Are personality traits familial risk factors for substance use disorders? Results of a controlled family study

OBJECTIVE

The well-documented association between maladaptive personality traits and substance use disorders has given rise to diverse explanatory models. In this investigation the authors examined one such explanation, that certain personality traits are familial risk factors for the development of substance abuse or dependence.

METHOD

Data were collected from a controlled family study using direct diagnostic interviews. The Multidimensional Personality Questionnaire was used to assess the personality traits of 325 probands, 205 of whom had diagnoses of substance abuse or dependence, and 262 of their first-degree relatives.

RESULTS

Probands with substance use disorders scored higher on alienation and negative emotionality than did probands without substance use disorders, and they scored lower on control, harm avoidance, and constraint. Relatives with substance use disorders also differed from relatives without these conditions on several of these same dimensions. To examine whether such personality traits could be conceptualized as familial risk factors for substance use disorders, a second set of analyses were limited to relatives without substance use disorders themselves but varying in terms of family history for these conditions. These groups of relatives did not differ significantly from each other on any of the identified personality traits.

CONCLUSIONS

These findings argue for caution in characterizing the personality correlates of substance use disorders as representing familial or heritable risk factors.

The substantive nature of psycholexical personality factors: a comparison across languages

The psycholexical approach to personality structure in American English has led to the Big Five factors. The present study considers whether this result is similar or different in other languages. Instead of placing the usual emphasis on quantitative indices, this study examines the substantive nature of the factors. Six studies in European languages were used to develop a taxonomy of content categories. The English translations of the relevant terms were then classified under this taxonomy. The results support the generality of Big Five Factor III (Conscientiousness). Factors IV (Emotional Stability) and V (Intellect) generally did not cohere. Factors I (Extraversion) and II (Agreeableness) tended to split when this was necessary to produce 5 factors. The analysis was extended to several additional studies.

The search for dimensional structure differences between normality and abnormality: a statistical review of published data on personality and psychopathology

A statistical review of published data for 37 personality and psychopathology inventories was conducted to determine whether there are dimensional structure differences between clinical and nonclinical respondents. Correlation and factor-loading matrices from multiscale inventories and from specialized measures were tested for structural invariance across populations. There was relatively consistent evidence for high levels of similarity between normal and abnormal populations both in the number of factors that exist in the data matrices and in the factor patterns. The dimensional universes of normality and abnormality are apparently the same, at least according to data derived from contemporary assessment instruments. Categorical-taxonic differences between clinical and nonclinical populations, which were not examined, may nevertheless exist within contexts of dimensional structure similarity.

Personality profiles in patients with eating disorders

The present review focused on the personality profiles of patients with eating disorders. Studies using the Structured Clinical Interview for DSM-III-R Personality Disorder showed high rates of diagnostic co-occurrence between eating disorders and personality disorders. The most commonly observed were histrionic, obsessive-compulsive, avoidant, dependent and borderline personality disorders. Studies using the Cloninger's personality theory suggested that high Harm Avoidance might be relevant to the pathology of anorexia nervosa and high Novelty Seeking and Harm Avoidance to bulimia nervosa. Moreover, high Self-Directedness was suggested to be associated with favorable outcome in bulimia nervosa. The assessment of personality in a cross-sectional study, however, might be influenced by the various states of the illness. Therefore, a sophisticated longitudinal study will be required to advance this area of research.

Cigarette smoking and panic: the role of neuroticism

OBJECTIVE

The authors sought to determine the relationship of panic attacks, cigarette smoking, and neuroticism.

METHOD

Data were drawn from the Midlife Development in the United States Survey, a representative household survey of the adult population of the United States (N=3,032). Multivariate logistic regression analyses were used to determine the association between panic attacks and cigarette smoking and to determine whether neuroticism was an independent predictor of the co-occurrence of cigarette smoking and panic attacks.

RESULTS

The majority of individuals with panic attacks had been regular smokers during their lifetime (81.1%), a significantly higher rate than seen among subjects without panic attacks (69.4%). Regular cigarette smoking was associated with a significantly greater risk of current panic attacks. This significant association persisted after analyses controlled for demographic characteristics, depression, and alcohol/substance use disorders but was no longer evident after analyses adjusted for neuroticism. Neuroticism independently predicted the co-occurrence of regular cigarette smoking and panic attacks but did not predict either panic attacks or cigarette smoking in the absence of the other.

CONCLUSIONS

Consistent with previous findings, these data suggest that panic attacks are associated with greater risk of cigarette smoking but provide new evidence that neuroticism may play an essential role in this relationship. These data are preliminary but, if replicated, suggest that neuroticism may reflect a shared vulnerability for the co-occurrence of cigarette smoking and panic attacks. Future studies are needed to further explore the mechanism of this association.

Impulse control disorders and depression

This study assessed the frequency of impulse control disorders (ICDs) and their association with bulimia, compulsive buying, and suicide attempts in a population of depressed inpatients. We investigated ICDs using the Minnesota Impulsive Disorders Interview. Patients answered the Zuckerman Sensation-Seeking Scale and the Barratt Impulsivity Rating Scale. Among the 31 depressed patients who met criteria for ICD (ICD+ group), we found 18 cases of intermittent explosive disorder, three cases of pathological gambling, four cases of kleptomania, three cases of pyromania, and three cases of trichotillomania. Patients with co-occurring ICDs were significantly younger (mean age = 37.7 versus 42.8 years). Patients with kleptomania had a higher number of previous depressive episodes (5.7 versus 1.3), and patients with pyromania had a higher number of previous depressions (3.3 versus 1.3, p =.01). Bipolar disorders were more frequent in the ICD+ group than in the ICD- group (19% versus 1.3%, p =.002), whereas antisocial personality was not (3% versus 1%, p = ns). Bulimia (42% versus 10.5%, p =.005) and compulsive buying (51% versus 22%, p =.006) were significantly more frequent in the ICD+ group. Patients from the ICD+ group had higher scores of motor impulsivity assessed with the Barratt Impulsivity rating scale (p =.01).

Characteristics of opiate dependent patients who attempt suicide

OBJECTIVE

To describe the characteristics of opiate dependent patients who attempt suicide.

METHOD

Opiate dependent patients (DSM-IV criteria) who had (N = 105) or had not (N = 141) attempted suicide were compared for family history of suicide, childhood trauma, personality traits, and experience of comorbidity with cocaine and/or alcohol dependence, major depressive disorder. and physical disorder.

RESULTS

Significantly more opiate dependent patients who had attempted suicide were female (p < .0001) and unemployed (p < .0006). Patients who had attempted suicide reported significantly more family history of suicide and more childhood trauma; scored significantly higher for introversion, hostility, and neuroticism; and had experienced significantly more comorbidity with lifetime cocaine and alcohol dependence, major depressive disorder, and current physical disorder (p < .05 for all).

CONCLUSION

Suicidal behavior in opiate dependent patients may involve risk factors from the family, childhood, personality, psychiatric, and physical domains.

Extending the search for folk personality constructs: the dimensionality of the personality-relevant proverb domain

College students (95 men and 264 women) rated how well 211 familiar proverbs described their behavior and beliefs. A factor analysis of these data yielded 7 major dimensions; many of the factors were similar to recognized lexical personality factors. Big Five Conscientiousness and Neuroticism were each strongly associated with a single proverb dimension (interpreted as Restraint and Enjoys Life, respectively). Big Five Agreeableness, Extraversion, and Intellect/Imagination were all associated with several proverb dimensions. Agreeableness was most strongly associated with proverb dimensions representing Machiavellian behavior and strong Group Ties, and both Extraversion and Intellect showed particularly notable associations with an Achievement Striving dimension. The 2 remaining proverb dimensions, which represented a belief that Life is Fair and an attitude of Cynicism, could not be accounted for by the Big Five.

Does resting electroencephalograph asymmetry reflect a trait? an application of latent state-trait theory

Recent research on brain asymmetry and emotion treated measures of resting electroencephalograph (EEG) asymmetry as genuine trait variables, but inconsistency in reported findings and modest retest correlations of baseline asymmetry are not consistent with this practice. The present study examined the alternative hypothesis that resting EEG asymmetry represents a superimposition of a traitlike activation asymmetry with substantial state-dependent fluctuations. Resting EEG was collected from 59 participants on 4 occasions of measurement, and data were analyzed in terms of latent state-trait theory. For most scalp regions, about 60% of the variance of the asymmetry measure was due to individual differences on a temporally stable latent trait, and 40% of the variance was due to occasion-specific fluctuations, but measurement errors were negligible. Further analyses indicated that these fluctuations might be efficiently reduced by aggregation across several occasions.

[The changes in personality in the aspect of incorrect nutritional habits among Cracovian students and secondary school pupils]

The aim of this work was the comparison of the degree of spreading of incorrect nutritional model among students and secondary school pupils. There were 1080 persons included in the examination: 637 students of Collegium Medicum of Jagiellonian University (478 female students and 159 male students) and 421 of Cracow secondary school pupils (254 schoolgirls and 167 schoolboys). The examinations were based on the Woman Self Image and Social Ideal questionnaire and precisely on its part containing Eating Disorders Inventory (EDI). BMI (Body Mass Index) was used as the indicator of the nutritional status. BMI < 18.5 were more often stated by women (27.6% of schoolgirls and 12.5% of female students) than by men (both schoolboys and male students--6.5%). Overweight (BMI >25) was stated by 2.8 of schoolgirls and 8.8% of female students and by 6.6% of schoolboys and 15.7% of male students. The answers given in the questionnaire by schoolchildren and students lead to the conclusion that schoolchildren are more imperilled by eating disorders than students. More or less 20% of schoolchildren with BMI <20 kg/m2 is not satisfied with their body shape. In spite of too low body mass they think that they have too big stomach, too fat hips and thighs and are eager to lose weight.

Mood disorder history and personality assessment in premenstrual dysphoric disorder

BACKGROUND

Menstrually related dysphoria is known to be associated with other affective disorders, notably major depressive disorder and puerperal depression. The relationship between premenstrual dysphoric disorder (PMDD) and maladaptive personality disorders and traits, however, is less established, at least in part because of the methodological and nosologic difficulties in the diagnosis of both PMDD and personality disorders. This study seeks to address this problem to elucidate the relationship between PMDD, other affective disturbances commonly experienced by women, and maladaptive personality.

METHOD

Axis I and II disorders were examined using standardized instruments and stringent diagnostic criteria (DSM-IV and the International Personality Disorders Examination) in 34 women with DSM-IV PMDD and 22 healthy women without severe premenstrual mood changes.

RESULTS

Seventy-seven percent of the PMDD group had suffered from a past Axis I disorder in comparison with 17% of the control group. Two thirds of the parous women with PMDD had suffered from major depressive disorder in the puerperium. Personality disorder diagnoses were not highly represented in either group of women. The women with PMDD had significantly more obsessional personality traits (p < .001 ) but not absolute personality disorder diagnoses.

CONCLUSION

Obsessional symptoms are known to cluster with the affective disorders and may reflect underlying temperamental and biological vulnerability. This study provides further evidence of the link between serotonergic dysregulation, personality vulnerability, and mood changes related to the female reproductive cycle.

MMPI-2 typology of pregnant drug-dependent women in treatment

The present study examined the validity of Minnesota Multiphasic Personality Inventory-2 (MMPI-2) typology for pregnant drug-dependent women. A 3-cluster solution based on 7 MMPI-2 clinical scales emerged as the best model and was replicated across split-half samples and different primary substance-use diagnoses and treatment modalities. The 3 subtypes identified included Type I (n = 40, 24%) with no clinical elevation, Type II (n = 72, 42%) with elevated psychopathic deviate scale, and Type III (n = 58, 34%) with elevations on all 7 scales. Analyses with interview and self-report measures showed good concurrent validity. Type II had higher retention than Type I and Type III across methadone and medication-free treatments, showing some predictive validity. An a priori method for classifying new cases on the basis of the proposed typology was developed and validated. Study findings support MMPI-2's use with pregnant drug-dependent women for assessment and possibly treatment planning.

Risk factors for posttrauma reactions in police officers: a longitudinal study

This prospective, longitudinal study investigated risk factors in the development of psychological ill health and posttraumatic stress symptoms in a sample of 223 junior police officers. Participants were assessed using a self-report methodology during training and again 12 months later on a range of personality, trauma exposure, and symptom measures. Risk factors for general psychological ill health at phase 2 of the research were found to comprise mostly stable, preexisting characteristics such as personality style, gender, and trait dissociation. Conversely, specific traumatic stress symptoms were more heavily influenced by experiences in the intervening 12 months, such as severity of incident exposure and peritraumatic dissociation. The implications for differential intervention are discussed.

Inverse relationship between serotonin 5-HT(1A) receptor binding and anxiety: a [(11)C]WAY-100635 PET investigation in healthy volunteers

OBJECTIVE

The authors investigated the relationship between anxiety--a facet of the Revised NEO Personality Inventory dimension of neuroticism--and serotonin 5-HT(1A) receptor binding potential.

METHOD

Positron emission tomography with [(11)C]WAY-100635 was used to estimate regional 5-HT(1A) binding potential in 19 healthy volunteers who completed the Revised NEO Personality Inventory. Correlation coefficients were calculated to determine the degree of association between 5-HT(1A) binding potential and personality inventory measures.

RESULTS

There was a significant negative correlation between 5-HT(1A) binding potential and anxiety in four regions: the dorsolateral prefrontal cortex, anterior cingulate cortex, parietal cortex, and occipital cortex.

CONCLUSIONS

The inverse relationship between 5-HT(1A) receptor binding potential and anxiety is consistent with 1) animal models that have shown higher anxiety in mice lacking 5-HT(1A) receptors and 2) clinical trial data that have demonstrated antianxiety properties of partial 5-HT(1A) agonists.

A prospective study of the paradoxical relationship between impulsivity and lethality of suicide attempts

BACKGROUND

Biological studies suggest that lower serotonergic activity is associated with both greater suicide lethality and impulsive personality traits. These results may lead to the conclusion that impulsivity in the attempt should be associated with greater lethality. However, Klerman's review of epidemiologic suicide studies suggests an inverse relationship between impulsivity and lethality. This seemingly paradoxical relationship between impulsivity and lethality has not been explored in large representative clinical samples of suicide attempts.

METHOD

During 1996 to 1998, 478 individuals who attempted suicide were studied in a general hospital in Madrid, Spain. Impulsivity was measured as described in the literature by combining 2 items of Beck's Suicidal Intent Scale (active preparation for attempt and degree of premeditation). Lethality of the attempt was assigned 1 of 4 levels according to the need for medical and/or psychiatric treatment.

RESULTS

More than half of the attempts were impulsive (55%; 95% confidence interval [CI], 51% to 59%), approximately one fourth of the attempts had an intermediate level of impulsivity (28%; 95% CI, 24% to 32%), and approximately one sixth of the attempts were not impulsive (17%, 95% CI, 13% to 21%). There was an inverse association between the impulsivity and lethality of the suicide attempt (chi2 = 62.639, df = 6, p < .0001). The most impulsive attempts tended to result in less morbidity, while the less impulsive attempts tended to be more lethal.

CONCLUSION

If the inverse relationship between impulsivity and lethality is replicated in other large and representative samples, new studies will be needed to clarify the complex interactions between the clinical dimensions (lethality, impulsivity as a state, and impulsivity as a personality trait) and the biological correlates (particularly serotonergic function) of suicidal behavior.

The interplay and etiological continuity of neuroticism, difficulties, and life events in the etiology of major and subsyndromal, first and recurrent depressive episodes in later life

OBJECTIVE

Stressful life events, long-term difficulties, and high neuroticism are established risk factors for depression. Less is known about their role in late-life depression, how they modify or mediate one another's effects, and whether this differs between major and subsyndromal, first and recurrent episodes.

METHOD

The authors used a prospective case-control design nested in a community survey of elderly subjects that included a measure of neuroticism. They compared 83 survey participants who subsequently developed a depressive episode with 83 randomly selected comparison participants. The authors determined dates of onset, history, and severity of episodes and dates of occurrence and severity of stressful life events and difficulties.

RESULTS

Stressful life events did not mediate the effects of high neuroticism and difficulties at onset, possibly because of the uncontrollable nature of common stressful life events in later life. Without both high neuroticism and difficulties, stressful life events did not increase risk. High neuroticism and difficulties increased risk, even without a stressful life event. In the presence of high neuroticism and/or difficulties, the depressogenic effect of stressful life events was substantial, suggesting effect modification. The authors found no evidence to suggest etiological discontinuity between major and subsyndromal episodes. First and recurrent episodes showed a discontinuous pattern of associations. Severe stressful life events had weaker associations, but high neuroticism and mild stressful life events had stronger associations with recurrent than with first episodes.

CONCLUSIONS

This study demonstrated the usefulness of a dynamic stress-vulnerability model for understanding late-life depression. Evidence was found suggesting etiological discontinuity between first and recurrent but not between major and subsyndromal episodes.

Anger, impulsivity, social support, and suicide risk in patients with posttraumatic stress disorder

An emerging literature suggests that posttraumatic stress disorder (PTSD) patients are at an increased risk for suicide. The objective of this study was: a) to reexamine the relationship between PTSD and suicide by comparing suicide risks of persons with PTSD, to persons with anxiety disorder and to matched controls; and b) to examine the relationship between anger, impulsivity, social support and suicidality in PTSD and other anxiety disorders. Forty-six patients suffering from PTSD were compared with 42 non-PTSD anxiety disorder patients and with 50 healthy controls on measures of anger, impulsivity, social support, and suicide risk. Persons with PTSD had the highest scores on the measures of suicide risk, anger, and impulsivity and the lowest scores on social support. Multivariate analysis revealed that in the PTSD group, impulsivity was positively correlated with suicide risk and anger was not. PTSD symptoms of intrusion and avoidance were only mildly correlated with suicide risk at the bivariate level but not at the multivariate level. For the PTSD and anxiety disorder groups, the greater the social support, the lower the risk of suicide. For the controls, social support and impulsivity were not related to suicide risk, whereas anger was. These findings suggest that persons with PTSD are at higher risk for suicide and that in assessing suicide risk among persons with PTSD, careful attention should be paid to levels of impulsivity, which may increase suicide risk, and to social support, which may reduce the risk.

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

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

Alcohol use inventory: screening and assessment of first-time driving-while-impaired offenders. II. Typology and predictive validity

This study evaluated the use of Alcohol Use Inventory (AUI) for driving-while-impaired (DWI) screening, by determining whether DWI offenders (n = 1644), grouped according to their reported alcohol involvement on the AUI, would have different rates of recidivism in a 5-year follow-up. Cluster analysis using the six second-order scales produced six groups (clusters 1-6) described as the Low-Profile (50%), Alcohol-Preoccupation (14%), Enhanced (22%), Enhanced-Disrupt (9%), Anxious-Disrupt (3%), and High-Profile (1%) types. They were characterized by different sociodemographic profiles. Members of cluster 4 were associated with the highest DWI recidivism rate (40%), committing one or more further DWI, and clusters 5 and 6 were associated with the highest rate of committing two or more DWIs. Rates of subsequent traffic convictions and crashes were, however, not statistically different among the clusters. Predictors of DWI recidivism included male gender, young age, less-educated, high blood-alcohol concentration at arrest, and clusters of 3 and 4. Different typologies indicated that the needs for treatment might be different. Evaluators should keep in mind the strength of AUI, use risk factors identified in the study, and take measures of test-taking defensiveness to enhance overall predictive validity.

Is substance abuse in schizophrenia related to impulsivity, sensation seeking, or anhedonia?

OBJECTIVE

The authors compared impulsivity, sensation seeking, and anhedonia in a group of schizophrenic patients with and without lifetime substance abuse or dependence.

METHOD

Patients (N=100) with schizophrenia or schizoaffective disorder (per DSM-III-R criteria) were assessed with the Composite International Diagnostic Interview's section on psychoactive substance use disorder, the Positive and Negative Syndrome Scale, the Barratt Impulsivity Scale, the Zuckerman Seeking Sensation Scale, and the Chapman Physical Anhedonia Scale.

RESULTS

The mean scores for impulsivity and sensation seeking were higher in the group with substance abuse (N=41) than in the group without substance abuse (N=59). No significant difference between groups was found regarding physical anhedonia.

CONCLUSIONS

As in the general population, high levels of impulsivity and sensation seeking are associated with substance abuse in patients with schizophrenia.

[Effect of group psychotherapy on changes in symptoms and personality traits in patients with anxiety syndromes]

Psychotherapy remains the most efficient form of treatment in neurotic and personality disorders. It is a process whereby the therapist can influence and change the patient's personality. As a result, patients are able to better understand their experiences and behavior and are given a chance to be freed from symptoms. The goal of the present study was to establish the relationship between group psychotherapy and specific symptom clusters, and to follow changes in the personality structure of patients of both genders diagnosed according to ICD-10 classification. The Symptoms Questionnaire and the Personality Factor test were used to determine the severity of symptoms and study personality traits. The study group consisted of 115 patients (76 women and 39 men) with neurotic or personality disorders, participating in group therapy at the Day Care Unit of the Department of Psychiatry, Pomeranian Academy of Medicine in Szczecin between 1992 and 1998. Four groups were formed depending on the diagnosis according to ICD-10 classification: anxiety disorders--F41; somatic disorders--F45; neurotic disorders--F48; and personality disorders--F60 (Table 1). Treatment started and ended with a CV Questionnaire, Symptoms Questionnaire and Personality Factor test. Group psychotherapy was in the open form and the duration of treatment was 12 weeks with 2 sessions per day. In order to detect any improvement in mental health and symptoms, patients were given the Symptoms Questionnaire on a weekly basis. Statistics were done with the SPSS software package. It was found that the global intensity of symptoms before treatment was highest in patients with somatic form of the disorder. In this group after therapy, the intensity of symptoms was lowest, probably because of conversion of primary to secondary anxiety. A considerable decrease in the intensity of symptoms may also be explained by stronger motivation of these patients to benefit from therapy because of their severe symptoms. A link between the clinical diagnosis according to ICD-10 and some symptoms reported by the patients was noted. Thus, the Symptoms Questionnaire could be a useful tool precisely revealing specific symptoms in some disorders. No statistically significant differences on the Symptoms Questionnaire scale based on ICD-10, nor any differences in personality traits were found. The personality traits were different for men and women before and after therapy. As for hysterical symptoms, improvement was greater in women. After psychotherapy, the structure of personality traits improved in both sexes (Fig. 1). An essential alleviation of symptoms was found at the beginning and at the end of treatment (Table 2). The main conclusions are: 1. Group psychotherapy is an efficient method of treatment for patients who suffer from anxiety-related disorders. 2. The Symptoms Questionnaire and Personality Factor test were very useful for assessing the results of psychotherapy. 3. Alleviation of symptoms during treatment differed between men and women in 3 out of 13 symptom clusters and no significant differences between disorders according to ICD-10 were found. Consequently, these criteria are of little value for preliminary evaluation of therapeutic success. 4. Alleviation of symptoms was observed at the beginning and end of treatment. Symptom severity remained constant in the middle part of treatment.

Cognitive factors related to suicidal ideation and resolution in psychiatrically hospitalized children and adolescents

OBJECTIVE

This study was conducted to determine whether there are changes in the cognitive factors of attributional style, hopelessness, and self-esteem when suicidal ideation fades in psychiatrically hospitalized children and adolescents.

METHOD

The cognitive factors of attributional style, hopelessness, and self-esteem were assessed in subjects aged 7-17 years (50 with and 50 without suicidal ideation) at admission and discharge from a psychiatric hospital.

RESULTS

For subjects with suicidal ideation, attributional style became significantly more positive and hopelessness was decreased from admission to discharge, by which time suicidal ideation had faded. There was no association between self-esteem and suicidal ideation after control for depression. These changes in cognitive factors were not seen in the group without suicidal ideation. There were no significant differences between children and adolescents in the pattern of results.

CONCLUSIONS

Change in attributional style was shown to be a factor significantly related to the resolution of suicidal ideation in children and adolescents. This cognitive style could be specifically addressed in psychotherapy with depressed children and adolescents as a means of reducing suicidal ideation. These results may have an implication for reducing the length of psychiatric inpatient stays.

The looming maladaptive style: anxiety, danger, and schematic processing

The importance of cognitive styles as psychological antecedents of psychopathology has gained increasing acceptance over the past 2 decades. Although ample research has explored cognitive styles that confer vulnerability to depression, cognitive styles that confer vulnerability to anxiety have received considerably less attention. In the present investigation, we examined the looming maladaptive style (LMS) as a cognitive style that functions as a danger schema to produce specific vulnerability to anxiety, but not to depression. In 4 studies, we examined the psychometric properties of a revised measure of the LMS, its predictive utility, and its effects on threat-related schematic processing. Results provided evidence for the validity of the LMS and indicated that it predicts anxiety and schematic processing of threat over and above the effects of other cognitive appraisals of threat, even in individuals who are currently nonanxious.

Adult attachment and the defensive regulation of attention and memory: examining the role of preemptive and postemptive defensive processes

Previous research has found that avoidant adults have more difficulty recalling emotional experiences than do less avoidant adults. It is unclear, however, whether such findings reflect differences in the degree to which avoidant adults (a) attend to and encode emotional information, (b) elaborate emotional information they have encoded, or (c) do both. Two studies were conducted to distinguish between the effects of these processes. Participants listened to an interview about attachment-related issues and were asked to recall details from the interview either immediately or at variable delays. An analysis of forgetting curves revealed that avoidant adults initially encoded less information about the interview than did nonavoidant adults, although avoidant and nonavoidant adults forgot the information they did encode at the same rate. The implications of these findings for current views on the nature and efficacy of defenses are discussed.

Personality type and neural circulatory control

Psychosocial factors, including type A personality, anger, hostility, and anxiety, have been implicated in the pathogenesis of cardiovascular disease. Abnormal sympathetic responses to stress may help explain the link between certain behavior patterns and cardiovascular disease. We tested the hypothesis that in normal humans, type A personality characteristics are associated with exaggerated heart rate, pressor, and sympathetic nerve responses to mental and physical stress. We measured heart rate, blood pressure, and muscle sympathetic nerve activity (obtained with direct intraneural recordings) at rest and during stress in 45 healthy subjects (19 men and 26 women, age 29.2+/-8.7 years) who had no chronic diseases and were taking no medications. Subjects were divided into tertiles based on type A scores. There were no significant differences in sympathetic or hemodynamic reactivity among the 3 different intensity levels of type A characteristics. Baseline measures and responses to stress tests were similar across the 3 groups. Sympathetic and hemodynamic changes during stress tests were also similar in subject groups stratified according to anger scale and cynicism scale. Sympathetic nerve and hemodynamic measurements at rest and during stress were not different in normal subjects with type A characteristics. Abnormalities in sympathetic or cardiovascular reactivity are unlikely to be implicated in any excess of cardiovascular disease in people with type A personality characteristics.

Does neuroticism influence cognitive self-assessment after epilepsy surgery?

PURPOSE

To examine how cognitive, personality, and seizure outcome variables influence the subjective cognitive functioning of patients with refractory temporal lobe seizures after epilepsy surgery.

METHODS

Thirty-three consecutive patients with drug-resistant partial epilepsy who underwent surgical treatment at a tertiary referral university epilepsy center were tested before surgery and 1 year after surgery. Objective cognitive and subjective cognitive functioning tests were used, and personality was assessed. Seizure control was operationalized as a dichotomous variable.

RESULTS

A significant inverse relationship was found between neuroticism and subjective cognitive functioning. None of the other pre- and postoperative cognitive and surgery outcome variables were significant predictors of subjective cognitive functioning, even after controlling for the effect of neuroticism.

CONCLUSIONS

Subjective and objective memory functioning are independent in patients with epilepsy after surgical treatment. Subjective memory functioning appears to be related not to seizure relief but to neuroticism. These data suggest that psychological factors such as personality traits predisposing to emotional distress should be taken into consideration in the clinical management and counseling of patients undergoing epilepsy surgery.

Type D personality. A potential risk factor refined

OBJECTIVE

Acute and chronic psychological distress have been associated with coronary heart disease (CHD) but little is known about the determinants of distress as a coronary risk factor. Broad and stable personality traits may have much explanatory power; this article selectively focuses on negative affectivity (NA; tendency to experience negative emotions) and social inhibition (SI; tendency to inhibit self-expression in social interaction) in the context of CHD.

METHODS

The first part of this article reviews research on NA and SI in patients with CHD. The second part presents new findings on NA and SI in 734 patients with hypertension.

RESULTS

Accumulating evidence suggests that the combination of high NA and high SI designates a personality subtype ("distressed" type or type D) of coronary patients who are at risk for clustering of psychosocial risk factors and incidence of long-term cardiac events. Type D and its contributing low-order traits (dysphoria/tension and reticence/withdrawal) could also be reliably assessed in a community-based sample of patients with hypertension. This finding was replicated in men and women, and in Dutch- and French-speaking subjects. Type D hypertensives reported more depressive affect than their non type D counterparts.

CONCLUSIONS

There is an urgent need to adopt a personality approach in the identification of patients at risk for cardiac events. NA and SI are broad and stable personality traits that may be of special interest not only in CHD, but in other chronic medical conditions as well.

Double-blind comparison of sertraline, imipramine, and placebo in the treatment of dysthymia: effects on personality

OBJECTIVE

Although previous studies have shown that dysthymia, or chronic depression, commonly responds to antidepressant medications (with improvements in depressive symptoms and psychosocial functioning), there have been no systematic studies of the impact of antidepressant treatment on personality variables in patients with this disorder.

METHOD

In a multicenter study, 410 patients with early-onset primary dysthymia were treated in a randomized prospective fashion with sertraline, imipramine, or placebo. The data were analyzed in terms of the subjects' scores on the Tridimensional Personality Questionnaire, a 100-item self-report instrument that measures four temperamental dimensions: harm avoidance, reward dependence, novelty seeking, and persistence.

RESULTS

At baseline, the harm avoidance scores of the dysthymic subjects were approximately 1.5 standard deviations higher than those of a previously reported community sample. After treatment, there was a significant decrease in harm avoidance scores, with no significant between-group differences. Remission of dysthymia was associated with significantly greater improvement in harm avoidance, with the greatest numerical change found in the patients treated with sertraline. Subjects' Tridimensional Personality Questionnaire scores were correlated at a 0.50 level with the Social Adjustment Scale both pre- and posttreatment, suggesting that a high degree of harm avoidance may be associated with poor social functioning.

CONCLUSIONS

Before treatment, chronically depressed patients demonstrate an abnormality in temperament, as measured by elevated degrees of harm avoidance. Remission of dysthymia is associated with improvement in this aspect of temperament.

Competitive worries, sport confidence, and performance ratings for young swimmers

The purpose of this study was to examine the relationships among competitive worries, sport confidence, and performance of young athletes. Participants were 143 young swimmers aged 11 to 12 years. The athletes completed trait and state questionnaires (competitive worries and sport confidence) in noncompetitive and competitive conditions, respectively. The results indicated: (a) significant relationships among trait and state characteristics and between trait General Self-confidence and performance ratings in both races as well as between performance ratings in Races 1 and 2; (b) significant differences in state variables among athletes with moderate or high and low scores on the trait variables; (c) significant differences in performance among athletes with moderate or high and low scores on the trait General Self-confidence and trait Positive Thinking in Race 1 and on variables trait General Self-confidence, state General Self confidence, and state Positive Thinking Race 2; and (d) trait General Self-confidence and trait Confidence in Unfavorable Situations were the most important predictors of young swimmers' performances. These results may be useful in application to competitive sports for young athletes. They may help in psychodiagnostic procedures and may be used for both the content and the direction of individual programs for psychological preparation of young athletes.

Do the dimensions of the temperament and character inventory map a simple genetic architecture? Evidence from molecular genetics and factor analysis

OBJECTIVE

It has been reported that the human temperament dimensions of novelty seeking and harm avoidance are associated with polymorphisms in the D(4) dopamine receptor gene (D4DR) and the serotonin-transporter-linked promoter region (5-HTTLPR), respectively. Although these findings are consistent with Cloninger's hypothesized psychobiological model of temperament and character, many studies failed to replicate these findings. In the present study the authors tested whether the psychobiological model taps the genetic architecture of personality by exploring associations between these candidate genes and the dimensions of the Temperament and Character Inventory and by examining its phenotypic structure.

METHOD

Of the 946 male and female participants in the Baltimore Longitudinal Study of Aging to whom the Temperament and Character Inventory was administered, 587 were genotyped for a polymorphism with a 48-base-pair repeat in the D4DR gene and 425 were genotyped for a 44-base-pair insertion or deletion in the 5-HTTLPR polymorphism.

RESULTS

There was no significant association between D4DR polymorphisms and novelty seeking. The authors also failed to find an association between 5-HTTLPR polymorphisms and harm avoidance. The factor structure of the Temperament and Character Inventory did not reveal the hypothesized phenotypic structure.

CONCLUSIONS

This investigation produced no support for the temperament-character model at either the biological or psychological level.

Personality predictors of injury-related posttraumatic stress disorder

This longitudinal, cohort study examined the effect of personality traits on the emergence of posttraumatic stress disorder (PTSD) in a recently traumatized, civilian, mixed-gender sample with significant injuries. Burn survivors (N = 70) were administered the NEO-Personality Inventory (NEO-PI) and the Structured Clinical Interview for DSM III-R (SCID) at hospital discharge and readministered the SCID 4 and 12 months later. Overall, the sample of burn survivors scored significantly higher on neuroticism and extraversion and lower on openness, agreeableness, and conscientiousness relative to a normative national sample. Furthermore, multivariate analysis of variance revealed that PTSD symptom severity groups (i.e., single symptom, multiple symptoms, subthreshold PTSD, PTSD) were differentially related to neuroticism and extraversion. Planned comparisons indicated that neuroticism was higher and extraversion was lower in those who developed PTSD compared with those who did not develop PTSD.

Classifying depression: should paradigms lost be regained?

OBJECTIVE

Classification of the depressive disorders has long been controversial. The dominant current model is unitarian, with disorders largely distinguished on the basis of severity. Both the unitarian and the contrasting binarian views (of two principal types) have proved to be unsatisfactory. The binarian model's procrustean requirements are too inflexible to address the evident heterogeneity contributed to by clinical manifestations and underlying personality features.

METHOD

This article briefly reviews the historically favored unitarian and binarian viewpoints on classification of depression.

RESULTS

The author argues that the "final common pathway" model, articulated in the early 1970s, helped to cement psychiatric classification in subsequent DSM and ICD revisions into a unitarian framework, leading to a relatively sterile period of depression research. Clinically described depressive typologies were obscured rather than refined by appropriate modeling paradigms. A contrasting, empirically based hierarchical model, driven by disorder-specific clinical manifestations such as psychotic features and observable psychomotor disturbance, is proposed as a paradigm for distinguishing psychotic, melancholic, and nonmelancholic classes of depression, while a spectrum model is favored for distinguishing the principal nonmelancholic subclasses.

CONCLUSIONS

Resolution of the better paradigm requires that the two models undergo comparative testing in applied studies, particularly ones pursuing neurobiological determinants and differential responses to antidepressant treatments.

Development of a random response scale for the multiple affect adjective check list-revised

A scale was constructed to identify random responses on the Multiple Affect Adjective Check List-Revised. Items chosen were the 14 least frequently checked items and 14 most frequently checked items, plus the seven most frequently checked negative items and the seven least frequently checked positive items (total=42). The Random Response Scale successfully differentiated random protocols from those produced by 420 college students, and scores on the scale were significantly higher for the college students than for the random sample. In addition, correlations between scores on the Random Response Scale and the Communality Scale (Adjective Check List) and the NEO-FFI Conscientiousness Scale suggest its usefulness as a measure of "conscientiousness" or "dependableness."

Interaction of psychological type and anxiety sensitivity on academic achievement

The Myers-Briggs Type Indicator and the Anxiety Sensitivity Index were administered to 143 undergraduate college students. Analyses of variance were performed to assess the relationship between these indices and semester grades (Grade Point Average). The Myers-Briggs Sensing-Intuitive and Judging-Perceiving dimensions showed significant main effects on GPA. The interaction of Judging-Perceiving and Anxiety Sensitivity was also significant (F = 18.00, p<.0001), although that of Sensing-Intuition and Anxiety Sensitivity was not (F = 3.51, p=.06). These findings suggest that personality factors measured by the Myers-Briggs Type Indicator may serve as mediating variables in evaluating whether trait anxiety has a facilitating or debilitating effect on academic achievement.

Stability of the Iceberg Profile as a function of perceived difficulty in defeating an opponent

9 starters and 8 nonstarters of a university women's softball team completed the Profile of Mood States prior to playing the team perceived to be the most and least difficult to defeat in their conference. A significant interaction indicated that nonstarters displayed higher fatigue prior to playing the opponent perceived as most difficult to defeat. In addition, significant mean differences were found between starters and nonstarters on constructs of Anger, Confusion, Tension, and Depression, suggesting that nonstarters may not share same psychological profile as their peers who start.

Needle sharing: a longitudinal study of female injection drug users

The objective of this study was to examine the psychosocial risk and protective factors related to needle-sharing behavior among female intravenous drug users (IDUs) positive (N = 96) and negative (N = 128) for human immunodeficiency virus (HIV). Participants in this longitudinal study were interviewed individually at two points in time, with a 6-month interval between interviews. The interviewers used a structured questionnaire, which included psychosocial measures and questions about drug and sexual risk behaviors. Data were analyzed using Pearson correlations and hierarchical regression analyses. The findings supported a developmental model in which the psychosocial domains and HIV status predicted T1 (initial) needle-sharing behavior, which in turn was related to T2 (follow-up) needle-sharing behavior. In addition, the relationship between personality and peer risk factors and T2 needle sharing was buffered by family-related protective factors. While HIV-positive status had a direct effect on T1 needle sharing with strangers, its effect was mediated by all of the psychosocial variables in its relation to T1 needle sharing with familiar people. Comparisons of these results were made with a companion study of male IDUs. The results suggest several intervention and treatment approaches that can be implemented at different points in the developmental pathways leading to risky needle-sharing practices among female IDUs.

Sociodemographic predictors of temperament and character

The Unified Biosocial Theory of Personality postulates that human personality is organized around four temperaments - Novelty Seeking, Harm Avoidance, Reward Dependence, and Persistence - and three characters - Self-Directedness, Cooperativeness, and Self-Transcendence. The objective of the present study was to investigate the influence of sociodemographic factors on temperament and character without the confounding influence of mental disorders. Volunteers (n=94) did not meet criteria for any Axis I and Axis II diagnosis, had no first-degree relatives with mental disorders, and were medically healthy. After giving written informed consent, volunteers completed the Temperament and Character Inventory. Analyses were conducted to determine the degree of association of each sociodemographic factor (i.e., age, gender, ethnicity, marital status, educational attainment, and occupational status) to personality dimension, while controlling for possible interactions with other sociodemographic factors. Partial correlation analysis showed a significant association between gender and Reward Dependence, and occupational status was significantly related to Reward Dependence, Cooperativeness, and Self-Transcendence. Stepwise regression analysis indicated that gender and occupational status were significant predictors of Reward Dependence. Occupational status was the only predictor of Cooperativeness and Self-Transcendence. These data suggest that sociodemographic factors should be considered in studies investigating temperaments and characters as defined by the Unified Biosocial Theory of Personality.

Personality in adolescents with chronic fatigue syndrome

Our aim was to study the presence of personality traits and disorder in adolescents with Chronic Fatigue Syndrome (CFS). Personality was then compared to other measures of functioning such as presence of psychiatric disorder and rating on the Child Behavior Checklist 4-18 (CBCL) and in relation to CFS outcome. Twenty-five adolescents with CFS followed-up after contacts with tertiary paediatric/psychiatric clinics were compared with 15 matched healthy controls. Interviews and questionnaires from parents and youngsters included Personality Assessment Schedule (PAS), Kiddie-SADS Psychiatric Interview, Child Behavior Checklist. CFS subjects were significantly more likely than controls to have personality difficulty or disorder. Personality features significantly more common amongst them were conscientiousness, vulnerability, worthlessness and emotional lability. There was a nonsignificant association between personality disorder and worse CFS outcome. Personality difficulty or disorder was significantly associated with psychological symptoms and decreased social competence on the CBCL but it was distinguishable from episodic psychiatric disorder. Personality difficulty and disorder are increased in adolescents with a history of CFS. Personality disorder may be linked to poor CFS outcome.

Prediction of detached personality in healthy subjects by low dopamine transporter binding

OBJECTIVE

Low striatal dopamine D(2) receptor binding in healthy human subjects has been associated with detached personality in studies using positron emission tomography (PET) and the Karolinska Scales of Personality questionnaire. The authors investigated whether a similar correlation exists between striatal dopamine transporter binding and detached personality.

METHOD

Eighteen healthy volunteers participated in a PET study with the specific dopamine transporter ligand [(18)F]CFT ([(18)F]WIN 35,428) and completed the Karolinska Scales of Personality questionnaire form.

RESULTS

Age-corrected dopamine transporter binding in the putamen, but not in the caudate, correlated negatively with detachment personality scores, especially in the right hemisphere.

CONCLUSIONS

This finding supports the hypothesis that low dopaminergic neurotransmission is associated with detached personality. Furthermore, since [(18)F]CFT binding is thought to reflect the density of dopaminergic nerve terminals in the brain, the authors suggest that the neurodevelopmental formation of the brain dopaminergic system may influence adult personality traits.

Personality traits in schizophrenia: comparison with a community sample

The objective of this study was to compare personality trait profiles in patients with schizophrenia and healthy controls. Male outpatients with schizophrenia (N = 24) and a male nonpsychiatric community sample (N = 46) completed the NEO-FFI personality questionnaire. Multivariate analyses were used to compare mean scale scores and scale profiles for each group. The overall personality profile of clinically stable patients with schizophrenia differed significantly from that of a community sample. On individual scales, patients scored significantly higher on neuroticism and significantly lower on conscientiousness. These results confirm and extend those of previous studies that used normative data for comparison and a much longer version of the same personality questionnaire. Prospective studies of populations at risk are needed to determine whether group differences reflect a premorbid diathesis for schizophrenia or a secondary effect of serious mental illness.

The assessment of Big Five Personality Factors and Temperament Domains as modifiers of cardiovascular response to occupational stress

The aim of the study was to explore the role of Big Five Personality Factors and Temperament Domains as the factors influencing cardiovascular response to work, and their moderating effect on the relationship between occupational stress and cardiovascular reactivity. The self-reported data on occupational stress and filled in NEO-Five Factor Inventory by Costa, and McCrae and Pavlovian Temperament Survey by Strelau et al. were collected from 97 bank clerks employed in large bank branches. The subjects also responded to the questionnaire on personal and professional background factors. A 24 hour monitoring of cardiovascular reactivity (heart rate and blood pressure) was also provided. Conscientiousness was found to be the only modifier of cardiovascular response to occupational stress reflected by systolic blood pressure. Several main, independent of stress effects of personality and temperament domains were also found. The ratio of heart rate at work to heart rate during sleep was associated with the strength of excitatory process, the percentage of maximum heart rate index with Conscientiousness, and systolic blood pressure at work was influenced by the strength of inhibitory process. However, generally speaking, physiological indicators of the cardiovascular system functioning were not very sensitive to changes in values of personality and temperament variables at the level of occupational stress reported by the bank clerks who participated in the study.

Geophysical variables and behavior: LXXXVIII. Atmospheric electromagnetism: the possible disturbing influence of natural sferics on ESP

Sferics are electromagnetic impulses generated by electrical discharges during thunderstorms (lightning). One category is comprised of very low frequency electromagnetic waves, traveling over distances up to a thousand kilometers. Sferics have been shown to affect biological responses such as pain syndromes, reaction times, and power in the alpha band of the EEG. In the present study, in which 100 subjects took part, sferics have been studied in their relation to performance on a forced-choice extrasensory perception (ESP) task and to several secondary variables. The general finding is a negative correlation between ESP performance and sferics activity around the time of the session, most notably 24-48 hours prior to the session. Secondary variables appear to modulate this correlation, as has been found in previous research on sferics: the correlation tended to be stronger for persons who scored lower on Neuroticism and higher on the Openness scale of a Five-Factor Personality Questionnaire.

[Temperament- and character traits as well as trait patterns in alcoholic men and controls]

This study is on the personality of alcoholics, an empirical investigation based on Cloninger's biopsychological temperament- and character-traits. His Temperament and Character Inventory (TCI) was applied to 94 detoxified men suffering from primary alcohol dependence as well as to controls matched for sex and sociodemographic data. The following questions were the matter of interest: (1) Do alcoholics and controls differ in their personality as reflected by the TCI and (2) are there indicators based on personality with potential relevance for differential therapies? A multiple univariate statistical comparison yielded significant differences between alcoholics and controls on only 2 subscales (Sentimentality, Resourcefulness). A multivariate analysis of the TCI temperament traits using two-sample configural frequency analysis revealed no statistically significant difference between the two groups. Temperament patterns associated with Cloninger's Type-I/Type-II alcoholics could not be demonstrated. Analyzing the temperament and character traits of the alcohol dependent subjects with a log-linear model revealed two bivariate temperament-/character classifications on the scales "Harm Avoidance" and "Self-Directedness" as well as "Reward Dependence" and "Self Transcendence"-both making it possible to define subgroups which may be relevant for different therapeutical approaches. Taken together, the results of this study suggest that it may be useful to closer investigate the personality of alcoholics even if it is not principally different from that of control subjects.