Genetics and personality traits in patients with social anxiety disorder: a case-control study in South Africa

New insights into recalled parental behavior in social anxiety disorder: A cluster analytic approach

BACKGROUND

Social Anxiety Disorder (SAD) is a highly heterogeneous disorder. To enlighten its heterogeneity, this study focused on recalled parental behavior and aimed to empirically identify if there are subgroups of SAD based on recalled parental behavior by means of cluster analysis. Further, the study investigated whether those subgroups differed on clinical, trauma, and personality variables.

METHODS

This study included 505 individuals diagnosed with SAD and 98 adult controls who were asked to fill out the Parental Bonding Instrument (PBI), the Adverse Childhood Experiences Questionnaire (ACE), and the Temperament and Character Inventory (TCI). Cluster analysis determined whether there are meaningful SAD subgroups based on PBI. The clusters obtained were compared with each other and with the control group with regard to clinical, ACE, and TCI variables.

RESULTS

The cluster analysis revealed two SAD clusters based on recalled parental behavior. SAD individuals in the first cluster (49.3 %) perceived their parents as intermediately caring, but not as overcontrolling. SAD individuals in the second cluster (50.7 %) perceived their parents as less caring and overcontrolling, reported more severe clinical symptoms and trauma, and had lower values in Self-Directedness and Cooperativeness.

LIMITATIONS

The present study is cross-sectional, therefore unable to confirm causal interpretations.

CONCLUSION

Parenting is meaningful to enlighten the heterogeneity of SAD symptomatology and to specify treatment approaches as there are two meaningful subgroups in individuals with SAD corresponding to differences in clinical presentation, trauma, and personality.

Personality subtypes in adults with social anxiety disorder - novelty seeking makes the difference

BACKGROUND

Up to now several subtypes of social anxiety disorder (SAD) have been proposed.

METHODS

In the present study, we used a cluster analytic approach to identify qualitatively different subgroups of SAD based on temperament characteristics, that is, harm avoidance (HA) and novelty seeking (NS) dimensions of Cloninger's Temperament and Character Inventory.

RESULTS

Based on a large, diverse clinical sample (n = 575), we found evidence for two distinct subgroups of SAD: a larger (59%) prototypic, inhibited cluster characterized by high HA and low NS, and a smaller atypic, and comparatively more impulsive cluster characterized by medium to high HA and increased NS. The subgroups differed regarding a variety of sociodemographic and clinical variables. While the prototypic SAD subtype suffered from more severe SAD and depressive symptoms, suicidal ideation, and reduced social functioning, the atypic NS subtype showcased higher reproductive behaviour, self-directedness and -transcendence, comparatively. Additional hierarchical logistic regression highlights the contribution of age and education.

CONCLUSIONS

Our results valuably extend previous evidence for the existence of at least two distinct subtypes of SAD. A better knowledge of the characteristic differences in prototypic behaviour, personality, coping strategies and comorbidities between the identified (and further) subtypes can contribute to the development of effective prevention interventions and promotes the conceptualization of tailored treatments.

Genetics of social anxiety disorder: a systematic review

Social anxiety disorder (SAD) is a common psychiatric disorder, often associated with avoidant temperament. Research studies have implicated a strong genetic architecture of SAD. We have conducted a systematic review on the genetics of SAD and yielded 66 articles. In general, prior research studies have focused on the serotonin transporter, oxytocin receptor, brain-derived neurotrophic factor and catechol-O-methyltransferase genes. Mixed and inconsistent results have been reported. Additional approaches and phenotypes have also been investigated, including pharmacogenetics of treatment response, imaging genetics and gene-environment interactions. Future directions warrant further international collaborative efforts, deep-phenotyping of clinical characteristics including consistent and reliable measurement-based symptom severity, and larger sample sizes to ensure sufficient power for stratification due to the heterogeneity of this chronic and often debilitating condition.

Personality Traits as Markers of Psychosis Risk in Kenya: Assessment of Temperament and Character

Specific personality traits have been proposed as a schizophrenia-related endophenotype and confirmed in siblings at risk for psychosis. The relationship of temperament and character with psychosis has not been previously investigated in Africa. The study was conducted in Kenya, and involved participants at clinical high-risk (CHR) for psychosis (n = 268) and controls (n = 251), aged 15–25 years. CHR status was estimated using the Structured Interview of Psychosis-Risk Syndromes (SIPS) and the Washington Early Psychosis Center Affectivity and Psychosis (WERCAP) Screen. Student’s t-tests were used to assess group differences on the Temperament and Character Inventory (TCI). Neurocognitive functioning, stress severity, and substance use were correlated with the TCI, correcting for psychosis severity. CHR participants were more impulsive (ie, higher novelty seeking [NS]) and asocial (ie, lower reward dependence) than controls. They were also more schizotypal (ie, high self-transcendence [ST] and lower self-directedness [SD] and cooperativeness [CO] than controls). CO was related to logical reasoning, abstraction, and verbal memory. Stress severity correlated with high HA and schizotypal character traits. Lifetime tobacco use was related to NS, and lifetime marijuana use to high NS, low SD and high ST. Temperament and character of Kenyan CHR youth is similar to that observed in schizophrenia. Psychosis risk in Kenya is associated with impulsive, asocial, and schizotypal traits. CHR adolescents and young adults with schizophrenia-specific personality traits may be most at risk for developing a psychotic disorder and to require early intervention to improve outcomes.

Reinforcement sensitivity, depression and anxiety: A meta-analysis and meta-analytic structural equation model

Reinforcement Sensitivity Theory (RST) posits that individual differences in reward and punishment processing predict differences in cognition, behavior, and psychopathology. We performed a quantitative review of the relationships between reinforcement sensitivity, depression and anxiety, in two separate sets of analyses. First, we reviewed 204 studies that reported either correlations between reinforcement sensitivity and self-reported symptom severity or differences in reinforcement sensitivity between diagnosed and healthy participants, yielding 483 effect sizes. Both depression (Hedges' g = .99) and anxiety (g = 1.21) were found to be high on punishment sensitivity. Reward sensitivity negatively predicted only depressive disorders (g = -.21). More severe clinical states (e.g., acute vs remission) predicted larger effect sizes for depression but not anxiety. Next, we reviewed an additional 39 studies that reported correlations between reinforcement sensitivity and both depression and anxiety, yielding 156 effect sizes. We then performed meta-analytic structural equation modeling to simultaneously estimate all covariances and control for comorbidity. Again we found punishment sensitivity to predict depression (β = .37) and anxiety (β = .35), with reward sensitivity only predicting depression (β = -.07). The transdiagnostic role of punishment sensitivity and the discriminatory role of reward sensitivity support a hierarchical approach to RST and psychopathology.

Social anxiety disorder and childhood trauma in the context of anxiety (behavioural inhibition), impulsivity (behavioural activation) and quality of life

Background

Social anxiety disorder (SAD) is one of the most prevalent psychiatric disorders in South Africa. Previous studies have linked childhood trauma with the development of SAD. The behavioural inhibition system (BIS) and the behavioural activation system (BAS), two dimensions of personality related to anxiety and impulsivity, respectively, are said to influence the development of psychopathology, including SAD. Both SAD and childhood trauma have an impact on quality of life. This study investigated the relationship between BIS, BAS and quality of life in patients with SAD with and without exposure to childhood trauma, compared to healthy controls.

Method

Data were collected for 102 adults. A total of 76 participants met SAD criteria, of which 51 were exposed to childhood trauma and 25 were not. The remaining 26 participants were demographically matched healthy controls. Measures of anxiety, impulsivity and quality of life were obtained by administering Carver and White’s BIS/BAS scales and the Quality of Life Enjoyment and Satisfaction Questionnaire – Self Report.

Results

A positive correlation was found between the severity of SAD symptoms and the amount of childhood trauma exposure. No significant differences in impulsivity were found across the three groups. Healthy controls reported significantly lower anxiety and a better quality of life than both groups with SAD, while no differences were found between patients with SAD and childhood trauma and those without childhood trauma.

Conclusion

More childhood trauma exposure appears to be associated with greater SAD severity. The lack of differences in BIS, BAS and quality of life in patients with SAD with or without childhood trauma requires further investigation.

Genetic influence alters the brain synchronism in perception and timing

Background

Studies at the molecular level aim to integrate genetic and neurobiological data to provide an increasingly detailed understanding of phenotypes related to the ability in time perception.

Main Text

This study suggests that the polymorphisms genetic SLC6A4 5-HTTLPR, 5HTR2A T102C, DRD2/ANKK1-Taq1A, SLC6A3 3’-UTR VNTR, COMT Val158Met, CLOCK genes and GABRB2 A/C as modification factor at neurochemical levels associated with several neurofunctional aspects, modifying the circadian rhythm and built-in cognitive functions in the timing. We conducted a literature review with 102 studies that met inclusion criteria to synthesize findings on genetic polymorphisms and their influence on the timing.

Conclusion

The findings suggest an association of genetic polymorphisms on behavioral aspects related in timing. However, order to confirm the paradigm of association in the timing as a function of the molecular level, still need to be addressed future research.

Temperamental predictors of developmental trajectories of inattention and hyperactivity-impulsivity problems in schoolchildren

Background

The current study aimed to examine the temperamental predictors of developmental trajectory subgroups of children's inattention and hyperactivity–impulsivity problems through a short-term longitudinal study.

Methods

Children (n = 1344) were divided into younger (age 6–8 years) and older (age 9–11 years) groups in order to observe changes in inattention and hyperactivity–impulsivity problems. Inattention and hyperactivity–impulsivity problems were measured three times at 5-month intervals and Cloninger's four temperaments (novelty seeking, harm avoidance, reward dependence, and persistence) were examined on the first occasion only. A cohort sequential design and growth mixture model were used for investigating trajectory subgroups and multiple logistic regression analysis to examine the temperamental predictors.

Results

Developmental trajectories of inattention and hyperactivity–impulsivity showed different subgroupings depending on the age group of children. Temperament (high score on novelty seeking and low score on persistence as well as high score on reward dependence) and gender predicted the likelihood of belonging to high-risk versus low-risk subgroups.

Conclusion

Suggestions taking into account the predictors of developmental trajectories in inattention and hyperactivity–impulsivity problems for future research are discussed along with the limitations of the current study.

Temperamental and character profiles of preschool children with ODD, ADHD, and anxiety disorders

BACKGROUND

The aim of the present research was to identify profiles of Cloninger's temperament and character dimensions associated with anxiety disorders, oppositional defiant disorder (ODD) and attention- deficit/hyperactive disorder (ADHD) in preschoolers.

METHOD

The parents of 120 children (mean age=4.65 years; S.D.=.88) completed the Preschool Temperament and Character Inventory (PsTCI). The sample consisted of 4 groups (n=30 per group): ADHD, anxious, ODD and control children. To diagnose the different disorders, the Preschool Age Psychiatric Assessment and Child Behavior Checklist 1.5-5 was administered to the parents.

RESULTS

The discriminant analysis showed that three temperamental dimensions (Harm Avoidance, Novelty Seeking and Persistence) enabled the correct classification of 75% of cases within their own group, which demonstrated an adequate accuracy rate. The ADHD children showed a temperamental profile that was characterized by high Novelty Seeking, low Reward Dependence and low Persistence, while the anxious children obtained high scores in Harm Avoidance. The profiles of the ODD children shared some common features (high Novelty Seeking) with the ADHD children, but the ODD children were characterized by higher Persistence and Harm Avoidance compared with ADHD children.

CONCLUSIONS

The present results indicate that Cloninger's temperamental dimensions allow to differentiate the three most frequent psychiatric disorders in preschoolers.

New evidence of heterogeneity in social anxiety disorder: defining two qualitatively different personality profiles taking into account clinical, environmental and genetic factors

PURPOSE

To study qualitatively different subgroups of social anxiety disorder (SAD) based on harm avoidance (HA) and novelty seeking (NS) dimensions.

METHOD

One hundred and forty-two university students with SAD (SCID-DSM-IV) were included in the study. The temperament dimensions HA and NS from the Cloninger's Temperament and Character Inventory were subjected to cluster analysis to identify meaningful subgroups. The identified subgroups were compared for sociodemographics, SAD severity, substance use, history of suicide and self-harm attempts, early life events, and two serotonin transporter gene polymorphisms (5-HTTLPR and STin2.VNTR).

RESULTS

Two subgroups of SAD were identified by cluster analysis: a larger (61% of the sample) inhibited subgroup of subjects with "high-HA/low-NS", and a smaller (39%) atypical impulsive subgroup with high-moderate HA and NS. The two groups did not differ in social anxiety severity, but did differ in history of lifetime impulsive-related-problems. History of suicide attempts and self-harm were as twice as frequent in the impulsive subgroup. Significant differences were observed in the pattern of substance misuse. Whereas subjects in the inhibited subgroup showed a greater use of alcohol (P=0.002), subjects in the impulsive subgroup showed a greater use of substances with a high-sensation-seeking profile (P<0.001). The STin2.VNTR genotype frequency showed an inverse distribution between subgroups (P=0.005).

CONCLUSIONS

Our study provides further evidence for the presence of qualitatively different SAD subgroups and the propensity of a subset of people with SAD to exhibit impulsive, high-risk behaviors.

Oxytocin's role in anxiety: a critical appraisal

A growing literature suggests that the oxytocin (OT) system may play a role in human anxiety states, anxiety-related traits, and moreover, that this system may be a target for the development of novel anxiolytic treatments. However, studies of OT's acute and chronic effects on various aspects of anxiety have produced mixed results. In this forward-looking review, we discuss the myriad phenomena to which the term "anxiety" is applied in the OT literature and the problem this presents developing a coherent picture of OT's role in anxiety. We then survey several different fields of research that support the role of the OT system in human anxiety, including evolutionary perspectives, translational and neuroimaging research, genetic studies, and clinical trials of intranasal OT. As an outgrowth of this data, we propose a "bowtie" model of OT's role at the interface of social attachment and anxiety. We next direct attention to understudied brain regions and neural circuits which may be important to study in OT experiments in humans anxiety disorders. Finally, we conclude by proposing questions and priorities for studying both the clinical potential of OT in anxiety, as well as mechanisms that may underlie this potential. Crucially, these priorities include targeted proof-of-concept clinical trials of IN OT in certain anxiety disorders, including investigations of individual moderators of OT's anxiolytic effects (i.e. sex, genetic factors, and early experience). This article is part of a Special Issue entitled Oxytocin and Social Behav.

Individual differences in positivity offset and negativity bias: Gender-specific associations with two serotonin receptor genes

Individual differences in the evaluation of affective stimuli, such as the positivity offset and negativity bias may have a biological basis. We tested whether two SNPs (HTR2A; 102T>C and HTR1A; 1019C>G) related to serotonin receptor function, a biological pathway associated with affective regulation, were differentially related to positivity offset and negativity bias for males and females. Participants were 109 cigarette smokers who rated a series of affective stimuli to assess reactions to positive and negative pictures. Gender × genotype interactions were found for both SNPs. Males with the 102T allele showed a greater positivity offset than males with the 102C allele. For females, in contrast, the 1019C allele was associated with a greater positivity offset than the 1019G allele, whereas the 102T allele was associated with a greater negativity bias than the 102C allele. Identifying how gender differences may moderate the effect of serotonin receptor genes on affective information processing may provide insight into their role in guiding behavior and regulating affect.

Sex-dependent correlations between the personality dimension of harm avoidance and the resting-state functional connectivity of amygdala subregions

Harm avoidance (HA) is a personality dimension involving the tendency to respond intensely to signals of aversive stimuli. Many previous neuroimaging studies have associated HA scores with the structural and functional organization of the amygdala, but none of these studies have evaluated the correlation between HA score and amygdala resting-state functional connectivity (rsFC). Moreover, the amygdala is not a homogeneous structure, and it has been divided into several structurally and functionally distinct subregions. Investigating the associations between HA score and properties of subregions of the amygdala could greatly improve our understanding of HA. In the present study, using a large sample of 291 healthy young adults, we aimed to uncover correlations between HA scores and the rsFCs of each amygdala subregion and to uncover possible sex-based differences in these correlations. We found that subregions of the amygdala showed different rsFC patterns, which contributed differently to individual HA scores. More specifically, HA scores were correlated with rsFCs between the laterobasal amygdala subregion and temporal and occipital cortices related to emotional information input, between the centromedial subregion and the frontal cortices associated with emotional output control, and between the superficial subregion and the frontal and temporal areas involved in both functions. Moreover, significant gender-based differences were uncovered in these correlations. Our findings provide a more detailed model of association between HA scores and amygdala rsFC, extend our understanding of the connectivity of subregions of the amygdala, and confirm sex-based differences in HA associations.

Pharmacotherapy of anxiety disorders: a critical review

Given the enormous contribution of anxiety disorders to the burden of disease, it is key to optimize their prevention and treatment. In this critical review we assess advances in the pharmacotherapy of anxiety disorders, as well as remaining challenges, in recent decades, the field has seen rigorous clinical trial methods to quantify the efficacy and safety of serendipitously discovered agents, more focused development of medications with selective mechanisms of action, and the gradual translation of insights from laboratory research into proof-of-principle clinical trials. On the positive side, a considerable database of studies shows efficacy and relative tolerability of the selective serotonin reuptake inhibitors in the major anxiety disorders, and secondary analyses of such datasets have informed questions such as optimal definition of response and remission, optimal dose and duration, and comparative efficacy of different agents. Significant challenges in the field include barriers to appropriate diagnosis and treatment of anxiety disorders, failure of a significant proportion of patients to respond to first-line pharmacotherapy agents, and a limited database of efficacy or effectiveness studies to guide treatment in such cases.

Serotonin 2A receptor, serotonin transporter and dopamine transporter alterations in dogs with compulsive behaviour as a promising model for human obsessive-compulsive disorder

Neuro-imaging studies have shown altered, yet often inconsistent, serotonergic and dopaminergic neurotransmission in patients with obsessive-compulsive disorder (OCD). We investigated both serotonergic and dopaminergic neurotransmission in 9 drug-naïve dogs with compulsive behaviour, as a potential model for human OCD. Single photon emission computed tomography was used with (123)I-R91150 and (123)I-FP-CIT, in combination with (99m)Tc-ECD brain perfusion co-registration, to measure the serotonin (5-HT) 2A receptor, dopamine transporter (DAT) and serotonin transporter (SERT) availability. Fifteen normally behaving dogs were used as reference group. Significantly lower 5-HT2A receptor radioligand availability in frontal and temporal cortices (bilateral) was observed. Further, in 78% of the compulsive dogs abnormal DAT ratios in left and right striatum were demonstrated. Interestingly, both increased and decreased DAT ratios were observed. Finally, significantly lower subcortical perfusion and (hypo)thalamic SERT availability were observed in the compulsive dogs. This study provides evidence for imbalanced serotonergic and dopaminergic pathways in the pathophysiology of compulsions in dogs. The similarities with the altered neurotransmission in human OCD provide construct validity for this non-induced, natural canine model, suggesting its usefulness for future investigations of the pathophysiology of human OCD as well as the effectiveness of psychopharmacological interventions.

Behavioral genetics of affective and anxiety disorders

As shown by clinical genetic studies, affective and anxiety disorders are complex genetic disorders with genetic and environmental factors interactively determining their respective pathomechanism. Advances in molecular genetic techniques including linkage studies, association studies, and genome-wide association studies allow for the detailed dissection of the genetic influence on the development of these disorders. Besides the molecular genetic investigation of categorical entities according to standardized diagnostic criteria, intermediate phenotypes comprising neurobiological or neuropsychological traits (e.g., neuronal correlates of emotional processing) that are linked to the disease of interest and that are heritable, have been proposed to be closer to the underlying genotype than the overall disease phenotype. These intermediate phenotypes are dimensional and more precisely defined than the categorical disease phenotype, and therefore have attracted much interest in the genetic investigation of affective and anxiety disorders. Given the complex genetic nature of affective and anxiety disorders with an interaction of multiple risk genes and environmental influences, the interplay of genetic factors with environmental factors is investigated by means of gene-environment interaction (GxE) studies. Pharmacogenetic studies aid in the dissection of the genetically influenced heterogeneity of psychotropic drug response and may contribute to the development of a more individualized treatment of affective and anxiety disorders. Finally, there is some evidence for genetic factors potentially shared between affective and anxiety disorders pointing to a possible overlapping phenotype between anxiety disorders and depression.

The interaction between serotonin receptor 2A and catechol-O-methyltransferase gene polymorphisms is associated with the novelty-seeking subscale impulsiveness

OBJECTIVE

Novelty seeking is a trait that has been consistently associated with problem behaviours. There is evidence for heritability of novelty seeking, but the molecular genetic basis of the trait is still widely unclear.

METHODS

The interaction between polymorphisms of catechol-O-methyltransferase (COMT) and serotonin receptor 2A genes was examined in relation to novelty seeking and its different subscales in healthy Finnish adults. A subsample of 1214 participants derived from a population-based sample was genotyped for the COMT Val158Met (rs4680) and HTR2A T102C (rs6313) genes. Novelty seeking was measured twice, with a 4-year interval, using Cloninger's Temperament and Character Inventory.

RESULTS

The interaction between COMT Val158Met and HTR2A T102C polymorphisms was found to be associated with subscale impulsiveness. T/T carriers of HTR2A T102C polymorphism, that also had Met/Met genotype of COMT Val158Met single nucleotide polymorphism, scored significantly higher on impulsiveness than Val allele carriers (P=0.005).

CONCLUSION

Our results suggest that the interaction between dopaminergic and serotonergic genes might underlie impulsiveness. Together with earlier research our results also stress the importance of considering novelty seeking as a heterogeneous trait with its subscales having different genetic backgrounds.

Familial risk factors in social anxiety disorder: calling for a family-oriented approach for targeted prevention and early intervention

Within the last decade, social anxiety disorder (SAD) has been identified as a highly prevalent and burdensome disorder. Both the characterization of its symptomatology and effective treatment options are widely documented. Studies particularly indicate that SAD aggregates in families and has its onset in early adolescence. Given the family as an important context for children's cognitive, emotional and behavioural development, familial risk factors could be expected to significantly contribute to the reliable detection of populations at risk for SAD. Reviewing studies on familial risk factors for SAD argues for the importance of parental psychopathology and unfavourable family environment, but also denotes to several shortcomings such as cross-sectional designs, short follow-up periods, diverging methodologies and the focus on isolated factors. Using a prospective longitudinal study that covers the high-risk period for SAD, including a broader spectrum of putative risk factors may help to overcome many of the methodological limitations. This review sets out to develop a more family-oriented approach for predicting the onset and maintenance of SAD that may be fruitful to derive targeted prevention and early intervention in SAD.

Estrogen receptor alpha (ESR-1) associations with psychological traits in women with PMDD and controls

Premenstrual Dysphoric Disorder (PMDD) is a mood disorder affecting about 5% of women and is associated with substantial morbidity. Albeit inconsistently, PMDD is described as being characterized by heritable personality traits. Although PMDD is a heritable disorder, it is unclear whether any of the heritable susceptibility to PMDD resides in heritable personality traits. In groups of carefully characterized women with PMDD (n=68) and controls (n=56), we attempted to determine whether diagnosis-related traits could be confirmed, as well as to determine whether such traits were associated with SNPs in estrogen receptor alpha (ESR-1) that we previously demonstrated were associated with PMDD. We observed 7/25 traits to be significantly different in patients and controls and further showed that 11/12 significant associations observed between these 7 traits and 16 ESR-1 SNPs involved the intron 4 SNPs previously shown to be the locus of the association with PMDD. While several interactions between genotype and diagnosis were observed, the effect of genotype in most instances was in the same direction in patients and controls. These data demonstrate affective state-independent personality traits that distinguish patients with PMDD from controls and further support the relevance of ESR-1 polymorphic variants in the regulation of non-reproductive behaviors.

Temperament and Character Correlates of Neuropsychological Performance

We investigate the association between temperament and character dimensions, on the one hand, and computerised neuropsychological test performance, on the other hand. Temperament and character dimensions were operationalised as scores on the subscales of the Temperament and Character Inventory (TCI), a 240-item measure that is based on the psychobiological theory of personality. Neuropsychological outcomes were measured on six computerised tests of executive functioning and abstract reasoning from the University of Pennsylvania Computerised Neuropsychological Test Battery (PennCNP). The executive and abstract reasoning tasks included a test of Motor Praxis (MPRAXIS), the Penn Abstraction, Inhibition and Working Memory Task (AIM), the Letter-N-Back (LNB2), the Penn Conditional Exclusion Task (PCET), the Penn Short Logical Reasoning Task (SPVRT) and the Short Raven's Progressive Matrices (SRAVEN). Results from this exploratory study yielded significant associations between neuropsychological performance and temperament and character traits. The temperament traits of Harm Avoidance and Reward Dependence were positively correlated with reaction time on the AIM and the SPVRT. The character dimension of Self-Transcendence was significantly associated with performance accuracy on the AIM and the temperament dimension of Novelty Seeking was inversely related to performance accuracy on the LNB2. These results confirm the importance of addressing the temperament and character correlates of neuropsychological performance in both clinical and non-clinical studies.

Panic disorder is associated with the serotonin transporter gene (SLC6A4) but not the promoter region (5-HTTLPR)

Panic disorder (PD) and social anxiety disorder (SAD) are moderately heritable anxiety disorders. We analyzed five genes, derived from pharmacological or translational mouse models, in a new case-control study of PD and SAD in European Americans: (1) the serotonin transporter (SLC6A4), (2) the serotonin receptor 1A, (3) catechol-O-methyltransferase, (4) a regulator of g-protein signaling and (5) the gastrin-releasing peptide receptor. Cases were interviewed using the schedule for affective disorders and schizophrenia and were required to have a probable or definite lifetime diagnosis of PD (N=179), SAD (161) or both (140), with first onset by age 31 and a family history of anxiety. Final diagnoses were determined using the best estimate procedure, blind to genotyping data. Controls were obtained from the National Institute of Mental Health Human Genetics Initiative; only subjects above 25 years of age who screened negative for all psychiatric symptoms were included (N=470). A total of 45 single nucleotide polymorphisms were successfully genotyped over the five selected genes using Applied Biosystems SNPlex protocol. SLC6A4 provided strong and consistent evidence of association with the PD and PD+SAD groups, with the most significant association in both groups being at rs140701 (chi(2)=10.72, P=0.001 with PD and chi(2)=8.59, P=0.003 in the PD+SAD group). This association remained significant after multiple test correction. Those carrying at least one copy of the haplotype A-A-G constructed from rs3794808, rs140701 and rs4583306 have 1.7 times the odds of PD than those without the haplotype (95% confidence interval: 1.2-2.3). The SAD only group did not provide evidence of association, suggesting a PD-driven association. The findings remained after adjustment for age and sex, and there was no evidence that the association was due to population stratification. The promoter region of the gene, 5-HTTLPR, did not provide any evidence of association, regardless of whether analyzed as a triallelic or biallelic locus, nor did any of the other four candidate genes tested. Our findings suggest that the serotonin transporter gene may play a role in PD; however, the findings require replication. Future studies should attend to the entire genetic region rather than the promoter.

Promotion of Well-Being in Person-Centered Mental Health Care

An understanding of the mechanisms of personality development provides a systematic way to promote health as an integrated state of physical, mental, social, and spiritual well-being. Individual differences in personality are causal antecedents of the full range of psychopathology. The maturation with integration of personality appears to be an important mechanism by which diverse modalities of treatment promote wellness and reduce illness. First, the authors review the relationship between personality and a wide range of psychiatric disorders. Second, the authors evaluate the impact of character structure on a wide range of measures of well-being, including positive emotions, negative emotions, life satisfaction, perceived social support, and perceived health. Third, the authors describe a practical and inexpensive clinical method for facilitating the maturation and integration of personality based on an understanding of the processes of human thought, which underlie changes in personality and well-being.

Temperament and character among Korean children and adolescents with anxiety disorders

The purpose of this study was to evaluate the temperament and character of children and adolescents with anxiety disorders in samples from Korean community. The study subjects were children and adolescents diagnosed with social phobia (n = 66), separation anxiety disorder (n = 47), specific phobia (n = 415), and obsessive-compulsive disorder (n = 42) with the diagnostic interview schedule for children, version IV (DISC-IV) in representative community samples. Among these, we excluded other psychiatric disorder comorbid samples, with the exception of externalizing disorders. We assessed the subjects of each anxiety group using the junior temperament and character inventory (JTCI). Social phobias were significantly associated with high harm avoidance and low self-directedness on the JTCI. The association of specific phobias with high harm avoidance, and obsessive-compulsive disorder with low self-directedness was also significant. Separation anxiety disorder was not associated with any temperament and character on the JTCI. Children and adolescents with anxiety disorders have different temperaments and character profiles in accordance with diagnostic groups, which implies the specific pathophysiological mechanism of each anxiety disorder.

The association between bodily anxiety symptom dimensions and the scales of the Revised NEO Personality Inventory and the Temperament and Character Inventory

The association between anxiety disorders and different measures of personality has been extensively studied to further the understanding of etiology, course, and treatment, and to possibly prevent the development of anxiety disorders. We have proposed a hierarchical model of bodily anxiety symptoms with 1 second-order severity factor and 5 first-order factors: cardio-respiratory, gastro-intestinal, autonomic, vertigo, and tension. The aim of this study was to investigate whether personality traits were differentially related to distinct symptom subdimensions or exclusively related to the general severity factor. Structural equation modeling of data on 120 patients with a primary diagnosis of social phobia and 207 patients with a primary diagnosis of panic disorder was used to examine the association between anxiety symptom dimensions and the scales of the Temperament and Character Inventory and of the Revised NEO Personality Inventory. When both sets of personality measures were simultaneously modeled as predictors, the Revised NEO Personality Inventory scales, neuroticism and extraversion, remained significantly associated with the severity factor, whereas the association between the Temperament and Character Inventory dimensions, harm avoidance and novelty seeking, and the severity factor became nonsignificant. Harm avoidance was negatively associated with the vertigo first-order factor, whereas neuroticism was negatively associated with the cardio-respiratory first-order factor, indicating that personality factors may be differentially related to specific anxiety subdimensions.