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Jukić T, Margetić BA, Jakšić N, Boričević V. Personality differences in patients with and without gallstones. J Psychosom Res 2023; 169:111322. [PMID: 37018955 DOI: 10.1016/j.jpsychores.2023.111322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVE Presence of gallstones is associated with a range of risk factors that have previously shown associations with personality traits. Our aim was to assess the differences in personality traits between the patients with and without gallstones. METHODS This study used a case-control design with 308 participants from the general population, 68.2% female, mean age 49.2 (SD 9.24) years, of whom 154 (50%) participants had asymptomatic gallstones. Personality was assessed with the Temperament and Character Inventory - Revised - 140 (TCI-R-140) and depression with the Center for Epidemiological Study of Depression Scale (CESD). Cut-off ≥16 on the CES-D was used as an exclusion criterion. Subjects were also checked for metabolic risk factors and sociodemographic characteristics. RESULTS The group with gallstones had significantly more pronounced metabolic risk factors and higher prevalence of smoking and alcohol usage in comparison with the group without gallstones. This group also exhibited higher temperament dimension Harm avoidance (HA) and lower character dimension Self-directedness (SD). Metabolic variables differed based on character dimension Cooperativeness (CO), smoking based on temperament dimensions Novelty seeking (NS) and HA, and alcohol usage on dimension NS within the gallstones group. In the logistic regression, controlled for smoking, alcohol usage and metabolic variables, temperament dimension HA was shown to be a significant predictor of the presence of gallstones. CONCLUSION Our findings indicate that personality may be associated with the presence of gallstones. Future longitudinal studies addressing the complex interplay of personality traits, psychological mechanisms and the associated behavioral, metabolic and neurobiological factors, are needed.
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Affiliation(s)
- Tatjana Jukić
- Neuropsychiatric Hospital Dr. Ivan Barbot, Popovaca, Croatia
| | - Branka Aukst Margetić
- Department of Psychiatry, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia; Croatian Catholic University, Zagreb, Croatia.
| | - Nenad Jakšić
- Department of Psychiatry and Psychological Medicine, University Hospital Center Zagreb, Zagreb, Croatia
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Choi JI, Jung S, Oh GH, Son KL, Lee KM, Jung D, Kim TY, Im SA, Lee KH, Shin MS, Hahm BJ, Yeom CW. The Effect of Temperament on the Association Between Pre-treatment Anxiety and Chemotherapy-Related Symptoms in Patients With Breast Cancer. Psychiatry Investig 2022; 19:949-957. [PMID: 36444158 PMCID: PMC9708865 DOI: 10.30773/pi.2022.0078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 09/04/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Pre-treatment anxiety (PA) before chemotherapy increases complaints of chemotherapy-related symptoms (CRS). The results on the association have been inconsistent, and the effect of temperament remains unclear. We aimed to determine whether PA is a risk factor for CRS and the effect of differing temperaments on CRS. METHODS This prospective study comprised 176 breast cancer patients awaiting adjuvant chemotherapy post-surgery. We assessed CRS, PA, and temperament using the MD Anderson Symptom Inventory (MDASI), the Hospital Anxiety and Depression Scale, and the short form of the Temperament and Character Inventory-Revised, respectively. The MDASI was re-administered three weeks after the first chemo-cycle. RESULTS PA showed weak positive correlation with several CRS after the first cycle; no CRS was significantly associated with PA when pre-treatment depressive symptoms and baseline CRS were adjusted in multiple regression analysis. Moderation model analysis indicated that the PA effect on several CRS, including pain, insomnia, anorexia, dry mouth, and vomiting, was moderated by harm avoidance (HA) but not by other temperament dimensions. In particular, PA was positively associated with CRS in patients with low HA. CONCLUSION The results in patients with low HA indicate that more attention to PA in patients with confident and optimistic temperaments is necessary.
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Affiliation(s)
- Jung-In Choi
- Department of Clinical Medical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sanghyup Jung
- Department of Psychiatry, National Rehabilitation Center, Seoul, Republic of Korea.,Department of Psychiatry and Behavioral Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Gyu Han Oh
- Public Health Medical Service, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung-Lak Son
- Department of Psychiatry, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | | | - Dooyoung Jung
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
| | - Tae-Yong Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Cancer Research Institute, Seoul National University, Seoul, Republic of Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung-Hun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.,Cancer Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Min-Sup Shin
- Department of Psychiatry and Behavioral Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Bong-Jin Hahm
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Psychiatry and Behavioral Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chan-Woo Yeom
- Department of Psychiatry, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Republic of Korea
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Nishi Y, Osumi M, Nobusako S, Takeda K, Morioka S. Avoidance Behavioral Difference in Acquisition and Extinction of Pain-Related Fear. Front Behav Neurosci 2019; 13:236. [PMID: 31680893 PMCID: PMC6797557 DOI: 10.3389/fnbeh.2019.00236] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/19/2019] [Indexed: 11/25/2022] Open
Abstract
Fear of movement-related pain leads to two types of avoidance behavior: excessive avoidance and pain-inhibited movement. Excessive avoidance is an absence of movement by fear, and pain-inhibited movements involve a change in motor behavior for the purpose of protecting the painful part. Here, we sought to clarify the acquisition process and adaptation of fear for each avoidance behavior. Thirty-one female and 13 male (age 20.9 ± 2.1 years) subjects could decide persistent behaviors: approach with an intense pain stimulus, pain-inhibited movement with weak pain stimulus, or excessive avoidance with no pain in acquisition and test phases. In the subsequent extinction phase, the pain stimulus was omitted. Subjects were divided into an approach group (n = 24), a pain-inhibited movement group (n = 10), and an excessive avoidance group (n = 10) by cluster analysis. The response latencies in approach and pain-inhibited movement groups were not affected by conditioned pain. The subjects in the excessive avoidance group exhibited delayed response latencies, and their high-fear responses remained in the acquisition, test, and extinction phases. In addition, the excessive avoidance group showed high harm avoidance and high trait anxiety. This study demonstrated that differences in pain-related avoidance behaviors are affected by psychological traits. Pain-related excessive avoidance behavior indicated a maladaptive fear, but pain-inhibited movement did not.
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Affiliation(s)
- Yuki Nishi
- Graduate School of Health Sciences, Kio University, Nara, Japan
| | - Michihiro Osumi
- Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Satoshi Nobusako
- Graduate School of Health Sciences, Kio University, Nara, Japan.,Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Kenta Takeda
- Department of Rehabilitation for the Movement Functions, Research Institute, National Rehabilitation Center for Persons with Disabilities, Saitama, Japan
| | - Shu Morioka
- Graduate School of Health Sciences, Kio University, Nara, Japan.,Neurorehabilitation Research Center, Kio University, Nara, Japan
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Sayah S, Rotgé JY, Francisque H, Gargiulo M, Czernecki V, Justo D, Lahlou-Laforet K, Hahn V, Pandolfo M, Pelissolo A, Fossati P, Durr A. Personality and Neuropsychological Profiles in Friedreich Ataxia. THE CEREBELLUM 2019; 17:204-212. [PMID: 29086357 DOI: 10.1007/s12311-017-0890-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Friedreich ataxia, an autosomal recessive mitochondrial disease, is the most frequent inherited ataxia. Many studies have attempted to identify cognitive and affective changes associated with the disease, but conflicting results have been obtained, depending on the tests used and because many of the samples studied were very small. We investigated personality and neuropsychological characteristics in a cohort of 47 patients with genetically confirmed disease. The neuropsychological battery assessed multiple cognition domains: processing speed, attention, working memory, executive functions, verbal memory, vocabulary, visual reasoning, emotional recognition, and social cognition. Personality was assessed with the Temperament and Character Inventory, and depressive symptoms were assessed with the Beck Depression Inventory. We found deficits of sustained attention, processing speed, semantic capacities, and verbal fluency only partly attributable to motor deficit or depressed mood. Visual reasoning, memory, and learning were preserved. Emotional processes and social cognition were unimpaired. We also detected a change in automatic processes, such as reading. Personality traits were characterized by high persistence and low self-transcendence. The mild cognitive impairment observed may be a developmental rather than degenerative problem, due to early cerebellum dysfunction, with the impairment of cognitive and emotional processing. Disease manifestations at crucial times for personality development may also have an important impact on personality traits.
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Affiliation(s)
- Sabrina Sayah
- AP-HP, Genetic Department, Pitié-Salpêtrière University Hospital, Paris, France.,ICM, Institut du Cerveau et de la Moelle Epinière, INSERM U1127, CNRS UMR7225, Sorbonne Universités - UPMC Université Paris VI UMR_S1127, Paris, France
| | - Jean-Yves Rotgé
- ICM, Institut du Cerveau et de la Moelle Epinière, INSERM U1127, CNRS UMR7225, Sorbonne Universités - UPMC Université Paris VI UMR_S1127, Paris, France.,AP-HP, Service de Psychiatrie, Pitié-Salpêtrière University Hospital, Paris, France
| | - Hélène Francisque
- APHP, Hôpitaux Universitaires Saint Louis Lariboisière Fernand-Widal, Paris, France
| | - Marcela Gargiulo
- AP-HP, Genetic Department, Pitié-Salpêtrière University Hospital, Paris, France.,Institut de Myologie, Pitié-Salpêtrière University Hospital, Paris, France.,Laboratoire de Psychologie Clinique et Psychopathologie, EA 4056, Université Paris Descartes, Sorbonne Paris Cité, Institut de Psychologie, Paris, France
| | - Virginie Czernecki
- AP-HP, Département des Maladies du Système Nerveux, Pitié-Salpêtrière University Hospital, Paris, France
| | - Damian Justo
- Unité de neurologie de la Mémoire et du Langage, Centre Hospitalier Sainte-Anne, Paris, France
| | - Khadija Lahlou-Laforet
- Unité de Psychologie et Psychiatrie de Liaison et d'Urgences, Hôpital Européen Georges Pompidou, Service de Psychiatrie Adulte et du Sujet Agé, Hôpitaux Universitaires Paris-Ouest, Paris, France
| | - Valérie Hahn
- Unité de neurologie de la Mémoire et du Langage, Centre Hospitalier Sainte-Anne, Paris, France
| | - Massimo Pandolfo
- Service de Neurologie, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Antoine Pelissolo
- AP-HP, Service de Psychiatrie, Hôpitaux Universitaires Henri-Mondor, Créteil, France
| | - Philippe Fossati
- ICM, Institut du Cerveau et de la Moelle Epinière, INSERM U1127, CNRS UMR7225, Sorbonne Universités - UPMC Université Paris VI UMR_S1127, Paris, France.,AP-HP, Service de Psychiatrie, Pitié-Salpêtrière University Hospital, Paris, France
| | - Alexandra Durr
- AP-HP, Genetic Department, Pitié-Salpêtrière University Hospital, Paris, France. .,ICM, Institut du Cerveau et de la Moelle Epinière, INSERM U1127, CNRS UMR7225, Sorbonne Universités - UPMC Université Paris VI UMR_S1127, Paris, France. .,ICM, Institut du Cerveau et de la Moelle épinière, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75651, Paris Cedex 13, France.
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Personality and Personality Disorders in Medication-Overuse Headache: A Controlled Study by SWAP-200. Pain Res Manag 2019; 2019:1874078. [PMID: 31281555 PMCID: PMC6594272 DOI: 10.1155/2019/1874078] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/04/2019] [Indexed: 12/17/2022]
Abstract
Background Medication-overuse headache (MOH) is a type of chronic headache, whose mechanisms are still unknown. The impact of psychological factors has been matter of debate from different perspectives. The role of personality and personality pathology in processes involved in MOH development has been advanced but was poorly studied. The hypothesis of addiction-like behaviors sustaining the drug misuse has been examined and reached contrasting findings. Objectives This study is aimed at detecting personality and its disorders (PDs) in MOH, with a specific attention to the addiction aspect. Methods Eighty-eight MOH patients have been compared with two clinical populations including 99 patients with substance use disorder (SUD) and 91 with PDs using the Shedler-Westen Assessment Procedure-200 (SWAP-200), a clinician-report tool that assesses both normal and pathological personality. MANCOVAs were performed to evaluate personality differences among MOH, SUD, and PD groups, controlling for age and gender. Results MOH patients were predominantly women and older. They showed lower traits of the SWAP-200's cluster A and B disorders than SUD and PD patients, who presented more severe levels of personality impairment. No differences in the SWAP-200's cluster C have been found, indicating common personality features in these populations. At levels of specific PDs, MOH patients showed higher obsessive and dysphoric traits and better overall psychological functioning than SUD and PD patients. Conclusion Although MOH, SUD, and PD populations have been evaluated in multiple sites with different levels of expertise, the study supported the presence of a specific constellation of personality in MOH patients including obsessive (perfectionist) and dysphoric characteristics, as well as good enough psychological resources. No similarities to drug-addicted and personality-disordered patients were found. Practitioners' careful understanding of the personality characteristics of MOH patients may be useful to provide a road map for the implementation of more effective treatment strategies and intervention programs.
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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: 60] [Impact Index Per Article: 8.6] [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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7
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Lewitzka U, Denzin S, Sauer C, Bauer M, Jabs B. Personality differences in early versus late suicide attempters. BMC Psychiatry 2016; 16:282. [PMID: 27506387 PMCID: PMC4979154 DOI: 10.1186/s12888-016-0991-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 08/02/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Suicidality is an individual behaviour caused by a complex framework of internal and external factors. The predictive values of personality traits for a suicide attempt have been demonstrated, especially in conjunction with Cloninger's TCI and impulsivity. Two issues remain unsolved, namely whether these traits alter over time after a suicide attempt, and how they may be influenced by depressive symptoms. METHODS We studied two patient cohorts: one sample of 81 patients after a suicide attempt no longer than 3 months previously (SA early) and another sample of 32 patients whose attempt had taken place more than 6 months previously (SA late). We carried out structured interviews with these subjects addressing diagnosis (MINI), suicidality (Scale for suicide ideation), depression (HAMD-17), temperament and character inventory (TCI), and impulsivity (BIS-10). Data analysis was done using SPSS 16.0. RESULTS Our two groups did not differ significantly in sociodemographics or suicidality. However, patients in the SA early group were significantly more depressed (p < 0.001), and scored lower in reward dependence (p < 0.001) and persistence (p = 0.005) but higher in harm avoidance (p < 0.001); they did not differ significantly in impulsivity (p < 0.01). Reward dependence, persistence, and harm avoidance remained significantly different between the two groups after controlling for depressive symptoms. CONCLUSIONS Our findings suggest that some personality traits vary after a suicide attempt. Further investigations are necessary to verify our results, ideally in longitudinal studies with larger, carefully-described cohorts. It would be also clinically important to investigate the influence of therapeutic strategies on the variability of personality traits and their impact on suicidal behavior.
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Affiliation(s)
- Ute Lewitzka
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, D-01307, Dresden, Germany.
| | | | - Cathrin Sauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, D-01307 Dresden, Germany
| | - Michael Bauer
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, D-01307 Dresden, Germany
| | - Burkhard Jabs
- Psychiatric Department of the Municipal Hospital Dresden-Neustadt, Dresden, Germany
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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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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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Saribacak A, Altinbaş K, Yilmaz H, Özkan A, Özkan L, Oral T. Affective Temperament Profiles of Overactive Bladder Patients. Noro Psikiyatr Ars 2014; 51:263-266. [PMID: 28360636 DOI: 10.4274/npa.y6889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 01/05/2013] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Overactive bladder (OAB) is generally characterized by urinary urgency with or without incontinence and increased frequency of voiding and nocturia. Although animal studies have demonstrated the relationship between defective serotonergic neurotransmission and OAB, its etiology is still unclarified. Temperament profiles are hypothesized to be related with serotonergic activity and are studied in many psychosomatic disorders. Thus, we assume that OAB is related with a certain type of temperament. METHOD 29 patients, who were admitted to the urology outpatient clinic at Kocaeli University and clinically diagnosed with OAB syndrome, were recruited for the study. Temperament profiles were evaluated with the Temperament Evaluation of Memphis Pisa Paris and San Diego Autoquestionnaire (TEMPS-A). Depressive, hyperthymic, cyclothymic, anxious and irritable temperament scores in patients were compared with those in 25 healthy controls. RESULTS Patient and control groups were similar in terms of age (p=.65), sex (p=.64) and educational level (p=.90). Anxious temperament scores were higher (p=.02) and hyperthymic temperament scores were lower (p=.02) in patients with OAB compared to controls. Depressive, cyclothymic and irritable temperament scores were similar in both groups. There was no significant differences between men and women in both groups in terms of different temperament profile scores. CONCLUSION Hypothetically, there might be an association between anxious temperament and OAB syndrome reflecting serotonergic dysfunction. However, OAB syndrome must be considered from the aspect of the interdependence of psychosomatic implications in a narrow sense and psychosomatic dimensions due to the psychological predisposition in the individual case.
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Affiliation(s)
| | - Kürşat Altinbaş
- Çanakkale Onsekiz Mart University Faculty of Medicine, Department of Psychiatry, Çanakkale, Turkey
| | - Hasan Yilmaz
- Seka State Hospital, Clinic of Urology, Kocaeli, Turkey
| | - Alp Özkan
- Kocaeli University Faculty of Medicine, Department of Urology, Kocaeli, Turkey
| | - Levend Özkan
- Kocaeli University Faculty of Medicine, Department of Urology, Kocaeli, Turkey
| | - Timuçin Oral
- İstanbul Commerce University, Department of Psychology, İstanbul, Turkey
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Abstract
While antidepressants are supposed to exert similar effects on mood and drive via various mechanisms of action, diverging effects are observed regarding side-effects and accordingly on neural correlates of motivation, emotion, reward and salient stimuli processing as a function of the drugs impact on neurotransmission. In the context of erotic stimulation, a unidirectional modulation of attentional functioning despite opposite effects on sexual arousal has been suggested for the selective serotonin reuptake-inhibitor (SSRI) paroxetine and the selective dopamine and noradrenaline reuptake-inhibitor (SDNRI) bupropion. To further elucidate the effects of antidepressant-related alterations of neural attention networks, we investigated 18 healthy males under subchronic administration (7 d) of paroxetine (20 mg), bupropion (150 mg) and placebo within a randomized placebo-controlled cross-over double-blind functional magnetic resonance imaging (fMRI) design during an established preceding attention task. Neuropsychological effects beyond the fMRI-paradigm were assessed by measuring alertness and divided attention. Comparing preceding attention periods of salient vs. neutral pictures, we revealed congruent effects of both drugs vs. placebo within the anterior midcingulate cortex, dorsolateral prefrontal cortex, anterior prefrontal cortex, superior temporal gyrus, anterior insula and the thalamus. Relatively decreased activation in this network was paralleled by slower reaction times in the divided attention task in both verum conditions compared to placebo. Our results suggest similar effects of antidepressant treatments on behavioural and neural attentional functioning by diverging neurochemical pathways. Concurrent alterations of brain regions within a fronto-parietal and cingulo-opercular attention network for top-down control could point to basic neural mechanisms of antidepressant action irrespective of receptor profiles.
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Oztürk P, Orhan FÖ, Ozer A, Karakaş T, Oksüz AN, Yetişir NY. Assessment of temperament and character profile with anxiety and depression in patients with acne. Balkan Med J 2013; 30:161-6. [PMID: 25207094 DOI: 10.5152/balkanmedj.2012.101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 10/15/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Acne is the most common skin disease, affecting nearly 85% of the population as well as their lives. Acne can severely affect social and psychological functioning. Patients with acne may have anxiety, depression, decreased self-esteem, interpersonal difficulties, unemployment, social withdrawal, and even suicidal intent. AIMS The aim of this study was to evaluate the temperament and character inventory (TCI) of patients with acne and to compare the results with those of healthy controls. STUDY DESIGN Case-control study. METHODS The study population consisted of 47 patients with acne, and 40 healthy control subjects. All participants were instructed to complete a self-administered 240-item TCI and the Hospital Anxiety and Depression Scale. RESULTS In this study, the scores for the temperament properties Worry and pessimism (HA1) and Dependence (RD4) and the character properties Social acceptance (C1) and Integrated conscience (C5) were found to be higher in acne patients than in healthy controls (p<0.05). Compared to the controls, depression and anxiety scores were found to be markedly higher in the patients with acne. Acne type correlated positively with the Disorderliness (NS4) subscale of Novelty seeking (NS) and anxiety. Additionally, acne type correlated negatively with the Attachment (RD3) subscale of Reward Dependence (RD), with the Transpersonal identification (ST2) and Spiritual acceptance (ST3) subscales of Self-Trancendence (ST), and with the Compassion (C4) sub-scale of Cooperativeness (C). CONCLUSION Studies in this area may lead to the development of specific and focused interventions for TCI in patients with acne vulgaris. We suggest that the evaluation and treatment of acne should also include psychosomatic approaches in clinical practice.
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Affiliation(s)
- Perihan Oztürk
- Department of Dermatology, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Kahramanmaraş, Turkey
| | - Fatma Özlem Orhan
- Department of Psychiatry, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Kahramanmaraş, Turkey
| | - Ali Ozer
- Department of Public Health, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Tuğba Karakaş
- Department of Dermatology, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Kahramanmaraş, Turkey
| | - Ali Nuri Oksüz
- Department of Psychiatry, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Kahramanmaraş, Turkey
| | - Nur Yalçın Yetişir
- Department of Psychiatry, Kahramanmaraş Sütçü İmam University Faculty of Medicine, Kahramanmaraş, Turkey
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Psychological issues in the evaluation and treatment of tension-type headache. Curr Pain Headache Rep 2013; 16:545-53. [PMID: 23054980 DOI: 10.1007/s11916-012-0301-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Tension-type headache is the most common headache disorder, affecting approximately 40 % of Americans within a one-year span. Although the most common form, episodic tension-type headache, is rarely impairing, more frequent tension-type headache can occur with significant disability and psychological comorbidity. Appreciating the psychological impact, assessing the associated biopsychosocial issues, and understanding patients' coping styles are important in forming an appropriate treatment plan and maximizing treatment outcomes. A range of psychological therapies including relaxation training, cognitive behavioral therapy, biofeedback and mindfulness have demonstrated utility in treating chronic pain conditions and reducing the associated disability. This may be particularly applicable to special populations, including pediatric patients, pregnant patients and geriatric. Psychological assessment and treatment may be done conjointly with medication management and expands treatment options. There is great need to continue researching the effects of psychological treatments, standardizing interventions and making them available to the wider population.
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Tuominen L, Salo J, Hirvonen J, Någren K, Laine P, Melartin T, Isometsä E, Viikari J, Cloninger CR, Raitakari O, Hietala J, Keltikangas-Järvinen L. Temperament, character and serotonin activity in the human brain: a positron emission tomography study based on a general population cohort. Psychol Med 2013; 43:881-894. [PMID: 22850434 DOI: 10.1017/s003329171200164x] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The psychobiological model of personality by Cloninger and colleagues originally hypothesized that interindividual variability in the temperament dimension 'harm avoidance' (HA) is explained by differences in the activity of the brain serotonin system. We assessed brain serotonin transporter (5-HTT) density in vivo with positron emission tomography (PET) in healthy individuals with high or low HA scores using an 'oversampling' study design. Method Subjects consistently in either upper or lower quartiles for the HA trait were selected from a population-based cohort in Finland (n = 2075) with pre-existing Temperament and Character Inventory (TCI) scores. A total of 22 subjects free of psychiatric and somatic disorders were included in the matched high- and low-HA groups. The main outcome measure was regional 5-HTT binding potential (BPND) in high- and low-HA groups estimated with PET and [11C]N,N-dimethyl-2-(2-amino-4-methylphenylthio)benzylamine ([11C]MADAM). In secondary analyses, 5-HTT BPND was correlated with other TCI dimensions. RESULTS 5-HTT BPND did not differ between high- and low-HA groups in the midbrain or any other brain region. This result remained the same even after adjusting for other relevant TCI dimensions. Higher 5-HTT BPND in the raphe nucleus predicted higher scores in 'self-directedness'. CONCLUSIONS This study does not support an association between the temperament dimension HA and serotonin transporter density in healthy subjects. However, we found a link between high serotonin transporter density and high 'self-directedness' (ability to adapt and control one's behaviour to fit situations in accord with chosen goals and values). We suggest that biological factors are more important in explaining variability in character than previously thought.
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Affiliation(s)
- L Tuominen
- Department of Psychiatry, University of Turku, Turku, Finland
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Antidepressants in healthy subjects: what are the psychotropic/psychological effects? Eur Neuropsychopharmacol 2010; 20:433-53. [PMID: 20079613 DOI: 10.1016/j.euroneuro.2009.11.009] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Revised: 11/12/2009] [Accepted: 11/22/2009] [Indexed: 12/16/2022]
Abstract
A wide debate is ongoing regarding whether antidepressant effects should be considered a general property of these agents or whether they exclusively belong to the context of target symptoms. The aim of the present review is to summarize findings on antidepressant influences on healthy volunteers, focusing on changes in psychological and cognitive functions. Differences have been detected between acute and chronic treatments. Acute treatment has been found to lead to positive bias in emotion processing and facilitation in negative emotion recognition. Chronic treatments have been found to stabilise some changes induced by acute treatment, such as increased social behaviours. Regarding antidepressant modulation of affective symptomatology contrasting results have been reported suggesting that the link between action on cognitive processes and mood may be not direct. In fact, meta-analyzing data on mood and anxiety symptoms no difference was detected between subjects receiving placebo and SSRIs. However, meta-analyzing data on negative affects, a significant decrease was detected in subjects receiving SSRIs in comparison with subjects receiving placebo. In summary, antidepressants seem to exert a detectable influence also in healthy subjects.
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Effects of paroxetine on emotional functioning and treatment awareness: a 4-week randomized placebo-controlled study in healthy clinicians. Psychopharmacology (Berl) 2010; 207:619-29. [PMID: 19826792 DOI: 10.1007/s00213-009-1691-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2009] [Accepted: 09/28/2009] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The objective of our study was to evaluate the effects of paroxetine on emotional functioning in three arms: double-blind paroxetine (DBPX), single-blind paroxetine (SBPX), and double-blind placebo (DBPO). Healthy psychologists and psychiatrists were elected for their ability to analyze with correct sensibility changes in their emotions. METHOD Thirty nonanxious, nondepressed participants working as psychiatrists (N = 18) or psychologists (N = 12) were randomly assigned to receive an ambulatory treatment with paroxetine (DBPX N = 10, SBPX N = 10) or placebo (DBPO N = 10). Paroxetine was administered for 4 weeks at 20 mg/day. Emotional functioning was evaluated with the Emotional State Questionnaire (ESQ), a self-questionnaire designed to assess four emotional dimensions: "recognition," "expression," "internal emotional experience," and "social context." Changes in emotional measures from baseline to D0, D7, D14, D28, and D42 were compared between treatment groups. RESULTS Analyses of ESQ showed in DBPX a significant decrease from baseline to D28 in internal emotional experience as compared to SBPX and DBPO groups. A different influence of gender between treatment groups on emotional recognition was observed. CONCLUSIONS This is the first study assessing the impact of a 4-week paroxetine treatment on emotional functioning in healthy psychiatrists and psychologists. The DBPX group was distinguishable from both SBPX and DBPO groups by a decrease in internal emotional experience, suggesting that two factors could be involved in the clinical response to paroxetine: a decrease in emotional feeling and treatment awareness.
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Giegling I, Olgiati P, Hartmann AM, Calati R, Möller HJ, Rujescu D, Serretti A. Personality and attempted suicide. Analysis of anger, aggression and impulsivity. J Psychiatr Res 2009; 43:1262-71. [PMID: 19481222 DOI: 10.1016/j.jpsychires.2009.04.013] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Revised: 04/28/2009] [Accepted: 04/29/2009] [Indexed: 11/29/2022]
Abstract
Suicide is one of the leading causes of death worldwide, mortality from suicide being approximately 2%. Attempted suicide appears to be a major risk factor for suicide completion. Anger, aggression and impulsivity are personality traits associated with suicide attempt. In this study we analysed a part of a previously reported sample in order to test anger, impulsivity and temperament/character scales as predictors of aggression and self-aggression in suicide attempters and to compare anger- and aggression-related traits between impulsive and premeditated suicide attempts as well as between violent and non-violent suicide methods. One-hundred-eleven consecutively admitted inpatients with a lifetime history of attempted suicide were assessed for anger (State-Trait Anger Expression Inventory, STAXI), aggression (Questionnaire for Measuring Factors of Aggression, FAF) and temperament/character (Temperament and Character Inventory, TCI). Higher aggression scores, as measured by FAF, were predicted by being male, meeting criteria for borderline personality disorder and having higher angry temperament scores as assessed by STAXI; low cooperativeness was also associated with aggression but not after controlling for STAXI scales. TCI dimensions associated with self-aggression were high harm avoidance, high impulsivity and low self-directedness; state anger, inwardly directed anger and inhibition of aggression were also predictors of self-aggression. In conclusion, impulsivity and harm avoidance have emerged as temperament dimensions independently associated with self-aggressive tendencies in personality. Such interactions could explain the correlation between temperament and suicidality but further research is needed. Anger and self-directedness appear to have some effects on suicide attempt.
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Affiliation(s)
- Ina Giegling
- Molecular and Clinical Neurobiology, Department of Psychiatry, Ludwig-Maximilians-University, Nussbaumstr. 7, D-80336 Munich, Germany
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Mazza M, Mazza O, Pomponi M, Di Nicola M, Padua L, Vicini M, Bria P, Mazza S. What is the effect of selective serotonin reuptake inhibitors on temperament and character in patients with fibromyalgia? Compr Psychiatry 2009; 50:240-4. [PMID: 19374968 DOI: 10.1016/j.comppsych.2008.08.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Revised: 08/20/2008] [Accepted: 08/27/2008] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The purpose of the present study was to assess a group of patients with fibromyalgia (FM) and control subjects using the personality questionnaire proposed by Cloninger and to determine possible changes in the Italian version of the Temperament and Character Inventory-Revised patterns of patients with FM after therapy with serotoninergic antidepressants (selective serotonin reuptake inhibitors [SSRIs]). METHODS Sixty patients with FM filled out the Temperament and Character Inventory-Revised and Beck Depression Inventory before and after 6-month therapy with SSRIs (escitalopram 10 mg, fluoxetine 20 mg, or paroxetine 20 mg). A total of 80 age-, sex-, and education level-matched healthy subjects were selected as a control group. RESULTS Both in the pretreatment and posttreatment period, patients were found to have higher harm avoidance and lower self-directedness scores than healthy controls. In addition, harm avoidance and self-directedness were state and trait dependent. CONCLUSIONS Depressive symptoms in patients with FM can be significantly decreased by treatment with SSRIs. A careful clinical assessment and study of personality profile is needed to identify patients with FM who may benefit from antidepressant pharmacologic therapy and specific psychotherapeutic interventions.
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Affiliation(s)
- Marianna Mazza
- Institute of Psychiatry, Catholic University of Sacred Heart of Rome, Largo F. Vito 1, Rome 00168, Italy.
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Rosen NL. Psychological issues in the evaluation and treatment of tension-type headache. Curr Pain Headache Rep 2008; 12:425-32. [DOI: 10.1007/s11916-008-0072-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Farmer RF, Goldberg LR. Brain Modules, Personality Layers, Planes of Being, Spiral Structures, and the Equally Implausible Distinction between TCI-R "Temperament" and "Character" Scales: A Reply to Cloninger. Psychol Assess 2008; 20:300-304. [PMID: 19727313 DOI: 10.1037/a0012932] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In this reply we address comments by Cloninger (this issue) related to our report (Farmer & Goldberg, this issue) on the psychometric properties of the revised Temperament and Character Inventory (TCI-R) and a short inventory derivative, the TCI-140. Even though Cloninger's psychobiological model has undergone substantial theoretical modifications, the relevance of these changes for the evaluation and use of the TCI-R remains unclear. Aspects of TCI-R assessment also appear to be theoretically and empirically incongruent with Cloninger's assertion that TCI-R personality domains are non-linear and dynamic in nature. Several other core assumptions from the psychobiological model, including this most recent iteration, are non-falsifiable, inconsistently supported, or have no apparent empirical basis. Although researchers using the TCI and TCI-R have frequently accepted the temperament/character distinction and associated theoretical ramifications, for example, we find little overall support for the differentiation of TCI-R domains into these two basic categories. The implications of these observations for TCI-R assessment are briefly discussed.
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