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Lopez-Ruiz M, Doreste Soler A, Pujol J, Losilla JM, Ojeda F, Blanco-Hinojo L, Martínez-Vilavella G, Gutiérrez-Rosado T, Monfort J, Deus J. Central Sensitization and Chronic Pain Personality Profile: Is There New Evidence? A Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2935. [PMID: 36833631 PMCID: PMC9957222 DOI: 10.3390/ijerph20042935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Personality traits are relevant for pain perception in persistent pain disorders, although they have not been studied in depth in sensitized and nonsensitized patients with knee osteoarthritis (OA). OBJECTIVE To explain and compare the personality profile of patients with OA, with and without central sensitization (CS), and fibromyalgia (FM). SETTING Participants were selected at the Rheumatology Department in two major hospitals in Spain. PARTICIPANTS Case-control study where the sample consists of 15 patients with OA and CS (OA-CS), 31 OA without CS (OA-noCS), 47 FM, and 22 controls. We used a rigorous and systematic process that ensured the sample strictly fulfilled all the inclusion/exclusion criteria, so the sample is very well delimited. PRIMARY OUTCOME MEASURES Personality was assessed by the Temperament and Character Inventory of Cloninger. RESULTS The percentile in harm-avoidance dimension for the FM group is higher compared to OA groups and controls. The most frequent temperamental profiles in patients are cautious, methodical, and explosive. Patients with FM are more likely to report larger scores in harm-avoidance, with an increase in logistic regression adjusted odds ratio (ORadj) between 4.2% and 70.2%. CONCLUSIONS Harm-avoidance seems to be the most important dimension in personality patients with chronic pain, as previously found. We found no differences between OA groups and between sensitized groups, but there are differences between FM and OA-noCS, so harm-avoidance might be the key to describe personality in patients with CS rather than the presence of prolonged pain, as found in the literature before.
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Affiliation(s)
| | - Andrea Doreste Soler
- MRI Research Unit, Department of Radiology, Hospital del Mar, 08003 Barcelona, Spain
| | - Jesus Pujol
- MRI Research Unit, Department of Radiology, Hospital del Mar, 08003 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM G21, 08003 Barcelona, Spain
| | - Josep-Maria Losilla
- Department of Methodology, Faculty of Psychology, Autonomous University of Barcelona (UAB), 08193 Barcelona, Spain
| | - Fabiola Ojeda
- Rheumatology Service, Hospital del Mar, 08003 Barcelona, Spain
| | - Laura Blanco-Hinojo
- MRI Research Unit, Department of Radiology, Hospital del Mar, 08003 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM G21, 08003 Barcelona, Spain
| | | | - Teresa Gutiérrez-Rosado
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
| | - Jordi Monfort
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM G21, 08003 Barcelona, Spain
| | - Joan Deus
- MRI Research Unit, Department of Radiology, Hospital del Mar, 08003 Barcelona, Spain
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
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Flowers KM, Colebaugh CA, Hruschak V, Azizoddin DR, Meints SM, Jamison RN, Wilson JM, Edwards RR, Schreiber KL. Introversion, Extraversion, and Worsening of Chronic Pain Impact during Social Isolation: A Mediation Analysis. J Clin Psychol Med Settings 2022:10.1007/s10880-022-09901-9. [PMID: 36076147 PMCID: PMC9458303 DOI: 10.1007/s10880-022-09901-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2022] [Indexed: 11/29/2022]
Abstract
COVID-19 social distancing mandates increased social isolation, resulting in changes in pain severity and interference among individuals with chronic pain. Differences in personality (e.g., introversion/extraversion) may modulate responses to social isolation. We examined the influence of introversion on reported social distancing-related increases in pain interference and assessed for mediators of this relationship. Individuals with chronic pain (n = 150) completed validated questionnaires 4–8 weeks after implementation of social distancing mandates. Introversion/extraversion was measured using a subscale of the Myers-Briggs Type Indicator and changes in pain and psychosocial variables were calculated by comparing participants’ recalled and current scores. Association between introversion/extraversion and other variables were assessed using linear regression. A parallel mediation was used to examine mediators of the association between introversion and change in pain interference. Higher introversion was associated with a decrease in pain interference after social distancing (Rho = − .194, p = .017). Parallel mediation analysis revealed that the relationship between introversion/extraversion and change in pain interference was mediated by changes in sleep disturbance and depression, such that higher introversion was associated with less isolation-induced sleep disruption and depression, and thereby less worsening of pain interference. These findings suggest that personality factors such as introversion/extraversion should be considered when personalizing treatment of chronic pain.
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Affiliation(s)
- K Mikayla Flowers
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 45 Francis St, MRB 611, Boston, MA, 02115, USA.
| | - Carin A Colebaugh
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 45 Francis St, MRB 611, Boston, MA, 02115, USA
| | - Valerie Hruschak
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 45 Francis St, MRB 611, Boston, MA, 02115, USA
| | - Desiree R Azizoddin
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Samantha M Meints
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 45 Francis St, MRB 611, Boston, MA, 02115, USA
| | - Robert N Jamison
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 45 Francis St, MRB 611, Boston, MA, 02115, USA
| | - Jenna M Wilson
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 45 Francis St, MRB 611, Boston, MA, 02115, USA
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 45 Francis St, MRB 611, Boston, MA, 02115, USA
| | - Kristin L Schreiber
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, 45 Francis St, MRB 611, Boston, MA, 02115, USA
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MADEN Ö, UMUR L, AKTAŞ S, ORHAN S, YILDIRIM C. Temperament and character traits in young men diagnosed with idiopathic scoliosis. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1052357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Tönük ŞB, Arısoy Ö, Öztürk EA, Boztaş MH, Çifci Kaygusuz Ç, Erdem Sultanoğlu T. Temperament and Character Profiles of Ankylosing Spondylitis Patients Compared With Major Depression Patients and Healthy Controls. J Clin Rheumatol 2021; 27:e425-e431. [PMID: 32815905 DOI: 10.1097/rhu.0000000000001510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVE Depressive disorder is common in patients with ankylosing spondylitis (AS), who exhibit specific brain imaging abnormalities resembling those in major depression (MD). We compared temperament and character profiles between patients with AS and MD. METHODS The study involved 36 patients with AS, 40 with MD, and 36 healthy controls (HCs). The participants were age-, sex-, and education-matched. Depression, anxiety, temperament, and character were evaluated using the Temperament and Character Inventory and physician-rated Hamilton Depression and Anxiety Scales. Disease severity was assessed using the Bath Ankylosing Spondylitis Disease Activity, Radiology, Metrology, and Functionality Indexes; erythrocyte sedimentation rate; and C-reactive protein. RESULTS Depression and anxiety scores were highest in MD, lowest in HCs, and intermediate in AS (p < 0.001). Harm avoidance was significantly higher in MD and AS than HCs (p = 0.01). Reward dependency was lower (p = 0.011) and self-transcendence higher in AS only (p = 0.034). Bath Ankylosing Spondylitis Radiology Index was negatively correlated with depression (p = 0.020). Bath Ankylosing Spondylitis Radiology Index and Bath Ankylosing Spondylitis Metrology Index were negatively correlated with harm avoidance (p < 0.05). Disease duration was negatively correlated with self-transcendence (p = 0.027). Harm avoidance was correlated with depression score (p = 0.029). Patients under tumor necrosis factor α inhibitor treatment had lower cooperativeness score (p = 0.022). CONCLUSIONS Patients with AS had a specific Temperament and Character Inventory pattern. Harm avoidance was common in both AS and MD. In AS, harm avoidance and depression decreased in patients with progression, probably because progressive fusion of the spinal segments causes decrease in pain. Harm avoidance (fear of pain) seemed to be an acting factor for occurrence of depressive symptoms in AS.
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Affiliation(s)
| | - Özden Arısoy
- Psychiatry, Bolu Abant Izzet Baysal University Medical Faculty, Bolu
| | - Erhan Arif Öztürk
- Department of Physical Therapy and Rehabilitation, Dışkapı Yıldırım Beyazıt Training and Research Hospital
| | | | | | - Tuba Erdem Sultanoğlu
- Department of Physical Therapy and Rehabilitation, Şehitkamil State Hospital, Gaziantep, Turkey
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Kaviani F, Tavakol Z, Salehiniya H. The relationship between warm and cold temperament and dysmenorrhea. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2020.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Petraşcu CM, Vaşadi VM, Moisă R, Manea MM. The link between personality dimensions and pain perception in patients with diabetes mellitus or cancer. Med Pharm Rep 2019; 92:253-260. [PMID: 31460506 PMCID: PMC6709967 DOI: 10.15386/mpr-1300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/02/2019] [Accepted: 04/13/2019] [Indexed: 11/26/2022] Open
Abstract
Background and aims Diabetes mellitus and cancer are two diseases with a strong psychological impact. Personality traits modulate the perception of pain and the response to disease. The specificity of this study consists of the assessment of personality, pain and emotional impact in the two diseases. Method The study included 130 participants assigned to 3 groups: patients with diabetes mellitus, patients with cancer disease, and a control group. The personality traits of all the participants were analyzed using Cloninger’s Temperament and Character Inventory (TCI). For the evaluation of pain, as well as associated anxiety and depression in the diabetes and cancer groups, the Brief Pain Inventory (BPI) and the Hospital Anxiety and Depression Scale (HADS) were used. Results Patients with diabetes mellitus and cancer disease had significantly higher total values on the Harm Avoidance scale (HA) (p<0.001) and lower total values on the Self-Directedness scale (SD), Reward Dependence scale (RD), Cooperativeness scale (CO) (p<0.001) compared to the control group. Major anxiety was predominant in patients with diabetes mellitus (34%), and major depression was prevalent in cancer patients (17.5%). Patients with diabetes mellitus obtained a significantly higher severity score at BPI scale than patients with cancer disease (p=0.03). Conclusions The existence of a mutual personality profile featuring high levels of Harm Avoidance and low levels of Self-Directedness in patients with diabetes mellitus and cancer who experience pain has great implications for the therapeutic approach. A potential future avenue of management in these diseases may lie in targeting particular personality aspects of chronic pain patients.
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Affiliation(s)
| | | | - Răzvan Moisă
- Psychiatry Clinic III, Emergency County Hospital Cluj, Cluj-Napoca, Romania
| | - Marinela Minodora Manea
- Discipline of Medical Psychology, Department of Medical Education, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Temperament and character traits in patients with anorectal disorder. JOURNAL OF SURGERY AND MEDICINE 2018. [DOI: 10.28982/josam.370190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Naylor B, Boag S, Gustin SM. New evidence for a pain personality? A critical review of the last 120 years of pain and personality. Scand J Pain 2017; 17:58-67. [PMID: 28850375 DOI: 10.1016/j.sjpain.2017.07.011] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 07/05/2017] [Accepted: 07/05/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Personality traits may influence development and adjustment to ongoing pain. Over the past 120 years, there has been considerable research into the relationship between pain and personality. This paper presents new evidence for common personality traits found amongst chronic pain sufferers. In particular, it evaluates evidence for Cloninger's biopsychosocial model of personality in distinguishing typical personality features of chronic pain sufferers. It evaluates this evidence in the context of the past 120 years of research including psychodynamic formulations, MMPI studies, personality disorder investigations, and the influence of neuroticism on chronic pain. METHODS A literature search was conducted using PubMed, Medline, PsycINFO, SCOPUS and Cochrane library. Search terms included chronic pain, pain, personality, neuroticism, harm avoidance, self-directedness, attachment, Temperament and Character Inventory (TCI-R), MMPI, MMPI-2, NEO-PI, EPI, Millon Clinical Multiaxial Inventory, Millon Behavioral Health Inventory, Millon Behavioral Medicine Diagnostic, the Personality Assessment Inventory, the Locus of Control Construct and different combinations of these terms. CONCLUSIONS Recent descriptive studies using Cloninger's Temperament and Character Inventory (TCI-R) suggest that higher harm avoidance and lower self-directedness may be the most distinguishing personality features of chronic pain sufferers. High harm avoidance refers to a tendency to be fearful, pessimistic, sensitive to criticism, and requiring high levels of re-assurance. Low self-directedness often manifests as difficulty with defining and setting meaningful goals, low motivation, and problems with adaptive coping. Evidence for this personality profile is found across a wide variety of chronic pain conditions including fibromyalgia, headache and migraine, temporomandibular disorder, trigeminal neuropathy, musculo-skeletal disorders and heterogeneous pain groups. Limitations are also discussed. For example, high harm avoidance is also found in those suffering anxiety and depression. While many studies control for such factors, some do not and thus future research should address such confounds carefully. The evidence is also evaluated within the context of past research into the existence of 'a pain personality'. Psychodynamic formulations are found to be deficient in objective scientific methods. MMPI studies lack sufficient evidence to support 'a pain personality' and may be confounded by somatic items in the instrument. More recent neuroticism studies suggest a relationship between neuroticism and pain, particularly for adjustment to chronic pain. Personality disorders are more prevalent in chronic pain populations than non-pain samples. CLINICAL IMPLICATIONS Because harm avoidance reflects a tendency to developed conditioned fear responses, we suggest that higher harm avoidance may create more vulnerability to developing a fear-avoidance response to chronic pain. Furthermore, lower self-directedness may contribute to keeping a sufferer within this vicious cycle of fear, avoidance and suffering. Moreover, we suggest that harm avoidance and self-directedness are broader and more complex constructs than current clinical targets of CBT such as fear-avoidance and self-efficacy. Thus, assessing such personality traits may help to address the complexity of chronic pain presentations. For example, it may help to identify and treat sufferers more resistant to treatment, more prone to comorbidity and more vulnerable to entering the vicious cycle of chronic pain, suffering and disability.
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Affiliation(s)
- Brooke Naylor
- Neuroscience Research Australia, Australia; School of Psychology, Macquarie University, Australia
| | - Simon Boag
- School of Psychology, Macquarie University, Australia
| | - Sylvia Maria Gustin
- Neuroscience Research Australia, Australia; School of Psychology, University of New South Wales, Australia.
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Vulnerability to Psychopathology and Dimensions of Personality in Patients With Fibromyalgia. Clin J Pain 2017; 33:991-997. [PMID: 28448425 DOI: 10.1097/ajp.0000000000000506] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Fibromyalgia (FM) patients may present psychopathology and some characteristic personality traits that may affect their adaptation to the disease. The aim of this paper was to study the relationship between personality dimensions according to the psychobiological model of Cloninger and the presence of psychopathology. MATERIALS AND METHODS The study sample consisted of 42 patients with FM and 38 pain-free controls. The assessment instruments administered were the Temperament and Character Inventory-Revised and the Millon Clinical Multiaxial Inventory. RESULTS A higher proportion of clinical psychopathologic syndromes (CPS) was observed in the FM group than in the control group, the most prevalent being anxiety disorder and dysthymia. Patients with FM (with CPS or without CPS) presented higher Harm Avoidance than the control group, and the presence of a CPS also increased Harm Avoidance scores. FM patients with CPS had low Self-directedness (SD) compared with both the control group and with their FM peers without CPS. Purposefulness and Anticipatory worry-Pessimism explained 38% of the variance of dysthymia, and anticipatory worry-Pessimism explained 18% of the variance of anxiety disorders. CONCLUSIONS Patients with FM have a high probability of anxious-depressive-type psychopathologic alterations. Their vulnerability to these conditions may be determined by personality traits. The SD character dimension may have implications for therapy, as low SD is associated with the presence of psychopathology and with a low capacity to cope with the disease.
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Facchin F, Barbara G, Saita E, Erzegovesi S, Martoni RM, Vercellini P. Personality in women with endometriosis: temperament and character dimensions and pelvic pain. Hum Reprod 2016; 31:1515-21. [PMID: 27165626 DOI: 10.1093/humrep/dew108] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 04/19/2016] [Indexed: 01/05/2023] Open
Abstract
STUDY QUESTION Is pelvic pain due to endometriosis associated with temperament and character dimensions? SUMMARY ANSWER Women with endometriosis and pelvic pain do not clearly exhibit a specific personality profile; however, personality is associated with pelvic pain perception. WHAT IS KNOWN ALREADY There is research evidence suggesting that endometriosis patients with pelvic pain are more likely to present psychological disruption. Little is known about the association between subjective factors, such as personality traits, and pelvic pain. STUDY DESIGN, SIZE, DURATION This cross-sectional study (N = 133) is part of a larger research on the association between endometriosis and several psychological variables carried out between 2012 and 2014. PARTICIPANTS/MATERIALS, SETTINGS, METHODS The participants were 82 endometriosis patients and 51 healthy controls. Endometriosis patients indicated on a dichotomous scale (yes/no) whether they were suffering from pelvic pain and were divided in two study groups: painful endometriosis group (N = 58) and pain-free endometriosis group (N = 24). The severity of pelvic pain (chronic pelvic pain, dysmenorrhoea, dyspareunia, and dyschezia) was rated on a 0-10 point numerical rating scale. All participants completed a 240-item psychometric test (TCI-R) evaluating personality in terms of temperament and character dimensions. MAIN RESULTS AND THE ROLE OF CHANCE Women with painful endometriosis had lower novelty seeking compared with the control group (P = 0.017) and higher harm avoidance (P = 0.007) and lower exploratory excitability (P = 0.034) and responsibility (P = 0.027) compared with the pain-free endometriosis group, as well as higher fatigability compared with the pain-free endometriosis group (P = 0.001) and the control group (P = 0.032). Higher harm avoidance (B = 0.081; P = 0.002) and lower self-directedness (B = -0.053; P = 0.015) were associated with a greater severity of chronic pelvic pain. LIMITATIONS, REASONS FOR CAUTION These study findings should be taken cautiously for several methodological reasons such as small sample size, differences in group sizes and cultural homogeneity. More research is needed to further investigate the association between personality and pelvic pain related to endometriosis. WIDER IMPLICATIONS OF THE FINDINGS Our findings suggest new avenues for future research and treatment of endometriosis. The association between the severity of chronic pelvic pain and personality may help clarify the lack of a direct correlation between pain severity and the type and stage of endometriosis, as well as the inconsistencies in patients' response to medical and/or surgical treatment. Therapeutic strategies should be specifically targeted on individual women and involve an integrated approach to the treatment of chronic pelvic pain related to endometriosis. STUDY FUNDING/COMPETING INTERESTS There was no external funding for this study and the authors have no conflicts of interest. TRIAL REGISTRATION NUMBER Not applicable to this study.
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Affiliation(s)
- Federica Facchin
- Faculty of Psychology, Catholic University of Milan, Largo A. Gemelli 1, Milan 20123, Italy
| | - Giussy Barbara
- Department of Obstetrics and Gynecology, 'G. Fornaroli' Hospital, Via Al Donatore Di Sangue 50, Magenta, Milan 20013, Italy
| | - Emanuela Saita
- Faculty of Psychology, Catholic University of Milan, Largo A. Gemelli 1, Milan 20123, Italy
| | - Stefano Erzegovesi
- Department of Clinical Neurosciences, IRCCS San Raffaele, Via Stamira d'Ancona 20, Milan 20127, Italy
| | - Riccardo Maria Martoni
- Department of Clinical Neurosciences, IRCCS San Raffaele, Via Stamira d'Ancona 20, Milan 20127, Italy
| | - Paolo Vercellini
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico and Università degli Studi di Milano, Via della Commenda 12, Milan 20122, Italy
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Leombruni P, Zizzi F, Miniotti M, Colonna F, Castelli L, Fusaro E, Torta R. Harm Avoidance and Self-Directedness Characterize Fibromyalgic Patients and the Symptom Severity. Front Psychol 2016; 7:579. [PMID: 27199814 PMCID: PMC4842927 DOI: 10.3389/fpsyg.2016.00579] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 04/07/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Evidence in the literature suggests peculiar personality traits for fibromyalgic (FM) patients, and it has been suggested that personality characteristics may be involved in patients' different symptomatic events and responses to treatment. The aim of the study is to investigate the personality characteristics of Italian FM patients and to explore the possibility of clustering them considering both personality traits and clinical characteristics. DESIGN The study used a cross-sectional methodology and involved a control group. A self-assessment procedure was used for data gathering. The study included 87 female FM patients and 83 healthy females. Patients were approached and interviewed in person during a psychiatric consultation. Healthy people were recruited from general practices with previous telephone contact. MAIN OUTCOME MEASURES Participants responded to the Hospital Anxiety and Depression Scale, the Temperament and Character Inventory, the Fibromyalgia Impact Questionnaire and the Short-Form-36 Health Survey. RESULTS FM patients scored significantly different from healthy participants on the Harm avoidance (HA), Novelty seeking (NS) and Self-directedness (SD). Two clusters were identified: patients in Cluster1 (n = 37) had higher scores on HA and lower scores on RD, SD, and Cooperativeness and reported more serious fibromyalgia and more severe anxious-depressive symptomatology than did patients in Cluster2 (n = 46). CONCLUSION This study confirms the presence of certain personality traits in the FM population. In particular, high levels of HA and low levels of SD characterize a subgroup of FM patients with more severe anxious-depressive symptomatology. According to these findings, personality assessment could be useful in the diagnostic process to tailor therapeutic interventions to the personality characteristics.
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Affiliation(s)
- Paolo Leombruni
- Department of Neuroscience "Rita Levi Montalcini", University of Turin Turin, Italy
| | - Francesca Zizzi
- Department of Neuroscience "Rita Levi Montalcini", University of Turin Turin, Italy
| | - Marco Miniotti
- Department of Neuroscience "Rita Levi Montalcini", University of Turin Turin, Italy
| | - Fabrizio Colonna
- Department of Neuroscience "Rita Levi Montalcini", University of Turin Turin, Italy
| | - Lorys Castelli
- Department of Psychology, University of Turin Turin, Italy
| | - Enrico Fusaro
- Rheumatology Unit, Azienda Ospedaliero-Universitaria Cittá della Salute e della Scienza di Torino Turin, Italy
| | - Riccardo Torta
- Department of Neuroscience "Rita Levi Montalcini", University of Turin Turin, Italy
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Fahlgren E, Nima AA, Archer T, Garcia D. Person-centered osteopathic practice: patients' personality (body, mind, and soul) and health (ill-being and well-being). PeerJ 2015; 3:e1349. [PMID: 26528411 PMCID: PMC4627917 DOI: 10.7717/peerj.1349] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 10/05/2015] [Indexed: 12/30/2022] Open
Abstract
Background. Osteopathic philosophy and practice are congruent with the biopsychosocial model, a patient-centered approach when treating disease, and the view of the person as a unity (i.e., body, mind, and soul). Nevertheless, a unity of being should involve a systematic person-centered understanding of the patient's personality as a biopsychosociospiritual construct that influences health (i.e., well-being and ill-being). We suggest Cloninger's personality model, comprising temperament (i.e., body) and character (i.e., mind and soul), as a genuine paradigm for implementation in osteopathic practice. As a first step, we investigated (1) the relationships between personality and health among osteopathic patients, (2) differences in personality between patients and a control group, and (3) differences in health within patients depending on the presenting problem and gender. Method. 524 osteopathic patients in Sweden (age mean = 46.17, SD = 12.54, 388 females and 136 males) responded to an online survey comprising the Temperament and Character Inventory and measures of health (well-being: life satisfaction, positive affect, harmony in life, energy, and resilience; ill-being: negative affect, anxiety, depression, stress, and dysfunction and suffering associated to the presenting problem). We conducted two structural equation models to investigate the association personality-health; graphically compared the patients' personality T-scores to those of the control group and compared the mean raw scores using t-tests; and conducted two multivariate analyses of variance, using age as covariate, to compare patients' health in relation to their presenting problem and gender. Results. The patients' personality explained the variance of all of the well-being (R (2) between .19 and .54) and four of the ill-being (R (2) between .05 and .43) measures. Importantly, self-transcendence, the spiritual aspect of personality, was associated to high levels of positive emotions and resilience. Osteopathic patients, compared to controls, scored higher in six of the seven personality dimensions. These differences were, however, not considerably large (divergences in T-scores were <1 SD, Cohen's d between 0.12 and 0.40). Presenting problem and gender did not have an effect on any of the health measures. Conclusion. The patient's personality as a ternary construct (i.e., body, mind, and soul), which is in line with osteopathy, is associated to both well-being and ill-being. The lack of substantial differences in personality between patients and controls implies that the patients had not any personality disorders. Hence, osteopaths might, with proper education, be able to coach their patients to self-awareness. The lack of differences in health variables between osteopathic patients with different presenting problems suggests that practitioners should focus on the person's health regardless of the type of presenting problem.
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Affiliation(s)
- Elin Fahlgren
- Network for Empowerment and Well-Being, Gothenburg, Sweden
- Dresden International University, Dresden, Germany
- Osteopathie Schule Deutschland, Hamburg, Germany
| | - Ali A. Nima
- Network for Empowerment and Well-Being, Gothenburg, Sweden
| | - Trevor Archer
- Network for Empowerment and Well-Being, Gothenburg, Sweden
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Danilo Garcia
- Network for Empowerment and Well-Being, Gothenburg, Sweden
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
- Blekinge Center of Competence, Blekinge County Council, Karlskrona, Sweden
- Centre for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Gothenburg, Sweden
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Tokura T, Kimura H, Ito M, Nagashima W, Sato N, Kimura Y, Arao M, Aleksic B, Yoshida K, Kurita K, Ozaki N. Temperament and character profiles of patients with burning mouth syndrome. J Psychosom Res 2015; 78:495-498. [PMID: 25796514 DOI: 10.1016/j.jpsychores.2015.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 02/11/2015] [Accepted: 02/12/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Burning mouth syndrome (BMS) is a chronic disease in which patients feel a burning sensation and pain in the oral cavity. Although personality traits have been suggested to influence the development and course of BMS, they have not yet been examined in detail. We therefore investigated the personality traits of BMS patients. METHODS Sample consisted of 65 BMS patients presenting to the Aichi-Gakuin Dental School Hospital between May 2005 and April 2009. They were also diagnosed as having pain disorder by a psychiatrist. The control group consisted of 116 healthy subjects. The Temperament and Character Inventory (TCI) was used to evaluate personality traits, while the Beck Depression Inventory (BDI) was used to evaluate the depression rate in both groups. RESULTS In TCI, we found that, in comparison to the control group, the novelty seeking score was significantly lower (p = 0.009), the harm avoidance score was significantly higher (p < 0.001), and the self-directedness score was significantly lower (p = 0.039) in the BMS group. To remove the influence of depression, we performed an analysis of covariance of each TCI item using the BDI score as a covariate. No significant differences were observed in harm avoidance or self-directedness, whereas the differences noted in novelty seeking were significant (p = 0.008). CONCLUSION The novelty seeking score was low in BMS patients in comparison to the control group. They also had high harm avoidance and low self-directedness tendencies, but these were attributed to the influence of depression.
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Affiliation(s)
- Tatsuya Tokura
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Hiroyuki Kimura
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Mikiko Ito
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Nagoya, Japan.
| | - Wataru Nagashima
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Naohiro Sato
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Yuki Kimura
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Nagoya, Japan.
| | - Munetaka Arao
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Nagoya, Japan.
| | - Branko Aleksic
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Keizo Yoshida
- Health Care Promotion Division, Denso Corporation, Kariya, Japan.
| | - Kenichi Kurita
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Aichi-Gakuin University, Nagoya, Japan.
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan.
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Gustin SM, Burke LA, Peck CC, Murray GM, Henderson LA. Pain and Personality: Do Individuals with Different Forms of Chronic Pain Exhibit a Mutual Personality? Pain Pract 2015; 16:486-94. [PMID: 25858277 DOI: 10.1111/papr.12297] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 11/23/2014] [Accepted: 02/11/2015] [Indexed: 01/03/2023]
Abstract
The role of personality in the experience of chronic pain is a growing field, with endless debate regarding the existence of a "pain personality". This study aims to compare different chronic pain types and consolidate the existence of a common personality. Thirty-two females with chronic orofacial pain and 37 age-matched healthy females were assessed with the Temperament and Character Inventory-Revised. Chronic pain subjects had either trigeminal neuropathy (neuropathic pain) or temporomandibular disorders (nociceptive pain). This study revealed that individuals with different chronic pain types exhibit a mutual personality profile encompassing significantly higher scores in Harm Avoidance and significantly lower scores in Self-Directedness when compared to healthy subjects. In fact, this combination is associated with Cluster C personality disorders. In conclusion, our study reveals that irrespective of type, chronic pain may be associated with Cluster C personality disorders. Indeed, there has never been empirical evidence in the past to suggest that chronic pain as an overall concept is associated with any particular personality disorders. Therefore, a potential future avenue of chronic pain treatment may lie in targeting particular personality aspects and shift the target of pain-relieving treatments from sensory and psychologically state focused to psychologically trait focused.
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Affiliation(s)
- Sylvia M Gustin
- Neuroscience Research Australia, Sydney, Australia.,Department of Anatomy & Histology, University of Sydney, Sydney, Australia.,School of Psychology, University of New South Wales, Sydney, Australia
| | - Lucinda A Burke
- Department of Anatomy & Histology, University of Sydney, Sydney, Australia
| | - Chris C Peck
- Jaw Function and Orofacial Pain Research Unit, Faculty of Dentistry, University of Sydney, Sydney, Australia
| | - Greg M Murray
- Jaw Function and Orofacial Pain Research Unit, Faculty of Dentistry, University of Sydney, Sydney, Australia
| | - Luke A Henderson
- Department of Anatomy & Histology, University of Sydney, Sydney, Australia
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Garcia-Fontanals A, García-Blanco S, Portell M, Pujol J, Poca-Dias V, García-Fructuoso F, López-Ruiz M, Gutiérrez-Rosado T, Gomà-I-Freixanet M, Deus J. Cloninger's psychobiological model of personality and psychological distress in fibromyalgia. Int J Rheum Dis 2014; 19:852-63. [PMID: 25483854 DOI: 10.1111/1756-185x.12473] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM Personality can play an important role in the clinical symptoms of fibromyalgia (FM). The aim of this study is to identify personality profiles in FM patients and the possible presence of personality disorder (PD) from the Temperament and Character Inventory-Revised (TCI-R), and to assess whether personality dimensions are related to psychological distress in FM. METHOD The sample consisted of 42 patients with FM and 38 healthy controls. The TCI-R, Hospital Anxiety and Depression Scale, State-Trait Anxiety Inventory, Short-Form-36 Health Survey, Fibromyalgia Impact Questionnaire and McGill Pain Questionnaire were administered. RESULTS The personality profile of the FM group based on the TCI-R is defined by high Harm Avoidance (HA), low Novelty Seeking (NS), and low Self-Directedness (SD). Only one-third of patients with FM present a possible psychometric PD, principally from Cluster C. In the FM group, HA and SD are associated positively and negatively, respectively, with indicators of emotional distress. Patients with higher HA present higher perceived pain intensity rated via a verbal-numerical scale while Determination (SD2) reduced the perceived level of pain induced by the stimulus. NS is negatively related to the number of work absences caused by FM. CONCLUSIONS The study suggests that HA and SD play an important role in psychological distress in FM. The fact that SD is prone to modification and has a regulatory effect on emotional impulses is a key aspect to consider from the psychotherapeutic point of view.
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Affiliation(s)
- Alba Garcia-Fontanals
- Department of Clinical and Health Psychology, Autonomous University of Barcelona, Barcelona, Spain.
| | | | - Mariona Portell
- Department of Psychobiology and Methodology of Health Sciences, Autonomous University of Barcelona, Barcelona, Spain
| | - Jesús Pujol
- MRI Research Unit, CRC Mar, Hospital del Mar, Barcelona, Spain.,CIBERSAM G21, Spain
| | | | | | | | - Teresa Gutiérrez-Rosado
- Department of Clinical and Health Psychology, Autonomous University of Barcelona, Barcelona, Spain
| | | | - Joan Deus
- Department of Clinical and Health Psychology, Autonomous University of Barcelona, Barcelona, Spain. .,MRI Research Unit, CRC Mar, Hospital del Mar, Barcelona, Spain.
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16
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Gustin SM, McKay JG, Petersen ET, Peck CC, Murray GM, Henderson LA. Subtle alterations in brain anatomy may change an individual's personality in chronic pain. PLoS One 2014; 9:e109664. [PMID: 25291361 PMCID: PMC4188621 DOI: 10.1371/journal.pone.0109664] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 09/10/2014] [Indexed: 01/03/2023] Open
Abstract
It is well established that gross prefrontal cortex damage can affect an individual’s personality. It is also possible that subtle prefrontal cortex changes associated with conditions such as chronic pain, and not detectable until recent advances in human brain imaging, may also result in subtle changes in an individual’s personality. In an animal model of chronic neuropathic pain, subtle prefrontal cortex changes including altered basal dendritic length, resulted in altered decision making ability. Using multiple magnetic resonance imaging techniques, we found in humans, although gray matter volume and on-going activity were unaltered, chronic neuropathic pain was associated with reduced free and bound proton movement, indicators of subtle anatomical changes, in the medial prefrontal cortex, anterior cingulate cortex and mediodorsal thalamus. Furthermore, proton spectroscopy revealed an increase in neural integrity in the medial prefrontal cortex in neuropathic pain patients, the degree of which was significantly correlated to the personality temperament of novelty seeking. These data reveal that even subtle changes in prefrontal cortex anatomy may result in a significant change in an individual’s personality.
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Affiliation(s)
- Sylvia M. Gustin
- Neuroscience Research Australia, Randwick, NSW, Australia
- * E-mail:
| | - Jamie G. McKay
- Department of Anatomy and Histology, University of Sydney, Sydney, NSW, Australia
| | - Esben T. Petersen
- Departments of Radiology and Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Chris C. Peck
- Faculty of Dentistry, University of Sydney, Sydney, NSW, Australia
| | - Greg M. Murray
- Faculty of Dentistry, University of Sydney, Sydney, NSW, Australia
| | - Luke A. Henderson
- Department of Anatomy and Histology, University of Sydney, Sydney, NSW, Australia
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17
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Evaluation of the temperament and character properties of patients with ankylosing spondylitis. Z Rheumatol 2014; 73:843-7. [PMID: 24549924 DOI: 10.1007/s00393-013-1336-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this study was to evaluate temperament and character of ankylosing spondylitis (AS) patients and to examine the association between these specific temperament and character properties and clinical variables. PATIENTS AND METHODS This study involved 73 AS patients. Temperament properties of patients were evaluated using Cloninger's Temperament and Character Inventory (TCI). Association between clinical variables and specific temperament features were evaluated using correlation and regression analyses. RESULTS Forty eight (65.8 %) of the study participants were men and the mean age was 42 ± 11.4 years. There was slight negative correlations between self directedness (S) and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores (p = 0.01, r = - 0.30), and between the Visual Analog Scale (VAS) and reward dependence (RD) scores (p = 0.03, r = - 0.26). Regression analysis showed that correlations between BASDAI and S, and between VAS and RD scores were statistically significant. CONCLUSION Our study showed that the dimensions temperament and character are related to disease activation, and disease course is more severe in patients who have low scores in these TCI dimensions. Therefore, we suggest that evaluating temperament and character properties of AS patients will help clinicians to predict treatment compliance and motivation of patients during disease course.
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18
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Borderline personality disorder and chronic pain: a practical approach to evaluation and treatment. Curr Pain Headache Rep 2014; 17:350. [PMID: 23801003 DOI: 10.1007/s11916-013-0350-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Patients with chronic pain present a spectrum of complexity that can be overwhelming for the individual practitioner. These patients require thoughtful care and a comprehensive treatment plan. This complexity should be acknowledged, not avoided, and the patient should be engaged, not shunned. A practical approach will assist in developing expertise and proceeding empathically. The presence of a superimposed personality disorder significantly increases the difficulty of caring for these patients. Studies investigating the prevalence of borderline personality disorder in patients with chronic pain averaged 30 %, highlighting the importance of being able to effectively treat this patient population. Appropriate management of these patients should focus on a collaboration to practice productive behaviors despite intense emotional distress. Longitudinal research provides a foundation for an optimistic prognosis that can be enhanced with this rehabilitative approach.
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20
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Knaster P, Estlander AM, Karlsson H, Kaprio J, Kalso E. Temperament traits and chronic pain: the association of harm avoidance and pain-related anxiety. PLoS One 2012; 7:e45672. [PMID: 23133510 PMCID: PMC3485083 DOI: 10.1371/journal.pone.0045672] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 08/23/2012] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Anxiety symptoms are common in chronic pain patients. High levels of anxiety are associated with increased pain experience and disability. Proneness to anxiety has a large interindividual variation. The aim of the study was to determine whether the anxiety-related temperament trait Harm Avoidance (HA), is associated with pain-related anxiety. METHODS One hundred chronic pain patients in a multidisciplinary pain clinic participated in the study. The patients were assessed using the HA scale of the Temperament and Character Inventory (TCI) of Cloninger and Pain Anxiety Symptoms Scale-20 (PASS-20). Both the HA total score and the four subscales of HA were analyzed. Current pain intensity was measured using the Visual Analogue Scale (VAS). The Beck Depression Inventory (BDI) was used to control for the influence of depression on the personality measurement. RESULTS The HA total score was associated with PASS-20, but the association became non-significant after controlling for depression. The HA4 Fatigability subscale was associated with the PASS scales. Depression did not influence this association. Pain intensity was not correlated with HA or the PASS scales. However, the association between HA4 Fatigability and PASS was influenced by pain intensity. Higher pain intensity was associated with stronger association between the scales. CONCLUSION Harm Avoidance, representing temperament and trait-related anxiety, has relevance in pain-related anxiety. Assessing personality and temperament may deepen the clinician's understanding of the pain experience and behavior in chronic pain patients.
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Affiliation(s)
- Peter Knaster
- Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland.
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21
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Gerhardt A, Hartmann M, Schuller-Roma B, Blumenstiel K, Bieber C, Eich W, Steffen S. The Prevalence and Type of Axis-I and Axis-II Mental Disorders in Subjects with Non-Specific Chronic Back Pain: Results from a Population-Based Study. PAIN MEDICINE 2011; 12:1231-40. [DOI: 10.1111/j.1526-4637.2011.01190.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Santos DDM, Lage LV, Jabur EK, Kaziyama HHS, Iosifescu DV, Lucia MCSD, Fraguas R. The association of major depressive episode and personality traits in patients with fibromyalgia. Clinics (Sao Paulo) 2011; 66:973-8. [PMID: 21808861 PMCID: PMC3129941 DOI: 10.1590/s1807-59322011000600009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 02/28/2011] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Personality traits have been associated with primary depression. However, it is not known whether this association takes place in the case of depression comorbid with fibromyalgia. OBJECTIVE The authors investigated the association between a current major depressive episode and temperament traits (e.g., harm avoidance). METHOD A sample of 69 adult female patients with fibromyalgia was assessed with the Temperament and Character Inventory. Psychiatric diagnoses were assessed with the Mini-International Neuropsychiatric Interview severity of depressive symptomatology with the Beck Depression Inventory, and anxiety symptomatology with the IDATE-state and pain intensity with a visual analog scale. RESULTS A current major depressive episode was diagnosed in 28 (40.5%) of the patients. They presented higher levels of harm avoidance and lower levels of cooperativeness and self-directedness compared with non-depressed patients, which is consistent with the Temperament and Character Inventory profile of subjects with primary depression. However, in contrast to previous results in primary depression, no association between a major depressive episode and self-transcendence was found. CONCLUSIONS The results highlight specific features of depression in fibromyalgia subjects and may prove important for enhancing the diagnosis and prognosis of depression in fibromyalgia patients.
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Affiliation(s)
- Danyella de Melo Santos
- Department and Institute of Psychiatry, Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
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Lundberg G, Anderberg UM, Gerdle B. Personality Features in Female Fibromyalgia Syndrome. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/10582450902820531] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Conrad R, Schilling G, Bausch C, Nadstawek J, Wartenberg HC, Wegener I, Geiser F, Imbierowicz K, Liedtke R. Temperament and character personality profiles and personality disorders in chronic pain patients. Pain 2007; 133:197-209. [PMID: 17964076 DOI: 10.1016/j.pain.2007.07.024] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2005] [Revised: 07/01/2007] [Accepted: 07/25/2007] [Indexed: 10/22/2022]
Abstract
In his psychobiological model of personality, Cloninger developed a novel approach concerning the relationships between psychopathological syndromes and personality. We investigated 207 chronic pain patients (CPPs) and compared them to 105 pain-free control subjects. Participants were assessed using the Temperament and Character Inventory (TCI), the Structured-Clinical-Interview-II, the Beck Depression Inventory and the Spielberger Anxiety Inventory. The CPPs scored higher on the depression and state anxiety scales and 41% fulfilled the criteria of having at least one personality disorder (PD). We used a covariance analysis to control for depression and state anxiety and found that the CPPs scored higher on the Harm Avoidance Temperament Dimension and lower on the Self-Directedness and Cooperativeness Character Dimensions. In CPPs, the symptom counts of all PD subtypes were significantly related to low Self-Directedness and, to a lesser degree, low Cooperativeness. The PD symptoms in Cluster A were related to low Reward Dependence, those in Cluster B were related to high Novelty Seeking and the PD symptoms in Cluster C were related to high Harm Avoidance. In multiple hierarchical regression analyses, controlling for age, gender, depression and state anxiety, TCI scales predicted on average 23% in PD symptom counts. The Self-Directedness and Cooperativeness personality traits appeared to be significant predictors in determining the presence or absence of a PD by correctly classifying 75.8% of CPPs. The TCI provides further insight into the mechanisms underlying the development of chronic pain. This useful diagnostic instrument helps to economically and validly facilitate the identification of core PD features.
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Affiliation(s)
- Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University of Bonn, Sigmund-Freud-Str. 25, 53105 Bonn, Germany.
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