation of Memphis, Pisa, Paris, and San Diego auto-rating (TEMPS-A) questionnaire was completed by 858 unselected, consecutive, consenting adults diagnosed with a DSM-5 major affective disorder (173 bipolar-1 [BD-1]), 250 BD-2, 435 major depressive disorder [MDD]) to score for anxious (anx), cyclothymic (cyc), dysthymic (dys), hyperthymic (hyp), and irritable (irr) affective temperaments. We tested their associations with diagnosis and selected clinical factors, including diagnosis, depression scores, suicidal ideation or acts, substance abuse, episodes/year, and %-time ill.ResultsScores for cyc ranked: BD-2 > BD-1 > MDD; anx ranked: MDD > BD-2 > BD-1; irr was greater in BD than MDD; dys was greater in MDD than BD; hyp did not differ by diagnosis. We confirmed associations of suicidal risk with higher scores of all temperament types except lower hyp scores. Higher cyc and irr scores and lower anx scores were associated with substance abuse. Several scores were higher with measures of greater affective morbidity: cyc with current depression, episodes/year, and %-time ill; irr with more episodes and depressions/year and greater %-time manic. Some of these associations were selective for BD or MDD.ConclusionsThe findings indicate that TEMPS-A ratings of affective temperament types can contribute to differential diagnoses and predict types and amounts of affective morbidity, as well as detecting suicidal risks.     

Personality dimensions in social phobics with or without depression

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