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Personality disorder diagnosis by means of the Temperament and Character Inventory (TCI)
Abstract
Personality disorders (PDs) criteria are still in development. Cloninger's biosocial theory of personality contributed to this discussion. The aim of the study was to explore the relationships between extreme expressions on temperament and an immature character according to Cloninger's assumptions. Eight hundred healthy volunteers and 200 psychiatric inpatients were consecutively recruited each from Sweden and Germany, and were asked to complete the Temperament and Character Inventory, which measures 4 temperament and 3 character dimensions. Patients differed from controls on temperament and character dimensions. The combination of low and very low character scores with extreme scores in either novelty seeking, harm avoidance, or reward dependence was found more often among patients with PD compared with patients without PD and controls; this is more pronounced with an increasing number of extreme temperament scores. The Temperament and Character Inventory represents a useful tool in the diagnostic process of personality disorders.
... Estos pacientes mostrarían poca capacidad para afrontar la vida, inseguridad en sí mismos, disminución de su capacidad de adaptar su comportamiento de acuerdo con los objetivos y valores propuestos y del sentimiento de pertenencia a la sociedad y de la empatía y una menor inclinación a ayudar a los demás (Cloninger, 2004). Al igual que en otros estudios (Richter et al., 2009;Conrad et al., 2007;Fassino et al., 2004;Gutiérrez et al, 2002), en el nuestro también son éstas escalas las diferencian a los pacientes con TP de los que no lo padecen. ...
... Esto estaría en concordancia con lo afirmado por Richter et al. (2009) Recompensa, son las que se asocian con una mayor probabilidad de pertenecer al grupo Sí TP frente al No TP. Estos resultados apoyan la utilidad de disponer de un diagnóstico dimensional que matice los rasgos y características de la personalidad de un sujeto en combinación con un diagnóstico categorial que indique claramente la presencia o ausencia de un TP (Richter et al., 2009). ...
... Esto estaría en concordancia con lo afirmado por Richter et al. (2009) Recompensa, son las que se asocian con una mayor probabilidad de pertenecer al grupo Sí TP frente al No TP. Estos resultados apoyan la utilidad de disponer de un diagnóstico dimensional que matice los rasgos y características de la personalidad de un sujeto en combinación con un diagnóstico categorial que indique claramente la presencia o ausencia de un TP (Richter et al., 2009). ...
1. Los participantes con diagnóstico categorial positivo de TP, según la entrevista semiestructurada IPDE, obtuvieron perfiles de personalidad en los cuestionarios dimensionales TCI, MMPI-2 y MCMI-II claramente diferentes a los sujetos con diagnóstico negativo. Los perfiles resultaron más patológicos en el caso de los sujetos con diagnóstico positivo de TP.
2. Existió una alta comorbilidad entre el diagnóstico clínico de patología psiquiátrica del Eje I y del Eje II.
3. Los pacientes con patología del Eje II presentan un perfil sociodemográfico diferente de aquellos que no presentaban dicha patología. En concreto, el grupo con TP presentó un menor consumo de alcohol, menor número de noviazgos, más puestos de trabajo diferentes, mayor frecuencia de estatus socioeconómico medio-bajo y menor vida sexual activa.
4. Los pacientes con comorbilidad entre los Ejes I y II no presentaron un perfil sociodemográfico diferente al que mostraron los sujetos sin tal comorbilidad.
5. Existió una mayor prevalencia de patología del Eje III en el grupo de participantes con patología del Eje II, que en el de aquellos sin esta patología.
6. Existe una combinación de puntuaciones en las escalas en cada uno de los cuestionarios dimensionales TCI, MMPI-2 y MCMI-II, capaz de diferenciar, de manera significativa, al grupo de participantes con un diagnóstico positivo de TP según la entrevista IPDE. En concreto, en el MMPI-2 el grupo con diagnóstico positivo de TP se caracteriza por la presencia de puntuaciones bajas en la escala K y puntuaciones elevadas en la escala Introversión Social. En el TCI, por puntuaciones disminuidas en la escala Dependencia de la Recompensa y puntuaciones elevadas en la escala Evitación del Riesgo y en el MCMI-II, por la existencia de altas puntuaciones en las escalas Alteración, Sinceridad, Esquizotipia, Depresiva, Dependencia de la Droga y Trastorno del Pensamiento.
... The TCI has repeatedly been shown to be able to reflect different diagnostic categories according to the DSM-IV, such as Bipolar Disorder, Major Depression, Personality Disorders, and Anxiety disorders (Allnutt, Wedgwood et al. 2008, Hori, Noguchi et al. 2008, Loftus, Garno et al. 2008, Celikel, Kose et al. 2009, Jylha, Ketokivi et al. 2013, Melegari, Nanni et al. 2015. It was found early on in the development of the TCI from the psychobiological theory that the dimensions of temperament and character traits efficiently identify personality disorders and differentiate its individual subtypes (Battaglia, Przybeck et al. 1996, de la Rie, Duijsens et al. 1998, Cloninger and Svrakic 2008, Richter and Brandstrom 2009). Character dimensions are used to predict the presence of a personality disorder, whereas temperament dimensions are used to differentiate between the types of personality disorder. ...
... When an individual shows extreme expressions on temperament dimensions, it is also likely that the person has an immature character (that is, low SD and/or low CO). The difficulty in coping with intense emotions derived from the extreme temperament leads to an increased probability of a PD diagnosis (Richter and Brandstrom 2009). The relation between psychopathic traits and the TCI has been studied and displays a similar pattern where; low CO, low RD, low HA and higher level of NS were correlated to the total PCL-R score (Snowden and Gray 2010). ...
... In adults, a low level of character maturity is indicative of a personality disorder with the severity of the disorder discerned by the degree of the deviation from the norm (Svrakic, Draganic et al. 2002, Richter andBrandstrom 2009). The character dimension that seemed to show the greatest association with AAB in adults was the inability to work with others, having low compassion and conscience, and a lack of will to share these with others, which is characteristic of a low CO (Appendix Table 12). ...
Background: There is an increasing knowledge that violent criminality is restricted to a group of individuals with early onset of behavioral problems. These problems often emerge in combination with substance abuse and evolve into an antisocial personality disorder when the individual reaches adulthood. This type of multifaceted problem can be defined as aggressive antisocial behavior (AAB). Aim: The aims of this thesis were to determine the occurrence of AAB in the Swedish nation-wide general population, investigate the risk factors of AAB, identify the personality profile of individuals with AAB, and study the association between personality traits and level of AAB. Methods and results: In a Swedish register study on violent crime convictions (1973–2004), including 2.5 million individuals, 4 % of the population was convicted at least once for a violent crime (AAB), of which almost one in four were persistent. They were characterized by male gender (90 %), early onset of criminality, personality disorders, substance use disorders, and a high rate of criminal recidivism. In two cross-sectional prison studies all study groups showed a common personality pattern, as measured by the Temperament and Character Inventory, deviating highly from the general population. Females were more deviant than males, and showed evidence of a stronger association between their personality and measures of trait aggression. A similar pattern in 9 and 12 year old children with AAB was found in a register study of Swedish twins, but with less pronounced gender differences. A salient pattern of low character maturity (Self-Directedness and Cooperativeness) combined with an extreme temperament (high Novelty Seeking and low Reward Dependence) emerged in all groups, where impulsiveness, sensation seeking and disorderliness together with detachment, insensitivity and independence from others were associated to AAB. Conclusion: A mature character with strong self-governance and capability to cooperate meaningfully with others emerged as important protective factors against AAB, which is why these personality traits appear to be promising targets for interventions.
... Cloninger et al. suggested that the configuration of temperament dimensions defines the so-called temperament type, thereby, the type of personality disorder. 15,22,39 If a subject shows extremely high or low scores in one or more temperament dimensions, the probability of having a personality disorder increases. If an individual shows such extreme expressions on temperament dimensions, it is likely that he or she has an immature character in terms of low SD and/or low CO and is unable to cope with or control the inconsistencies and extreme behaviors caused by extreme temperament. ...
... If an individual shows such extreme expressions on temperament dimensions, it is likely that he or she has an immature character in terms of low SD and/or low CO and is unable to cope with or control the inconsistencies and extreme behaviors caused by extreme temperament. Character maturity indicates whether an individual has a personality disorder, and temperament configuration determines the type of personal- 39,40 This discussion has meaningful therapeutic implications considering that temperament is determined by inherited traits, whereas character is influenced by experiences that grow and change throughout life. Character growth can improve psychological wellness even if a patient has a temperament that predisposes them to mental health problems. ...
Objective This study explored whether temperament profiles are associated with psychological functioning and whether character maturity affects this association in patients with panic disorders (PD).Methods A total of 270 patients with PD were enrolled in this study. Measurements included the Temperament and Character Inventory-revised-short (TCI-RS), a self-report version of the Panic Disorder Severity Scale (PDSS-SR), Beck Depression Inventory-II (BDI-II), and Spielberger State-Trait Anxiety Inventory (STAI). Cluster analysis was used to define the patients’ temperament profiles, and the differences in discrete variables among temperament clusters were calculated using a one-way analysis of variance. An analysis of covariance was conducted to control for the impact of character maturity on psychological functioning among clusters.Results We identified four temperament clusters of patients with PD. Significant differences in the PDSS-SR, BDI-II, STAI-state, and STAI-trait scores among the four clusters were detected [F(3, 262)=9.16, p<0.001; F(3, 266)=33.78, p<0.001; F(3, 266)=19.12, p<0.001; F(3, 266)=39.46, p<0.001]. However, after controlling for the effect of character maturity, the effect of cluster type was either eliminated or reduced ([STAI-state] cluster type: F(3, 262)=0.94, p>0.05; SD+CO: F(1, 262)=65.95, p<0.001, η<sub>p</sub><sup>2</sup> =0.20).Conclusion This study enabled a more comprehensive and integrated understanding of patients by exploring the configuration of all temperament dimensions together rather than each temperament separately. Furthermore, we revealed that depending on the degree of character maturity, the psychological functioning might differ even within the same temperament cluster. These results imply that character maturity can complement inherently vulnerable temperament expression.
... Good evidence was found to suggest that the personality dimensions low Self-Directedness and low Cooperativeness were significant, but most of the studies concerned outpatients Fassino et al, 2003). For Cloninger (1993), low scores on these two dimensions were predictive of the presence of a personality disorder, whatever its type, and the results have often been replicated (Richter and Brändström, 2009). Persistence was the only TCI dimension associated with dropout in the study with eating disorder inpatients (Dalle Grave, 2008). ...
... Nous pouvons remarquer que pourCloninger (Svrakik, 1993), l'association de scores bas sur les deux dimensions Auto-détermination et Coopération était en faveur de la présence d'un TP catégoriel, et ces données ont souvent été répliquées(Richter, 2009).Dans la seule étude concernant des patients hospitalisés pour la prise en charge de leur TCA(Dalle Grave, 2008), seul un score bas à la dimension Persistance était associé aux SPH.Il faut cependant remarquer dans notre étude, les diagnostics catégoriels DSM-IV de TP semblent plus performants dans la prédictivité de la SPH que les dimensions de personnalité du modèle dimensionnel TCI ; dans le modèle à deux facteurs testé sur notre échantillon, seul le facteur comorbidité avec un TP reste significatif dans le modèle multivarié.Notre échantillon de patients est constitué de patients adultes, ayant un TCA sévère et chronique, notre Unité de soins TCA étant un centre de soins de troisième ligne. Nos résultats ne peuvent pas être extrapolés directement à l'ensemble des sujets ayant un TCA.comme dans les autres recherches sur le sujet, nous avons testé le nombre d'hospitalisations antérieures pour TCA. ...
First, eating disorders (ED) and personality disorders (PD) definitions, diagnostic criteria and assessments are described. Then, empirical studies about EDs and PDs comorbidity are reviewed : - prevalence data of ED-PD comorbidity - influence of PD comorbidity on clinical presentation of ED - influence of PD on ED outcome. Main theorical models of PD-ED comorbidity are described, with empirical studies about or against these models. Specific patterns of treatment of ED-PD patients are detailed. We close this theorical review of ED-PD comorbidity with a frequent comorbidity in clinical practice : Borderline PD and ED comorbidity. In the last part of our work, we present our two studies about this topic : - we assessed personality traits and PD in a sample of 100 consecutive patients hospitalized in an ED Unit - we compared the ED patients and the non-ED patients, in a sample of 85 borderline adolescents To close our work, we discuss our results in the international litterature context, and we describe our ongoing studies, and the need for future research.
... However, other Clusters B and C personality disorders like narcissistic and avoidant personality disorders are also reported to be more common in adults with ADHD (Cumyn, French, & Hechtman, 2009;Matthies et al., 2011;Miller et al., 2008). In general, the TCI dimensions low Self-directedness and in particular low Cooperativeness indicate a personality disorder (Richter & Brandstrom, 2009). ASPD has, similarly to ADHD, in some studies been related to high scores of Novelty seeking (Basoglu et al., 2011), high scores of Harm avoidance (Basoglu et al., 2011;Svrakic, Whitehead, Przybeck, & Cloninger, 1993), and low scores of Self-directedness (Basoglu et al., 2011). ...
... When adjusting for comorbidity, we found that the ASPD group showed a low score of Cooperativeness. Low score on Cooperativeness is considered to be an important indicator of a personality disorder (Richter & Brandstrom, 2009), and individuals low on Cooperativeness are characterized as revengeful, intolerant, self-absorbed and primarily looking out for themselves (Cloninger et al., 1994). Such features are consistent with one of the core traits in ASPD: "lack of remorse, as indicated being indifferent to or rationalizing having hurt, mistreated, or stolen from another" (APA, 2000, p. 292). ...
Objective:
To assess personality traits using the Temperament and Character Inventory (TCI) in a group of 63 previously diagnosed ADHD patients and 68 population controls and investigate the impact of common comorbid psychiatric disorders on these personality measures.
Method:
Psychiatric comorbidity was assessed with the Mini International Neuropsychiatric Interview Plus and personality traits by the TCI.
Results:
The patient group had significantly higher scores on the TCI dimensions Harm avoidance and Novelty seeking compared with the control group. However, when adjusting for comorbid anxiety and depressive disorder, the ADHD group no longer showed higher Harm avoidance than the control group. The difference in Novelty seeking between the patient and control groups was correlated with lifetime diagnosis of antisocial personality disorder (ASPD).
Conclusion:
It is important to take comorbid psychiatric disorders into account while investigating personality traits in ADHD.
... 8,[11][12][13] One of the reasons to use TCI in this study is its capacity to detect personality deviations such as extreme temperament dimensions and immature character, which have been shown to indicate vulnerability to psychiatric diseases. 7,10,14 Demographic data Data on marriage status, biological children of their own, age and occupation, as well as whether the donor was known to the recipient couples, were collected with studyspecific items in the questionnaire. ...
... In other studies this dimension has been found to indicate vulnerability to psychiatric change decreases. 8,12,14 Furthermore, the sperm donors were all in the normal range of character, which means that the donors perceived themselves as autonomous individuals with the capacity to take responsibility, who can behave in a goal-directed manner and are resourceful and self-acceptant. They also described themselves as being well integrated in society and having a capacity for relatively high identification with and acceptance of other people. ...
To study the personality characteristics of identifiable sperm donors in a national sample in comparison with the same characteristics of a control group.
Descriptive study.
All clinics (n=7) performing gamete donation in Sweden.
All Swedish sperm donors recruited during 2005-08. An age-matched group of Swedish men served as controls.
Standardised questionnaires were used to measure personality.
Demographics and the Temperament and Character Inventory (TCI).
The mean age of the donors was 33.8±7.8 years (18-56 years). About one-third (36.5%) of the donors had biological children of their own. With regard to personality, significant differences were present on harm avoidance, with lower means for sperm donors (P=0.002, 95% CI -3.74 to -0.85), and on self-directedness and cooperativeness, with higher means for donors (P=0.002, 95% CI 0.97-4.19; P=0.001; 95% CI 0.75-2.95, respectively), compared with controls. This indicates that the donors in general feel less worried and suffer less from uncertainty, shyness and fatigability than controls. They also perceive themselves as being autonomous, with a capacity to take responsibility, to behave in a goal-directed manner, to be resourceful and self-acceptant, and to behave in a manner guided by meaningful values and goals. Furthermore, they describe themselves as being well integrated in humanity or society, and having a good capacity for identification with and acceptance of other people.
The screening process at the clinics seems to generate a group of stable, mature and well-integrated donors, and this is a promising result for the future.
... However, this is not true of those receiving care as usual and engaging in physical activity equivalent in frequency and duration to the TAY classes. This relevance of the self-directedness domain within our study population stems from previous findings that have indicated a strong association between the presence of psychiatric disorders (e.g., personality disorders, autism spectrum disorder, attention deficit/hyperactivity disorder, behavioral disorders, and even trait aggression in inmates) and immature character maturity, characterized by low self-directedness (and low cooperativeness) (Richter and Brändström, 2009;Nilsson et al., 2016;Vuijk et al., 2018;Perroud et al., 2016;Flak et al., 2017). Importantly, a previous study identified significant increases in self-directedness among inmates who engaged in yoga practice (Kerekes et al., 2019). ...
... Character structure is composed of three dimensions encompassing self-directedness (SD), which pertains to responsibility, self-acceptance and inclination toward goal setting; cooperativeness (C), which ascribes to the capacity to recognize and admire other people; self-transcendence (ST), which shows an inclination toward value system, spirituality and being as important part of natural world (15). The concept of character became extremely influential and greatly considered by numerous prominent studies of psychopathology, but few studies have been conducted on the Cloninger's model of personality for severity of grief (16,17). Bridging this gap is the one purpose of this research in Iran . ...
Objective: Identification of the risk factors and psychological correlates of prolonged grief disorder is vital for health promotions in relatives of persons who died of cancer. The aim of this research was to investigate the role of defense mechanisms, character dimension of personality and demographic factors on complicated grief following a loss of a family member to cancer. Method: A number of 226 persons who had lost a family member to cancer in a cancer institute at Tehran University of Medical Science were selected through compliance sampling and completed the Inventory of complicated Grief-Revised (ICG-R), the Defense Styles Questionnaire (DSQ), the Character dimension of Temperament and Character Inventory (TCI), and the Demographical questionnaire. Data were analyzed by stepwise multiple regression analysis, using the PASW version 18. Results: Findings revealed that neurotic defense style had a significant positive predictive role in the complicated grief; and cooperativeness, age of the deceased person, self-transcendence and mature defense style had a significant negative predictive role in complicated grief (p<0.001). R2 was 0.73 for the final model (p<.001). Conclusion: The results revealed that two character dimensions (low cooperativeness and self-transcendence), high neurotic defense style and young age of the deceased person were involved in the psychopathological course of the complicated and prolonged grief. It was concluded that personality characteristics of the grieving persons and demographics of the deceased person should be addressed in designing tailored interventions for complicated grief.
... Historically, research on relationships between PDs and personality dimensions (note that we will use the term dimensions to refer personality traits in order to distinguish them from domains of the PID-5) has mainly been focused on the FFM (Costa & Widiger, 2002). Only a few studies have analyzed models such as Cloninger's Temperament and Character (Gutiérrez et al., 2008;Richter & Brändström, 2009;Svrakic, Whitehead, Przybeck, & Cloninger, 1993) or Zuckerman's Alternative FFM (Aluja, Cuevas, García, & García, 2007b;Wang, Du, Wang, Livesley, & Jang, 2004;Zuckerman, 1999). ...
A dimensional approach for Personality Disorders was proposed in the DSM-5. To assess this approach, a new instrument (the Personality Inventory for DSM-5 [PID-5]) was developed in 2012. One research line has analyzed its convergent validity with personality traits, focusing almost exclusively on the Five-Factor Model (FFM). However, previous evidence about the relationships between Categorical Personality Disorders and other personality trait models shows that they can improve our understanding of Personality Disorders beyond the FFM. The aim of the present study is to compare the power of three personality models (FFM, Cloninger’s, and Zuckerman’s) to predict PID-5 domains. Three samples from the Spanish and Catalan general population were collected for this study depending on which personality questionnaire was applied (1,052 for revised NEO Personality Inventory [NEO-PI-R], 465 for Zuckerman-Kuhlman-Aluja Personality Questionnaire [ZKA-PQ], and 332 for Temperament and Character Inventory Revised [TCI-R-140]). The PID-5 was also applied to all subjects. Factor and regression results indicate that the three models were able to predict Dimensional Personality Disorders well, although some differences emerge between them. Specific relationships between dimensional disorders and traits, the role of the facets as well as the utility of the results reported are discussed.
... In contrast, extreme immaturity has been associated with the presence of a personality disorder. Previous research suggests that the diagnosis of a personality disorder is based on character maturity, while the various subtypes of personality disorders are differentiated by temperament dimensions (Svrakic et al., 2002;Richter and Brändström, 2009). ...
Previous research has suggested that personality and cognitive functions are essential in the emergence of persistent aggressive antisocial behaviors and that character maturity could be an important protective factor against these behaviors. The aims of this study were (1) to determine associations between personality traits, intellectual ability, and executive function in young male violent offenders, and (2) to investigate differences in intellectual ability and executive function between groups of violent offenders with low, medium, and high character maturity. A cohort of 148 male violent offenders (18–25 years of age) participated in this study. The Temperament and Character Inventory was used as a self-report measure of personality traits, and cognitive functions were measured with the Wechsler Adult Intelligence Scale – Third Edition and the Cambridge Neuropsychological Test Automated Battery. Intellectual ability was negatively correlated to the temperament dimension Harm Avoidance and the character dimension Self-Transcendence, and positively correlated to the character dimensions Self-Directedness and Cooperativeness and the temperament dimension Novelty Seeking. Visual sustained attention correlated positively to the temperament dimension Persistence and negatively to the temperament dimension Harm Avoidance. Spatial working memory correlated negatively to the character dimension Cooperativeness. Character maturity, however, did not affect intellectual and executive functions to a statistically significant degree. Our findings indicate that offender personality characteristics such as optimism, responsibility, empathy, curiosity, and industry that would seem more favorable to positive intervention outcomes are related to better cognitive functioning. Possible implications are that interventions in offender populations could be more effective if tailored to participants’ personality dimensions and cognitive proficiencies, rather than offered as “one size fits all.”
... The character dimensions, self-directedness, cooperativeness, and self-transcendence, are based on social learning, and are therefore expected to mature over time (5,8). Low scores on selfdirectedness and cooperativeness, indicating immaturity, low selfgovernance, social incompetence or intolerance, uncooperativeness, and revengefulness, have repeatedly been associated with mental ill-health (5,(9)(10)(11)(12), also in forensic populations (13), and with aggressive and antisocial behaviors in inmates (4). ...
Background: A specific personality profile, characterized by low character maturity (low scores on the self-directedness and cooperativeness character dimensions) and high scores on the novelty seeking temperament dimension of the temperament and character inventory (TCI), has been associated with aggressive antisocial behavior in male prison inmates. It has also been shown that yoga practiced in Swedish correctional facilities has positive effects on the inmates’ well-being and on risk factors associated with criminal recidivism (e.g., antisocial behavior). In this study, we aimed to investigate whether the positive effect of yoga practice on inmates’ behaviors could be extended to include eventual changes in their personality profile.
Methods: Male prison inmates (N = 111) in Sweden participated in a randomized controlled 10-week long yoga intervention trial. Participants were randomly assigned to either a yoga group (one class a week; n = 57) or a control group (free of choice weekly physical activity; n = 54). All the inmates completed the TCI questionnaire before and after the intervention period as part of an assessment battery.
Results: After the 10-week-long intervention period male inmates scored significantly lower on the novelty seeking and the harm avoidance and significantly higher on the self-directedness dimensions of the TCI. There was a significant medium strong interaction effect between time and group belonging for the self-directedness dimension of character favoring the yoga group.
Conclusion: A 10-week-long yoga practice intervention among male inmates in Swedish correctional facilities increased the inmates’ character maturity, improving such abilities as their capability to take responsibility, feel more purposeful, and being more self-acceptant—features that previously were found to be associated with decreased aggressive antisocial behavior.
... Temperament traits have proven to be useful in understanding the pathogenesis, co-morbidity and treatment of mental illness (Lei et al., 2014). Notably, clinical practice has demonstrated that individuals who have extreme temperament scores are concerned with a spectrum of personality or neuropsychiatric disorders such as depression, addiction, borderline personality disorder or obsessive-compulsive disorder (Celikel et al., 2009;Ettelt et al., 2008;Loftus et al., 2008;Richter and Brandstrom, 2009;Sui et al., 2018). Even in not-dysfunctional situations, the variance in the normal range of temperaments appears to be linked to several neurobiological measures, e.g., neurotransmitter metabolites, in-vivo neuroimaging markers in specific brain areas, especially the cortico-limbic pathways (Laricchiuta et al., 2014a). ...
... In literature, some personality traits such as high harm avoidance and low self-directedness has been reported to be associated with chronic diseases (20). TCI is a commonly used valid instrument to identify personality profiles (13,21). In the present study among the TCI dimensions, reward dependence, persistence, self-directedness, cooperativeness, and selftranscendence scores were higher in patients with chronic hepatitis B compared to age-matched heatlhy subjects. ...
... In the present study we used Self-Directedness and Cooperativeness to measure character maturity, as the construct of these two character dimensions previously has been shown to be highly relevant for children's mental health [27]as well as pro-social behavior [46]. This has also been described in adults [21,47]. ...
Background:
Childhood aggressive antisocial behavior (CD) is one of the strongest predictors of mental health problems and criminal behavior in adulthood. The aims of this study were to describe personality profiles in children with CD, and to determine the strength of association between defined neurodevelopmental symptoms, dimensions of character maturity and CD.
Methods:
A sample of 1886 children with a close to equal distribution of age (9 or 12) and gender, enriched for neurodevelopmental and psychiatric problems were selected from the nationwide Child and Adolescent Twin Study in Sweden. Their parents rated them according to the Junior Temperament and Character Inventory following a telephone interview during which information about the children's development and mental health was assessed with the Autism-Tics, AD/HD and other Comorbidities inventory.
Result:
Scores on the CD module significantly and positively correlated with scores on the Novelty Seeking temperament dimension and negatively with scores on character maturity (Self-Directedness and Cooperativeness). In the group of children with either neurodevelopmental or behavioral problems, the prevalence of low or very low character maturity was 50%, while when these two problems coexisted the prevalence of low or very low character maturity increased to 70%. Neurodevelopmental problems (such as: oppositional defiant disorder, symptoms of attention deficit/hyperactivity disorder and autism spectrum disorder) and low scores on character maturity emerged as independently significant predictors of CD; in a multivariable model, only oppositional defiant symptoms and impulsivity significantly increased the risk for coexisting CD while a mature self-agency in a child (Self-Directedness) remained a significant protective factor.
Conclusion:
These results suggest that children's willpower, the capacity to achieve personally chosen goals may be an important protective factor - even in the presence of neurodevelopmental and psychiatric problems - against progressing into persistent negative outcomes, such as aggressive antisocial behaviors.
... Considering that the prevalence of ADHD in the prison population is estimated to as much as 25% (Young et al., 2015a(Young et al., , 2015b, that ASD is ten times more frequent in the prison population than in the general population (Brugha et al., 2011), and that twothirds of Swedish inmates meet criteria for at least one PD (Billstedt, 2009;Hofvander et al., In preparation), the resemblance in personality profiles of inmates and persons with mental health problems is not surprising. In patients low character maturity is a sign of the presence of a psychiatric problem, and constellations of extreme scores on specific temperament dimensions will define what kind of problem the patient has (Richter and Brandstrom, 2009;Svrakic et al., 2002). While possessing an extreme temperament by itself is neither pathological nor abnormal, in combination with low character maturity it predicts psychiatric problems and/or aggressive/antisocial behaviors. ...
Gender specific personality profiles in association with the level of aggressive antisocial behavior in offenders have not been previously investigated. In the present study we analyzed data collected from 65 male and 50 female offenders using structured protocols regarding criminal history (by criminal register data), trait aggression (by the Life History of Aggression (LHA) questionnaire), and personality profiles (by the Temperament and Character Inventory (TCI)). Prison inmates differed significantly on several personality dimensions, most pronouncedly were they characterized with low character maturity (low scores in the Self-Directedness and Cooperativeness dimensions of TCI) when compared to gender and age matched controls of the general population. The majority of offenders scored distinctively high on trait aggression. There were moderate to strong associations between the personality dimensions and each of the subscales of LHA (Aggression, Self-directed Aggression and Antisocial behavior). These associations were stronger in the female offender sample. Trait aggression could be best explained by a model, which included male gender, younger age, high novelty seeking temperament and low character maturity. Our results suggest that therapies aiming at strengthening self-governance and increasing cooperativeness (focusing on character maturity) may alleviate aggressive antisocial behavior in offenders.
... It is important to mention that an excessive tendency for NS predicts vulnerability to psychiatric disorders (Richter and Brändström, 2009). Specifically, high levels of impulsive behavior, as in high-scoring NS subjects, determine increased risk of exhibiting substance abuse and antisocial behavior (Meyer et al., 1999;Mitchell and Nelson-Gray, 2006). ...
In recent years the use of psychostimulants for cognitive enhancement in healthy individuals with no psychiatric disorders has been on the rise. However, it is still unclear whether psychostimulants improve certain cognitive functions at the cost of others, and how these psychostimulants interact with individual personality differences. In the current study, we investigated whether the effect of one common stimulant, methylphenidate (MPH), on creativity is associated with novelty seeking. Thirty-six healthy adults, without attention-deficit hyperactivity disorder (ADHD) symptomology, were assigned randomly in a double-blind fashion to receive MPH or placebo. We found that the effect of MPH on creativity was dependent on novelty-seeking (NS) personality characteristics of the participants. MPH increased creativity in individuals with lower NS, while it reduced creativity levels in individuals with high NS. These findings highlight the role of the dopaminergic system in creativity, and indicate that among healthy individuals NS can be seen as a predictor of the effect of MPH on creativity.
... Finally, temperament × character interactions have a marginal role in predicting problems if compared with the direct effect of dimensions. This does not challenge the finding that extreme temperament and low character are more frequent in PDs [42] but suggests that personality dysfunction arises from the summative effects of each dimension rather than from particular combinations of traits. Therefore, we shall discuss these individual effects in some detail. ...
Background: On the way toward an agreed dimensional taxonomy for personality disorders (PD), several pivotal questions remain unresolved. We need to know which dimensions produce problems and in what domains of life; whether impairment can be found at one or both extremes of each dimension; and whether, as is increasingly advocated, some dimensions measure personality functioning whereas others reflect style.
Method: To gain this understanding, we administered the Temperament and Character Inventory to a sample of 862 consecutively attended outpatients, mainly with PDs (61.2%). Using regression analysis, we examined the ability of personality to predict 39 variables from the Life Outcome Questionnaire concerning career, relationships, and mental health.
Results: Persistence stood out as the most important dimension regarding career success, with 24.2% of explained variance on average. Selfdirectedness was the best predictor of social functioning (21.1%), and harm avoidance regarding clinical problems (34.2%). Interpersonal dimensions such as reward dependence and cooperativeness were mostly inconsequential. In general, dimensions were detrimental only in one of their poles.
Conclusions: Although personality explains 9.4% of life problems overall, dimensions believed to measure functioning (character) were not better predictors than those measuring style (temperament). The notion that PD diagnoses can be built upon the concept of “personality functioning” is unsupported.
... In Cloniger's model, the four temperament dimensions (harm avoidance, novelty seeking, reward dependence, persistence) are presumed to be heritable and relatively stable qualities, whereas the three character dimensions (selfdirectedness, cooperativeness, self-transcendence) are considered to be influenceable by learning and development. The dimensions low self-directedness and low cooperativeness seem to indicate a personality disorder [41]. Instanes et al. [40] found higher scores on the dimensions harm avoidance and novelty seeking in the ADHD patient group. ...
Children suffering from attention deficit hyperactivity disorder (ADHD) may remit until adulthood. But, more than 60–80 % have persisting ADHD symptoms. ADHD as an early manifesting neurodevelopmental disorder is considered a major risk factor for the development of comorbid psychiatric disorders in later life. Particularly, personality disorders are oftentimes observed in adult patients suffering from ADHD. If ADHD and personality disorders share common etiological mechanisms and/or if ADHD as a severely impairing condition influences psychological functioning and learning and leads to unfavorable learning histories is unclear. The development of inflexible and dysfunctional beliefs on the basis of real and perceived impairments or otherness due to the core symptoms of ADHD is intuitively plausible. Such beliefs are a known cause for the development of personality disorders. But, why some personality disorders are more frequently found in ADHD patients as for example antisocial and borderline personality disorder remains subject of debate. Because of the high prevalence of ADHD and the high impact of personality disorders on daily functioning, it is important to take them into account when treating patients with ADHD. Research on the developmental trajectories leading to personality disorders in adult ADHD patients might open the door for targeted interventions to prevent impairing comorbid clinical pictures.
... Conclusively, temperamental traits provide mechanisms to expand the range of stimuli and possibilities, protect one from potentially aversive contexts, and supply the appropriate feedback for sculpting the brain and developing interest in specific domains. It has to be noticed that excessive tendency to a specific temperamental trait predicts vulnerability to psychiatric disorders [10]. In particular, high levels of impulsive behaviors, as in high-scored NS subjects, determine increased risk of exhibiting substance abuse and antisocial behavior [11,12], and conversely, high levels of behavioral inhibition, as in high-scored HA subjects, determine increased risk for developing anxiety disorders and depression [13,14]. ...
The variance in the range of personality trait expression appears to be linked to structural variance in specific brain regions. In evidencing associations between personality factors and neurobiological measures, it seems evident that the cerebellum has not been up to now thought as having a key role in personality. This paper will review the most recent structural and functional neuroimaging literature that engages the cerebellum in personality traits, as novelty seeking and harm avoidance, and it will discuss the findings in the context of contemporary theories of affective and cognitive cerebellar function. By using region of interest (ROI)- and voxel-based approaches, we recently evidenced that the cerebellar volumes correlate positively with novelty seeking scores and negatively with harm avoidance scores. Subjects who search for new situations as a novelty seeker does (and a harm avoiding does not do) show a different engagement of their cerebellar circuitries in order to rapidly adapt to changing environments. The emerging model of cerebellar functionality may explain how the cerebellar abilities in planning, controlling, and putting into action the behavior are associated to normal or abnormal personality constructs. In this framework, it is worth reporting that increased cerebellar volumes are even associated with high scores in alexithymia, construct of personality characterized by impairment in cognitive, emotional, and affective processing. On such a basis, it seems necessary to go over the traditional cortico-centric view of personality constructs and to address the function of the cerebellar system in sustaining aspects of motivational network that characterizes the different temperamental traits.
... Character structure is composed of three dimensions encompassing self-directedness (SD), which pertains to responsibility, self-acceptance and inclination toward goal setting; cooperativeness (C), which ascribes to the capacity to recognize and admire other people; self-transcendence (ST), which shows an inclination toward value system, spirituality and being as important part of natural world (15). The concept of character became extremely influential and greatly considered by numerous prominent studies of psychopathology, but few studies have been conducted on the Cloninger's model of personality for severity of grief (16,17). Bridging this gap is the one purpose of this research in Iran . ...
Objective:
Identification of the risk factors and psychological correlates of prolonged grief disorder is vital for health promotions in relatives of persons who died of cancer. The aim of this research was to investigate the role of defense mechanisms, character dimension of personality and demographic factors on complicated grief following a loss of a family member to cancer.
Method:
A number of 226 persons who had lost a family member to cancer in a cancer institute at Tehran University of Medical Science were selected through compliance sampling and completed the Inventory of complicated Grief-Revised (ICG-R), the Defense Styles Questionnaire (DSQ), the Character dimension of Temperament and Character Inventory (TCI), and the Demographical questionnaire. Data were analyzed by stepwise multiple regression analysis, using the PASW version 18.
Results:
Findings revealed that neurotic defense style had a significant positive predictive role in the complicated grief; and cooperativeness, age of the deceased person, self-transcendence and mature defense style had a significant negative predictive role in complicated grief (p<0.001). R2 was 0.73 for the final model (p<.001).
Conclusion:
The results revealed that two character dimensions (low cooperativeness and self-transcendence), high neurotic defense style and young age of the deceased person were involved in the psychopathological course of the complicated and prolonged grief. It was concluded that personality characteristics of the grieving persons and demographics of the deceased person should be addressed in designing tailored interventions for complicated grief.
... High NS individuals are impulsive, excitable, and quick-tempered, while low NS individuals are rigid, stoic, and slow-tempered (Cloninger, 1986;Cloninger et al., 1993). However, excessive NS has been linked to psychiatric disorders (Richter and Brandstrom, 2009), such as ADHD (Instanes et al., 2013;Jacob et al., 2014), pathological gambling (Kim and Grant, 2001) and substance abuse (Milivojevic et al., 2012), while reduced levels of NS are correlated with obsessive-compulsive disorders (Lyoo et al., 2001). A number of genetic and neuroimaging studies have attempted to examine the biological basis of NS, but results have been mixed and the combined genetic-neural mechanism of the NS remains to be explored. ...
... The character traits, Self-Directedness, Cooperativeness, and Self-Transcendence, change with maturation and are more closely associated with higher cognitive processes including interpretation and formal construction . Richter and Brändström (2009) compared TCI scores of 200 psychiatric inpatients to 800 healthy volunteers. The results showed that both patients' groups, with and without PDs, differ from healthy volunteers on temperament and character dimensions. ...
The relationship between psychopathy and traits of temperament and character in a specific population of criminals, such as murderers, has not been sufficiently investigated. This study assesses the relationship between psychopathy and temperament and character traits in murderers. The sample consisted of 118 men divided into three groups: psychopathic murderers (N=40), non-psychopathic murderers (N=40) and 38 non-psychopathic non-criminals (controls). All individuals were evaluated by Psychopathy Checklist Revised (PCL-R) and The Temperament and Character Inventory (TCI). Psychopathic murderers presented higher scores than the other two groups in PCL-R; both criminal groups presented higher scores than non-psychopathic non-criminals. Psychopathic murderers showed lower scores than non-psychopathic murderers on Harm Avoidance, Reward Dependence, Persistence, Self-Directness and Cooperativeness. There was no difference between murderers groups regarding Novelty Seeking and Self-transcendence. In all TCI personality traits psychopathic and non-psychopathic murderers showed scores lower than controls, except Harm Avoidance for non-psychopathic murderers. In conclusion, most personality traits assessed by TCI were associated with psychopathy, while Novelty Seeking and Self-transcendence were associated with homicidal behavior independently of the psychopathy.
... Harm avoidance (HA) and novelty seeking (NS) are temperament dimensions defined by the Temperament and Character Inventory (TCI), reflecting a heritable bias for responding intensely to aversive stimuli or for excitement in response to novel stimuli, respectively, (Cloninger, 1987;Cloninger et al., 1993). It is particularly interesting that extreme expression on these temperaments is associated with vulnerability to psychiatric disorders (Richter and Brandstrom, 2009). Increased levels of HA are thought to play a role as a risk factor for development of depression (Joffe et al., 1993;Richter et al., 2000;Farmer et al., 2003;Abrams et al., 2004;Smith et al., 2005;Celikel et al., 2009;Quilty et al., 2010) and anxiety disorders (Jylha and Isometsa, 2006;Mertol and Alkin, 2012). ...
Harm avoidance (HA) and novelty seeking (NS) are temperament dimensions defined by Temperament and Character Inventory (TCI), respectively, reflecting a heritable bias for intense response to aversive stimuli or for excitement in response to novel stimuli. High HA is regarded as a risk factor for major depressive disorder and anxiety disorder. In contrast, higher NS is linked to increased risk for substance abuse and pathological gambling disorder. A growing body of evidence suggests that patients with these disorders show abnormality in the power of slow oscillations of resting-state brain activity. It is particularly interesting that previous studies have demonstrated that resting state activities in medial prefrontal cortex (MPFC) are associated with HA or NS scores, although the relation between the power of resting state slow oscillations and these temperament dimensions remains poorly elucidated. This preliminary study investigated the biological bases of these temperament traits by particularly addressing the resting state low-frequency fluctuations in MPFC. Regional hemodynamic changes in channels covering MPFC during 5-min resting states were measured from 22 healthy participants using near-infrared spectroscopy (NIRS). These data were used for correlation analyses. Results show that the power of slow oscillations during resting state around the dorsal part of MPFC is negatively correlated with the HA score. In contrast, NS was positively correlated with the power of resting state slow oscillations around the ventral part of MPFC. These results suggest that the powers of slow oscillation at rest in dorsal or ventral MPFC, respectively, reflect the degrees of HA and NS. This exploratory study therefore uncovers novel neural bases of HA and NS. We discuss a neural mechanism underlying aversion-related and reward-related processing based on results obtained from this study.
... The four temperament dimensions are Novelty Seeking, Harm Avoidance, Reward Dependence, and Persistence, and the three character dimensions are Self-Directedness, Cooperativeness, and Self-Transcendence. The TCI-R is a widely used alternative to the FFM and has shown both high relevance to PDs [53,54] and suitable psychometric properties in its Spanish version [55]. ...
Despite general support for dimensional models of personality disorder, it is currently unclear which, and how many, dimensions a taxonomy of this kind should include. In an attempt to obtain an empirically-based, comprehensive, and usable structure of personality, three instruments - The Temperament and Character Inventory-Revised (TCI-R), the Personality Diagnostic Questionnaire-4+(PDQ-4+), and the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ) - were administered to 960 outpatients and their scales factor-analyzed following a bass ackwards approach. The resulting hierarchical structure was interpretable and replicable across gender and methods up to seven factors. This structure highlights coincidences among current dimensional models and clarifies their apparent divergences, and thus helps to delineate the unified taxonomy of normal and abnormal personality that the field requires.
... This finding is in concordance with other studies finding that low C or SD scores are important predictors of the incidence of personality disorders, especially when the individual had a very low C score. 16,40,41 C reflects the ability to collaborate, work with others, and accept and support them. In other words, a low C score means low sociality. ...
Recently, an increasing number of Korean male conscripts have been retiring because of military maladjustment despite the presence of qualifying medical and psychological screening tests in the Korean army. These problems suggest the presence of a common personality problem. To further examine this possibility, the present study used Cloninger's psychobiological model to investigate the temperament and character of soldiers suffering from military maladjustment.
Seventy-nine maladjusted male conscripts and eighty-seven controls enrolled at the 1596th unit from April 2011 to June 2012 participated in the present study. To measure participant personality, we used the Korean version of the Temperament and Character Inventory, Revised-Short. We used logistic regression analysis to examine the association between TCI-RS scores and risk of military maladjustment.
The maladjustment group had a lower rank, socioeconomic status, education level, and a shorter duration of military service than the control group. The harm avoidance and self-transcendence scores were significantly higher in the maladjustment group, with lower scores for reward dependence, persistence, self-directedness, and cooperativeness scores. However, of these measures, only low cooperativeness was associated with an increased risk of military maladjustment.
These results suggest that a low level of cooperativeness can predict military inadequacy. Maladjusted male conscripts may have different personality characteristics from normals. To validate our results, further follow-up or cohort studies with a larger sample will be required.
... action (LeDoux 2000). Excessive tendency to NS or HA predicts vulnerability to psychiatric disorders (Richter and Brändström 2009). In particular, high levels of behavioral inhibition, as in high-scored HA subjects, determine increased risk for developing anxiety disorders and depression (Biederman et al. 2001;Muris et al. 2001) and conversely, high levels of impulsive behavior, as in high-scored NS subjects, determine increased risk of exhibiting substance abuse and antisocial behavior (Meyer et al. 1999;Mitchell and Nelson-Gray 2006). ...
Novelty Seeking (NS) and Harm Avoidance (HA) temperamental traits are related to approaching or avoiding motivational circuits relying on the integrity and functionality of distributed brain areas implicated in arousal and action. The present study verified whether and how macro- and micro-structural variations of basal ganglia are correlated with scores obtained in the NS and HA temperamental scales of the Temperament and Character Inventory by Cloninger. To this aim, 125 healthy adults aged 18-67 years of both sexes completed the Temperament and Character Inventory and underwent a high-resolution T1-weighted magnetic resonance imaging and a diffusion tensor imaging using a 3T scanner. The scores obtained in the temperamental scales were associated with volumes, mean diffusivity and fractional anisotropy measures of basal ganglia of both hemispheres separately, by using linear regression analyses. We found increased bilateral caudate and pallidum volumes associated with higher NS scores, as well as increased mean diffusivity in the bilateral putamen associated with higher HA scores. Macro- and micro-structural variations of basal ganglia regions contribute to explain the biological variance associated with NS or HA personality phenotype. The present findings evidencing some brain-temperament relationships highlight the importance of obtaining macro- and micro-structural measures in relation to individual differences.
... A deficit on SD represents irresponsible and undisciplined personality traits, and an inappropriately lower C would be associated with a lack of empathy, intolerance, and insensitiveness. Although the above-mentioned characteristics represented by lower SD and C are not specific traits for any individual type of personality disorder, these were considered to be common traits in personality problems (Gutierrez et al., 2008;Ha et al., 2007;Richter and Brandstrom, 2009). Those who have a deficit in the characteristic personality traits would be associated with a more severe vulnerability to adjustment problems and subjective distress than would healthy controls under stressful situations. ...
Personality is an important clinical factor for successful adjustment in stressful situations. The aim of this study was to examine possible differences in temperament and character dimensions between patients with adjustment disorder with depressed mood and healthy controls. Among the young male conscripts, 86 subjects with adjustment disorder with depressed mood and 86 healthy controls were included. The mean scores in the 7 dimensions and 25 subscales of the Temperament and Character Inventory were compared between the patients with adjustment disorder with depressed mood and the control group by an independent t-test. The patients with adjustment disorder with depressed mood had significantly higher scores on harm-avoidance and lower scores on self-directedness, cooperativeness, and self-transcendence than did the controls. There were no differences in novelty seeking, reward dependence, and persistence in temperament between the two groups. The results of this study suggest that the personality traits of the subjects with adjustment disorder with depressed mood would make them vulnerable to stressful situations and less skilled in coping with conscription.
... Good evidence was found to suggest that the personality dimensions low Self-directedness and low Cooperativeness were significant, but most of the studies concerned outpatients (Fassino et al., 2002(Fassino et al., , 2003. For Cloninger et al. (1993), low scores on these two dimensions were predictive of the presence of a personality disorder, whatever its type, and the results have often been replicated (Richter and Brändström, 2009). Persistence was the only TCI dimension associated with dropout in the study with eating disorder inpatients (Dalle Grave et al., 2008). ...
Dropout rates from inpatient treatment for eating disorders are very high and have a negative impact on outcome. The purpose of this study was to identify personality factors predictive of dropout from hospitalization. A total of 64 adult patients with anorexia nervosa consecutively hospitalized in a specialized unit were included; 19 patients dropped out. The dropout group and the completer group were compared for demographic variables, clinical features, personality dimensions, and personality disorders. There was no link between clinical features and dropout, and among demographic variables, only age was associated with dropout. Personality factors, comorbidity with a personality disorder and Self-transcendence dimension, were statistically predictive of premature termination of hospitalization. In a multivariate model, these two factors remain significant. Personality traits (Temperament and Character Inventory personality dimension and comorbid personality disorder) are significantly associated with dropout from inpatient treatment for anorexia nervosa. Implications for clinical practice, to diminish the dropout rate, will be discussed.
... In general, patients suffering from a personality disorder (PD) are found to be characterized by immature character traits and extreme temperament traits. In clinical practice, the temperament as well as the character dimensions were found to be of interest in the assessment and the differential diagnosis of PDs (Cloninger et al., 1993;Richter and Brändström, 2009;Svrakic et al., 2002). Furthermore, all seven personality dimensions have proven to be useful in understanding the epidemiology, co-morbidity and treatment of mental illnesses such as mood disorders (MD) (Cloninger et al., , 2006Farmer and Seeley, 2009). ...
The psychobiological personality model of Cloninger distinguishes four heritable temperament traits (harm avoidance (HA), novelty seeking (NS), reward dependence (RD) and persistence (P)) and three character traits (self-directedness (SD), cooperativeness (CO) and self-transcendence (ST)) which develop during lifetime. Prior research already showed that individual differences in temperament are reflected in structural variances in specific brain areas. In this study, we used voxel-based morphometry (VBM) to correlate the different temperament and character traits with local gray and white matter volumes (GMV and WMV) in young healthy female volunteers. We found correlations between the temperament traits and GMV and WMV in the frontal, temporal and limbic regions involved in controlling and generating the corresponding behavior as proposed in Cloninger's theory: anxious for HA, impulsive for NS, reward-directed for RD and goal-directed for P. The character traits correlated with GMV and WMV in the frontal, temporal and limbic regions involved in the corresponding cognitive tasks: self-reflection for SD, mentalizing and empathizing with others for CO and religious belief for ST. This study shows that individual variations in brain morphology can be related to the temperament and character dimensions, and lends support to the hypothesis of a neurobiological basis of personality traits.
BACKGROUND: Eating disorders (ED) are severe, chronic, and complex in nature mental illnesses that are difficult to treat. One of the ways to stave off EDs is by screening among adolescents to preempt the development of clinical forms of ED in risk groups.
AIM: 1) to investigate the prevalence of ED risk among adolescent girls and compare subgroups at high and low risk of ED; 2) to investigate using a multidimensional approach those variables that can interact with temperament and character traits to predict ED symptomatology.
METHODS: The cross-sectional observational self-report study of a community sample of adolescent girls 1217 years old (n=298; M=14.771.13) was carried out in the city of Ryazan, Russia. The Russian versions of Eating Attitudes Test and Cloningers Temperament and Character Inventory-Revised were used. In addition, an original questionnaire (Risk Factors of Eating Disorders) was developed. Regression models (to test for significant moderation) and path analysis (to test for significant mediations) were used.
RESULTS: Girls at risk of developing EDs are characterized by a heightened level of concern about weight and dissatisfaction with their body, tend to suffer from low self-directedness, higher novelty seeking and tendency to higher harm avoidance, display high alexithymia, experience self-distrust, negative emotionality and are dissatisfied with family relationships. They also suffer from low self-esteem and tend to be perfectionism and engage in risk behavior. Significant moderating effects were uncovered between the following ED risk factors: (1) self-distrust/risk behavior and BMI; (2) alexithymia/negative emotionality/self-esteem and cooperativeness; and (3) negative emotionality/risk behavior and self-transcendence. Family relationship dissatisfaction mediates the association between self-directedness/cooperativeness/self-transcendence and disordered eating.
CONCLUSION: There are various mutual influences between the numerous ED risk and prevention factors, which all together determine the paths between the predictors and final outcome.
The present study tested the possibility of distinguishing between different types of antisocial adolescents based on psychopathic characteristics, and the differences between antisocial adolescents of different ages and subtypes in relation to the Cloninger's personality dimension. The sample included 101 antisocial male adolescents, divided into two age groups (71 respondents in the 13-17 age group and 30 in the 18-25 age group). After conducting model-based cluster analyses, non-psychopathic type (without pronounced signs of psychopathy) and psychopathic type (with pronounced antisocial, lifestyle and interpersonal facet) (Hare’s model) were singled out in the whole sample. Within the psychopathic type, in comparison with juveniles, older adolescents showed a significantly lower expression of character dimensions of Self-directedness and Cooperativeness, which are key in determining all personality disorders. Within the group of juvenile offenders, members of the two subtypes did not differ significantly in temperament and character, which indicates that juveniles are in the process of personality development, especially when it comes to their character, so they are more susceptible to treatment and their outcomes are uncertain. The results suggest that the inflation of psychopathic scores may occur in juveniles due to the identification of developmental features of adolescence (impulsivity, immaturity) as psychopathic, which implies the need to apply basic personality models in the assessment of antisocial adolescent.
Relation of the Nine Types of Temperament Model with personality disorders Objective: Aim of this study is to determine the correspondence between personality categories and the types making up the Nine Types of Temperament Model (NTTM) –a new temperament model which evaluates personality disorders within the context of temperament traits and maladaptive personality features-and conceptualization of NTTM types. Method: The sample group is composed of 117 participants with a personality disorder. SCID II and Nine Types of Temperament Scale (NTTS) were applied to participants. Results: According to the findings, all NTTM types have shown significant correlation with at least one personality disorder. According to the regression analysis results, it was determined that the NTTM types were explained by personality disorders at a rate of 19-41%. Conclusions: In this study, it is found that knowing the temperament features that form the basis of an individual's personality structure is helpful to diagnose and to determine the tendency to develop personality disorders that are pathological responses to personality characteristics. In addition, this study brings up questions such as whether the individual differences between patients with the same personality disorders can be evaluated on the basis of temperament and whether it is possible to determine therapy and treatment approaches according to an individual's temperament type.
Relation of the Nine Types of Temperament Model with personality disorders Objective: Aim of this study is to determine the correspondence between personality categories and the types making up the Nine Types of Temperament Model (NTTM) –a new temperament model which evaluates personality disorders within the context of temperament traits and maladaptive personality features-and conceptualization of NTTM types. Method: The sample group is composed of 117 participants with a personality disorder. SCID II and Nine Types of Temperament Scale (NTTS) were applied to participants. Results: According to the findings, all NTTM types have shown significant correlation with at least one personality disorder. According to the regression analysis results, it was determined that the NTTM types were explained by personality disorders at a rate of 19-41%. Conclusions: In this study, it is found that knowing the temperament features that form the basis of an individual's personality structure is helpful to diagnose and to determine the tendency to develop personality disorders that are pathological responses to personality characteristics. In addition, this study brings up questions such as whether the individual differences between patients with the same personality disorders can be evaluated on the basis of temperament and whether it is possible to determine therapy and treatment approaches according to an individual's temperament type.
Background: It is extremely important to validate psychological (psychometric) tools before use in research projects. In fact without reliable and valid psychological tools, we can not rely on research results. TCI contains subscales designed to measure seven different personality traits and characteristics. This paper presents complementary findings to a previous study. In fact, the aim of this study was to summarize a normative data of TCI for an Iranian sample of men and women with different ages. Methods: At first all research workers, who collected data in present study, were trained for the skills needed in order to communicate with the participant and to conduct the questionnaire. Randomly selected participants (n=1212) completed TCI questionnaire. Results: The results showed normative data for the subscales novelty seeking (NS), harm avoidance (HA), reward dependence (RD), persistence (Per), self directiveness (SD), cooperation (Co) and self transcendence (ST) for different gender and age classes. Conclusions: Similarities and differences of the present findings and other studies will be theoretically discussed. The sample of participants in this study allows us to generalize the collected data. The results shows that now we can benefit from using the questionnaire in Iranian society. Different applications of TCI in various clinical and normal settings will be discussed. The present results is complementary to the previous findings reported in the same journal.
Objectives : The purpose of this study is to examine the general personality profiles of patients who visited an oriental neuropsychiatric clinic and to investigate the specific profiles of patients diagnosed with Hwa-byung. Methods : We analyzed the profiles of 122 patients who completed TCI-RS questionnaire for the purpose of counseling. Patients were divided by sex, age and diagnosis related groups. Scales and subscales of each group were compared by an independent t-test and ANCOVA with SPSS windows 16.0. Types of temperament and character were classified by percentile ranks of the total patients and diagnosis related groups. Results : 1. Total patients were classified as the high harm avoidance type of temperament and of low self-directedness type of character. 2. Male patients showed significantly higher scores on NS, all subscales of NS, P2 and P3 than female patients. HA4 and C5 scores were significantly higher in the female group. Younger patients showed significantly higher scores on NS, all subscales of NS, HA1 and P3. However, older patients had significantly higher scores on SD4, SD5, ST2 and ST3. 3. Between diagnosis related groups, Hwa-byung group had significantly higher scores on RD, ST, SD3 and ST2. However P3 score of non-hwa-byung patients was higher than hwa-byung patients. In typical classification, both hwa-byung and non-hwa-byung groups were classified as the same types as total patients. Conclusions : This study showed that the patients visited an oriental neuropsychiatric clinic and had similar personality with that of general psychiatric disorders. Hwa-byung patients exhibited higher RD and ST scores than other disorders, but they had no typical differences.
Objective: Determining the type of personality traits in substance abusers may play an important role in the treatment compliance. The aims of the study were to assess the personality traits of substance abusers and to compare them with the healthy controls.
Methods: Eighty-seven male substance abusers and 50 healthy male volunteers referred to Manisa Military Hospital between February 2010 and October 2010 were enrolled in the study. Participants filled out the Temperament and Character Inventory.
Results: Significantly higher scores for novelty seeking (NS) and harm avoidance (HA), and significantly lower scores for persistence (P), self-directedness (SD), and cooperativeness (C) were detected in substance abusers than in the controls.
Conclusion: Substance abusers have distinctive temperament and character dimensions compared with the healthy controls. Further studies with larger samples are required to confirm the results of the present study.
The seven-factor biopsychosocial model of personality distinguished four biologically based temperaments and three psychosocially based characters. Previous studies have suggested that the four temperaments-Novelty Seeking (NS), Reward Dependence (RD), Harm Avoidance (HA), and Persistence (P)-have their respective neurobiological correlates, especially in the striatum-connected subcortical and cortical networks. However, few studies have investigated their neurobiological basis in the form of fiber connectivity between brain regions. This study correlated temperaments with fiber connectivity between the striatum and subcortical and cortical hub regions in a sample of 50 Chinese adult males. Generally consistent with our hypotheses, results showed that: (1) NS was positively correlated with fiber connectivity from the medial and lateral orbitofrontal cortex (mOFC, lOFC) and amygdala to the striatum; (2) RD was positively correlated with fiber connectivity from the mOFC, posterior cingulate cortex/retrosplenial cortex (PCC), hippocampus, and amygdala to the striatum; (3) HA was positively linked to fiber connectivity from the dorsolateral prefrontal cortex (dlPFC) and PCC to the striatum; and (4) P was positively linked to fiber connectivity from the mOFC to the striatum. These results extended the research on the neurobiological basis of temperaments by identifying their anatomical fiber connectivity correlates within the subcortical-cortical neural networks.
Objective: To evaluate the relationship of trauma history with alexithymia and personality dimensions in male alcohol dependent inpatients. Method: Participants were 156 consecutively admitted male alcohol dependents. Patients were investigated with the Toronto Alexithymia Scale (TAS-20), the Temperament and Character Inventory (TCI) and the Traumatic Experiences Checklist (TEC). Results: Among alcohol dependent inpatients, 49.4% (n=77) were considered as the group having trauma history according to definition of DSM-IV, although this rate was 92% according to TEC. Rate of being single and alexithymic were higher, whereas age for regular alcohol use was lower in traumatic group. Current age, employment status, and duration of education did not differ between groups. Mean scores of difficulty in identifying feelings, alexithymia total score and personality dimensions of novelty seeking, harm avoidance and self-transcendence were higher in traumatic group whereas self-directedness (S) and cooperativeness (C) were lower in this group. Lower S score was determinant for trauma history (according to the DSM-IV) in Forward Logistic Regression model, whereas lower C was determinant for number of trauma types (according to the TEC) in Stepwise Linear Regression model. Conclusions: Alexithymia, temperament and character may all be related with trauma history in male alcohol dependent inpatients. Finding low S score which predicts the presence of trauma history and low C score which predicts the severity of trauma suggest that lifetime trauma experience is related with higher probability of negative personality characteristics, although causal relationship is not clear.
The aims of this study were to examine the relationships between Cloninger's psychobiological model of personality, defense styles, and severity of grief, and to identify the influential temperament and character dimensions that differentiate subjects with prolonged grief from those without prolonged grief.
A sample of 72 bereaved elderly persons for whom the loss of a loved one occurred on average 2.58 years (SD = 1.92) prior to participation in this study were assessed using the Inventory of Complicated Grief-Revised, the Temperament and Character Inventory, and the Defense Styles Questionnaire. Using the algorithm developed by Prigerson et al. (2009) for diagnosing prolonged grief, 18 of our participants were identified as having this disorder.
A multiple regression analysis revealed that time since loss, persistence, an immature defense style, and the age of the bereaved person positively predicted severity of grief, whereas cooperativeness and the age of the deceased loved one negatively predicted severity of grief. A binary logistic regression showed that gender, a close kinship relation to the deceased, time since loss, self-directedness (SD), and self-transcendence (ST) were predictors of prolonged grief, whereas the age of the deceased and cooperativeness (CO) were negatively related to prolonged grief.
Our sample was small. Self-report measures of grief were not supplemented with clinical evaluation.
Our results suggest that only character dimensions (high SD and ST, and low CO) are involved in the psychopathology of prolonged grief. Also, according to Cloninger's character cube (Cloninger, 2004), high SD and ST scores, and low CO scores are indicative of a fanatical character.
• A systematic method for clinical description and classification of both normal and abnormal personality variants is proposed based on a general biosocial theory of personality. Three dimensions of personality are defined in terms of the basic stimulus-response characteristics of novelty seeking, harm avoidance, and reward dependence. The possible underlying genetic and neuroanatomical bases of observed variation in these dimensions are reviewed and considered in relation to adaptive responses to environmental challenge. The functional interaction of these dimensions leads to integrated patterns of differential response to novelty, punishment, and reward. The possible tridimensional combinations of extreme (high or low) variants on these basic stimulusresponse characteristics correspond closely to traditional descriptions of personality disorders. This reconciles dimensional and categorical approaches to personality description. It also implies that the underlying structure of normal adaptive traits is the same as that of maladaptive personality traits, except for schizotypal and paranoid disorders.
In order to establish new norms of the Swedish version of the Temperament and Character Inventory (TCI), data from 2,209 Swedish individuals (age between 13 and 80) was analyzed. The second aim was to evaluate the impact of age and gender on the questionnaire scores. The third aim was to investigate whether the TCI can be meaningfully applied to adolescents in personality assessment as a basis for further research and clinical studies. Age and gender showed independent effects on personality dimensions, which implies that age and gender specific norms have to be established for the TCI. Furthermore, the results in terms of inconsistencies in the correlational and factorial structure, as well as low internal consistency scores in the younger age groups, suggest that the adult version of the TCI should not be applied below the age of 17; for these age groups we recommend the use of the junior TCI (JTCI). The inventory is under further development and several items are in need of revision in order to create less complicated formulations, enabling an improvement in the psychometrics. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This review of the recent literature on personality disorders summarizes theoretical and methodologic issues, DSM-III-R criteria sets, nosological controversies, and current treatment approaches. Work in the personality disorders is burgeoning, with increasing attention to improved reliability and validity of diagnosis. Investigators are looking at such issues as the development of dimensional taxonomies, the effect of state variables, the problem of diagnostic overlap, the effect of comorbid conditions on course and treatment, the predictive power of criteria, and external validators. The DSM-III-R criteria sets, despite their polythetic format, may be no more reliable than their predecessors. Because treatment remains largely unresearched, the clinician must continue to rely on skillful assessment of each patient, with psychoanalytic psychotherapy and symptom-oriented drug trials providing the foundation of therapy.
A community sample of adults with a standardized DSM-III, Axis II self-report instrument yielded an age adjusted community prevalence of 11.1% of DSM-III personality disorders. When those with personality disorders (PDs) (n = 26) were compared to those without personality traits (n = 167) the PD group had less education 14.9 (3.0) years vs 16.5 (3.3) years, p = 0.02) and a greater percentage with difficulty with alcohol (19% vs 0.6%, p = 0.0001). Of those married, more PDs reported marital difficulties (29% vs 3.5%, p = 0.002). There was a trend for the PD group to have longer unemployment (p = 0.07).
A systematic method for clinical description and classification of both normal and abnormal personality variants is proposed based on a general biosocial theory of personality. Three dimensions of personality are defined in terms of the basic stimulus-response characteristics of novelty seeking, harm avoidance, and reward dependence. The possible underlying genetic and neuroanatomical bases of observed variation in these dimensions are reviewed and considered in relation to adaptive responses to environmental challenge. The functional interaction of these dimensions leads to integrated patterns of differential response to novelty, punishment, and reward. The possible tridimensional combinations of extreme (high or low) variants on these basic stimulus-response characteristics correspond closely to traditional descriptions of personality disorders. This reconciles dimensional and categorical approaches to personality description. It also implies that the underlying structure of normal adaptive traits is the same as that of maladaptive personality traits, except for schizotypal and paranoid disorders.
A general theory of heritable personality traits and their neurobiological basis is described. Three independent dimensions of personality are defined and related to heritable variation in patterns of response to specific types of environmental stimuli: 'novelty seeking' is due to a heritable tendency toward frequent exploratory activity and intense excitement in response to novel stimuli; 'harm avoidance' is due to a heritable tendency to respond intensely to aversive stimuli and to learn to avoid punishment, novelty, and non-reward passively; and 'reward dependence' is due to a heritable tendency to respond intensely to reward and succorance and to learn to maintain rewarded behavior. Evidence suggests that variation in each dimension is strongly correlated with activity in a specific central monoaminergic pathway: novelty seeking with low basal dopaminergic activity, harm avoidance with high serotonergic activity, and reward dependence with low basal noradrenergic activity. These neurobiological dimensions interact to give rise to integrated patterns of differential responses to punishment, reward, and novelty. The combination of high novelty seeking, high reward dependence, and low harm avoidance (histrionic personality) or the combination of high harm avoidance, low reward dependence, and low novelty seeking (obsessional personality) are each associated with information-processing patterns that lead to unreliable discrimination of safe and dangerous situations and hence to chronic anxiety. In individuals with high novelty seeking, chronic anxiety is characterized by global uneasiness or alarm without specific premonitory cues, frequent bodily pains due to low pain and sensation thresholds, low sedation threshold, and slow fatigability. In contrast, in individuals with high harm avoidance, chronic anxiety is characterized by frequent anticipatory worries based on specific cues, high pain and sedation thresholds, and easy fatigability. In response to frustrative non-reward, individuals with high reward dependence are susceptible to compensatory noradrenergic hyperactivity and hence acute or recurrent states of agitated dysphoria associated with reward-seeking behaviors such as overeating and increased sexual activity. Specific predictions are made about normal personality development as well as the development and familial aggregation of anxiety, somatoform, depressive and personality disorders. These predictions are compared with available information, and recommendations are made for future research.
We used multiaxial structured interviews and questionnaires to evaluate the ability of self-reports on seven personality dimensions to predict independent interview diagnoses of DSM-III-R personality disorders. We studied 136 consecutive adult psychiatric inpatients, excluding those with psychosis, organic mental disorders, and severe agitation. Sixty-six patients had interview diagnoses of DSM-III-R personality disorders. Most also had mood disorders. We confirmed the hypotheses that self-reports of low self-directedness and cooperativeness strongly predicted the number of personality symptoms in all interview categories, whereas the other factors distinguished among subtypes as predicted. Self-directedness and cooperativeness also predicted the presence of any personality disorder by differentiating patients varying in risk from 11% to 94%. Patients in clusters A, B, and C were differentiated by low reward dependence, high novelty seeking, and high harm avoidance, respectively. We conclude that low self-directedness and cooperativeness are core features of all personality disorders and are validly measured by the seven-factor Temperament and Character Inventory, but not the five-factor Neuroticism-Extraversion-Openness inventory. Each DSM-III-R personality disorder category is associated with a unique profile of scores in the seven-factor model, providing an efficient guide to differential diagnosis and treatment.
In this study, we describe a psychobiological model of the structure and development of personality that accounts for dimensions of both temperament and character. Previous research has confirmed four dimensions of temperament: novelty seeking, harm avoidance, reward dependence, and persistence, which are independently heritable, manifest early in life, and involve preconceptual biases in perceptual memory and habit formation. For the first time, we describe three dimensions of character that mature in adulthood and influence personal and social effectiveness by insight learning about self-concepts. Self-concepts vary according to the extent to which a person identifies the self as (1) an autonomous individual, (2) an integral part of humanity, and (3) an integral part of the universe as a whole. Each aspect of self-concept corresponds to one of three character dimensions called self-directedness, cooperativeness, and self-transcendence, respectively. We also describe the conceptual background and development of a self-report measure of these dimensions, the Temperament and Character Inventory. Data on 300 individuals from the general population support the reliability and structure of these seven personality dimensions. We discuss the implications for studies of information processing, inheritance, development, diagnosis, and treatment.
Knowledge of the prevalence and correlates of personality disorders in the community is important for identifying treatment needs and for provision of psychiatric services.
To estimate the prevalence of personality disorders in a community sample and to identify demographic subgroups with especially high prevalence.
Clinical psychologists used the International Personality Disorder Examination to assess DSM-IV and ICD-10 personality disorders in a sample of 742 subjects, ages 34-94 years, residing in Baltimore, Maryland. Logistic regression was used to evaluate the association between demographic characteristics and DSM-IV personality disorder clusters.
The estimated overall prevalence of DSM-IV personality disorders was 9%. Cluster A disorders were most prevalent in men who had never married. Cluster B disorders were most prevalent in young men without a high school degree, and cluster C disorders in high school graduates who had never married.
Approximately 9% of this community sample has a DSM-IV personality disorder. Personality disorders are over-represented in certain demographic subgroups of the community.
The validity of Cloninger's psychobiological model and the Five-Factor Model of personality to predict DSM-IV personality disorders was examined in a psychiatric in-patient sample of 130 individuals. Patients completed Dutch authorized versions of the TCI (Cloninger, Svrakic, & Przybeck, 1993) and the NEO PI-R (Costa & McCrae, 1992) and were also administered the ADP-IV (Schotte & De Doncker, 1994), a Dutch self-report questionnaire to assess Axis-II disorders. No personality-descriptive model proved to be superior in explaining personality disorder symptoms at the higher-order level: the TCI dimensions better explained the Obsessive-Compulsive and the Narcissistic disorders, whereas the FFM accounted for more variance of the Avoidant disorder. However, differences were apparent at the lower-order level with the NEO facets out performing the TCI subscales for six to four personality disorders. FFM facet-level predictions of Widiger, Trull, Clarkin, Sanderson, and Costa (2002) were partially confirmed, with substantially better results using residualized facet scores. A set of TCI subscale personality disorder relationships is suggested.
This study compared the latent structure of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition personality disorders (PDs) with the 5-factor model (FFM) of general personality dimensions. The subjects in the study were 742 community-residing individuals who participated in the Hopkins Epidemiology of Personality Disorders Study. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition PD traits were assessed by psychologists using the International Personality Disorder Examination, and PD dimensions were derived previously using dichotomous factor analysis. The Revised NEO Personality Inventory, a measure of the FFM, was administered to all subjects. The relationship between the 2 sets of personality-related constructs was examined using a construct validity framework and also using Pearson correlation coefficients, multiple linear regression models, and spline regression models. The 5 PD factors each exhibited small to moderate correlations with several NEO dimensions; together, the NEO domain and facet scores explained a fifth to a third of the variance in PD dimensions. Examples of nonlinear relationships between the personality dimensions were identified. There is a modest correspondence between the PD dimensions and FFM traits, and the traits of FFM only partially explain the variance of the PDs. Dimensional measures of general personality may be a suitable alternative to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Whether additional maladaptive traits would better define the domain of PDs remains an important objective for future research.
All human beings have spontaneous needs for happiness, self-understanding and love. In Feeling Good: The Science of Well Being, psychiatrist Robert Cloninger describes a way to coherent living that satisfies these strong basic needs through growth in the uniquely human gift of self-awareness. The scientific findings that led Dr Cloninger to expand his own views in a stepwise manner during 30 years of research and clinical experience are clearly presented so that readers can consider the validity of his viewpoint for themselves. The principles of well-being are based on a non-reductive scientific paradigm that integrates findings from all the biomedical and psychosocial sciences. Reliable methods are described for measuring human thought and social relationships at each step along the path of self-aware consciousness. Practical mental exercises for stimulating the growth of self-awareness are also provided. The methods are supported by data from brain imaging, genetics of personality, and longitudinal biopsychosocial studies. Feeling Good: The Science of Well-Being will be of value to anyone involved in the sciences of the mind or the treatment of mental disorders. It will also interest theologians, philosophers, social scientists, and lay readers because it provides contemporary scientific concepts and language for addressing the perennial human questions about being, knowledge, and conduct.
The prevalence of personality disorders as defined by DSM-III or DSM-III-R in the general population has received very insufficient study. Only for antisocial and histrionic personality disorders are epidemiological figures available. In a family study, an unscreened control sample of 109 families was assessed for lifetime diagnoses of both Axis I disorders and personality disorders. Among 452 subjects who were personally interviewed, 9.6% of the male and 10.3% of the female subjects were diagnosed as having at least one personality disorder. Compulsive, dependent, and passive-aggressive personality disorders were most frequent. Significant associations between Axis I disorders and personality disorders were observed; anxiety disorders with avoidant personality disorder, and affective disorders with borderline personality disorder. Due to the lower base rates and the reduced severity of individual disorders, these associations were less stringent than in clinical samples.
We used multiaxial structured interviews and questionnaires to evaluate the ability of self-reports on seven personality dimensions to predict independent interview diagnoses of DSM-III-R personality disorders. We studied 136 consecutive adult psychiatric inpatients, excluding those with psychosis, organic mental disorders, and severe agitation. Sixty-six patients had interview diagnoses of DSM-III-R personality disorders. Most also had mood disorders. We confirmed the hypotheses that self-reports of low selfdirectedness and cooperativeness strongly predicted the number of personality symptoms in all interview categories, whereas the other factors distinguished among subtypes as predicted. Selfdirectedness and cooperativeness also predicted the presence of any personality disorder by differentiating patients varying in risk from 11% to 94%. Patients in clusters A, B, and C were differentiated by low reward dependence, high novelty seeking, and high harm avoidance, respectively. We conclude that low self-directedness and cooperativeness are core features of all personality disorders and are validly measured by the seven-factor Temperament and Character Inventory, but not the five-factor NeuroticismExtraversion-Openness inventory. Each DSM-III-R personality disorder category is associated with a unique profile of scores in the seven-factor model, providing an efficient guide to differential diagnosis and treatment.
Four different models of Borderline Personality Disorder (BPD), each based on a different psychopathological theory, have produced manualized treatments and on this basis controlled outcome studies that evidenced their efficacy. It can be argued, on the ground of the comparable results of the outcome studies, that these different treatments share a common mechanism of action related to the same psychopathological kernel of BPD. The hypothesis that such a psychopathological kernel can be described as dissociative and caused by chronic psychological traumatization in the developmental years allows for a synthetic description of the basic psychotherapy processes allegedly shared by the four different models of BPD treatment.
Background Knowledge of the prevalence and correlates of personality disorders in the community is important for identifying treatment needs and for provision of psychiatric services.
Aims To estimate the prevalence of personality disorders in a community sample and to identify demographic subgroups with especially high prevalence.
Method Clinical psychologists used the International Personality Disorder Examination to assess DSM-IV and ICD-10 personality disorders in a sample of 742 subjects, ages 34-94 years, residing in Baltimore, Maryland. Logistic regression was used to evaluate the association between demographic characteristics and DSM-IV personality disorder clusters.
Results The estimated overall prevalence of DSM-IV personality disorders was 9%. Cluster A disorders were most prevalent in men who had never married. Cluster B disorders were most prevalent in young men without a high school degree, and cluster C disorders in high school graduates who had never married.
Conclusions Approximately 9% of this community sample has a DSM-IV personality disorder. Personality disorders are over-represented in certain demographic subgroups of the community.
Dimensional scores were computed for the 11 DSM-3 personality disorders (PDs) in 797 relatives of psychiatric patients and never ill control subjects interviewed with the Structured Interview for DSM-III Personality Disorders. The distribution of scores for all 11 PD dimensions was skewed to the right. A principal components analysis with varimax rotation produced three factors that closely corresponded to DSM-III's suggested clustering of the PDs into eccentric, dramatic, and anxious types. Men scored significantly higher on the paranoid, schizoid, compulsive, antisocial, and narcissistic dimensions, whereas women had significantly higher histrionic, dependent, and avoidant scores. Age was negatively correlated with most of the PD dimensions, and the correlations were strongest with the four PDs in cluster 2 (histrionic, antisocial, narcissistic, and borderline). Each of the eight axis I disorders examined was associated with increased axis 2 pathology.
Compared the American, Swedish, and German versions of the Temperament and Character Inventory. The samples were 150 male and 150 female Americans (mean age 34.1 yrs), 194 male and 248 female Swedes (mean age 28.4 yrs) and 189 male and 320 female Germans (mean age 38.3 yrs). Each sample was matched for age and sex. The analyses indicate a high agreement for scores on the temperament and character dimensions and subscales across the samples. Exceptions include minor differences that appear to be due to cultural variations, differences in sampling methods, and some minor difficulties with two subscales (Exploratory Excitability and Self-acceptance) as well as defining the Persistence factor as an independent dimension of Temperament. The subscales yielded similar internal consistencies, correlational structure, factor structures, and high factor congruence coefficients. The results indicate a cross-cultural transferability of the Temperament and Character dimensions of the inventory. Also, the validity and stability of the seven-factor model of personality, as suggested by C. R. Cloninger et al (1993), is supported. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Multivariate genetic analyses were applied to the six facets defining each of the five personality domains (Neuroticism, Extraversion, Openness to Experience, Agreeableness, and Conscientiousness) assessed by Costa and McCrae's Revised NEO Personality Inventory (NEO-PI-R). The analyses are designed to partition the observed covariance of facets defining each domain into their genetic and environmental bases to determine the basis for their coherence as a domain. The analyses were applied separately to a sample of 253 identical and 207 fraternal twin pairs from Canada and 526 identical and 269 fraternal pairs from Germany. Results showed that each of the NEO-PI-R domains is composed of multiple genetic and environmental factors common to the facets supporting the observed coherence of the NEO-PI-R facet sets. Differences between the German and Canadian sample appeared limited to the magnitude of the genetic and environmental effects on each facet, but not the number or type of genetic and environmental influences.
This study evaluated the extent to which the features of personality disorders are organized into the 11 diagnoses proposed by DSM-III-R. The traits composing personality disorder diagnoses were identified in earlier studies. Seventy-nine traits were required to represent personality diagnoses. Self-report scales were developed to measure each trait. The factorial structure underlying the trait scales was examined in a sample of 158 patients with a primary diagnosis of personality disorder and a sample of 274 general population subjects. Eleven principal components were extracted from each data set and were rotated to the same oblique criterion. The decision to extract 11 components was based on a priori expectations derived from DSM-III-R. Factor comparability coefficients were computed to quantify the similarity of the 2 solutions. A high degree of similarity was observed between the factor structure in the clinical and general population samples, suggesting that features of personality pathology are continuous dimensions. Although a number of factors demonstrated a degree of resemblance to some DSM-III-R diagnostic categories, the overall correspondence was not strong. A second-order factor analysis failed to reproduce the 3 Axis II diagnostic clusters. The results do not support the categorical model used in DSM-III-R and they provide only limited support for DSM-III-R diagnostic concepts.
Dimensional scores were computed for the 11 DSM-III personality disorders (PDs) in 797 relatives of psychiatric patients and never ill control subjects interviewed with the Structured Interview for DSM-III Personality Disorders. The distribution of scores for all 11 PD dimensions was skewed to the right. A principal components analysis with varimax rotation produced three factors that closely corresponded to DSM-III's suggested clustering of the PDs into eccentric, dramatic, and anxious types. Men scored significantly higher on the paranoid, schizoid, compulsive, antisocial, and narcissistic dimensions, whereas women had significantly higher histrionic, dependent, and avoidant scores. Age was negatively correlated with most of the PD dimensions, and the correlations were strongest with the four PDs in cluster 2 (histrionic, antisocial, narcissistic, and borderline). Each of the eight axis I disorders examined was associated with increased axis II pathology.
The need to define dependence arises out of accumulating evidence that it contributes to depression-proneness. Its accurate definition is therefore a prerequisite for the development of valid methods of measuring it.
Because dependence is more a feature of childhood than of adulthood, a dependent person may usefully be viewed as an adult behaving as though he were a child. Dependence is best understood therefore in terms of those developmental deficiencies from which it results. These are failure to separate successfully from the principal parent figure and from the family as a whole, failure to establish a secure personal identity, failure to acquire a general feeling of competence and a realistic assessment of self-worth and failure to feel deserving of the status of adult and to feel on equal terms with other adults.
Consequently, adult dependence is characterized by the need to stay close to others, the inclination to be primarily the recipient in interpersonal transactions and the tendency to relate to others from a position of inferiority and humility. The dependent person receives from others a borrowed identity, guidance and direction, compensation for those areas in which he is incompetent and, most important of all, acceptance, approval and affirmation of worth.
This paper attempts to construct a simplified system for the classification of personality disorders, and relates this system to normally distributed human personality characteristics. One hundred and forty-eight subjects with a variety of psychiatric diagnoses were evaluated using the SCID-II structured clinical interview for personality disorders. A four-factor solution of personality disorder symptoms was obtained and we labelled these factors 'the four As': antisocial, asocial, asthenic and anankastic. The factors related to the four temperament dimensions of the Tridimensional Personality Questionnaire (TPQ), but less closely to Eysenck Personality Questionnaire (EPQ) dimensions. The four factors were similar to those identified in a number of studies using a variety of assessment methods and this lends some credibility to our findings. It suggests that a more parsimonious set of trait descriptors could be used to provide simpler, less overlapping categories that retain links with current clinical practice. In addition, these factors can be seen as extremes of normally distributed behaviours obtained using the TPQ questionnaire.
The Temperament and Character Inventory (TCI) is a self-report personality questionnaire based on Cloninger's psychobiological model of personality, which accounts for both normal and abnormal variation in the two major components of personality, temperament and character. Normative data for the Swedish TCI based on a representative Swedish sample of 1,300 adults are presented, and the psychometric properties of the questionnaire are discussed. The structure of the Swedish version replicates the American version well for the means, distribution of scores, and relationships within the between scales and subscales. Further, the Swedish inventory had a reliable factor structure and test-retest performance. The results of this study confirm the theory of temperament and character as a seven-factor model of personality.
The last decade has seen a renewed interest and research effort focused on the broad areas of personality and personality disorder. Issues preoccupying researchers include problems of classification (especially categorical versus dimensional models), the absence of theoretical models, and implications of the suggested continuity between personality dimensions and personality disorder.
Personality psychology is as active today as at any point in its history. The classic psychoanalytic and trait paradigms are active areas of research, the behaviorist paradigm has evolved into a new social-cognitive paradigm, and the humanistic paradigm is a basis of current work on cross-cultural psychology. Biology and evolutionary theory have also attained the status of new paradigms for personality. Three challenges for the next generation of research are to integrate these disparate approaches to personality (particularly the trait and social-cognitive paradigms), to remedy the imbalance in the person-situation-behavior triad by conceptualizing the basic properties of situations and behaviors, and to add to personality psychology's thin inventory of basic facts concerning the relations between personality and behavior.
Distribution by age and sex of the dimensions of the Temperament and Character Inventory were assessed cross-culturally for samples in Sweden, Germany, and the USA. The Temperament and Character Inventory is a 240-item (Sweden, 238-item), self-administered, true-false format, paper-and-pencil test developed by Cloninger and his coworkers based on his unified biosocial theory of personality. The inventory measures the Temperament dimensions Novelty Seeking, Harm Avoidance, Reward Dependence, and Persistence as well as the Character dimensions, Self-directedness, Cooperativeness, and Self-transcendence. The samples consisted of 300 German subjects, 300 Swedish subjects, and 300 U.S. subjects matched by age cohort and sex. Stability of the personality dimensions was evaluated across samples as were their age and sex distributions. We found significant effects of age, sex, and culture in univariate and multivariate comparisons on the personality dimensions. However, several significant differences in the personality dimensions for both European samples appear to be similar compared with those of the U.S. sample. We have to conclude that sex- and age-specific norms for the dimensions of the Temperament and Character Inventory are necessary given the established significant differences.
In this paper, we explore the underlying dimensional structure of personality disorder, propose a novel approach to its diagnosis, and outline our concepts of its etiology and treatment based on the seven factor psychobiological model of temperament and character.
Temperament and character traits were evaluated in a consecutive series of 109 psychiatric out-patients, with or without personality disorder and varying mood and anxiety states.
Low scores on character dimensions consistently correlated with high symptom counts for personality disorder. Each subtype of personality disorder created a unique combination of correlations with the four temperament traits.
Temperament and Character Inventory (TCI) temperament and character traits efficiently diagnose personality disorder and differentiate its individual subtypes. Character traits are used to diagnose the presence and the severity of personality disorder, whereas temperament traits are used for differential diagnosis. The distinction between temperament and character provides an attractive theoretical basis for etiological postulates and treatment of personality disorder.
The current meta-analysis reviews research examining the relationships between each of the five-factor model personality dimensions and each of the 10 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) personality disorder diagnostic categories. Effect sizes representing the relationships between these two constructs were compiled from 15 independent samples. Results were analyzed both within each individual personality disorder category and across personality disorders, indicating how personality disorders are different and similar, respectively, with regard to underlying personality traits. In terms of how personality disorders differ, the results showed that each disorder displays a five-factor model profile that is meaningful and predictable given its unique diagnostic criteria. With regard to their similarities, the findings revealed that the most prominent and consistent personality dimensions underlying a large number of the personality disorders are positive associations with Neuroticism and negative associations with Agreeableness. Extraversion appears to be a more discriminating dimension, as indicated by prominent but directionally variable associations with the personality disorders. The implications of these meta-analytic findings for clinical application and the advancement of future research are discussed.
Virtually no research has tested alternatives to the diagnostic method used since DSM-III, which requires decisions about the presence/absence of individual diagnostic criteria, followed by counting symptoms and applying cutoffs (the count/cutoff method). This study tested an alternative, prototype matching procedure designed to simplify diagnosis. The procedure was applied to personality disorders.
A random national sample of psychiatrists and clinical psychologists (N=291) described a randomly selected patient in their care. Clinician-provided diagnostic data were used to generate categorical and dimensional DSM-IV diagnoses (number of symptoms present per disorder). Clinicians also used one of two prototype matching systems to provide a diagnosis for the selected patient.
Prototype diagnosis led to reduced comorbidity relative to DSM-IV diagnosis, yielded similar estimates of validity in predicting criterion variables (adaptive functioning, treatment response, and etiology), and outperformed DSM-IV diagnosis in ratings of clinical utility and ease of use. Adding a personality health prototype further increased prediction.
A simple prototype matching procedure provides a viable alternative for improving diagnosis of personality disorders in clinical practice. Prototype diagnosis has multiple advantages, including ease of use, minimization of artifactual comorbidity, compatibility with naturally occurring cognitive processes, and ready translation into both categorical and dimensional diagnosis.
Although empirical evidence strongly supports a dimensional representation of personality disorder, there is strong resistance to dimensional classification due in part to concerns about clinical utility. Acceptance of an evidence-based dimensional classification would be facilitated by information on how such a system would map onto existing diagnoses. With this objective in mind, an integrated framework is proposed that combines categorical and dimensional diagnoses. A two-component classification is adopted that distinguishes between the diagnosis of general personality disorder and the assessment of individual differences in the form the disorder takes. Then, the DSM definition of personality disorders is extended by defining individual disorders as categories of trait dimensions. This makes it possible to develop an integrated classification organized around a set of empirically derived primary traits. Assessments of these traits may then be combined to generate categorical and dimensional diagnoses. It is argued that this approach would introduce an etiological perspective into the classification of personality disorder and improve categorical classification by providing an explicit definition of each diagnosis. The clinical utility of incorporating a dimensional classification is discussed in terms of convenience and acceptability, value in predicting outcomes and treatment planning, and usefulness in organizing and selecting interventions.
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