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Temperament and Character Domains of Personality and Depression
Name: Temperament and Character Domains of Personality and Depression
Pages: 185
Year: 2012
Language: English
File Size: 3.22 MB
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Editorial Board Martin Alda, Canada Osvaldo Almeida, Australia Bernhard Baune, Australia Mathias Berger, Germany Michael Berk, Australia Graham Burrows, Australia Charles DeBattista, USA Pedro Delgado, USA A. Delini Stula, Switzerland Koen Demyttenaere, Belgium Timothy G. Dinan, Ireland Ronald S. Duman, USA Klaus Ebmeier, UK Yvonne Forsell, Sweden K. N. Fountoulakis, Greece Robert N. Golden, USA H. Grunze, UK Martin Hautzinger, GermanyRobert M. A. Hirschfeld, USA Fritz Hohagen, Germany PeterR.Joyce,NewZealand Paul Linkowski, Belgium Chia Yih Liu, Taiwan Athina Markou, USA Keith Matthews, UK Roger S. McIntyre, Canada Charles B. Nemero ,USA Alexander Neumeister, USA Georg Northo ,Canada Gabriel Nowak, Poland SagarV.Parikh,Canada BarbaraL.Parry,USA Angel Pazos, Spain S. S. Pedersen, The Netherlands Eric D. Peselow, USA Bettina F. Piko, HungaryJames B. Potash, USA Martin Preisig, Switzerland Mark Rapaport, USA Arun V. Ravindran, Canada Zoltan Rihmer, Hungary Janusz K. Rybakowski, Poland Bernard Sabbe, Belgium John R. Seeley, USA Alessandro Serretti, Italy Verinder Sharma, Canada Axel Steiger, Germany Wai Kwong Tang, Hong Kong Gustavo Turecki, Canada Dietrich van Calker, Germany Willem Van Der Does, The Netherlands Harm W. J. van Marwijk, The Netherlands Frans G. Zitman, The Netherlands


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Contents Temperament and Character Domains of Personality and Depression, Toshinori Kitamura and C. Robert Cloninger Volume 2011, Article ID 765691, 2 pages An Increase of the Character Function of Self Directedness Is Centrally Involved in Symptom Reduction during Remissionfrom Major Depression, Jaap G. Goekoop, Remco F. P. De Winter, and Rutger Goekoop Volume 2011, Article ID 749640, 8 pages Temperament and Character in PsychoticDepression Compared with Other Subcategories of Depressionand Normal Controls, Jaap G. Goekoop and Remco F. P. De Winter Volume 2011, Article ID 730295, 7 pages EarlyLifeStress and ChildTemperament Style as Predictors of ChildhoodAnxiety and Depressive Symptoms: Findings from the Longitudinal Study ofAustralian Children, Andrew J. Lewis and Craig A. Olsson Volume 2011, Article ID 296026, 9 pages TheEffects of Temperament and Character on Symptoms of Depression in a ChineseNonclinical Population, Zi Chen, Xi Lu, and Toshinori Kitamura Volume 2011, Article ID 198591, 8 pages Eating Disordersand Major Depression: Roleof Anger and Personality, Abbate Daga Giovanni, Gramaglia Carla, Marzola Enrica, Amianto Federico, Zuccolin Maria, and Fassino Secondo Volume 2011, Article ID 194732, 7 pages PersonalityPro les IdentifyDepressiveSymptoms over Ten Years?A Population Based Study, Kim Josefsson, P aivi Merjonen, Markus Jokela, Laura Pulkki R aback, and Liisa Keltikangas J arvinen Volume 2011, Article ID 431314, 11 pages Cognitive and Affective Correlates of Temperament inParkinson s Disease, Graham Pluck and Richard G. Brown Volume 2011, Article ID 893873, 8 pages TheRelationshipbetween Personalityand DepressioninExpectant Parents, Elda Andriola, Michela Di Trani, Annarita Grimaldi, and Renato Donfrancesco Volume 2011, Article ID 356428, 5 pages Exposureto Community Violence, Psychopathology, and PersonalityTraits in RussianYouth, Roman Koposov and Vladislav Ruchkin Volume 2011, Article ID 909076, 10 pages TheRelationshipbetween Individual Personality Traits (Internality Externality) and Psychological DistressinEmployees in Japan, Masahito Fushimi Volume 2011, Article ID 731307, 6 pages Bipolar Disorderand the TCI: Higher Self Transcendence in Bipolar DisorderCompared to Major Depression, James A. Harley, J. Elisabeth Wells, Christopher M. A. Frampton, and Peter R. Joyce Volume 2011, Article ID 529638, 6 pages


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Hindawi Publishing Corporation Depression Research and Treatment Volume 2011, Article ID 765691,2pages doi:10.1155/2011/765691 Editorial Temperamentand Character Domains of Personality and Depression Toshinori Kitamura 1 and C. Robert Cloninger 2 1 Kitamura Institute of Mental Health Tokyo, 8 12 4 305 Akasaka, Tokyo 107 0052, Japan 2 Department of Psychiatry, Washington University in St. Louis, 660 South Euclid Avenue, St. Louis, MO 63130, USA Correspondence should be addressed to Toshinori Kitamura,[email protected] of mental health.jp Received 14 December 2011; Accepted 14 December 2011 Copyright 2011 T. Kitamura and C. R. Cloninger. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The link between personality and depression has long in trigued researchers and clinicians alike. Personality has been viewed as contributing to the onset and course of depression aswellasinfluencingtherapeuticchoicesfordepression.Two major current personality theories are the "Big Five," in which the NEO PI is used as a measuring instrument, and the Psychobiology Theory of Personality, which uses the TemperamentandCharacterInventory (TCI)asameasuring instrument. This special issue deals with the latter theory in terms of its interrelations with depression and related con ditions. The last couple of decades have witnessed a great num ber of research reports on this topic. The association of TCI dimension with diverse types of health problems, and de pression in particular, has been reported in the literature. The TCI has also been studied in terms of predicting treat ment responses of depressed patients. Genetic and environ mental correlates of TCI dimensions are a hot topic among researchers. Hence we believe that the present special issue is very timely. This issue consists of six reports. K. Josefsson and col leagues, in Finland, present results from a longitudinal study of young Finns. Based on TCI scores at Time 1, the group triedtopredictlevelsofdepression10yearslater.Theyfound that both high harm avoidance (HA) and low self directed ness (SD) independently predicted later depression severity. Thus,aprospectivepopulation baseddesignyieldedfindings that echoed the results of past cross sectional and clinical treatment studies. In a two year follow up study of a clinical population of depression, J. G. Goekoop and colleagues in the Netherlandreported that only the increase in SD (in this two year pe riod) was related to the decrease in emotional dysregulation symptoms, while the increase in SD was associated with the decrease in HA. This suggests that symptomatic recovery follows reversibility of lowered SD. People with current depression may be diagnosed with bipolar disorder if they have a lifelong history of manic or hypomanic episodes. Hence the association of TCI profiles with depression should be examined in terms of previous diagnoses of mood disorders. J. A. Harley and colleagues, in New Zealand, relate the results of their South Island Bipolar Study,namely,thathighHAscoresdifferentiatedpeoplewith major depressive disorder (MDD) and those with bipolar disorder (BD) from unaffected relatives of bipolar probands after controlling for the current severity of depression. HA, however, failed to differentiate those with MDD from those with BD. On the other hand, high self transcendence (ST) differentiated people with bipolar I (major depression with manic episodes) from those with MDD and unaffected rela tives, confirming other reports of the importance of self transcendence in the creativity of people with bipolar dis orders. People with depression are diagnosed with psychotic de pression if they show positive symptoms simultaneously. J. G. Goekoop and colleagues in the Netherland in a followup study of clinical samples of depression reported that whereas patients with depression as a whole were characterized by higher HA and lower SD than healthy controls during the acute episode and higher HA after full remission, patients with psychotic depression were characterized by lower coop erativeness and lower reward dependence (RD) in the acute


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2Depression Research and Treatment episode and lower RD after full remission. Hence it may be that people with psychotic depression share the same per sonality traits of low RD with people with schizophrenia al though the latter may be differentiated by high self trans cendence. Z. Chen and colleagues in China, in their cross section al nonclinical population study, conducted a unique exami nation of TCI subscale score associations not with the total score of Zung's Self rating Depression Scale but with the scores of its subscales. Unexpectedly, it was not the nega tive subscale score but the positive subscale score (consisting of items such as "enjoy things" (reverse) and "feel useful and needed" (reverse)) that was predicted by low SD, cooper ativeness, RD, and persistence. This observation shows the importance of the absence of positive emotions in addition to the presence of negative emotions in mood disorders. Depression is often observed among pregnant women. E. Andriola and colleagues, in Italy, present unique preliminary findings on TCI patterns among expectant mothers and their partners. Both groups were characterized by low SD, whereas only expectant mothers were demonstrated to have high HA. Eating disorders (ED) are often comorbid with depres sion, and individuals with both conditions are known to be resistanttotreatment.A.D.Giovanniandcolleagues,inItaly, reportahighprevalenceofmajordepression(MD)inoutpa tients with ED. Compared to patients with ED only, those with ED and MD demonstrated higher anger and eating disorder pathology scores. They were also characterized by high HA and low SD. C. R. Cloninger hypothesized dopamine, serotonin, and noradrenaline to be biological substrates of novelty seeking (NS), HA, and RD, respectively. Hence it may be of research interest to investigate the temperaments of patients suffering from conditions characterized primarily by deficiencies of these neurotransmitters. Parkinson's disease (PD) is such an example. PD is known to be caused by dopamine deficiency in cells of the substantia nigra. Pluck and Brown, in the UK, studied PD patients and controls. They found that NS scores correlated with a reaction time measure of attentional orien tation to visual novelty, whereas HA scores correlated with anxiety scores. These observations confirm Cloninger's orig inal hypotheses about attention and learning in NS and HA. Now that we have identified links between temperament and character domain patterns and depression, we must further investigate what mediates these effects. One possible mediator is coping style. M. Fushimi, in Japan, provides a hint that external locus of control is linked to psychological maladaptive patterns. Such coping styles may be based on personality traits. Other promising candidate mediators in clude self esteem and self efficacy, depressogenic dysfunc tional attitudes and thinking errors, lack of social supports and social networks, poor coping reaction (rather than per ceived coping styles), and stressful life events induced by specific personal traits. Deeper insight into the association between personality and depression may contribute to the more efficacious treat ment of depression. Toshinori Kitamura C. Robert Cloninger


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Hindawi Publishing Corporation Depression Research and Treatment Volume 2011, Article ID 749640,8pages doi:10.1155/2011/749640 Research Article An Increase of the Character Function of Self Directedness Is Centrally Involved in Symptom Reduction during Remission from Major Depression JaapG.Goekoop, 1 RemcoF.P.DeWinter, 2 andRutger Goekoop 3 1 Department of Psychiatry, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands 2 Psycho Medical Centre, Parnassia, Monsterseweg 93, 2553 RJ The Hague, The Netherlands 3 Programma Depressie Ambulant, Parnassia, PsyQ, Lijnbaan 4, 2512 VA The Hague, The Netherlands Correspondence should be addressed to Jaap G. Goekoop,[email protected] Received 10 April 2011; Accepted 3 October 2011 Academic Editor: C. Robert Cloninger Copyright 2011 Jaap G. Goekoop et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Studies with the Temperament and Character Inventory (TCI) in depressive disorders have shown changes ( )ofthe character of Self Directedness (SD) and the temperament of Harm Avoidance (HA). The central question of this study is which of thesetwochangesismostproximallyrelatedtotheproductionofdepressivesymptoms.Methods.Thestartandendpointdatafrom a two year followup of 58 depressed patients were reanalyzed. We used the HA and SD scores as well as the scores on three dimensions of psychopathology, called Emotional Dysregulation (ED), Retardation (RET), and Anxiety (ANX). The presence of the main relation between personality and psychopathology was tested in all patients and in four subcategories. The data were analyzed by MANCOVA and Structural Equation Modelling (SEM).Results. HA and SD correlated negatively, and only SD was related (negatively) to ED. This pattern was found in all subcategories. SEM showed HA and SD had an ambiguous causal interrelationship, while SD, RET, and ANX had unidirectional effects on ED.Conclusion. The results correspond with a central pathogenetic role for a state related deficit at the character level in depression. This may have important consequences for investigations of endophenotypes and clinical treatment. 1.Introduction A change of personality has been found consistently in major depressive episodes . A central question is whether this should be seen as an epiphenomenon or an essential step in the pathogenetic process. The current study focuses on changes of personality and relations with changes in the production of depressive symptoms in the course of remission. In order to allow for a fine grained analysis of the personality changes involved, and for an optimal detection of relations with dimension(s) of psychopathology, we used multidimensional rating scales. The choice of dimensions for personality and psychopathology to be considered is importantinsuchanalyses.Thiswillbediscussedherebelow. Previous studies of personality in patients with a major depressive disorder have shown that the premorbid person ality traits of Neuroticism , Harm Avoidance (HA) ,and Self Directedness (SD) are related to the life time risk of a depressive episode. Since Neuroticism is positively correlated with HA and negatively with SD , whereas HA and SD are themselves negatively correlated , these findings suggest that HA and SD represent different aspects of the more global vulnerability or resilience trait, that is nonspecifically covered by the Neuroticism dimensions of several other personality models . Since Neuroticism does not predict the time of onset of the depressive episode , this global dimension may not be su ciently differentiated to allow for the detection of the most proximal personality dimension that, in interaction with stress, would be involved in the eventual pathogenesis of the depres sive disorder. For this reason, we used the Temperament and Character Inventory (TCI) with its differentiation between SD and HA in this global domain of personality. In order to enhance the chance of finding the dimension that


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2Depression Research and Treatment is most proximally related to the transition from normal to pathological functioning and therefore to the production of depressive symptoms, we used state related changes. Changes of personality have been found before to be related to changes of depression in varying degrees of severity, and the findings may vary depending on the use of the measures of personality change. The first to mention are relations between subsyndromal symptom production and changes of Neuroticism immediately above the basal level . In the higher severity range of symptom production changes of Neuroticism have been found to be present butsmall, while highly reproducible changes have been found for the HA and SD dimensions of the TCI . The varying frequency of "comorbid" Axis II diagnoses in patients with major depression couldbe a third way in which personality changes may be assessed. From the perspective of the TCI, low basic levels of SD are the defining hallmark of personality disorders . As improvement of the level of depressive symptoms has been found to correlate with the change in Axis II prediction based on this SD score , the state related reduced SD in depression may be involved in this Axis II "comorbidity". These findings support the necessity to differentiate between the dimensions of SD and HA in the studies of the primary andmostproximallyrelatedfactorintheonsetandremission of depressive disorders. In the present study we therefore used the change of both dimensions, hypothesizing that either HA or SD would be most directly involved in the production of symptoms in depressive disorders. The analyses were carried out in all depressed patients as well as in four subcategories to test if the relation between the change of personality and change of psychopathology found is a general characteristic of all depressive disorders or just pertains to one or more subcategories. The phenotypical significance of HA or SD can be derived from the personality model of the TCI and the subscales that are comprised by these dimensions. According to the TCI , personality can be conceived as a multidimensional construct comprising higher and lower levels of personal functioning and coping called character and temperament respectively. Whereas character is thought to involve conscious adaptive information processing, tem perament involves automatic adaptation via conditioned response patterns. The model includes three character dimensions called Self Directedness (SD), Cooperativeness (CO), and Self Transcendence (ST) and four temperament dimensions called Harm Avoidance (HA), Reward Depen dence (RD), Novelty Seeking (NS), and Persistence (PER). HAcomprisesthesubscalesorfacetsof worrying/pessimism, fear of uncertainty, shyness, and fatigability, while low SD results in apathy, a loss of goals or direction, loss of self striving behaviour, externalizing, and an incongruent second nature. This suggests that either or both changes could be directly involved in the pathogenesis of depression or one or more subcategories in particular. To optimize the chances of finding relations with specific aspectsofmajordepression,wealsousedamultidimensional approach to assess psychopathology. This involved the administration of the Comprehensive PsychopathologicalRating Scale (CPRS) , which enables the assessment of six global dimensions of psychopathology called Emotional Dysregulation (ED), Motivational Inhibition (or retardation (RET), Autonomous Dysregulation (or anxiety (ANX), Motivational Disinhibition (or Mania), Perceptual Disintegration, and Behavioural Disintegration. For the present study we used the three nonpsychotic and non manic global dimensions of ED, RET, and ANX. Emotional Dysregulation (ED) is a 20 item scale that comprises 9 of the 10 items of the Montgomery Asberg Depression Rating Scale (MADRS) . Other items of the dimension of ED concern specific neurotic symptoms like compulsive thoughts, pho bias, indecision, fatigability, failing memory, reduced sexual interest, reported muscular tension, loss of sensation or movements, derealisation, and depersonalisation . The dimension of RET comprises items of inability to feel, appar ent sadness, observed lack of appropriate emotion, reduced speech, and slowness of movement. The dimension of ANX comprises items of inner tension, reduced sleep, reported autonomic disturbances, aches and pains, observed auto nomic disturbances signs, and observed muscular tension .Weusedtheseglobaldimensionsofpsychopathologyin the present study as we previously have found combinations ofANXandRETtobespecificallyinvolvedinthephenotypes of subcategories of depression derived from the melancholic subtype . This method has also enabled the detection of a phenotypic homology between one of these subcategories called depression with above normal vasopressin concen tration and the stress induced behavioural pattern of the animal model for depression called high anxiety like behaviour rat . Moreover, the combination of ED and RET appeared to be involved in psychotic depression . As has already been reported previously , we investi gated the changes of personality and psychopathology in the context of a two year follow up study of patients treated for an acute episode of major depression. We used the change scores between the start and the end of this two year follow up period. We first analyzed the correlations between the changes of the dimensions of personality and the dimen sions of psychopathology by using Pearson's correlations and MANCOVA. Thereafter, we used Structural Equation Modelling(SEM)toanalyzethepathwaybetweenpersonality change and change of psychopathology and at the same time the pathways between the changes of the dimensions of psy chopathology. Since the personality dimensions of character and temperament and the dimensions of psychopathology represent different levels of functioning from the conscious conceptual level of character via the temperamental level of automatic conditioned behaviour to instinctual response patterns, the results of the present study are discussed from the perspective of the hierarchic organization of brain regions involved in depression. The support for either of two pathogenetic models will be evaluated. These models are based on the hypothesis of a continuity between premorbid temperament, increased temperament score, subsyndromal symptom level, major depressive disorder , and the hypothesis of the development of a high level functional deficit as precondition for the production of depressive


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