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

A cluster analysis of attachment styles in patients with borderline personality disorder, bipolar disorder and ADHD

BACKGROUND

Insecure adult attachment has been associated with psychiatric disorders characterized by emotional dysregulation, such as borderline personality disorder (BPD), bipolar disorder (BD) and attention deficit/hyperactivity disorder (ADHD). However, little is known about the differences in attachment patterns between these diagnostic groups. The aim of this study was to identify clusters of adult attachment style in a cross-diagnostic group of patients with BDP and/or BD and/or ADHD and explore the characteristics of these clusters based on temperament profile, childhood trauma and psychiatric diagnoses.

METHODS

K-means cluster analysis was used to identify subgroups, based on the Attachment Style Questionnaire Short Form dimensions, in a clinical cohort of 150 young adults (113 women and 37 men, mean age ± SD = 23.3 ± 2.1) diagnosed with BPD, and/or BD, and/or ADHD.

RESULTS

Three distinct clusters were identified: a secure, an insecure/avoidant-anxious and an insecure/avoidant cluster. These three clusters differed in temperament profile and related psychiatric diagnoses.

CONCLUSIONS

The three clusters of attachment in individuals with BPD, BD and/or ADHD could support differentiation between the disorders as well provide information usable for planning of treatment.

Gut Microbiota and Fear Processing in Women Affected by Obesity: An Exploratory Pilot Study

The microbiota–gut–brain axis extends beyond visceral perception, influencing higher-order brain structures, and ultimately psychological functions, such as fear processing. In this exploratory pilot study, we attempted to provide novel experimental evidence of a relationship between gut microbiota composition and diversity, and fear-processing in obesity, through a behavioral approach. Women affected by obesity were enrolled and profiled for gut microbiota, through 16S rRNA amplicon sequencing. Moreover, we tested their ability to recognize facial fearful expressions through an implicit-facial-emotion-recognition task. Finally, a traditional self-report questionnaire was used to assess their temperamental traits. The participants exhibited an unbalanced gut microbiota profile, along with impaired recognition of fearful expressions. Interestingly, dysbiosis was more severe in those participants with altered behavioral performance, with a decrease in typically health-associated microbes, and an increase in the potential pathobiont, Collinsella. Moreover, Collinsella was related to a lower expression of the persistence temperamental trait, while a higher expression of the harm-avoidance temperament, related to fear-driven anxiety symptoms, was linked to Lactobacillus. Once confirmed, our findings could pave the way for the design of innovative microbiome-based strategies for the treatment of psychological and emotional difficulties by mitigating obesity-related consequences and behaviors.

The relationship between temperament, polygenic score for intelligence and cognition: A population-based study of middle-aged adults

We investigated whether temperament modifies an association between polygenic intelligence potential and cognitive test performance in midlife. The participants (n = 1647, born between 1962 and 1977) were derived from the Young Finns Study. Temperament was assessed with Temperament and Character Inventory over a 15-year follow-up (1997, 2001, 2007, 2012). Polygenic intelligence potential was assessed with a polygenic score for intelligence. Cognitive performance (visual memory, reaction time, sustained attention, spatial working memory) was assessed with CANTAB in midlife. The PGSI was significantly associated with the overall cognitive performance and performance in visual memory, sustained attention and working memory tests but not reaction time test. Temperament did not correlate with polygenic score for intelligence and did not modify an association between the polygenic score and cognitive performance, either. High persistence was associated with higher visual memory (B = 0.092; FDR-adj. p = 0.007) and low harm avoidance with higher overall cognitive performance, specifically better reaction time (B = -0.102; FDR-adj; p = 0.007). The subscales of harm avoidance had different associations with cognitive performance: higher "anticipatory worry," higher "fatigability," and lower "shyness with strangers" were associated with lower cognitive performance, while the role of "fear of uncertainty" was subtest-related. In conclusion, temperament does not help or hinder one from realizing their genetic potential for intelligence. The overall modest relationships between temperament and cognitive performance advise caution if utilizing temperament-related information e.g. in working-life recruitments. Cognitive abilities may be influenced by temperament variables, such as the drive for achievement and anxiety about test performance, but they involve distinct systems of learning and memory.

Short-Term Effects of a Multidisciplinary Residential Rehabilitation Program on Perceived Risks, Confidence Toward Continuous Positive Airway Pressure Treatment, and Self-Efficacy in a Sample of Individuals Affected by Obstructive Sleep Apnea Syndrome

Continuous positive airway pressure (CPAP) therapy is the standard treatment for obstructive sleep apnea (OSA) syndrome. However, optimizing adherence to CPAP therapy of individuals remains very challenging for clinicians because of the role played by the psychological components. In this study, we verified the changes in cognitions and beliefs of individuals after a four-week multidisciplinary residential rehabilitation program targeting the adaptation to CPAP therapy for OSA syndrome. We assessed the components of perceived risks, confidence toward the treatment, and self-efficacy through the self-report questionnaire, namely the Self-Efficacy Measure for Sleep Apnea (SEMSA) questionnaire. We also explored the role played by the temperamental traits on the changes registered in these components after the treatment. Forty-five participants completed the rehabilitation program, showing a higher level of adherence to the treatment. Significant changes were observed in terms of confidence toward the treatment, although no change was reported in terms of perceived risks and self-efficacy. Moreover, those individuals with a higher persistent temperamental trait reported a significant improvement in perceived risks, in the absence of other significant results. After the rehabilitation treatment, our participants were more prone to consider the effect of CPAP treatment on health outcomes. This was in line with the educational aim of the rehabilitation treatment. The temperament seemed to play only a marginal role in the global changes reported by our participants. We discussed the need for behavioral interventions, in addition to education, in improving self-efficacy.

Psychological Well-Being in Obstructive Sleep Apnea Syndrome Associated With Obesity: The Relationship With Personality, Cognitive Functioning, and Subjective and Objective Sleep Quality

Obstructive sleep apnea (OSA) syndrome severely affects psychological well-being. This syndrome frequently occurs in obesity; however, no previous study has investigated the level of psychological well-being in the case of OSA syndrome associated with obesity. In this work, we assessed the level of psychological well-being in fifty-two individuals affected by OSA syndrome and obesity through the Psychological General Well-Being Index. Moreover, we investigated the role of personality, cognitive functioning and attentional capabilities, subjective perception and objective measurement about sleeping, on the subjective perception of psychological well-being. Our sample reported a lower level of psychological well-being; the participants' scores were below the normative cut-off in all components, except for depression symptoms. A lower expression of harm avoidance temperament and a lower level of daily sleepiness predicted a higher level of psychological well-being. Psychological well-being seemed to be severely affected in individuals affected by OSA syndrome and obesity. The temperament and subjective perception of daily alertness and sleepiness, rather than the syndrome severity, seemed to play a crucial role in the individual perception of the psychological well-being.

Psychological Aspects Associated With Fertility Preservation in Oncology: An Exploratory Study

Objective

Gonadotoxicity is considered one of the most distressing side effects of cancer treatment. Although fertility preservation can be a valid solution, it also involves a challenging process. A clear understanding of the features of women who decide to pursue fertility preservation after cancer diagnosis is missing. The purpose of the present study was therefore to analyze the personality profile of female patients referred to oncofertility prior to gonadotoxic treatment.

Methods

Fifty-two female cancer patients took part in the study. The Temperament and Character Inventory-Revised (TCI-R), the Response Evaluation Measure-71 (REM-71), the Beck Depression Inventory (BDI-II), and the State-Trait Anxiety Inventory-Y Form (STAI-Y) were administered to examine personality characteristics, defense mechanisms, depression and anxiety symptoms.

Results

Compared with reference data of the Italian population, our sample reported significantly lower scores in Harm Avoidance and trait anxiety, and significantly higher levels of mature defense mechanisms. Most of the patients reported low scores in immature defense mechanisms, depression, and trait anxiety, and medium scores in state anxiety.

Conclusions

Our findings suggest that these women display functional personality traits and defensive style, in association with low levels of depression and trait anxiety. These features may enable a proactive attitude to cancer and the ability to make long-term plans. This may favor psychological adjustment to cancer and a projection toward the future.

Personality structure and attachment models of women who kill their children. A systematic review on maternal filicide

BACKGROUND

A mother's ability to attune with her child is crucial in structuring one's attachment style and personality. Both dimensions shape mother-child interactions, and they are therefore likely to impact on the risk of filicide. Numerous risk factors for filicide have been identified, but personality and attachment look relatively understudied.

OBJECTIVE

We focused on filicide mothers' personality and states of mind regarding attachment to shed new light on this phenomenon, for the purpose of an improved and earlier identification of at-risk maternities.

METHODS

A systematic review of five electronic databases was performed. All studies on filicide, infanticide or neonaticide were included in the search, regardless of the study design or the socio-demographic characteristics of the offenders.

RESULTS

Twelve original articles were found to be eligible for the systematic review. The data were categorized in personality and attachment related, and then by study design. Only two studies performed comparisons with control groups, and only three reported data about psychodiagnostic/neuropsychiatric tests or questionnaires. Personality diagnoses were strongly heterogeneous (mostly pertaining to cluster B and C), and not supported by statistically significant evidence. Attachment was examined by only one study, which showed that the most frequent states of mind regarding attachment were unresolved/unclassifiable (U/CC).

CONCLUSIONS

Despite their pivotal importance in determining relational patterns in an individual, both personality and attachment are almost unacknowledged across the literature about maternal filicide. It is thus advisable to further focus on them, carrying out structured and validated assessments, to better define the causes of this dramatic event.

Temperament, character and personality disorders

Objective

To study, whether temperament and character remain stable over time and whether they differ between patients with and without personality disorder (PD) and between patients with specific PDs.

Methods

Patients with (n = 225) or without (n = 285) PD from Jorvi Bipolar Study, Vantaa Depression Study (VDS) and Vantaa Primary Care Depression Study were interviewed at baseline and at 18 months, and in the VDS also at 5 years. A general population comparison group (n = 264) was surveyed by mail.

Results

Compared with non-PD patients, PD patients scored lower on self-directedness and cooperativeness. Cluster B and C PDs associated with high Novelty Seeking and Harm Avoidance, respectively. In logistic regression models, sensitivity and specificity of Temperament and Character Inventory (TCI) dimensions for presence of any PD were 53% and 75%, and for specific PDs from 11% to 41% and from 92% to 100%, respectively. The 18-month test-retest correlations of TCI-R dimensions ranged from 0.58 to 0.82.

Conclusions

Medium-term temporal stability of TCI in a clinical population appears good. Character scores differ markedly between PD and non-PD patients, whereas temperament scores differ only somewhat between the specific PDs. However, the TCI dimensions capture only a portion of the differences between PD and non-PD patients.

Clinical and personality characteristics of adolescents with anorexia nervosa with or without non-suicidal self-injurious behavior

PURPOSE

About one-fifth of patients with anorexia nervosa (AN) engage in non-suicidal self-injury (NSSI). This study examined clinical and temperament profile of female adolescents with both disorders (AN+NSSI) as compared with peers with AN only.

METHODS

A consecutive sample of 73 female adolescents with AN (mean age: 13.77 years), who had been admitted to inpatient or day-hospital services, received clinical, cognitive, and temperament/character evaluations. Of them, 32 met DSM-5 criteria also for NSSI. Assessments included demographics, standard nutrition parameters, Youth Self-Report (YSR), Wechsler Intelligence Scale for Children IV (WISC-IV), Temperament and Character Inventory (TCI), and Global Assessment of Functioning (GAF).

RESULTS

No differences were detected between AN+NSSI and AN in demographics, body mass index, or age at onset of AN. AN+NSSI had higher rate of binging and purging, higher YSR scores for both internalizing and externalizing psychopathology, lower total IQ, and lower Self-directedness and Cooperativeness scores.

CONCLUSIONS

These data suggest that adolescents with AN+NSSI have psychopathological, cognitive and overall character features that differ from patients with AN only. These characteristics may have implications for treatment and outcome.

Dissociative identity as a continuum from healthy mind to psychiatric disorders: Epistemological and neurophenomenological implications approached through hypnosis

The topic of multiple personality, redefined as Dissociative Identity Disorders (DIDs) in the DSM-5, is an intriguing and still debated disorder with a long history and deep cultural and epistemological implications, extending up to the idea of possession. Hypnosis is an appealing and valuable model to manipulate subjective experience and get an insight on both the physiology and the pathophysiology of the mind-brain functioning; it and has been closely connected with DIDs and possession since its origin in 18th century and as recently proved the capacity to yield a loss of sense of agency, mimicking delusions of alien control and spirit possession. In this study we report on five very uncommon "hypnotic virtuosos" (HVs) free from any psychiatric disorder, spontaneously undergoing the emergence of multiple identities during neutral hypnosis; this allowed us to check the relationship between their experience and fMRI data. During hypnosis the subjects underwent spontaneous non-intrusive experiences of other selves which were not recalled after the end of the session, due to post-hypnotic amnesia. The fMRI showed a significant decrease of connectivity in the Default Mode Network (DMN) especially between the posterior cingulate cortex and the medial prefrontal cortex. Our results and their contrast with the available data on fMRI in DIDs allows to draw the hypothesis of a continuum between healthy mind - where multiple identities may coexist at unconscious level and may sometimes emerge to the consciousness - and DIDs, where multiple personalities emerge as dissociated, ostensibly autonomous components yielding impaired functioning, subject's loss of control and suffering. If this is the case, it seems more reasonable to refrain from seeking for a clear-cut limit between normality (anyway a conventional, statistical concept) and pathology, and accept a grey area in between, where ostensibly odd but non-pathological experiences may occur (including so-called non-ordinary mental expressions) without calling for treatment but, rather, for being properly understood.

Sex differences in an old adult sample with substance use disorder: A 6 months follow-up study

Substance use disorder (SUD) is a worldwide concern that has its own particularities regarding age and sex. This study aims to assess the differences between old SUD women and men regarding socio-demographics, clinical factors and outcomes. A 6-months follow-up longitudinal study was conducted in an outpatient center, on a convenience sample of 115 SUD old adults (≥65 years old, average age of 71.57). Descriptive, bivariate, and multivariate analyses were performed. Data showed statistical significant differences between men and women related to sociodemographic variables (marital status, coexistence, criminal records and stress factors), medical and psychiatric conditions (women suffer higher rates of depression and anxiety, with worse health-related quality of life), family records (women had more presence of family psychiatric records) and SUD related parameters (men tend to use more alcohol, had an early onset, consume higher doses, report more craving and more tobacco life use while women had higher rates of prescription drugs use). At 6-month follow-up, the whole sample showed excellent rates of adherence and abstinence, without sex differences. The study points out sex differences on several sociodemographic and clinical variables, indicating their specific needs. This research could facilitate better approaches by considering a sex perspective in SUD old adults.

Psychopathological Features of Bipolar Depression: Italian Validation of the Bipolar Depression Rating Scale (I-BDRS)

Background: Aim of the study was the validation of the Bipolar Disorder Rating Scale (BDRS) in an Italian population. Secondary aim was the evaluation of differences between unipolar and bipolar depression and between bipolar I and II depressed patients.

Method: 125 Bipolar Disorder and 60 Major Depressive Disorder patients were administered an Italian translation of the BDRS (I-BDRS), Hamilton Depression Rating Scale (HDRS), Montgomery-Asberg Depression Rating Scale (MADRS), Young Mania Rating Scale (YMRS) and Temperament and Character Inventory-Revised (TCI-R).

Results: I-BDRS showed considerable validity and reliability. Factor analysis found 3 subscales, two linked to depressive symptoms and one to mixed symptoms. Measures concerning depression (MADRS and HAM-D) were positively related to the I-BDRS's subscales, but mostly to the two subscales measuring depression. In mixed symptoms, the mean of the bipolar group was significantly higher than the unipolar group suggesting that the BDRS was able to distinguish between unipolar and bipolar depressed patients.

Conclusion: I-BDRS is a valid scale for the measurement of depression in BD patients, with a notable internal consistency (Cronbach's α 0.82), a significant consistency between items/total (Cronbach's α from 0.80 to 0.82) and positive correlation with other scales (MADRS r = 0.67, p < 0.001; HDRS r = 0.81, p < 0.001; YMRS r = 0.46 p < 0.0001). The mixed state sub-scale shows usefulness in differentiating bipolar from unipolar patients. I-BDRS could be a sensitive tool, both in pure depression and in mixed states, and could be used in the everyday screening and treatment of Bipolar Disorder.

Emotional eating and temperamental traits in Eating Disorders: A dimensional approach

Growing evidence shows that temperamental features and emotional dysregulation are linked to Eating Disorders (EDs). Aim of this study was to explore the possible relationship between temperament and emotional eating (EE) from a dimensional standpoint, and the association of specific temperamental dimensions with overeating triggered by specific emotions. We enrolled 253 women with Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder. Of those, 189 (74.7%), 73 (28.8%), and 80 (31.6%) reported binge eating, purging, or restrictive behaviors, respectively (the categories are not mutually exclusive). Participants completed the Emotional Eating Scale (EES), the Temperament and Character Inventory, the Eating Disorder Examination Questionnaire (EDE-Q) and the Symptom Checklist 90-Revised (SCL-90-R). Higher Persistence scores were found in the Restriction group, while the Binge group reported lower Persistence and higher Novelty Seeking scores. The Purge group showed lower Reward Dependence, Self Directedness and Cooperativeness scores. Patients with Purge also reported lower BMI and higher scores on EDE-Q restriction and eating concern subscales as well as higher scores for all SCL 90-R subscales. Patterns of association between temperamental traits and specific emotions were found in each group. Therefore, some temperamental features could be considered predictors of specific associations between emotions and the tendency to eat.

Temperament and Character Traits Associated with Health-Related Quality of Life in Cancer Patients

Background

There is an increase in the attention to factors influencing the quality of life of cancer patients. The aim of the present study was to evaluate temperament and character traits related to health-related quality of life (HRQoL) in patients with cancer.

Methods

Two hundred and three inpatients from three Italian oncology departments filled in the Temperament Character Inventory (TCI-140) based on Cloninger's personality model, the SF-36 questionnaire assessing HRQoL, and the Hospital Anxiety and Depression Scale (HADS). Eighty percent of patients were undergoing chemotherapy.

Results

Lower levels of harm avoidance and higher levels of self-directedness were significantly correlated with a better HRQoL. Regression analysis controlling for psychopathology (anxiety and depression symptoms) showed that the influence of temperament and character traits on quality of life seemed to add little to the influence of psychopathology.

Conclusions

The present study demonstrates the existence of some relations between HRQoL and temperament and character traits assessed using the TCI-140 questionnaire. However, among the psychological factors, psychopathology seems to retain more influence on HRQoL of cancer patients.

The Psychometrics of the European Portuguese Version of the Temperament and Character Inventory-Revised

Cloninger's psychobiological model of personality integrates contributions from behavioral genetics, neurobiology, and psychology in the description of the human personality. The temperament and character inventory (TCI) is its assessment instrument. The Brazilian Portuguese version of the TCI has shown good psychometric properties. However, Portuguese spoken in Brazil presents marked and substantial differences to that spoken in Portugal, and no study has yet described the psychometrics of the European Portuguese version. The objective of this study was thus to describe the psychometric properties of the European Portuguese adult version of the TCI (the temperament and character inventory-revised (TCI-R)). This study involved 1400 Portuguese adult participants. The factorial structure of the European Portuguese version was tested using four methods: exploratory factor analysis, orthogonal procrustes rotation analysis, confirmatory factor analysis, and exploratory structural equation modeling. The integration of data coming from these methods suggested that the Portuguese version of the TCI-R presented good structural validity (as revealed by the emergence of the temperament and character structures predicted by theory) and high levels of congruence between the American and the Portuguese versions. An improvement in the goodness of fit of the models for the Portuguese population was achieved by using exploratory structural equation modeling over confirmatory factor analysis. Although some facets registered questionable consistency, all dimensions had acceptable to good consistency (all ≥ .79). These results confirm the validity of the Portuguese TCI-R and its adequacy for use in European Portuguese samples.

Personality and trait aggression profiles of male and female prison inmates

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.

Behavioral activation and inhibition system's role in predicting addictive behaviors of patients with bipolar disorder of Roozbeh Psychiatric Hospital

Background:

Nowadays, prevalence of addictive behaviors among bipolar patients is considered to be a serious health threat by the World Health Organization. The aim of this study is to investigate the role of behavioral activation and inhibition systems in predicting addictive behaviors of male patients with bipolar disorder at the Roozbeh Psychiatric Hospital.

Materials and Methods:

The research method used in this study is correlation. The study population consisted of 80 male patients with bipolar disorder referring to the psychiatrics clinics of Tehran city in 2014 who were referred to the Roozbeh Psychiatric Hospital. To collect data, the international and comprehensive inventory diagnostic interview, behavioral activation and inhibition systems scale, and addictive behaviors scale were used.

Results:

The results showed that there is a positive and significant relationship between behavioral activation systems and addictive behaviors (addictive eating, alcohol addiction, television addiction, cigarette addiction, mobile addiction, etc.). In addition, correlation between behavioral inhibition systems and addictive behaviors (addictive eating, alcohol addiction, TV addiction, cigarette addiction, mobile addiction) is significantly negative. Finally, regression analysis showed that behavioral activation and inhibition systems could significantly predict 47% of addictive behaviors in patients with bipolar disorder.

Conclusions:

It can be said that the patients with bipolar disorder use substance and addictive behaviors for enjoyment and as pleasure stimulants; they also use substances to suppress unpleasant stimulants and negative emotions. These results indicate that behavioral activation and inhibition systems have an important role in the incidence and exacerbation of addictive behaviors. Therefore, preventive interventions in this direction seem to be necessary.

Age and Sex Differences in Temperament and Character Dimensions in a French Nonclinical Population

Abstract. The authors examined age and sex trends on the seven dimensions and 25 facets assessed by the Temperament and Character Inventory (TCI) collected between 2006 and 2014. This cross-sectional study sought to better understand personality differences according to age and sex cohorts in a French nonclinical community sample (1,181 participants). Our results show significant differences in age groups in Novelty Seeking, Reward Dependence, Harm Avoidance, and Self-Transcendence. Women scored higher than men in Harm Avoidance, Reward Dependence, and Cooperativeness. Men between 18 and 29 years old reported higher Novelty Seeking whereas older women had higher Harm Avoidance. Among all the dimensions of the TCI, only Self-Directedness presents a consistent Gender × Age interaction. Our study confirmed that there were personality-specific features in men and women. In addition, there were personality changes with age in both temperament and character dimensions. Our research highlighted the need to take into account both age and gender of subjects in the future analyses and interpretations of findings from the temperament and character inventories.

Personality in women with endometriosis: temperament and character dimensions and pelvic pain

STUDY QUESTION

Is pelvic pain due to endometriosis associated with temperament and character dimensions?

SUMMARY ANSWER

Women with endometriosis and pelvic pain do not clearly exhibit a specific personality profile; however, personality is associated with pelvic pain perception.

WHAT IS KNOWN ALREADY

There is research evidence suggesting that endometriosis patients with pelvic pain are more likely to present psychological disruption. Little is known about the association between subjective factors, such as personality traits, and pelvic pain.

STUDY DESIGN, SIZE, DURATION

This cross-sectional study (N = 133) is part of a larger research on the association between endometriosis and several psychological variables carried out between 2012 and 2014.

PARTICIPANTS/MATERIALS, SETTINGS, METHODS

The participants were 82 endometriosis patients and 51 healthy controls. Endometriosis patients indicated on a dichotomous scale (yes/no) whether they were suffering from pelvic pain and were divided in two study groups: painful endometriosis group (N = 58) and pain-free endometriosis group (N = 24). The severity of pelvic pain (chronic pelvic pain, dysmenorrhoea, dyspareunia, and dyschezia) was rated on a 0-10 point numerical rating scale. All participants completed a 240-item psychometric test (TCI-R) evaluating personality in terms of temperament and character dimensions.

MAIN RESULTS AND THE ROLE OF CHANCE

Women with painful endometriosis had lower novelty seeking compared with the control group (P = 0.017) and higher harm avoidance (P = 0.007) and lower exploratory excitability (P = 0.034) and responsibility (P = 0.027) compared with the pain-free endometriosis group, as well as higher fatigability compared with the pain-free endometriosis group (P = 0.001) and the control group (P = 0.032). Higher harm avoidance (B = 0.081; P = 0.002) and lower self-directedness (B = -0.053; P = 0.015) were associated with a greater severity of chronic pelvic pain.

LIMITATIONS, REASONS FOR CAUTION

These study findings should be taken cautiously for several methodological reasons such as small sample size, differences in group sizes and cultural homogeneity. More research is needed to further investigate the association between personality and pelvic pain related to endometriosis.

WIDER IMPLICATIONS OF THE FINDINGS

Our findings suggest new avenues for future research and treatment of endometriosis. The association between the severity of chronic pelvic pain and personality may help clarify the lack of a direct correlation between pain severity and the type and stage of endometriosis, as well as the inconsistencies in patients' response to medical and/or surgical treatment. Therapeutic strategies should be specifically targeted on individual women and involve an integrated approach to the treatment of chronic pelvic pain related to endometriosis.

STUDY FUNDING/COMPETING INTERESTS

There was no external funding for this study and the authors have no conflicts of interest.

TRIAL REGISTRATION NUMBER

Not applicable to this study.

Psychometric properties of the Greek TCI-R and its clinical correlates: schizotypy and the self-regulation of affective and cognitive functioning

Background. The revised Temperament and Character Inventory (TCI-R) measures Cloninger’s psychobiological model of personality. The average effects of individual temperament and character traits have been associated with schizotypy and with impaired regulation of affect and cognition. We extended prior research by testing predictions about the association of specific multidimensional configurations of temperament and character traits on schizotypy, affect balance, and self-perceived cognitive functioning.

Method. A well-educated sample of native Greeks (N = 483), completed a new Greek translation of the TCI-R, as well as the Schizotypal Personality Questionnaire (SPQ), the Positive/Negative Affect Schedule (PANAS) and the Cognitive Failures Questionnaire (CFQ). The factor structure of the TCI-R was examined with exploratory and confirmatory tests. Associations between reported measures were examined with correlational and regression analyses.

Results. The TCI-R had good psychometric properties as expected from studies in other countries. As predicted, specific configurations of temperament and character were associated with schizotypy, negative affect balance, and cognitive lapses. The “Borderline/Explosive temperament” (high Novelty Seeking, high Harm Avoidance, low Reward Dependence), “Schizotypal/Disorganized character” (low Self-directedness, low Cooperativeness, high Self-transcendence), and “Low Ego Strength/Fragile” profile (high Harm Avoidance, low Persistence, low Self-Directedness) were each strongly associated with higher stereotypy, negative affect balance (low positive affect and high negative affect), and subjective cognitive lapses compared to their contrast groups.

Discussion. Multidimensional TCI profiles are strongly related to individual differences in schizotypy and self-reported regulation of affect and cognition. The Greek translation of the TCI-R is psychometrically sound and useful for clinical assessment and research.

The revised Temperament and Character Inventory: normative data by sex and age from a Spanish normal randomized sample

Objectives. The psychometric properties regarding sex and age for the revised version of the Temperament and Character Inventory (TCI-R) and its derived short version, the Temperament and Character Inventory (TCI-140), were evaluated with a randomized sample from the community. Methods. A randomized sample of 367 normal adult subjects from a Spanish municipality, who were representative of the general population based on sex and age, participated in the current study. Descriptive statistics and internal consistency according to α coefficient were obtained for all of the dimensions and facets. T-tests and univariate analyses of variance, followed by Bonferroni tests, were conducted to compare the distributions of the TCI-R dimension scores by age and sex. Results. On both the TCI-R and TCI-140, women had higher scores for Harm Avoidance, Reward Dependence and Cooperativeness than men, whereas men had higher scores for Persistence. Age correlated negatively with Novelty Seeking, Reward Dependence and Cooperativeness and positively with Harm Avoidance and Self-transcendence. Young subjects between 18 and 35 years had higher scores than older subjects in NS and RD. Subjects between 51 and 77 years scored higher in both HA and ST. The alphas for the dimensions were between 0.74 and 0.87 for the TCI-R and between 0.63 and 0.83 for the TCI-140. Conclusion. Results, which were obtained with a randomized sample, suggest that there are specific distributions of personality traits by sex and age. Overall, both the TCI-R and the abbreviated TCI-140 were reliable in the 'good-to-excellent' range. A strength of the current study is the representativeness of the sample.

Temperament and character profiles in bipolar I, bipolar II and major depressive disorder: Impact over illness course, comorbidity pattern and psychopathological features of depression

BACKGROUND

Studies comparing temperament and character traits between patients with mood disorders and healthy individuals have yielded variable results.

METHODS

The Temperament and Character Inventory (TCI) was administered to 101 bipolar I (BP-I), 96 bipolar II (BP-II), 123 major depressive disorder (MDD) patients, and 125 HS. A series of generalized linear models were performed in order to: (a) compare the TCI dimensions across groups; (b) test any effect of the TCI dimensions on clinical features of mood disorders; and (c) detect any association between TCI dimensions and the psychopathological features of a major depressive episode. Demographic and clinical variables were also included in the models as independent variables.

RESULTS

Higher Harm Avoidance was found in BP-II and MDD, but not in BP-I. Higher Self-Transcendence was found in BP-I. Our models also showed higher Self-Directedness in HS, either vs MDD or BP-II. No association was found between any TCI dimension and the severity of symptoms. Conversely, a positive association was found between Harm Avoidance and the overall burden of depressive episodes during lifetime.

LIMITATIONS

The cross-sectional design and the heterogeneity of the sample may be the main limitations of our study.

CONCLUSION

In general, our sample seems to support the view of a similar profile of temperament and character between MDD and BP-II, characterized by high Harm Avoidance and low Self-Directedness. In contrast, patients with BP-I only exhibit high Self-Transcendence, having a near-normal profile in terms of Harm Avoidance or Self-Directedness.

Might the temperament be a bias in clinical study on attention-deficit hyperactivity disorder (ADHD)?: Novelty Seeking dimension as a core feature of ADHD

Some clinical studies on attention deficit hyperactivity disorder (ADHD) have been found to overlap those of studies on personality, particularly those on the Novelty Seeking trait (NS) as measured by the Junior Temperament and Character Inventory (JTCI). The aim of this study was to evaluate the potential role of NS in clinical research on ADHD. We enroled 146 ADHD children (125 boys; mean age=9.61, S.D.=2.50) and 223 age- and gender-matched control children (178 boys; mean age=9.41, S.D.=2.30). All the parents filled in the JTCI for the evaluation of personality according to Cloninger׳s model. An exploratory factor analysis differentiated the NS items that concern "Impulsivity" (NS1) from those that concern other features (NS2). Multivariate Analysis of Variance (MANOVAs) revealed significant differences between ADHD children and non-ADHD children in temperamental dimensions: the scores of ADHD children were higher than those of non-ADHD children in Total NS, NS1-Impulsivity and NS2. Our results show that the NS dimension of the JTCI in ADHD children is higher than in non-ADHD children, even when a correction is made for impulsivity items. This finding suggests that the NS trait plays a central role in ADHD diagnosis even when items referred to impulsivity are removed from the NS scale.

Validation of the Italian translation of the Revised Temperament and Character Inventory--TCI-140--in adult participants and in participants with medical diseases

INTRODUCTION

This study aimed at assessing the reliability and construct validity of the TCI-140.

SAMPLE

428 Italian participants.

EXCLUSION CRITERIA

psychiatric disorders. 100 subjects - longitudinal retest study.

RESULTS

The results of descriptive statistics of internal consistency reliabilities (Cronbach coefficient) of TCI-R dimensions showed: a strong internal consistence of the scales: HA (α = 0.84); RD (α = 0.70); SD (α = 0.86); C (α = 0.75); ST (α = 0.83); a low level in NS (α = 0.60). In relation to facets, internal consistency reliabilities (Cronbach coefficient) ranged from 0.14 C3 to 0.79 C4 (from 3rd to 4th facet of C scale). Correlations: highest inverse correlation between HA and SD (r = -0.56); moderate inverse correlations for: HA and PS (r = -0.37); C and RD(r = 0.32); C and SD (r = 0.44). P, SD, C and ST showed good inter class correlations (ICC) ≥ 70 maintaining a good stability of the measures over the time. Four factors accounted for 56.3% of the variance for temperament subscale. Subscales of: PS4, PS3 PS2, PS1, NS3 for factor 1; HA2, HA1, HA4, HA3 for factor 2; RD1, RD2 and RD3 for factor 3; NS4, NS1 and NS2 for factor 4. Three factors that were identified accounted for 58.3% of the variance for character subscales of: SD3, SD5, SD1, SD2 for factor 1; C4, C1, C5, SD4, C3 for factor 2; ST2, ST1, ST3, C2 for factor 3.

CONCLUSION

The reliability coefficients were significantly good for some dimensions of TCI-140 and showed a good correlation after time, while some dimensions as NS have low reliability. In the principal components analysis does not saturate all dimensions in its theoretical factor. Moreover TCI-140 is a useful inventory for the evaluation of the principal dimensions of temperament and character.

A perfect childhood? Clinical correlates of minimization and denial on the childhood trauma questionnaire

Childhood trauma has pervasive and enduring effects on myriad health outcomes, and the Childhood Trauma Questionnaire (CTQ) is a widely used screening tool. To assess recall and reporting biases, the CTQ includes a Minimization/Denial (MD) Scale, although this scale is typically omitted or not reported on. As this practice is not supported by empirical data, we sought to examine the clinical correlates of the CTQ MD Scale, as well as its function as a response bias index (i.e., its moderation effects). We examined correlations between the MD Scale and attachment style, temperament, personality, depression, and clinical diagnoses in a group of 200 adult psychiatric outpatients. Regression analyses were performed to assess the impact of MD on the relationships between the CTQ and clinical variables. Twenty percent of our sample met MD criteria. When patients were grouped as MD-positive versus MD-negative, significant between-group differences were found on several clinical measures. MD status, however, did not significantly moderate the relationships between the CTQ and clinical variables. This is one of the first clinically focused examinations of the CTQ's MD Scale. Although the MD Scale was associated with several clinical variables, it did not significantly moderate the relationship between the CTQ and clinical variables. These findings, therefore, call into question the value of the MD Scale as a response bias index, although they should be replicated in larger studies before the currently ubiquitous practice of ignoring it can be considered evidence-based.

Co-occurrence of alcohol use disorder and behavioral addictions: relevance of impulsivity and craving

PURPOSE

The aims of the study were to evaluate the occurrence of behavioral addictions (BAs) in alcohol use disorder (AUD) subjects and to investigate the role of impulsivity, personality dimensions and craving.

METHODS

95 AUD outpatients (DSM-5) and 140 homogeneous controls were assessed with diagnostic criteria and specific tests for gambling disorder, compulsive buying, sexual, internet and physical exercise addictions, as well as with the Barratt Impulsiveness Scale (BIS-11) and Temperamental and Character Inventory-Revised (TCI-R). The Obsessive Compulsive Drinking Scale (OCDS) and Visual Analogue Scale for craving (VASc) were also administered to the AUD sample.

RESULTS

28.4% (n=27) of AUD subjects had at least one BA, as compared to 15% (n=21) of controls (χ(2)=6.27; p=.014). In AUD subjects, direct correlations between BIS-11 and Compulsive Buying Scale (CBS), Internet Addiction Disorder test (IAD), Exercise Addiction Inventory-Short Form (EAI-SF) scores (p<.01), between OCDS obsessive and CBS and VASc and CBS, IAD scores (p<.003), were found. BIS-11 (t=-2.36; p=.020), OCDS obsessive (Z=-4.13; p<.001), OCDS compulsive (Z=-2.12; p=.034) and VASc (Z=-4.94; p<.001) scores were higher in AUD subjects with co-occurring BAs. The occurrence of BAs was associated with higher impulsivity traits (BIS-11 scores; OR=1.08; p=.012) and higher craving levels (VASc scores; OR=2.48; p<.001).

CONCLUSIONS

Our findings emphasize a significant rate of co-occurrence of BAs in AUD. High levels of impulsivity and craving for alcohol seem to be associated with other addictive behaviors.

Temperament and character dimensions assessed in general population, in individuals with psychoactive substance dependence and in young male conscripts

BACKGROUND

In this work we consider Cloninger's psychobiological model, which measures two dimensions of personality: character and temperament. Temperament refers to the biological basis of personality and its characteristics, while character refers to an individual's attitudes towards own self, towards humanity and as part of the universe.

METHODS

The Temperament and Character Inventory-Revised-140 (TCI-R-140) was administered to 3 divergent samples: a general population sample, a sample of male conscripts and a sample of individuals attending a substance abuse rehabilitation programme. Score differences among the three samples were assessed controlling for age and gender and reliability coefficients are reported. The latent structure was studied in all samples, using exploratory and confirmatory factor analysis methods (EFA and CFA respectively).

RESULTS

The proposed structure was partially replicated via EFA. CFA however indicated less than satisfactory fit, as in previously reported results. To improve the fit, the path diagram was augmented to account for multiple factor complexity, as suggested by the EFA results in all samples. While retaining the original seven-factor structure, the augmented model provided adequate fit. The consistency of the inventory was satisfactory in all samples. Evidence for the construct validity was found in relation to aggression.

CONCLUSIONS

This is the first study to conclude in adequate fit, after allowing for the indicators to load on more than one factor within each dimension. While cross-national differences apply, our results were similar (when comparable) with previously reported ones in the literature.

Psychometric properties and factor structure of the Temperament and Character Inventory-Revised (TCI-R) in a Croatian psychiatric outpatient sample

OBJECTIVE

The goal of this study was to investigate psychometric properties and factorial structure of the Croatian adaptation of the Temperament and Character Inventory-Revised (TCI-R) in a sample of psychiatric outpatients (n=328).

METHOD

The participants filled out the TCI-R, as well as self-report measures of the Big-Five personality traits (IPIP-50), trait impulsivity (BIS-11), depression (BDI-II), suicidality (SBQ-R), and life satisfaction (SWLS). We explored the internal consistency of 7 domains and 29 subscales and compared it with the Croatian version of the original TCI used in prior studies. Principal component analysis with promax rotation was conducted on temperament and character subscales separately, while concurrent validity was examined through the TCI-R's relations with the abovementioned psychological measures.

RESULTS

The TCI-R scales showed adequate internal consistencies, with Cronbach's alpha values ranging from 0.77 to 0.93. The internal consistency showed to be higher in comparison with the Croatian version of the original TCI. The postulated four-factor structure of temperament and the three-factor structure of character were confirmed. The meaningful associations with other measures supported the concurrent validity of the TCI-R.

CONCLUSION

The Croatian adaptation of the TCI-R exhibited satisfactory reliability and validity in a sample of psychiatric outpatients. These findings support the use of the TCI-R in Croatian clinical settings over its predecessor (TCI).

Childhood trauma, temperament, and character in subjects with major depressive disorder and bipolar disorder

In nonclinical samples, childhood trauma (CT) has been found to negatively affect temperament/character traits. In major depressive disorder (MDD) and bipolar disorder (BD), abnormal personality traits have been found to impair clinical course/treatment outcome. Although a link between CT and MDD/BD is firmly established, no previous studies explored the relationship between CT and temperament/character in these populations. We investigated this issue in a preliminary sample of inpatients with MDD (n = 29) or BD (n = 50). We assessed CT (sexual/physical/emotional abuse, physical/emotional neglect) (Childhood Trauma Questionnaire), personality traits (Temperament and Character Inventory-Revised version), and illness severity (Brief Psychiatric Rating Scale). We found significant (p < 0.01) associations between emotional neglect, emotional abuse, physical neglect, and low self-directedness (SD). Potential underlying mechanisms are discussed. Because low SD has been previously associated with illness severity and poor outcome, the relationship between CT and low SD might partly explain the well-known negative impact of CT on course and outcome of MDD/BD.

Adult separation anxiety and TCI-R personality dimensions in patients with anxiety, alcohol use, and gambling: a preliminary report

Background. Nowadays, adult separation anxiety disorder (ASAD) is an established diagnostic category but is little investigated in subjects with addictive behaviours. Objective. To assess the presence of ASAD among patients with addictive disorders in comparison with anxiety patients and measure the personality correlates in all these groups. Methods. 103 outpatients, meeting DSM-IV-TR criteria for anxiety disorders (38 patients), alcohol dependence (30 patients), or pathological gambling (35 patients), were assessed by the Structured Clinical Interview for Separation Anxiety Symptoms (SCI-SAS) and the Adult Separation Anxiety Checklist (ASA-27) for separation anxiety and by the Temperament and Character Inventory-Revised (TCI-R) for personality characteristics. Results. ASAD is detected in 34.2% of anxiety patients, 13.3% of alcoholics, and 11.4% of gamblers. Separation anxiety scores correlate positively with harm avoidance and negatively with self-directedness in all groups; further correlations are seen among addictive patients only, that is, self-transcendence for gamblers and cooperativeness for both alcoholics and gamblers. Conclusions. The prevalence of ASAD is lower among addictive patients than in those with anxiety disorders; correlations are found between separation anxiety and specific TCI-R dimensions, with some matching across the three diagnostic groups.

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

BACKGROUND

Impulsivity is closely related to substance use and abuse, both as a contributor to use and as a consequence of use. Particular dimensions of temperament and character were reported to be associated with trait impulsivity in different populations.

AIM

The aim of the present study was to evaluate the relationship of personality dimensions with impulsivity among men with alcohol dependence. Also we wanted to control the effect of depression and anxiety symptoms on this relationship.

METHODS

Participants were consecutively admitted male alcohol-dependent inpatients (n = 94) and healthy controls (n = 63). Patients were investigated with the Barratt Impulsiveness Scale, version 11 (BIS-11), the Temperament and Character Inventory (TCI) and the Symptom Checklist-Revised (SCL-90-R).

RESULTS

Severity of impulsivity and dimensions of impulsivity were higher in alcohol-dependent inpatients than in healthy controls. Impulsivity was negatively correlated with reward dependence, persistence, self-directedness and cooperativeness, but positively correlated with novelty seeking, harm avoidance, depression and anxiety. Although high depression and temperament dimensions (high novelty seeking, harm avoidance and low reward dependence) predicted impulsivity, combinations of personality dimensions that predict dimensions of impulsivity differed.

CONCLUSIONS

RESULTS may suggest that together with depression when impulsivity is the problem, both dimensions of impulsivity and personality must be evaluated and the treatment should be shaped accordingly for alcohol-dependent inpatients.

Food choice in disorders of eating behavior: correlations with the psychopathological aspects of the diseases

Eating disorders (ED) are characterized by alterations in food choice and in the quantity and quality of nutrient intake. In a population of 124 female patients with ED (anorexia nervosa restricting subtype [AN-R, n=37]; AN bingeing-purging subtype [AN-BP, n=18]; bulimia nervosa purging subtype [BN-P, n=40]; and binge eating disorder [BED, n=29]) and healthy age-matched controls ([C], n=20) we compared food choice and macronutrient intake with psychopathologic symptoms of the disorders. Data were collected from the probands' 7-day food diaries and the scores from two assessment scales (Eating Disorder Inventory-2 [EDI-2] and Temperament and Character Inventory-revised [TCI-R]) that measure symptom domains, dimensions of personality and character dimensions, respectively. Multiple regression analysis was applied to the nutritional data and scale scores. When compared to the values for the control group, intake of animal proteins (grams) was significantly lower for all patient groups, intake of lactoproteins was lower for the AN-R and AN-BP than BN-P and BED groups, intake of vegetal proteins was higher for the AN-R, AN-BP, BN-P and BED groups, intake of dietary fats was lower for the AN-R and AN-BP subtype groups, and intake of total carbohydrates and oligosaccharides was lower for the AN-R and AN-BP groups, and oligosaccharides also for the BED, when calculated in grams but not when expressed in percent. When studied as percent values animal proteins were lower in patients than in controls, lactoprotein in BN-P and BED, vegetal proteins higher in all the patients, fat lower in AN-R and AN-BP, while carbohydrates did not differ between patients and controls. Significant correlations emerged between food choice and TCI-R and EDI-2 scale scores. Food choice in ED might depend on alterations in neurotransmitter peptides, neuropeptides, and peripheral peptides, which regulate and are regulated by macronutrient intake and underlie psychological and temperamental alterations.

Co-morbid anxiety disorders predict early relapse after inpatient alcohol treatment

INTRODUCTION

Alcohol dependence and anxiety disorders often co-occur. Yet, the effect of co-morbid anxiety disorders on the alcohol relapse-risk after treatment is under debate. This study investigated the effect of co-morbid anxiety disorders on relapse rates in alcohol dependence. We hypothesized that co-morbid anxiety disorders would be particularly predictive for early relapse, but not late relapse.

SUBJECTS AND METHODS

In a prospective design, male alcohol dependent patients (n=189) were recruited from an inpatient detoxification clinic. Psychiatric diagnoses and personality traits were assessed using the Mini International Neuropsychiatric Interview for psychiatric disorders and the Temperament and Character Inventory. The addiction severity index was used to assess addiction severity and follow-up.

RESULTS

One year after detoxification, 81 patients (53%) relapsed and nine patients (7%) were deceased, due to alcohol related causes. Co-morbid anxiety disorder, marital status, addiction severity, in particular legal problems, and harm avoidance predicted relapse. Anxiety disorders specifically predicted early relapse.

CONCLUSION

Alcohol dependence is a severe mental disorder, with high relapse rates and high mortality. Alcohol dependent patients with co-morbid anxiety disorders are particularly prone to relapse during the first three months of treatment. These patients may therefore require additional medical and psychological attention.

Maturity and change in personality: developmental trends of temperament and character in adulthood

We studied the developmental trends of temperament and character in a longitudinal population-based sample of Finnish men and women aged 20-45 years using the Temperament and Character Inventory model of personality. Personality was assessed in 1997, 2001, and 2007 (n = 2,104, 2,095, and 2,056, respectively). Mean-level changes demonstrated qualitatively distinct developmental patterns for character (self-directedness, cooperativeness, and self-transcendence) and temperament (novelty seeking, harm avoidance, reward dependence, and persistence). Character developed toward greater maturity, although self-transcendence decreased with age. However, self-transcendence was the strongest predictor of overall personality change. Cohort effects indicated lower level of self-transcendence and higher level of self-directedness and cooperativeness in younger birth cohorts. Regarding temperament, novelty seeking decreased and persistence increased slightly with age. Both high novelty seeking and high persistence predicted overall personality change. These findings suggest that temperament and character traits follow different kinds of developmental trajectories.

Attachment, affective temperament, and personality disorders: a study of their relationships in psychiatric outpatients

BACKGROUND

As the result of extensive translational and cross-disciplinary research, attachment theory is now a construct with significant neuropsychiatric traction. The correlation of attachment with other influential conceptual models (i.e. temperament and personality) is therefore of interest. Consequently, we explored how two attachment dimensions (attachment anxiety and attachment avoidance) correlated with measures of temperament and personality in 357 psychiatric outpatients.

METHODS

We performed a retrospective review of four questionnaires (the Experiences in Close Relationship scale (ECR-R), Temperament and Character inventory (TCI), Temperament Evaluation of the Memphis, Pisa, Paris and San Diego questionnaire (TEMPS-A), and Personality Self-Portrait Questionnaire (PSQ)). Frequency measures and correlations were examined, as was the predictive value of attachment security for a personality disorder (PD).

RESULTS

Significant, robust correlations were found between attachment anxiety and (1) several negative affective temperaments (dysthymic and cyclothymic); (2) several indices of personality pathology (low self-directedness (TCI), DSM-IV paranoid, borderline, histrionic, avoidant and dependent personality traits). Attachment avoidance had fewer large correlations. In an exploratory model, the negative predictive value of attachment security for a PD was 86%.

LIMITATIONS

Subjects were a relatively homogeneous subset of ambulatory psychiatric outpatients. PD diagnoses were via self-report.

CONCLUSIONS

Clinically, these findings highlight the significant overlap between attachment, affective temperament, and personality and support the value of attachment as a screen for PDs. More broadly, given our growing understanding of the neurobiology of attachment (i.e. links with the oxytocin system), these results raise interesting questions about underlying biological systems and psychiatric treatment.

Affective temperaments and psychopathological dimensions of personality in bipolar and cyclothymic patients

The aims of the study were: (1) to study possible associations between temperament, personality dimensions, and psychopathological variables in a clinical sample of euthymic patients with bipolar disorder (BD) and cyclothymia; and (2) to assess how Cloninger's temperament and personality dimensions were associated with affective temperaments. Participants, consisting of 60 patients with BD (type I or II) and cyclothymia in the euthymic phase, completed Akiskal's Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A), and Cloninger's Temperament and Character Inventory-revised version (TCI-R). The diagnostic groups differed in past hospitalization, for age at onset of the disorder, and on two affective temperaments: the TEMPS-A Hyperthymia, and the TEMPS-A Irritability. There were six significant associations between affective temperaments and Cloninger's personality dimensions, ranging from 0.26 to 0.54. The measures of Akiskal and of Cloninger tap common behavioral features in patients with bipolar disorder and cyclothymia, yet the differences indicate that the two measures are not redundant. BD and cyclothymic patients differed significantly in temperament and personality, differences that may have important implications for treatment.

The factor structure of the Chinese version of the Temperament and Character Inventory: factorial robustness and association with age and gender

OBJECTIVE

To examine the factor structure of the 144-item Chinese version of the Temperament and Character Inventory (TCI) and its association with age and gender in a large non-clinical population.

METHOD

We recruited 1966 non-clinical participants in China who completed the TCI Chinese version. They were randomly divided into two independent samples. One sample (n=983) was used for exploratory factor analysis (EFA), and the other (n=983) for confirmatory factor analysis (CFA).

RESULTS

An EFA suggested a four-factor structure for temperament domains and a three-factor structure for character domains. This was confirmed by a CFA. Women showed significantly higher scores on harm avoidance, reward dependence, co-operativeness, and self-transcendence than men. Age affected every subscale expect for reward dependence.

CONCLUSION

The factor structure of the Chinese TCI was similar to the original factor structure, with some differences reflecting the culture of a Chinese population.

Personality and depression: evidence of a possible mediating role for anger trait in the relationship between cooperativeness and depression

BACKGROUND

An increasingly growing area of empirical research has found consistent links between anger, depression, and temperament and character domains of personality, separately. However, precise nature of these relationships remains still unclear, and little is known about its underlying processes.

OBJECTIVES

The aim of our explorative research was to conduct a more detailed investigation into the relationships among depression, anger trait, and personality characteristics based on Cloninger's 7-factor personality theory in healthy individuals.

METHOD

In this preliminary study, 230 Italian undergraduates were investigated by using the Temperament and Character Inventory-Revised, the State-Trait Anger Expression Inventory-2, and the Beck Depression Inventory-II. Depression and cooperativeness were expected to have a negative and significant relationship and separate relationships with the trait-anger. Theoretically, a new hypothesis was that the trait-anger would mediate the relationship between depression and cooperativeness.

RESULTS

Zero-order and partial correlations and a path analysis based on Baron and Kenny's method (J Pers Soc Psychol.1986;51:1173-1182) for calculating multiple regression analyses were calculated. Consistent with the hypotheses, cooperativeness and depression were strongly associated; the trait-anger was significantly associated with both cooperativeness and depression, and the mediation model fit the data.

CONCLUSIONS

Behaviors related to the trait-anger could help to explain how depression and reduced cooperativeness are related each other.

Temperamental characteristics in childhood migraine without aura: a multicenter study

BACKGROUND

Children with migraine seem to be more anxious, sensitive, deliberate, cautious, fearful, vulnerable to frustration, tidy, and less physically enduring than comparisons. To the best our knowledge no studies about the temperamental and the characterial dimension aspects in childhood migraine was conducted. Therefore, the aim of the present study was to describe the temperamental and character aspects in a sample of children affected by migraine without aura (MoA) and their relationship with clinical aspects of MoA such as frequency, duration, and severity of attacks.

MATERIALS AND METHODS

In our study, 486 children affected by MoA (239 male, 247 female) aged 7-12 years, (mean 10.04 ± 2.53 years) and 518 typical developing children comparable for age (P = 0.227) and sex (P = 0.892) were enrolled to assess their temperamental characteristics. The mothers of all subjects filled out the Junior Temperament and Character Inventory: Parent Version.

RESULTS

Children affected by migraine show a higher prevalence of harm avoidance and persistence temperamental domains (P < 0.001) and significantly lower prevalence of the self-directedness character trait (P = 0.023) with respect to the comparisons, according to Cloninger's model. The Spearman rank correlation analysis shows a significant relationship between migraine characteristics and temperamental domains.

CONCLUSION

The present study first identified differences in temperamental characteristics in children affected by MoA with respect to the comparisons, suggesting the need for this evaluation in order for better psychological pediatric management of children with migraine, with possible consequences and impact on the future outcomes of these subjects.

The Junior Temperament and Character Inventory: Italian validation of a questionnaire for the measurement of personality from ages 6 to 16 years

The Junior Temperament and Character Inventory (JTCI) has been developed for the assessment of the personality in individuals 6 to 14 years old according to the psychobiological model of Cloninger. The aim of the present study was to evaluate the psychometric properties of an Italian version of JTCI. The sample included 459 subjects ranging in age from 6 to 15.9 years. Starting from the original parent version, an Italian version of JTCI was developed and administered to parents recruited in primary schools of Lazio and Campania. Using statistically appropriate methods for the analysis of dichotomous variables (binary coded), we analyzed the factor structure, the internal consistency, and the test-retest reliability. The architecture of the JTCI was consistent with the original hypothesis of the Cloninger model. Parent reports of each of the JTCI dimensions had good internal consistency and test-retest reliability over 3 months. Regarding the analysis of risk personality traits, significant correlations were found between several JTCI factors and Strengths and Difficulties Questionnaire scales. The JTCI is useful in research and in clinical practice to evaluate the role of temperament and character dimensions in psychopathology.

Investigating the development of temperament and character in school-aged children using a self-report measure

BACKGROUND

Developmental studies of temperament and character dimensions are crucial for a better understanding of how genetic and environmental factors interact in shaping individual personality. However, although several studies have been conducted in adults, a few studies have addressed the evaluation of temperament and character in children. Here, we tested the suitability of self-report evaluation and the developmental trend of temperament and character dimensions among school-aged children using an Italian version of the junior Temperament and Character Inventory (jTCI).

METHODS

The jTCI was completed by 572 Italian children (292 girls and 280 boys) aged 8 to 12 years. We evaluated the internal consistency of the 7 jTCI scales at each age, the intercorrelations between the scales, and the factorial model of the questionnaires. Furthermore, we tested the differences between the development of the temperament and character dimensions in girls and boys.

RESULTS

Although the data from 8-year children showed unacceptably low internal consistency, better reliability was observed for older children. Intercorrelations and factor analysis partially confirmed the hypothesized structure of the jTCI items, with problems observed for some items of the Novelty Seeking, Harm Avoidance, Reward Dependence (RD), and Self-Directedness scales. Furthermore, in keeping with previous studies, girls presented lower scores in Novelty Seeking and higher RD, Self-Directedness, and Cooperativeness scales than did boys, with the between-sex difference in RD becoming larger at older ages.

CONCLUSIONS

Although the use of the self-administered jTCI in clinical settings should be cautious, it may serve as a useful complementary instrument to describe the development of personality in childhood.

Psychometric properties of the Temperament and Character Inventory-Revised (TCI-R) in Czech adolescent sample

The psychometric properties of the TCI-R method were investigated in a cohort of 15-year-old adolescents (n = 787). This is the lowest recommended age for using the adult version of the method. A factor analysis of the temperament and character scales was carried out on the basis of Principal Component Analysis with Varimax rotation. We compared our results with a previous TCI version which was used in the pilot study of 15-year-olds (n = 171), with established norms for the Czech adolescents and adults, and in regard to gender differences. The principal component analyses for all scales with eigenvalues ≥ 1 resulted in only a 6 factor structure, in contrast to the 7 factor structure postulated by Cloninger. But the factor solution, computed separately for temperament (4F) and character (3F), approximately reflected the Cloninger's model except for the temperament subscales NS1 (Exploration Excitability), RD1 (Sentimentality) and RD4 (Dependence), which load multiple factors, and the character subscale SD 4 (Self-acceptance), which loads the Cooperativeness factor. The internal consistency of the main TCI-R scales was excellent; the Cronbach's alpha varied from .83 (NS) to .89 (HA). However, for some subscales (NS4, RD4, and CO5) the consistency was rather weak. In our research, the previous version of TCI showed less satisfying psychometric properties than TCI-R did. In terms of gender differences, girls scored higher in NS, RD, HA, CO and ST, whereas boys scored higher in PS; no statistically significant differences for SD were found. In general, our results support the Cloninger's postulated 7 factor personality structure and the appropriateness of the TCI-R usage for 15-year-old adolescents.

Amantadine in the treatment of pathological gambling: a case report

Despite almost a decade of intense research, effective treatment strategies for Pathological Gambling (PG) remain very challenging. This paper details a case report suggesting that the treatment of PG may benefit from the use of the non-specific glutamate blocker amantadine. The drug was well-tolerated and effective, leading to a 43-64% reduction in severity of gambling symptoms (as measured with G-SAS). Our result is discussed in the context of the glutamatergic hypothesis of addiction and in light of previous observations on the potential impact of glutamatergic agents in the treatment of PG. The role of the dopaminergic system, and its interaction with the glutamatergic system, is also explored. Further studies are required to define the true benefits of amantadine for the treatment of PG.

Role of substance abuse comorbidity and personality on the outcome of depression in bipolar disorder: harm avoidance influences medium-term treatment outcome

Comorbid conditions are frequent in bipolar disorder (BD) and may complicate the treatment and course of illness. We investigated the role of substance use disorder (SUD), axis II personality disorders (PD) and continuous personality traits on the medium-term outcome (6 months) of treatment for bipolar depression. One hundred and thirty-nine BD patients meeting criteria for a depressive episode were included in the study. SUD and PD were diagnosed according to structured interviews. Personality dimensions were evaluated by the Temperament and Character Inventory. Depressive severity over time was evaluated by the Hamilton Rating Scale for Depression. Neither PD nor SUD influenced the outcome of depression. Variables independently associated with a poor outcome were a high baseline severity and high scores for the temperamental trait of Harm Avoidance. Though several limitations characterize the present study, neurotic personality traits seem to be associated with a slower recovery from depressive symptoms in BD, independently from their initial severity.

The Italian version of the Inventory of Interpersonal Problems Personality Disorders Scales (IIP-47): psychometric properties and clinical usefulness as a screening measure

The Inventory of Interpersonal Problems-47 (IIP-47) is a brief and valid self-report measure for screening Personality Disorders (PDs). This study examined internal consistency, factor structure, criterion validity, temporal stability, and operating characteristics of the Italian version of the IIP-47 in two independent samples: PD subjects (n = 120) and nonclinical subjects (n = 475). Alpha coefficients ranged from .70 to .90. Multiple-Group Confirmatory Factor Analyses showed that the five-correlated-factor model reported in literature had the highest measurement invariance across the two groups. Criterion validity was supported by correlations among IIP-47 scale scores and scores on established measures of personality dimensions and pathology. Test-retest indices ranged from .71 to .95. PD subjects scored significantly higher than nonclinical subjects on all IIP-47 scales and cut-off scores for different levels of specificity and sensibility are reported. It is concluded that the psychometric properties of the original IIP-47 were preserved in its Italian version.