Relationship between the five-factor model of personality and unipolar, bipolar and schizophrenic patients

On the Usefulness of Measures of Normal Personality for Clinical Assessment: Evidence of the Incremental Validity of the Revised NEO Personality Inventory

As a means of examining the incremental validity of a normal personality measure in the prediction of selected Axis I and II diagnoses, 1,342 inpatient substance abusers completed the Revised NEO Personality Inventory (NEO-PI-R) and the Minnesota Multiphasic Personality Inventory--2 (MMPI-2) and were assessed with structured clinical interviews to determine diagnostic status. Results demonstrated that scores from the NEO-PI-R (a) were substantially related to the majority of diagnoses, accounting for between 8% and 26% of the variance in the diagnostic criteria; (b) explained an additional 3% to 8% of the variability beyond 28 selected MMPI-2 scale scores; (c) increased diagnostic classification an additional 7% to 23% beyond MMPI-2 scale scores; and (d) were significantly more useful when examined at the facet trait level than at the domain trait level. Implications for incorporating measures of normal personality into clinical assessment batteries are discussed.

Schema-focused cognitive therapy for bipolar disorder: reducing vulnerability to relapse through attitudinal change

OBJECTIVE

Acceptance of, and adaptability to illness, are major determinants of adherence to treatment and functional recovery. This paper addresses the major psychosocial factors associated with bipolar disorder and the role of psychological interventions in symptom management and adaptability to the illness experience. A new model is presented highlighting the role of developmental experiences and temperament in determining reactions to bipolar disorder. The authors propose that by addressing reactions to the illness experiences and effects on self-concept through schema-focused cognitive therapy, functional recovery is more likely to occur among those patients functioning below expectation.

METHOD

A systematic review of the current literature including an Index Medicus/MEDLINE search was conducted, focusing on risk factors, cognitive vulnerabilities and triggers associated with bipolar disorder. Psychological treatments available for the treatment of bipolar disorder are reviewed and details of a novel schema-focused cognitive model for this condition are presented. Traditional models of adaptation to chronic illness are outlined and incorporated into the proposed model. Schema-focused cognitive therapy is proposed as an approach to help patients reduce cognitive vulnerability to relapse in addition to adopting effective mood management strategies.

RESULTS AND CONCLUSIONS

There is a need for psychological treatments which reduce the risks associated with poor functionality in patients with bipolar disorder. Schema-focused cognitive therapy specifically targets the temperament, developmental experiences and cognitive vulnerabilities that determine adjustment to illness. This proposed treatment, combined with pharmacotherapy, may offer new psychotherapeutic options for the future.

Longitudinal outcome in patients with bipolar disorder assessed by life-charting is influenced by DSM-IV personality disorder symptoms

OBJECTIVES

Few studies have examined the question of how personality features impact outcome in bipolar disorder (BD), though results from extant work and studies in major depressive disorder suggest that personality features are important in predicting outcome. The primary purpose of this paper was to examine the impact of DSM-IV personality disorder symptoms on long-term clinical outcome in BD.

METHODS

The study used a 'life-charting' approach in which 87 BD patients were followed regularly and treated according to published guidelines. Outcome was determined by examining symptoms over the most recent year of follow-up and personality symptoms were assessed with the Structured Clinical Interview for DSM-IV (SCID-II) instrument at entry into the life-charting study.

RESULTS

Patients with better outcomes had fewer personality disorder symptoms in seven out of 10 disorder categories and Cluster A personality disorder symptoms best distinguished euthymic and symptomatic patients.

CONCLUSIONS

These results raise important questions about the mechanisms linking personality pathology and outcome in BD, and argue that conceptual models concerning personality pathology and BD need to be further developed. Treatment implications of our results, such as need for psychosocial interventions and treatment algorithms, are also described.

A categorical and dimensional perspective on depression within a nonclinical sample of couples

The present study investigated the role of psychosocial variables that are indicators for depressive symptomatology within a couple. The variables chosen for this study were conflict communication, marital adjustment, attachment, attribution style, and personality traits--all potentially specific indicators. A global factor analysis on all our measures revealed that our individual and relational measures were stable findings. We wanted to compare a dimensional and categorical view of depression. First, we focused on the total nonclinical sample, considering depression on a continuum, and studying the selected characteristics along with the varying degree of depressive complaints. The results highlighted the importance of individual characteristics (neuroticism and life satisfaction) covarying with the level of depressive symptomatology in the nonclinical sample (n = 186 couples). Second, in addition to this correlational design, we compared the group of most depressed subjects and their partners with a control sample (n = 34). Both approaches pointed to the same conclusion: individual characteristics covaried with mild depression, whereas couple characteristics only came into the picture with a higher level of depressive complaints. The lowest levels of depressive complaints were associated with individual co-morbidity only, whereas increasing complaints went along with additional relational complaints. Implications for assessment and future research are discussed.

Myers Briggs Type indicator personality profiles in unipolar depressed patients

OBJECTIVE

The current study was designed to compare the distribution of Myers Briggs Type Indicator (MBTI) personality types in patients with Unipolar Depression compared to normative data.

METHOD

The MBTI divides individuals into four dichotomous types: Extroverted and Introverted, Sensing and Intuitive, Thinking and Feeling, and Judging and Perceiving. This yields eight single-factor and sixteen four-factor types. One-hundred-thirty Unipolar Depressed patients were administered the MBTI-Form F.

RESULTS

Unipolar Depressed patients were significantly more often Introverted, Sensing, Feeling, and Perceiving single-factor types respectively, and Introverted-Sensing-Feeling-Perceiving, and Introverted-Intuitive-Feeling-Perceiving four-factor types. The male Introverted-Sensing-Feeling-Perceiving four-factor type was the most dramatically over-represented.

CONCLUSION

The MBTI effectively discriminates a patient group with Unipolar Depression from a normative population.

Obsessive-compulsive disorder and the five-factor model of personality: distinction and overlap with major depressive disorder

Research on individual differences in obsessive-compulsive disorder (OCD) has focused largely on analogue models with participants experiencing sub-clinical obsessions and/or compulsions. Few studies have examined the association between normal, dimensional personality traits and obsessive-compulsive symptomatology in a clinical sample. The purpose of this study was to examine personality differences in patients with a primary diagnosis of OCD (n = 98) or major depression (n = 98) using the domains and facets of the five-factor model of personality (FFM). Patients completed the self-report version of the Revised NEO Personality Inventory (NEO PI-R). When contrasted with community controls (Revised NEO Personality Inventory (NEO-PI-R) and NEO Five-Factor Inventory (NEO-FFI) professional manual, Psychological Assessment Resources, Odessa, FL, 1992), participants with OCD were found to differ across the domains (and facets) of neuroticism, extraversion, and conscientiousness and the facets of openness and agreeableness. Further, when compared to depressed participants, those with OCD were found to be more extraverted, agreeable, conscientious and less neurotic. With the exception of the conscientiousness domain (and facets), these significant differences were maintained even after controlling for depression severity. These results highlight the unique associations between trait domains and facets of the FFM and OCD.

Development of a measure that integrates positive and negative affect and personality: the Comprehensive Personality and Affect Scales

The development, reliability and validity of a new measure of personality and affect, the Comprehensive Personality and Affect Scales (COPAS) was investigated in three studies of college students. In study 1, the factor structure of personality, negative affect, and positive affect was assessed, with five-factors found in each of the three analyses. Fifteen scales (Personality: Emotionality, Extroversion, Openness, Conscientiousness, and Agreeableness; Negative Affect: Depression, Hostility, Agitation, Anxiety, and Social Anxiety; Positive Affect: Contentment, Joy, Love, Vigor, and Excitement) were constructed based on results of the factor analysis. Confirmatory factor analyses confirmed the measurement model. In study 2, the reliability and construct validity of each of the 15 factor-derived scales was assessed in both referred and non-referred college students. Study 3 investigated the utility of the COPAS scales in differentiating referred and non-referred college students. Results indicated that reliability of the scales was good to excellent, while convergent and divergent validity was good for most scales. The COPAS scales were also shown to differentiate between referred and non-referred samples of college students. Overall, the COPAS was shown to be suitable for research with college student populations.

Caregiver burden in recent-onset schizophrenia and spectrum disorders: the influence of symptoms and personality traits

Earlier studies that used two symptom dimensions indicate that the caregiver burden for patients with schizophrenia is significantly determined by their negative symptoms. The purpose of this study is to examine the relationship between symptom severity in recent-onset schizophrenia and caregiver burden in a more differentiated way (i.e., five-symptom dimensions). Based on previous research, which shows that patients' personality traits influence the course of schizophrenia, we theorize that personality traits could also influence caregiver burden. So far, this hypothesis has never been studied. Therefore, the second purpose of this study is to examine whether patients' personality traits would contribute to caregiver burden. The results of this study showed that the disorganization symptom component was the predicting variable of the subscales supervision, tension, urging, distress, and the overall amount of caregiver burden in a linear regression analysis. Personality traits of patients played no substantial role in caregiver burden. These findings suggest that psychoeducational programs should address the severity of disorganization symptoms to reduce caregiver burden in the early phase of schizophrenia.

NEO-FFI factor scores as predictors of clinical response to fluoxetine in depressed outpatients

Research in unipolar depression suggests that neuroticism is associated with poor long-term outcome and greater chronicity. The objective of this study was to determine whether baseline neuroticism scores predict response to treatment with fluoxetine in depressed outpatients. Seventy-six depressed outpatients participating in a clinical trial of fluoxetine (fixed/flexible dosing) completed the NEO-FFI (five factor inventory short form) at baseline. Clinical response was defined as a 50% or greater decrease in the 17-item Hamilton Depression Rating Scale (HAM-D-17) total score (final visit--baseline). Logistic regression evaluated NEO-FFI factor scores as predictors of treatment outcome within an intent-to-treat model. Scores on the neuroticism scale were not found to significantly predict treatment response as measured by the HAM-D-17. Strengths of this study include a standardized treatment protocol and use of structured interview instruments, while limitations include a modest sample size, lack of continuation data, state/trait effects, and lack of generalizability to other antidepressant treatments.

Relationship of Myers Briggs type indicator personality characteristics to suicidality in affective disorder patients

The current study characterized the Myers Briggs Type Indicator (MBTI) personality profiles of 64 suicidal and 30 non-suicidal psychiatric inpatients with affective disorder diagnoses. The MBTI divides individuals categorically into eight personality preferences (Extroverted and Introverted, Sensing and Intuitive, Thinking and Feeling, and Judging and Perceiving). Compared to the group of non-suicidal affective disorder patients, suicidal affective disorder patients were significantly more Introverted and Perceiving using ANCOVA analyses, and significantly more Introverted alone using Chi Square analyses.

Introversion and extroversion: implications for depression and suicidality

A growing body of information suggests that core or underlying personality is a significant concomitant of depression and suicidality. Introversion (ie, low extroversion) is especially promising in its relationship to the phenomenology and outcome of depression, and may represent an underlying heritable trait of etiologic significance. Furthermore, the presence of introversion has implications for differentiating unipolar and bipolar depression. It is likely that introversion acts in concert with other core personality variables, including neuroticism and having a feeling-type personality to influence depression. Considering depression from the perspective of core personality allows for novel psychotherapeutic approaches based on targeting underlying personality variables.

The P3 auditory event-related brain potential indexes major personality traits

BACKGROUND

The amplitude of the auditory P3 event-related potential is reduced in patients with axes I and II disorders. Data regarding P3 amplitude and normal personality traits in healthy individuals have been inconsistent, however, although more extreme variants of dimensional traits such as neuroticism and extraversion are associated with psychiatric morbidity.

METHODS

Male subjects (n = 18) recruited from the community completed the NEO Five-Factor Inventory, which consists of five scales: Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness. P3 potentials were generated using an auditory discrimination paradigm to which a third, novel stimulus was added. Partial least squares analysis, a multivariate statistical procedure, was used to test the relationship, in both stimulus conditions, between P3 amplitude at six electrode sites and the five personality dimensions.

RESULTS

P3 amplitude across conditions and sites was positively related to Extraversion, Openness, Agreeableness, and Conscientiousness and negatively related to Neuroticism.

CONCLUSIONS

Previous studies have shown that both reduced P3 amplitude and a high Neuroticism/low Extraversion-Openness-Agreeableness-Conscientiousness trait pattern are associated with the presence of, and risk for, substantial psychiatric morbidity. Our results suggest that processes indexed by auditory P3 amplitude are related to these broad personality dimensions in healthy individuals.

Effectiveness of NEO-PI-R research validity scales for discriminating analog malingering and genuine psychopathology

We investigated the research validity scales for the NEO Personality Inventory-Revised (NEO-PI-R) proposed by Schinka, Kinder, and Kremer (1997): Positive Presentation Management (PPM) and Negative Presentation Management (NPM). Additionally, an experimental analog to the Minnesota Multiphasic Personality Inventory-2's (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) F-K index was calculated by subtracting the raw score on PPM from the raw score on NPM (NPM-PPM). In 2 studies, all indexes showed significant between-group differences when samples of analog malingerers (n = 97) were contrasted with psychiatric outpatients (n = 272). The sensitivity and specificity of these validity indexes indicated that although none performed well in extremely low base rate environments, the NPM and NPM-PPM indexes showed promise when the base rate of faking bad rose to higher levels.

Personality and the affective disorders: past efforts, current models, and future directions

The existence of a relation between personality and the affective disorders has long been observed but with little agreement as to how it can best be described. This paper reviews attempts to address this issue, beginning with an examination of subaffective personality types. The personality dimensions of two major predominant theories, the Five Factor Model of Personality and the Seven Factor Dimensional Psychobiological Model of Temperament and Character, and the relation of these dimensions with bipolar disorder and unipolar depression is also examined. Throughout, the state-versus-trait issue is explored, and the last section is a critical reexamination of this continuing controversy. The overall objective is to search for commonalities in past and present models, and to deal with ongoing concerns, in order to point the way for future research in the field.

Response style and the revised NEO personality inventory: validity scales and spousal ratings in a Chinese psychiatric sample

The effects of response style bias on profile scores from the family of NEO scales and the resultant influence of response style on the predictive capacity of these scales continues to be debated. In this study, a large sample of Chinese psychiatric patients were categorized into four response style groups based on their scores from recently developed "validity" scales for the revised NEO Personality Inventory (NEO PI-R). Mean differences and correlations between self-report and spousal ratings of these patients were examined for the NEO PI-R domain and facet scales. Excessive positive self-presentation bias resulted in mean differences between the self-report and spousal ratings for N and E. Correlations between self-report and spousal ratings were reduced in patients engaging in positive self-presentational bias compared to those who were not so categorized on three of the five NEO PI-R scales. However, these results were manifest only in a sub-sample of psychotic patients. Negative self-presentational bias did not affect mean differences or diminish the correlations between the self-report and spousal ratings.

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.

Myers Briggs Type Indicator and Tridimensional Personality Questionnaire differences between bipolar patients and unipolar depressed patients

OBJECTIVES

The current study was designed to compare personality differences between bipolar patients and unipolar depressed patients, as evaluated on the Myers Briggs Type Indicator (MBTI) and the Tridimensional Personality Questionnaire (TPQ).

METHODS

A group of bipolar and a group of unipolar depressed patients filled out the MBTI, the TPQ, the Beck Depression Inventory, and the CAGE questionnaire. The two groups were compared with each other as to responses on the above surveys, and subgroups of bipolar depressed and bipolar patients with manic symptoms were also compared.

RESULTS

Bipolar patients were found to be significantly more extroverted (p = 0.004) and less judging (p = 0.007) on the MBTI. They were significantly more novelty seeking (p = 0.004) and less harm avoidant (p = 0.002) on the TPQ. Of the above differences, only the TPQ harm avoidance scale appeared strongly linked to the patients' level of depression.

CONCLUSION

Significant differences in personality exist between bipolar disorder and unipolar depressed patients.