Temperament and Character Domains of Personality and Depression

185 Pages·2012·3.22 MB·English

Depression Research and Treatment
Temperament and Character
Domains of Personality
and Depression
Guest Editors: Toshinori Kitamura, C. Robert Cloninger, Andrea Fossati,
Jörg Richter, and Peter R. Joyce
Temperament and Character Domains
of Personality and Depression
Depression Research and Treatment
Temperament and Character Domains
of Personality and Depression
Guest Editors: Toshinori Kitamura, C. Robert Cloninger,
Andrea Fossati, Jo¨rg Richter, and Peter R. Joyce
Copyright©2011HindawiPublishingCorporation.Allrightsreserved.
Thisisaspecialissuepublishedin“DepressionResearchandTreatment.”Allarticlesareopenaccessarticlesdistributedunderthe
CreativeCommonsAttributionLicense,whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedthe
originalworkisproperlycited.
Editorial Board
MartinAlda,Canada RobertM.A.Hirschfeld,USA JamesB.Potash,USA
OsvaldoAlmeida,Australia FritzHohagen,Germany MartinPreisig,Switzerland
BernhardBaune,Australia PeterR.Joyce,NewZealand MarkRapaport,USA
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MichaelBerk,Australia Chia-YihLiu,Taiwan ZoltanRihmer,Hungary
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Contents
TemperamentandCharacterDomainsofPersonalityandDepression,ToshinoriKitamuraand
C.RobertCloninger
Volume2011,ArticleID765691,2pages
AnIncreaseoftheCharacterFunctionofSelf-DirectednessIsCentrallyInvolvedinSymptomReduction
duringRemissionfromMajorDepression,JaapG.Goekoop,RemcoF.P.DeWinter,andRutgerGoekoop
Volume2011,ArticleID749640,8pages
TemperamentandCharacterinPsychoticDepressionComparedwithOtherSubcategoriesof
DepressionandNormalControls,JaapG.GoekoopandRemcoF.P.DeWinter
Volume2011,ArticleID730295,7pages
EarlyLifeStressandChildTemperamentStyleasPredictorsofChildhoodAnxietyandDepressive
Symptoms:FindingsfromtheLongitudinalStudyofAustralianChildren,AndrewJ.Lewisand
CraigA.Olsson
Volume2011,ArticleID296026,9pages
TheEffectsofTemperamentandCharacteronSymptomsofDepressioninaChineseNonclinical
Population,ZiChen,XiLu,andToshinoriKitamura
Volume2011,ArticleID198591,8pages
EatingDisordersandMajorDepression:RoleofAngerandPersonality,Abbate-DagaGiovanni,
GramagliaCarla,MarzolaEnrica,AmiantoFederico,ZuccolinMaria,andFassinoSecondo
Volume2011,ArticleID194732,7pages
PersonalityProfilesIdentifyDepressiveSymptomsoverTenYears?APopulation-BasedStudy,
KimJosefsson,Pa¨iviMerjonen,MarkusJokela,LauraPulkki-Ra˚back,andLiisaKeltikangas-Ja¨rvinen
Volume2011,ArticleID431314,11pages
CognitiveandAffectiveCorrelatesofTemperamentinParkinson’sDisease,GrahamPluckand
RichardG.Brown
Volume2011,ArticleID893873,8pages
TheRelationshipbetweenPersonalityandDepressioninExpectantParents,EldaAndriola,
MichelaDiTrani,AnnaritaGrimaldi,andRenatoDonfrancesco
Volume2011,ArticleID356428,5pages
ExposuretoCommunityViolence,Psychopathology,andPersonalityTraitsinRussianYouth,
RomanKoposovandVladislavRuchkin
Volume2011,ArticleID909076,10pages
TheRelationshipbetweenIndividualPersonalityTraits(Internality-Externality)andPsychological
DistressinEmployeesinJapan,MasahitoFushimi
Volume2011,ArticleID731307,6pages
BipolarDisorderandtheTCI:HigherSelf-TranscendenceinBipolarDisorderComparedtoMajor
Depression,JamesA.Harley,J.ElisabethWells,ChristopherM.A.Frampton,
andPeterR.Joyce
Volume2011,ArticleID529638,6pages
HindawiPublishingCorporation
DepressionResearchandTreatment
Volume2011,ArticleID765691,2pages
doi:10.1155/2011/765691
Editorial
Temperament and Character Domains of
Personality and Depression
ToshinoriKitamura1andC.RobertCloninger2
1KitamuraInstituteofMentalHealthTokyo,8-12-4-305Akasaka,Tokyo107-0052,Japan
2DepartmentofPsychiatry,WashingtonUniversityinSt.Louis,660SouthEuclidAvenue,St.Louis,MO63130,USA
CorrespondenceshouldbeaddressedtoToshinoriKitamura,[email protected]
Received14December2011;Accepted14December2011
Copyright©2011T.KitamuraandC.R.Cloninger. This is an open access article distributed under the Creative Commons
AttributionLicense,whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalworkis
properlycited.
The link between personality and depression has long in- reported that only the increase in SD (in this two-year pe-
triguedresearchersandcliniciansalike.Personalityhasbeen riod)wasrelatedtothedecreaseinemotionaldysregulation
viewedascontributingtotheonsetandcourseofdepression symptoms,whiletheincreaseinSDwasassociatedwiththe
aswellasinfluencingtherapeuticchoicesfordepression.Two decrease in HA. This suggests that symptomatic recovery
major current personality theories are the “Big Five,” in followsreversibilityofloweredSD.
which the NEO-PI is used as a measuring instrument, and People with current depression may be diagnosed with
the Psychobiology Theory of Personality, which uses the bipolar disorder if they have a lifelong history of manic or
TemperamentandCharacterInventory(TCI)asameasuring hypomanic episodes. Hence the association of TCI profiles
instrument.Thisspecialissuedealswiththelattertheoryin with depression should be examined in terms of previous
terms of its interrelations with depression and related con- diagnosesofmooddisorders.J.A.Harleyandcolleagues,in
ditions. NewZealand,relatetheresultsoftheirSouthIslandBipolar
The last couple of decades have witnessed a great num- Study,namely,thathighHAscoresdifferentiatedpeoplewith
berofresearchreportsonthistopic.TheassociationofTCI major depressive disorder (MDD) and those with bipolar
dimension with diverse types of health problems, and de- disorder(BD)fromunaffectedrelativesofbipolarprobands
pression in particular, has been reported in the literature. after controlling for the current severity of depression. HA,
The TCI has also been studied in terms of predicting treat- however,failedtodifferentiatethosewithMDDfromthose
mentresponsesofdepressedpatients.Geneticandenviron- with BD. On the other hand, high self-transcendence (ST)
mentalcorrelatesofTCIdimensionsareahottopicamong differentiated people with bipolar I (major depression with
researchers.Hencewebelievethatthepresentspecialissueis manicepisodes)fromthosewithMDDandunaffectedrela-
verytimely. tives, confirming other reports of the importance of self-
This issue consists of six reports. K. Josefsson and col- transcendence in the creativity of people with bipolar dis-
leagues,inFinland,presentresultsfromalongitudinalstudy orders.
of young Finns. Based on TCI scores at Time 1, the group Peoplewithdepressionarediagnosedwithpsychoticde-
triedtopredictlevelsofdepression10yearslater.Theyfound pression if they show positive symptoms simultaneously. J.
thatbothhighharmavoidance(HA)andlowself-directed- G.GoekoopandcolleaguesintheNetherlandinafollowup
ness(SD)independentlypredictedlaterdepressionseverity. studyofclinicalsamplesofdepressionreportedthatwhereas
Thus,aprospectivepopulation-baseddesignyieldedfindings patients with depression as a whole were characterized by
that echoed the results of past cross-sectional and clinical higher HA and lower SD than healthy controls during the
treatmentstudies. acute episode and higher HA after full remission, patients
Inatwo-yearfollow-upstudyofaclinicalpopulationof withpsychoticdepressionwerecharacterizedbylowercoop-
depression,J.G.GoekoopandcolleaguesintheNetherland erativenessandlowerrewarddependence(RD)intheacute
2 DepressionResearchandTreatment
episodeandlowerRDafterfullremission.Henceitmaybe
that people with psychotic depression share the same per-
sonalitytraitsoflowRDwithpeoplewithschizophreniaal-
though the latter may be differentiated by high self-trans-
cendence.
Z.ChenandcolleaguesinChina,intheircross-section-
alnonclinicalpopulationstudy,conductedauniqueexami-
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-
tivesubscalescorebutthepositivesubscalescore(consisting
ofitemssuchas“enjoythings”(reverse)and“feelusefuland
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
tothepresenceofnegativeemotionsinmooddisorders.
Depressionisoftenobservedamongpregnantwomen.E.
Andriolaandcolleagues,inItaly,presentuniquepreliminary
findingsonTCIpatternsamongexpectantmothersandtheir
partners.BothgroupswerecharacterizedbylowSD,whereas
onlyexpectantmothersweredemonstratedtohavehighHA.
Eating disorders (ED) are often comorbid with depres-
sion,andindividualswithbothconditionsareknowntobe
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
highHAandlowSD.
C.R.Cloningerhypothesizeddopamine,serotonin,and
noradrenaline to be biological substrates of novelty seeking
(NS),HA,andRD,respectively.Henceitmaybeofresearch
interesttoinvestigatethetemperamentsofpatientssuffering
from conditions characterized primarily by deficiencies of
theseneurotransmitters.Parkinson’sdisease(PD)issuchan
example.PDisknowntobecausedbydopaminedeficiency
incellsofthesubstantianigra.PluckandBrown,intheUK,
studiedPDpatientsandcontrols.TheyfoundthatNSscores
correlatedwithareactiontimemeasureofattentionalorien-
tation to visual novelty, whereas HA scores correlated with
anxietyscores.TheseobservationsconfirmCloninger’sorig-
inalhypothesesaboutattentionandlearninginNSandHA.
Nowthatwehaveidentifiedlinksbetweentemperament
and character domain patterns and depression, we must
furtherinvestigatewhatmediatestheseeffects.Onepossible
mediator is coping style. M. Fushimi, in Japan, provides a
hintthatexternallocusofcontrolislinkedtopsychological
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
andsocialnetworks,poorcopingreaction(ratherthanper-
ceived coping styles), and stressful life events induced by
specificpersonaltraits.
Deeper insight into the association between personality
anddepressionmaycontributetothemoreefficacioustreat-
mentofdepression.
ToshinoriKitamura
C.RobertCloninger
HindawiPublishingCorporation
DepressionResearchandTreatment
Volume2011,ArticleID749640,8pages
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,1RemcoF.P.DeWinter,2andRutgerGoekoop3
1DepartmentofPsychiatry,LeidenUniversityMedicalCentre,2300RCLeiden,TheNetherlands
2Psycho-MedicalCentre,Parnassia,Monsterseweg93,2553RJTheHague,TheNetherlands
3ProgrammaDepressie-Ambulant,Parnassia,PsyQ,Lijnbaan4,2512VATheHague,TheNetherlands
CorrespondenceshouldbeaddressedtoJaapG.Goekoop,[email protected]
Received10April2011;Accepted3October2011
AcademicEditor:C.RobertCloninger
Copyright©2011JaapG.Goekoopetal. This is an open access article distributed under the Creative Commons Attribution
License,whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalworkisproperly
cited.
Background.StudieswiththeTemperamentandCharacterInventory(TCI)indepressivedisordershaveshownchanges(Δ)ofthe
characterofSelf-Directedness(SD)andthetemperamentofHarmAvoidance(HA).Thecentralquestionofthisstudyiswhichof
thesetwochangesismostproximallyrelatedtotheproductionofdepressivesymptoms.Methods.Thestartandendpointdatafrom
atwo-yearfollowupof58depressedpatientswerereanalyzed.WeusedtheΔHAandΔSDscoresaswellastheΔscoresonthree
dimensionsofpsychopathology,calledEmotionalDysregulation(ED),Retardation(RET),andAnxiety(ANX).Thepresenceof
themainrelationbetweenpersonalityandpsychopathologywastestedinallpatientsandinfoursubcategories.Thedatawere
analyzedbyMANCOVAandStructuralEquationModelling(SEM).Results.ΔHAandΔSDcorrelatednegatively,andonlyΔSD
wasrelated(negatively)toΔED.Thispatternwasfoundinallsubcategories.SEMshowedΔHAandΔSDhadanambiguouscausal
interrelationship, while ΔSD, ΔRET, and ΔANX had unidirectional effects on ΔED. Conclusion. The results correspond with a
centralpathogeneticroleforastate-relateddeficitatthecharacterlevelindepression.Thismayhaveimportantconsequencesfor
investigationsofendophenotypesandclinicaltreatment.
1.Introduction and Self-Directedness (SD) [3] are related to the life-time
risk of a depressive episode. Since Neuroticism is positively
A change of personality has been found consistently in correlatedwithHAandnegativelywithSD[4],whereasHA
majordepressiveepisodes[1].Acentralquestioniswhether and SD are themselves negatively correlated [5–17], these
this should be seen as an epiphenomenon or an essential findingssuggestthatHAandSDrepresentdifferentaspects
step in the pathogenetic process. The current study focuses of the more global vulnerability or resilience trait, that is
on changes of personality and relations with changes in nonspecifically covered by the Neuroticism dimensions of
the production of depressive symptoms in the course of severalotherpersonalitymodels[18–20].SinceNeuroticism
remission.Inordertoallowforafine-grainedanalysisofthe does not predict the time of onset of the depressive
personality changes involved, and for an optimal detection episode [21], this global dimension may not be sufficiently
ofrelationswithdimension(s)ofpsychopathology,weused differentiatedtoallowforthedetectionofthemostproximal
multidimensional rating scales. The choice of dimensions personalitydimensionthat,ininteractionwithstress,would
for personality and psychopathology to be considered is be involved in the eventual pathogenesis of the depres-
importantinsuchanalyses.Thiswillbediscussedherebelow. sive disorder. For this reason, we used the Temperament
Previous studies of personality in patients with a major and Character Inventory (TCI) [5] with its differentiation
depressivedisorderhaveshownthatthepremorbidperson- betweenSDandHAinthisglobaldomainofpersonality.In
alitytraitsofNeuroticism[2],HarmAvoidance(HA)[1,3], order to enhance the chance of finding the dimension that
2 DepressionResearchandTreatment
ismostproximallyrelatedtothetransitionfromnormalto Rating Scale (CPRS) [31], which enables the assessment
pathologicalfunctioningandthereforetotheproductionof of six global dimensions of psychopathology [32] called
depressivesymptoms,weusedstate-relatedchanges. EmotionalDysregulation(ED),MotivationalInhibition(or
Changes of personality have been found before to be retardation (RET), Autonomous Dysregulation (or anxiety
related to changes of depression in varying degrees of (ANX), Motivational Disinhibition (or Mania), Perceptual
severity,andthefindingsmayvarydependingontheuseof Disintegration, and Behavioural Disintegration. For the
themeasuresofpersonalitychange.Thefirsttomentionare present study we used the three nonpsychotic and non-
relations between subsyndromal symptom production and manicglobaldimensionsofED,RET,andANX.Emotional
changes of Neuroticism immediately above the basal level Dysregulation(ED)isa20-itemscalethatcomprises9ofthe
[22]. In the higher severity range of symptom production 10itemsoftheMontgomeryAsbergDepressionRatingScale
changes of Neuroticism have been found to be present (MADRS)[33].OtheritemsofthedimensionofEDconcern
[23]butsmall[24],whilehighlyreproduciblechangeshave specific neurotic symptoms like compulsive thoughts, pho-
been found for the HA and SD dimensions of the TCI bias,indecision,fatigability,failingmemory,reducedsexual
[1, 25–28]. The varying frequency of “comorbid” Axis-II interest, reported muscular tension, loss of sensation or
diagnoses in patients with major depression [29] could be movements, derealisation, and depersonalisation [32]. The
a third way in which personality changes may be assessed. dimensionofRETcomprisesitemsofinabilitytofeel,appar-
From the perspective of the TCI, low basic levels of SD entsadness, observed lack of appropriate emotion, reduced
are the defining hallmark of personality disorders [30]. As speech,andslownessofmovement.ThedimensionofANX
improvement of the level of depressive symptoms has been comprises items of inner tension, reduced sleep, reported
found to correlate with the change in Axis-II prediction autonomic disturbances, aches and pains, observed auto-
based on this SD score [25], the state-related-reduced SD nomic disturbances signs, and observed muscular tension
indepressionmaybeinvolvedinthisAxis-II“comorbidity”. [32].Weusedtheseglobaldimensionsofpsychopathologyin
Thesefindingssupportthenecessitytodifferentiatebetween thepresentstudyaswepreviouslyhavefoundcombinations
thedimensionsofSDandHAinthestudiesoftheprimary ofANXandRETtobespecificallyinvolvedinthephenotypes
andmostproximallyrelatedfactorintheonsetandremission ofsubcategoriesofdepressionderivedfromthemelancholic
of depressive disorders. In the present study we therefore subtype[34].Thismethodhasalsoenabledthedetectionof
used the change of both dimensions, hypothesizing that aphenotypichomologybetweenoneofthesesubcategories
either ΔHA or ΔSD would be most directly involved in called depression with above-normal vasopressin concen-
the production of symptoms in depressive disorders. The tration [35] and the stress-induced behavioural pattern
analyses were carried out in all depressed patients as well of the animal model for depression called high anxiety-
as in four subcategories to test if the relation between the like behaviour rat [36]. Moreover, the combination of ED
changeofpersonalityandchangeofpsychopathologyfound and RET appeared to be involved in psychotic depression
is a general characteristic of all depressive disorders or just [37].
pertainstooneormoresubcategories. As has already been reported previously [1], we investi-
The phenotypical significance of ΔHA or ΔSD can gatedthechangesofpersonalityandpsychopathologyinthe
be derived from the personality model of the TCI and contextofatwo-yearfollow-upstudyofpatientstreatedfor
the subscales that are comprised by these dimensions. an acute episode of major depression. We used the change
According to the TCI [5], personality can be conceived as scoresbetweenthestartandtheendofthistwo-yearfollow-
a multidimensional construct comprising higher and lower up period. We first analyzed the correlations between the
levels of personal functioning and coping called character changes of the dimensions of personality and the dimen-
andtemperamentrespectively.Whereascharacteristhought sions of psychopathology by using Pearson’s correlations
to involve conscious-adaptive information processing, tem- and MANCOVA. Thereafter, we used Structural Equation
perament involves automatic adaptation via conditioned Modelling(SEM)toanalyzethepathwaybetweenpersonality
response patterns. The model includes three character changeandchangeofpsychopathologyandatthesametime
dimensions called Self-Directedness (SD), Cooperativeness thepathwaysbetweenthechangesofthedimensionsofpsy-
(CO), and Self-Transcendence (ST) and four temperament chopathology.Sincethepersonalitydimensionsofcharacter
dimensions called Harm Avoidance (HA), Reward Depen- and temperament and the dimensions of psychopathology
dence (RD), Novelty Seeking (NS), and Persistence (PER). represent different levels of functioning from the conscious
HAcomprisesthesubscalesorfacetsofworrying/pessimism, conceptual level of character via the temperamental level
fear of uncertainty, shyness, and fatigability, while low SD ofautomaticconditioned behaviourtoinstinctualresponse
results in apathy, a loss of goals or direction, loss of self- patterns, the results of the present study are discussed
strivingbehaviour,externalizing,andanincongruentsecond fromtheperspectiveofthehierarchicorganizationofbrain
nature. This suggests that either or both changes could be regions involved in depression. The support for either of
directlyinvolvedinthepathogenesisofdepressionoroneor twopathogeneticmodelswillbeevaluated.Thesemodelsare
moresubcategoriesinparticular. basedonthehypothesisofacontinuitybetweenpremorbid
Tooptimizethechancesoffindingrelationswithspecific temperament, increased temperament score, subsyndromal
aspectsofmajordepression,wealsousedamultidimensional symptom level, major depressive disorder [38, 39], and the
approach to assess psychopathology. This involved the hypothesis of the development of a high-level functional
administration of the Comprehensive Psychopathological deficit as precondition for the production of depressive