Exploring the link between character, personality disorder, and neuropsychological function

The Relationship Between Behavior Aspects of Executive Functions and Personality Traits in Healthy Young Adults

Executive functions (ЕF) are complex cognitive processes that govern our behavior and thoughts. Associations between personality traits and executive functions clarify the mechanisms of a person's ability to function in everyday situations. The main goal of this study was to explore different personality dimensions relevant to the prediction of two different executive functions - Inhibition and Working Memory. The Big Five Inventory and the Adult Executive Functioning Inventory (ADEXI) were administered on a community sample comprising 549 young adults aged 18-35 years (mean age 22.10 years, SD 3.13). After controlling for age, gender and level of education, Conscientiousness and Extraversion were the most predictive personality traits, while Neuroticism and Agreeableness made specific contributions to the prediction of one of the two executive measures: Working Memory or Inhibition. Specifically, high Conscientiousness and Extraversion with low Neuroticism were significant predictors of Working Memory ability. On the other hand, high Conscientiousness and Agreeableness with low Extraversion predicted better Inhibition ability. These findings support the conclusion that these dimensions of individual differences seem to have numerous points of overlap at both psychological and neurobiological levels, but differences between these constructs are still significant.

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.

Minimal emotional dysfunctions (MED) in personality disorders

The concept of minimal emotional dysfunctions (MED) refers to traditional psychopathology in order to describe, classify, and understand personality disorders. Emotional dysfunctions encompass disorders of affect predominance, production, expression, experience, modulation, and regulation. MED can explain the dimensional nature of personality disorders, their multidimensionality and problems with categorical classifications. It can stimulate research on the etiology of personality disorders in reference to modern developmental brain research and trauma psychology. It can guide new developments in pharmacotherapy and psychotherapy. It is suggested to focus on MED in future developments of the description and classification of personality disorders.

Personality and Cognitive Functions in Violent Offenders - Implications of Character Maturity?

Previous research has suggested that personality and cognitive functions are essential in the emergence of persistent aggressive antisocial behaviors and that character maturity could be an important protective factor against these behaviors. The aims of this study were (1) to determine associations between personality traits, intellectual ability, and executive function in young male violent offenders, and (2) to investigate differences in intellectual ability and executive function between groups of violent offenders with low, medium, and high character maturity. A cohort of 148 male violent offenders (18–25 years of age) participated in this study. The Temperament and Character Inventory was used as a self-report measure of personality traits, and cognitive functions were measured with the Wechsler Adult Intelligence Scale – Third Edition and the Cambridge Neuropsychological Test Automated Battery. Intellectual ability was negatively correlated to the temperament dimension Harm Avoidance and the character dimension Self-Transcendence, and positively correlated to the character dimensions Self-Directedness and Cooperativeness and the temperament dimension Novelty Seeking. Visual sustained attention correlated positively to the temperament dimension Persistence and negatively to the temperament dimension Harm Avoidance. Spatial working memory correlated negatively to the character dimension Cooperativeness. Character maturity, however, did not affect intellectual and executive functions to a statistically significant degree. Our findings indicate that offender personality characteristics such as optimism, responsibility, empathy, curiosity, and industry that would seem more favorable to positive intervention outcomes are related to better cognitive functioning. Possible implications are that interventions in offender populations could be more effective if tailored to participants’ personality dimensions and cognitive proficiencies, rather than offered as “one size fits all.”

Imprisoning Yoga: Yoga Practice May Increase the Character Maturity of Male Prison Inmates

Background: A specific personality profile, characterized by low character maturity (low scores on the self-directedness and cooperativeness character dimensions) and high scores on the novelty seeking temperament dimension of the temperament and character inventory (TCI), has been associated with aggressive antisocial behavior in male prison inmates. It has also been shown that yoga practiced in Swedish correctional facilities has positive effects on the inmates' well-being and on risk factors associated with criminal recidivism (e.g., antisocial behavior). In this study, we aimed to investigate whether the positive effect of yoga practice on inmates' behaviors could be extended to include eventual changes in their personality profile. Methods: Male prison inmates (N = 111) in Sweden participated in a randomized controlled 10-week long yoga intervention trial. Participants were randomly assigned to either a yoga group (one class a week; n = 57) or a control group (free of choice weekly physical activity; n = 54). All the inmates completed the TCI questionnaire before and after the intervention period as part of an assessment battery. Results: After the 10-week-long intervention period male inmates scored significantly lower on the novelty seeking and the harm avoidance and significantly higher on the self-directedness dimensions of the TCI. There was a significant medium strong interaction effect between time and group belonging for the self-directedness dimension of character favoring the yoga group. Conclusion: A 10-week-long yoga practice intervention among male inmates in Swedish correctional facilities increased the inmates' character maturity, improving such abilities as their capability to take responsibility, feel more purposeful, and being more self-acceptant-features that previously were found to be associated with decreased aggressive antisocial behavior.

Personality and trait aggression profiles of male and female prison inmates

Gender specific personality profiles in association with the level of aggressive antisocial behavior in offenders have not been previously investigated. In the present study we analyzed data collected from 65 male and 50 female offenders using structured protocols regarding criminal history (by criminal register data), trait aggression (by the Life History of Aggression (LHA) questionnaire), and personality profiles (by the Temperament and Character Inventory (TCI)). Prison inmates differed significantly on several personality dimensions, most pronouncedly were they characterized with low character maturity (low scores in the Self-Directedness and Cooperativeness dimensions of TCI) when compared to gender and age matched controls of the general population. The majority of offenders scored distinctively high on trait aggression. There were moderate to strong associations between the personality dimensions and each of the subscales of LHA (Aggression, Self-directed Aggression and Antisocial behavior). These associations were stronger in the female offender sample. Trait aggression could be best explained by a model, which included male gender, younger age, high novelty seeking temperament and low character maturity. Our results suggest that therapies aiming at strengthening self-governance and increasing cooperativeness (focusing on character maturity) may alleviate aggressive antisocial behavior in offenders.

Neuropsychological performance and affective temperaments in Euthymic patients with bipolar disorder type II

Affective temperament has been suggested as a potential mediator of the effect between genetic predisposition and neurocognitive functioning. As such, this report seeks to assess the extent of the correlation between affective temperament and cognitive function in a group of bipolar II subjects. 46 bipolar II outpatients [mean age 41.4 years (SD 18.2); female 58.9%] and 46 healthy controls [mean age 35.1 years (SD 18); female 56.5%] were evaluated with regard to their demographic and clinical characteristics, affective temperament, and neurocognitive performance. Crude bivariate correlation analyses and multiple linear regression models were constructed between five affective temperament subscales and eight neurocognitive domains. Significant correlations were identified in bipolar patients between hyperthymic temperament and verbal memory and premorbid IQ; cyclothymic temperament and attention; and irritable temperament, attention, and verbal fluency. In adjusting for potential confounders of the relationship between temperament and cognitive function, the strongest mediating factors among the euthymic bipolar patients were found to be residual manic and depressive symptoms. It is therefore concluded that affective temperaments may partially influence the neurocognitive performance of both healthy controls and euthymic patients with bipolar disorder type II in several specific domains.

Executive functions and psychiatric symptoms in drug-refractory juvenile myoclonic epilepsy

PURPOSE

The pattern of executive dysfunction reported in juvenile myoclonic epilepsy (JME) resembles that of patients with cluster B personality disorders. This study examined whether executive dysfunction and maladaptive behavior reported in patients with JME are related.

METHOD

Sixty patients with drug-refractory JME were administered tests of intellect, memory, and executive dysfunction. Anxiety, depression, personality traits, impact of epilepsy, and perceived cognitive effects of antiepileptic drugs were measured.

RESULTS

Half of the cohort exhibited moderate to severe anxiety symptoms. The patients performed most poorly on naming ability and inhibition switching. Duration of epilepsy exacerbated poor performance on inhibition switching. Females presented with pathological scores for neurotic and introvert traits and males for introvert traits. Abnormal personality traits and psychiatric disorders were associated with worse intellectual and executive functioning. People with extreme Eysenck Personality Scale - Brief Version (EPQ-BV) scores demonstrated the greatest level of executive impairment. Furthermore, the same degree of dysfunction was not seen in any individual with unremarkable EPQ-BV scores.

CONCLUSION

This study indicates that specific patterns of executive dysfunction are related to maladaptive behavior in JME. Distinct behavioral patterns may be used to identify functional and anatomical differences between people with JME and for stratification to enable gene discovery.

Neurocognitive disorders in sentenced male offenders: implications for rehabilitation

BACKGROUND

Neurocognitive deficits are frequent among male offenders and tend to be associated with a more serious risk of anti-social activity, but they are not systematically allowed for in rehabilitation programmes.

AIM

The aim of this study was to evaluate neurocognitive performance in a sample of sentenced Finnish male prisoners and consider the implications for prison programme entry.

METHODS

Seventy-five sentenced male prisoners were examined using a neurocognitive test battery.

RESULTS

Depending on the neurocognitive domain, from 5% to 49% of the men demonstrated marked neurocognitive deficits in tests of motor dexterity, visuospatial/construction skills, verbal comprehension, verbal and visual memory and attention shift. Verbal IQ was more impaired than performance IQ. There was no association between most serious offence type and neurocognitive performance, but correlations between attention deficit indices and number of previous convictions suggested that recidivists may have an attention disorder profile. Cluster analysis identified two subgroups of offenders, separated by very poor or merely poor cognitive performance. Motor dexterity, visuo-construction and verbal memory deficits were not wholly explained by lower IQ measures.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Our sample was small, but the nature and extent of the neurocognitive deficits found suggest that wider use of neurocognitive assessments, which the men generally tolerated well, could help select those most likely to need offender programmes and that the effectiveness of these may be enhanced by some specific cognitive remediation before progressing to more complex social tasks.

A latent profile analysis of schizotypy, temperament and character in a nonclinical population: association with neurocognition

Schizotypy is conceptualized as a latent personality construct that confers liability for schizophrenia, while it is also suggested that schizotypy can relate to certain favorable aspects. Investigating individual-level interactions between schizotypy and broader personality characteristics might give a clue to this question. We aimed to identify homogeneous classes of individuals based on schizotypy, temperament and character and to validate this classification using comprehensive neurocognitive data. We studied 455 nonclinical adults using the Schizotypal Personality Questionnaire, the Temperament and Character Inventory, and an array of neuropsychological tests. A latent profile analysis (LPA) of schizotypy, temperament and character was conducted, and cognitive performance was compared as a function of latent class membership. LPA provided a 3-class solution. Of the sample, 15% was classified into a "high-positive-schizotypy/adaptive" group characterized by high cognitive-perceptual but low interpersonal schizotypy, together with low harm avoidance and high self-directedness, cooperativeness and self-transcendence; 18% was classified into a "high-schizotypy/maladaptive" group characterized by overall high schizotypy, together with high harm avoidance and low self-directedness and cooperativeness; and 67% was classified into a "low-schizotypy/adaptive" group characterized by overall low schizotypy, together with intermediate-to-low harm avoidance, high self-directedness and intermediate-to-high cooperativeness. Overall cognitive performance of the high-positive-schizotypy/adaptive group was comparable to that of the low-schizotypy/adaptive group and superior to that of the high-schizotypy/maladaptive group. The present LPA clearly defines a group of individuals who have adaptive personality traits and intact neuropsychological functions despite high positive schizotypy, suggesting that there may be complex, nonlinear relationships between schizotypal traits and psychopathology.

Relationships between season of birth, schizotypy, temperament, character and neurocognition in a non-clinical population

While schizophrenia has been associated with a slight excess of winter/early spring birth, it is unclear whether there is such an association in relation to schizotypal personality traits. Season of birth has also been reported to relate to temperament and character personality dimensions and cognitive functioning. Moreover, non-clinical schizotypy has been shown to be associated with mild cognitive impairment, although its precise nature is yet to be elucidated. Here we examined the relationships between season of birth, schizotypal traits, temperament and character, and cognitive function. Four hundred and fifty-one healthy adults completed the Schizotypal Personality Questionnaire (SPQ). The Temperament and Character Inventory (TCI) and a neuropsychological test battery consisting of full versions of the Wechsler Memory Scale-Revised and the Wechsler Adult Intelligence Scale-Revised, and the Wisconsin Card Sorting Test, were also administered to most of the participants. The total SPQ score of those born in winter was significantly higher than that of the remaining participants. Season of birth was not significantly associated with any of the TCI dimensions or cognitive test results. Significant but mild relationships between higher SPQ scores and lower scores on some aspects of IQ were observed. These results support the notion that schizotypy and schizophrenia are neurodevelopmental conditions on the same continuum.

Cognitive dysfunction and health-related quality of life after a cardiac arrest and therapeutic hypothermia

BACKGROUND

Evidence-based treatment protocols including therapeutic hypothermia have increased hospital survival to over 50% in unconscious out-of-hospital cardiac arrest survivors. In this study we estimated the incidence of cognitive dysfunctions in a group of cardiac arrest survivors with a high functional outcome treated with therapeutic hypothermia. Secondarily, we assessed the cardiac arrest group's level of cognitive performance in each tested cognitive domain and investigated the relationship between cognitive function and age, time since cardiac arrest and health-related quality of life (HRQOL).

METHODS

We included 26 patients 13-28 months after a cardiac arrest. All patients were scored using the Cerebral Performance Category scale (CPC) and Mini-Mental State Examination (MMSE). Twenty-five of the patients were tested for cognitive function using the Cambridge Neuropsychological Test Automated Battery (CANTAB). These patients were tested using four cognitive tests: Motor Screening Test, Delayed Matching to Sample, Stockings of Cambridge and Paired Associate Learning from CANTAB. All patients filled in the Short Form-36 for the assessment of HRQOL.

RESULTS

Thirteen of 25 (52%) patients were classified as having a cognitive dysfunction. Compared with the reference population, there was no difference in the performance in motor function and delayed memory but there were significant differences in executive function and episodic memory. We found no associations between cognitive function and age, time since cardiac arrest or HRQOL.

CONCLUSION

Half of the patients had a cognitive dysfunction with reduced performance on executive function and episodic memory, indicating frontal and temporal lobe affection, respectively. Reduced performance did not affect HRQOL.

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.

What do all personality disorders have in common? Ineffectiveness and uncooperativeness

We still lack operative and theoretically founded definitions of what a personality disorder (PD) is, as well as empirically validated and feasible instruments to measure the disorder construct. The Temperament and Character Inventory (TCI) is the only personality instrument that explicitly distinguishes personality style and disordered functioning. Here, we seek to (1) confirm in a clinical sample that the character dimensions of the TCI capture a general construct of PD across all specific PD subtypes, (2) determine whether such core features can be used to detect the presence of PD, and (3) analyze whether such detection is affected by the presence and severity of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis I symptoms. Two hundred five anxious/depressed outpatients were evaluated with the Structural Clinical Interview for DSM-IV Axis I and II Disorders. Assessment also included the TCI, the Hamilton rating scales for depression and anxiety, and the Panic and Agoraphobia Scale. Sixty-one patients (29.8%) were diagnosed as having a DSM-IV PD. Self-directedness and Cooperativeness, but no other TCI dimensions, predicted the presence of PD (Nagelkerke R(2) = 0.35-0.45) and had a moderate diagnostic utility (kappa = 0.47-0.58) when Axis I symptoms were absent or mild. However, accuracy decreased in anxious or depressed patients. Our study supports the hypothesis of a disorder construct that is not related to the intensity of any specific PD subtype but which is common to all PDs. This construct relies largely on internal representations of the self revealing ineffectiveness and uncooperativeness.

Personality disorders and violence

PURPOSE OF REVIEW

To review the most recent literature on the relationship between personality disorders and violent behavior. The review does not aim to address the issue of a possible etiological connection between previously being the victim of violent acts and later developing a personality disorder.

RECENT FINDINGS

Recent data suggest that personality disorders, especially antisocial and borderline, are strongly related to the manifestation of violent acts. Substance abuse is another strong factor which could act either independently or additively. Biological factors seem to constitute a risk factor for violent behavior independently of personality. Although intelligence does not seem to be related to violence, some patients may manifest specific cognitive deficits. The ethical and legal questions posed by the above correlations are difficult to answer, and research has not yet provided enough data on this issue.

SUMMARY

The most recent data support the relationship between antisocial personality and violence, especially when substance abuse is also present, although the presence of confounding factors in the diagnostic criteria suggest caution in the interpretation of the literature.

The neuropsychological correlates of borderline personality disorder and suicidal behaviour

OBJECTIVE

In subjects with borderline personality disorder (BPD), compared with subjects who attempted suicide, to review neuropsychological (NP) function that may predispose to suicidal behaviour along a continuum of high and low lethality.

METHOD

We undertook electronic searches of MEDLINE, PsycINFO, EMBASE, Biosos Reviews, and Cinhal. The searches were restricted to English-language publications from 1985 onward. The search terms borderline personality disorder, suicide, suicide attempt, self-harm behaviour, neuropsychological, executive function (EF), neurocognitive, and neuropsychological function produced 29 neuropsychology studies involving BPD and 7 neuropsychology studies of suicide attempters, regardless of psychiatric diagnosis.

RESULTS

Of the BPD studies, 83% found NP impairment in one or more cognitive domains, irrespective of depression, involving specific or generalized deficits linked to the dorsolateral prefrontal and orbitofrontal regions. The functions most frequently reported (in 71% to 86% of BPD studies) are response-inhibitory processes affecting executive function performance that requires speeded attention and visuomotor skills. Decision making and visual memory impairment are also most frequently affected; 60% to 67% of BPD studies report attentional impairment, verbal memory impairment, and visuospatial organizational impairment. Least affected processes in BPD appear to involve spatial working memory, planning, and possibly, IQ. The similarities in NP deficits found in BPD and suicide-attempt studies involve decision making and Trails performances. BPD studies, however, reflect more frequent impairment on the Stroop Test and Wisconsin Card Sort Test performance than the suicide-attempt studies, whereas verbal fluency appears to be more frequently impaired in those attempting suicide.

CONCLUSIONS

Impaired EF and disinhibitory processes, as indicated by verbal fluency, Trails, and Stroop performance, primarily associated with dorsolateral prefrontal cortical regions may represent a dominant executive pathway to suicide attempt. A primary motivational inhibitory pathway involving conflictual, affective, and reflexive decision-making processes associated with orbitofrontal brain regions, in combination with significant cognitive rigidity, may influence the repetitive expression of self-harm or low-lethality suicidal behaviour. The hypothesis of a specific trait-like cognitive vulnerability for suicidal behaviour involving dysregulatory, disinhibiting pathways awaits confirmation.

Personality disorders: new data versus old concepts

PURPOSE OF REVIEW

The purpose of this paper is to review the most recent literature on personality disorders.

RECENT FINDINGS

Recent data suggest that individual personality disorder criteria and full diagnosis may remit within 1-2 years. The same line of evidence disputes the separation of axis I and axis II disorders and suggests the presence of a continuum. Neuropsychological, neurobiological and genetic studies favor the presence of cognitive disorders and a non-specific mode of hereditability concerning all externalizing disorders. How to best treat personality disorders remains elusive. The most impressive news in the forensic field concerns the introduction of a new concept, dangerous and severe personality disorder by the UK government, for prevention and treatment purposes.

SUMMARY

The most recent data do not adequately support a separate axis II. Future classification may need to move personality disorders to axis I, each under a suitable group of diseases and eliminate the very term 'personality' from the nomenclature, since it constitutes an empirically unsupported theoretical invasion in a system supposed to be 'atheoretical'.

Neuropsychological characteristics of juvenile delinquency

Knowledge of the neuropsychological characteristics related to JD and other behavioral disturbances in childhood is an important aspect of pediatric care. Referral of patients with developing behavioral problems for neuropsychological evaluation may assist pediatricians with identifying neuropsychological risk factors for JD, clarifying differential diagnostic questions, providing information for the nature of intervention efforts, and providing useful predictive tools for long-term planning and outcome. Thus, referrals for neuropsychological evaluation should not occur solely within the context of a patient with known central nervous system compromise. Neuropsychological results may be of benefit with disorders wherein the precise brain-behavior relationship is unclear, such as with JD. Once a child's neuropsychological characteristics are known and evaluated from a behavioral risk standpoint, pediatricians will have information that is pivotal to asserting recommendations for modifications to the home and school environments, as well as for direct intervention and treatment. The direction of future neuropsychological research includes the early identification of children and adolescents with potential behavioral disturbance. Accurate early differential diagnosis and knowledge of neuropsychological risk factors help to achieve this goal. Neuropsychological research and knowledge assist with understanding the complexities of interactions between environmental vulnerabilities and neuropsychological risk factors, and can provide useful predictive and preventative information for pediatricians.