High Harm Avoidance Research Articles

Predictors of distress and anxiety during pregnancy

There is a high incidence of distressing psychological symptoms including anxiety in pregnancy. Nevertheless, predictors of distress and anxiety during pregnancy have not been well characterized. We determined whether temperament and character, trait anxiety, resilience, and social support predicted distress and anxiety symptoms in pregnancy. Pregnant women (n=105) with low risk singleton pregnancies were recruited from Midwife Obstetric Units. Assessments of distress (using the K-10) and anxiety (using the Spielberger State Inventory) were undertaken in trimester 2 and 3. Measures of temperament and character, trait anxiety, resilience and social support were undertaken at the same time points. Regression analyses were used to determine predictors of distress and anxiety at each trimester. Predictors of distress and anxiety were lower selfdirectedness, higher harm avoidance, higher trait anxiety, lower resilience, and lower social support, at each time point. Understanding predictors of distress and anxiety in pregnancy may be useful in developing interventions for addressing such symptoms, as well as perhaps in preventing potential sequelae such as anxiety and mood disorders.

Temperament and character in individuals at ultra-high risk for psychosis and with first-episode schizophrenia: Associations with psychopathology, psychosocial functioning, and aspects of psychological health

ObjectiveThe psychobiological model of temperament and character indicates that personality traits are heritable and, during development, constantly influence one’s susceptibility to schizophrenia. Our objective was to evaluate temperament and character in subjects at ultra-high risk (UHR) for psychosis and individuals with first-episode schizophrenia. MethodsUHR for psychosis subjects (n=50), first-episode schizophrenia patients (n=33), and normal controls (n=120) were compared on temperament and character dimensions, and correlation analysis of each personality dimension with psychopathologies, global and social functioning, and self-esteem. General and social self-efficacy reports were conducted. UHR subjects were followed-up for 24months and the baseline personality dimensions were compared between the converted and non-converted groups. ResultsBoth clinical groups showed abnormal personality traits in terms of temperament (higher harm avoidance, lower reward dependence and persistence) and character (lower self-directedness and cooperativeness). Psychosocial functioning and psychological health components were found to be correlated with some personality dimensions. The conversion rate of overt psychotic disorder was 25.0% at the 24-month follow-up. Baseline cooperativeness dimension was a significant predictive dimension for conversion into overt psychosis in the UHR group during the follow-up period. ConclusionPatients with first episode schizophrenia have a pervasively altered personality profile from normal controls. More importantly, this altered personality profile already emerged in putative prodromal, UHR individuals. The present findings indicate that certain personality traits can play a protective or vulnerable role in developing schizophrenia.

Alterations in white matter microstructure in women recovered from anorexia nervosa

A recent study of ill individuals with anorexia nervosa (AN) reported microstructural alterations in white matter integrity including lower fractional anisotropy and higher mean diffusivity. This study was designed to determine whether such alterations exist in long-term recovered AN individuals and to examine potential associations with underlying AN traits. Twelve adult women recovered from restricting-type AN and 10 control women were studied using diffusion tensor imaging. Overall, there was no significant fractional anisotropy alteration in recovered AN, in contrast to a prior study reporting lower fractional anisotropy in ill AN. Further, recovered AN showed lower mean diffusivity in frontal, parietal and cingulum white matter relative to control women, contrary to elevated mean diffusivity previously reported in ill AN. Lower longitudinal diffusivity in recovered AN was associated with higher harm avoidance. However, more severe illness history was associated with worse white matter integrity after recovery in the same direction as reported in prior work. Our findings suggest that fractional anisotropy in recovered AN is not different from controls, however, a novel pattern of lower mean diffusivity was evidenced in recovered AN, and this alteration was associated with harm avoidance. Notably, severity of illness history may have long-term consequences, emphasizing the importance of aggressive treatment.

Personality Traits as Risk Factors for Treatment-Resistant Depression

BackgroundThe clinical outcome of antidepressant treatment in patients with major depressive disorder (MDD) is thought to be associated with personality traits. A number of studies suggest that depressed patients show high harm avoidance, low self-directedness and cooperativeness, as measured on the Temperament and Character Inventory (TCI). However, the psychology of these patients is not well documented.MethodsPsychological evaluation using Cloninger’s TCI, was performed on treatment-resistant MDD patients (n = 35), remission MDD patients (n = 31), and age- and gender-matched healthy controls (n = 174).ResultsTreatment-resistant patients demonstrated high scores for harm avoidance, and low scores for reward dependence, self-directedness, and cooperativeness using the TCI, compared with healthy controls and remission patients. Interestingly, patients in remission continued to show significantly high scores for harm avoidance, but not other traits in the TCI compared with controls. Moreover, there was a significant negative correlation between reward dependence and harm avoidance in the treatment-resistant depression cohort, which was absent in the control and remitted depression groups.ConclusionsThis study suggests that low reward dependence and to a lesser extent, low cooperativeness in the TCI may be risk factors for treatment-resistant depression.

Association between DRD2, 5-HTTLPR, and ALDH2 genes and specific personality traits in alcohol- and opiate-dependent patients

The vulnerability of developing addictions is associated with genetic factors and personality traits. The predisposing genetic variants and personality traits may be common to all addictions or specific to a particular class of addiction. To investigate the relationship between genetic variances, personality traits, and their interactions in addiction are important. We recruited 175 opiate-dependent patients, 102 alcohol-dependent patients, and 111 healthy controls. All participants were diagnosed using DSM-IV criteria and assessed with Tridimensional Personality Questionnaire (TPQ). The dopamine D2 receptor (DRD2), 5-HTT-linked promoter region (5-HTTLPR), and aldehyde dehydrogenase 2 (ALDH2) genes were genotyped using PCR. The genotype frequency of the 5-HTTLPR and ALDH2 was significantly different between the patients and controls (P=0.013, P<0.001, respectively), and borderline significant (P=0.05) for DRD2 polymorphism. Both Novelty Seeking (NS) and Harm Avoidance (HA) scores were higher for patients (P<0.001). After stratification by candidate genes, addicts with ALDH2 *1/*1 interacting with the low-functional group of DRD2 and 5-HTTLPR genes have higher HA traits, whereas addicts with ALDH2 *1/*2 or *2/*2 and low-functional group of DRD2 and 5-HTTLPR genes have higher NS traits. We concluded that addicts, both alcohol- and opiate-dependent patients, have common genetic variants in DRD2 and 5-HTTLPR but specific for ALDH2. Higher NS and HA traits were found in both patient groups with the interaction with DRD2, 5-HTTLPR, and ALDH2 genes. The ALDH2 gene variants had different effect in the NS and HA dimension while the DRD2 and 5-HTTLPR genes did not.

Temperament and Character Traits in Patients With Epilepsy

Personality and behavioral changes in epilepsy are well documented. However, neither the quantitative characteristics nor the etiology of these changes is clear yet. Cloninger has developed a psychobiological personality model that provides a way to evaluate personality in a dimensional way. This study examined the relationship between epilepsy and Cloninger's dimensional psychobiological personality model. A total of 73 epilepsy outpatients and 79 healthy controls were examined using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I Disorders, the Turkish version of the Temperament and Character Inventory, and an epilepsy questionnaire. Epilepsy patients had higher harm avoidance (HA) and lower persistence, self-directedness (SD), and cooperativeness scores than healthy controls did. In epileptic subjects, there was no correlation between age and duration of epilepsy. Subjects with partial seizures had higher HA scores and lower SD scores than generalized ones. Comorbid depression was represented with lower SD scores. In multiple linear regression models, only major depressive disorder predicted lower scores of SD. This study confirms specific personality changes among epileptics according to Cloninger's dimensional personality model and indicates a relationship between the characteristics of epilepsy and psychiatric comorbidity.

Linking novelty seeking and harm avoidance personality traits to basal ganglia: volumetry and mean diffusivity

Novelty Seeking (NS) and Harm Avoidance (HA) temperamental traits are related to approaching or avoiding motivational circuits relying on the integrity and functionality of distributed brain areas implicated in arousal and action. The present study verified whether and how macro- and micro-structural variations of basal ganglia are correlated with scores obtained in the NS and HA temperamental scales of the Temperament and Character Inventory by Cloninger. To this aim, 125 healthy adults aged 18-67years of both sexes completed the Temperament and Character Inventory and underwent a high-resolution T1-weighted magnetic resonance imaging and a diffusion tensor imaging using a 3T scanner. The scores obtained in the temperamental scales were associated with volumes, mean diffusivity and fractional anisotropy measures of basal ganglia of both hemispheres separately, by using linear regression analyses. We found increased bilateral caudate and pallidum volumes associated with higher NS scores, as well as increased mean diffusivity in the bilateral putamen associated with higher HA scores. Macro- and micro-structural variations of basal ganglia regions contribute to explain the biological variance associated with NS or HA personality phenotype. The present findings evidencing some brain-temperament relationships highlight the importance of obtaining macro- and micro-structural measures in relation to individual differences.

Temperamental Patterns in Female Adolescents With Borderline Personality Disorder

A specific composition of temperament traits with high novelty seeking (NS), high harm avoidance (HA), and low reward dependence (RD) has been attributed to adult patients with borderline personality disorder (BPD). This study examined whether an analogue personality profile is specifically associated with adolescent BPD. The female study sample comprised 33 adolescents with BPD, 35 clinical controls (CCs), and 31 healthy controls (HCs). Dimensions of temperament and character were measured according to Cloninger's biopsychosocial model of personality. Significantly higher means of NS and HA but lower means of RD could be determined in the adolescents with BPD compared with the CCs and the HCs. The comparable findings of this specific temperament constellation in adolescents and adult patients with BPD suggest that heritable factors such as temperamental traits may contribute to the vulnerability for developing BPD. Early identification of a "borderline temperament" may facilitate early intervention and lower the risk for developing BPD.

Neuropsychological and emotional correlates of personality traits in Parkinson's disease.

Parkinson’s disease (PD) is, apart from the well-known motor symptoms, also characterized by neuropsychological and emotional disturbances. However, patients also often present with a personality profile of low Novelty Seeking and high Harm Avoidance. This profile can be identified as the disease emerges, which raises the question whether these traits correlate with more fundamental neuropsychological and emotional disturbances. This study determined the neuropsychological and emotional correlates of Novelty Seeking, Harm Avoidance and two other personality traits that are often considered in PD, i.e. Reward Dependence and Persistence.Forty-three patients and 25 healthy participants were assessed with the Temperament and Character Inventory, a symptoms of depression questionnaire and neuropsychological tests.PD patients showed a higher Harm Avoidance than healthy participants, which was predicted by symptoms of depression. Groups did not differ regarding Novelty Seeking, Reward Dependence and Persistence. While cognitive flexibility was a predictor of Reward Dependence, Persistence was predicted by divergent thinking and inhibition. Novelty Seeking was not predicted by cognition or emotion.In conclusion, cognition and emotion are selectively related to personality traits in PD. Whereas Harm Avoidance covaries with emotional symptoms, Persistence and Reward Dependence are related to cognition. Alterations in personality, cognition and emotion in PD are thus not independent from each other.

1927 – Depressed mood modulates the perception of emotion facial expressions: the role of personality vulnerability factors

Introduction Deficits in decoding emotion facial expressions have been reported in depressed patients and in subclinical depression. These deficits would be related to an attentional bias towards negative vs. positive expressions in the late stages of face processing. Such emotional bias would be a vulnerability factor for depression. Vulnerability to depressed mood has also been related to specific personality patterns (namely: high harm avoidance and low selfdirectedness) and it was advanced that personality-related differences in emotional stimulus processing might mediate this vulnerability. Objectives Therefore, the present study aims to precise the role of personality in emotion facial expression perception deficits in subclinical depression, by the mean of event-related potentials (ERPs). Methods ERPs were recorded in 21 subclinically depressed participants and 18 not-depressed ones, while they were presented neutral and emotional faces (happy, sad, fearful). Results The results show that in subclinically depressed participants only, happy faces elicited smaller P300 and LPP amplitudes than both negative and neutral faces, while earlier processing stages were not modulated by depressed mood. Covariance analysis indicated that these modulations are related to the decreased selfdirectedness reported in subclinically depressed participants, but not to increased harm avoidance. Conclusions These results suggest that harm avoidance would be independent from the specific bias of emotional face processing related to depressed mood, whereas selfdirectedness would be involved in this phenomenon. The results will be discussed regarding clinical implications.

Temperament, Character, and Depressive Symptoms during Pregnancy: A Study of a Japanese Population

Background. To examine the effects of temperament and character domains on depression during pregnancy. Methods. We examined 601 pregnant women using a questionnaire that included the Edinburgh Postnatal Depression Scale (EPDS), the Temperament and Character Inventory (TCI), and demographic variables. Results. In a hierarchical regression analysis, severity of depression during pregnancy was predicted by the women's negative response towards the current pregnancy, low self-directedness, and high harm avoidance, persistence, and self-transcendence. Conclusion. Depression during pregnancy is predicted by personality traits as well as women's negative attitudes towards the current pregnancy.

Neuropsychological and Emotional Correlates of Personality Traits in Parkinson’s Disease

Parkinson’s disease (PD) is, apart from the well-known motor symptoms, also characterized by neuropsychological and emotional disturbances. However, patients also often present with a personality profile of low Novelty Seeking and high Harm Avoidance. This profile can be identified as the disease emerges, which raises the question whether these traits correlate with more fundamental neuropsychological and emotional disturbances. This study determined the neuropsychological and emotional correlates of Novelty Seeking, Harm Avoidance and two other personality traits that are often considered in PD, i.e. Reward Dependence and Persistence.Forty-three patients and 25 healthy participants were assessed with the Temperament and Character Inventory, a symptoms of depression questionnaire and neuropsychological tests.PD patients showed a higher Harm Avoidance than healthy participants, which was predicted by symptoms of depression. Groups did not differ regarding Novelty Seeking, Reward Dependence and Persistence. While cognitive flexibility was a predictor of Reward Dependence, Persistence was predicted by divergent thinking and inhibition. Novelty Seeking was not predicted by cognition or emotion.In conclusion, cognition and emotion are selectively related to personality traits in PD. Whereas Harm Avoidance covaries with emotional symptoms, Persistence and Reward Dependence are related to cognition. Alterations in personality, cognition and emotion in PD are thus not independent from each other.

The Iowa Gambling Task in depression – what have we learned about sub-optimal decision-making strategies?

Our earlier study found patients with depression to show a preference for larger reward as measured by the Iowa Gambling Task (IGT). In this IGT version, larger rewards were associated with even larger consequent losses. In the light of the clinical markers defining depressive disorder, this finding might appear controversial at first. Performance of depressed patients on various decision-making (DM) tasks is typically found to be impaired. Evidence points toward reduced reward learning, as well as the difficulty to shift strategy and integrate environmental changes into DM contingencies. This results in an impaired ability to modulate behavior as a function of reward, or punishment, respectively. Clinical symptoms of the disorder, the genetic profile, as well as personality traits might also influence DM strategies. More severe depression increased sensitivity to immediate large punishment, thus predicting future decisions, and was also associated with higher harm avoidance. Anhedonic features diminished reward learning abilities to a greater extent, even predicting clinical outcome. Several questions about how these aspects relate remain to be clarified. Is there a genetic predisposition for the DM impairment preceding mood symptoms? Is it the consequence of clinical signs or even learned behavior serving as a coping strategy? Are patients prone to develop an aversion of loss or are they unable to sense or deal with reward or the preference of reward? Does the DM deficit normalize or is a persisting impairment predictor for clinical outcome or relapse risk? To what extent is it influenced by medication effects? How does a long-lasting DM deficit affect daily life and social interactions? Strikingly, research evidence indicates that depressed patients tend to behave less deceptive and more self-focused, resulting in impaired social DM. The difficulty in daily interpersonal interactions might contribute to social isolation, further intensifying depressive symptoms.

Resting state low-frequency fluctuations in prefrontal cortex reflect degrees of harm avoidance and novelty seeking: an exploratory NIRS study

Harm avoidance (HA) and novelty seeking (NS) are temperament dimensions defined by Temperament and Character Inventory (TCI), respectively, reflecting a heritable bias for intense response to aversive stimuli or for excitement in response to novel stimuli. High HA is regarded as a risk factor for major depressive disorder and anxiety disorder. In contrast, higher NS is linked to increased risk for substance abuse and pathological gambling disorder. A growing body of evidence suggests that patients with these disorders show abnormality in the power of slow oscillations of resting-state brain activity. It is particularly interesting that previous studies have demonstrated that resting state activities in medial prefrontal cortex (MPFC) are associated with HA or NS scores, although the relation between the power of resting state slow oscillations and these temperament dimensions remains poorly elucidated. This preliminary study investigated the biological bases of these temperament traits by particularly addressing the resting state low-frequency fluctuations in MPFC. Regional hemodynamic changes in channels covering MPFC during 5-min resting states were measured from 22 healthy participants using near-infrared spectroscopy (NIRS). These data were used for correlation analyses. Results show that the power of slow oscillations during resting state around the dorsal part of MPFC is negatively correlated with the HA score. In contrast, NS was positively correlated with the power of resting state slow oscillations around the ventral part of MPFC. These results suggest that the powers of slow oscillation at rest in dorsal or ventral MPFC, respectively, reflect the degrees of HA and NS. This exploratory study therefore uncovers novel neural bases of HA and NS. We discuss a neural mechanism underlying aversion-related and reward-related processing based on results obtained from this study.

1606 – Temperament in individuals with psychotic disorders before and after the onset of illness

Introduction The Temperament and Character Inventory (TCI) is used to measure novelty seeking (NS), harm avoidance (HA), reward dependence RD), and persistence (P). Objectives We will study temperament in individuals with psychosis and healthy controls. Aim We aim to study the stability of temperament in individuals with psychotic disorders (with onset of illness before and after first follow-up) and in healthy controls. Methods As part of the 31-year follow-up survey of the prospective population based Northern Finland 1966 Birth Cohort, the TCI was filled by a large sample of individuals. A subsample of psychotic individuals, with the onset of illness before (n=16) or after (n=15) the 31-year follow-up, and healthy controls (n=117) filled in these scales again at the age of 43. We studied also the association between psychotic symptoms and premorbid temperament. Results The 31-year and 43-year temperament scores correlated strongly among controls (Pearson's r: NS 0.68, HA 0.60, RD 0.56, P 0.54), whereas correlations among psychotic individuals with the onset of psychosis before first follow-up were weaker (NS 0.38, HA 0.50, RD 0.17, P 0.53). High HA before the onset of illness (at age of 31 years) associated significantly with a lower likelihood of remission and with more negative, disorganization and total symptoms in the PANSS. High NS before illness associated with a higher likelihood of remission according to the PANSS. Conclusions Temperament was stable among controls, and more unstable in individuals with psychoses. Premorbid harm avoidance and novelty seeking predicts the clinical outcome in schizophrenia.

1883 – Anxiety personality traits and cannabinoid polymorphisms genes

There is increasing data supporting the role of endocannabinoid system (eCB) in the control of emotional homeostasis, mainly acting through CB1R activation (Menchoulam&Parker, 2012). eCB seems important to maintain baseline anxiety levels and to recovery/adapt to stressful and aversive situations (Moreira&Luz, 2008). A misbalance in eCB system might contribute to the etiology of anxiety related disorders (Crippa et al., 2009; Marco et al., 2012). The cannabinoid receptor 1 (CNR1) gene has been associated to “high neuroticism” and “low agreeableness” phenotype (Juhasz et al., 2009). Study the association between personality traits and genetic polymorphisms located in genes related to eCB ( CNR1, CNR2, FAAH and MGKLL ) in patients with anxiety disorders. In a case-control study, we analyzed 48 polymophisms tagSNPs in sample of 507 Caucasians subjects of both genders. All were assessed using the Semi-Structural Interview of DSM-IV criteria and the Temperament and Character Inventory of Cloninger. Multiple regression analysis was used to determine whether the different personality traits were associated with each variant in CNr1, CNr2, FAAH, and MGKLL , using age and gender as confounder variables. A significant association was found between “high Harm-avoidance” trait and rs1049353 in the CNR1 gene (p< 0.005) and rs1157694 in the FAAH gene (p< 0.001). “Low novelty-seeking” trait was associated with rs324490 in the FAAH gene (p< 0.005). These findings suggest that genetic variations in the CNR1 and FAAH genes may modulate the expression of some clinical aspects of anxiety traits and probably anxiety disorders. Grants: ICIII G03/184; SGR2009/1435 .

기질 및 성격검사(TCI)에 나타난 한방신경정신과 환자의 전반적 특성 및 화병 환자의 특성

Objectives : The purpose of this study is to examine the general personality profiles of patients who visited an oriental neuropsychiatric clinic and to investigate the specific profiles of patients diagnosed with Hwa-byung. Methods : We analyzed the profiles of 122 patients who completed TCI-RS questionnaire for the purpose of counseling. Patients were divided by sex, age and diagnosis related groups. Scales and subscales of each group were compared by an independent t-test and ANCOVA with SPSS windows 16.0. Types of temperament and character were classified by percentile ranks of the total patients and diagnosis related groups. Results : 1. Total patients were classified as the high harm avoidance type of temperament and of low self-directedness type of character. 2. Male patients showed significantly higher scores on NS, all subscales of NS, P2 and P3 than female patients. HA4 and C5 scores were significantly higher in the female group. Younger patients showed significantly higher scores on NS, all subscales of NS, HA1 and P3. However, older patients had significantly higher scores on SD4, SD5, ST2 and ST3. 3. Between diagnosis related groups, Hwa-byung group had significantly higher scores on RD, ST, SD3 and ST2. However P3 score of non-hwa-byung patients was higher than hwa-byung patients. In typical classification, both hwa-byung and non-hwa-byung groups were classified as the same types as total patients. Conclusions : This study showed that the patients visited an oriental neuropsychiatric clinic and had similar personality with that of general psychiatric disorders. Hwa-byung patients exhibited higher RD and ST scores than other disorders, but they had no typical differences.

Alexithymia and personality in relation to social anxiety among university students

The aims of the present study were to investigate the relationship of social anxiety symptoms with alexithymia and personality dimensions in university students and to control the effects of depression and anxiety on this relationship. A total of 319 university students (85 males and 234 females) from two different universities in Ankara were investigated with the Liebowitz Social Anxiety Scale (LSAS), the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), the Toronto Alexithymia Scale (TAS-20) and the Temperament and Character Inventory (TCI). We found that subscales of the LSAS (fear or anxiety and avoidance) were positively correlated with depression and alexithymia and “difficulty in identifying feelings” (DIF) and “difficulty in describing feelings” (DDF) subscales of the TAS-20. Harm avoidance (HA) showed positive correlations with subscales of the LSAS, whereas self-directedness (SD) showed negative correlations with these subscales. High TAS-20 DDFand HA and low SD predicted fear or anxiety LSAS subscale scores, whereas high TAS-20 DDF, HA and depression scores were predictors for LSAS avoidance subscale scores. Although our sample is not representative of the whole Turkish university student population, we conclude that both fear or anxiety and avoidance were mainly interrelated with DDF and HA, although the causal relationship is not clear.

Temperament and character profiles of Japanese university student suicide completers

ObjectiveThe aims of this study were to investigate the personality traits of suicide completers using the Temperament and Character Inventory (TCI) scale. MethodsNewly enrolled students who enrolled at Hokkaido University in 1999–2002 and 2004–2007 completed the TCI. Among these students, twenty subjects (2 females and 18 males) later completed suicide. We compared the TCI scales of these subjects with those of 60 (6 females and 54 males) well-matched controls. The controls were matched for age, gender, university department and year of enrollment in the university. Because the number of females was too small, the statistical analyses for the TCI subscales and logistic regression analysis were performed only with the 18 males. ResultsA univariate analysis of seven personality dimensions on the TCI revealed higher scores of harm avoidance (HA) in subjects with suicide completion (P=0.034). Analysis of the male subjects showed that suicide completers had higher scores for anticipatory worry (HA1, P=0.007) and fear of uncertainty (HA2, P=0.036) and lower scores for spiritual acceptance (ST3, P=0.038) than did the controls. A multivariate analysis, which was performed to adjust confounding factors, demonstrated significantly higher scores for HA1 among suicide completers (P=0.01, OR=1.32). ConclusionsThese results suggest that higher HA scores may predict suicide completion.

Personality characteristics and body image in obese individuals

The aim of this study was to determine the personality characteristics of obese and morbidly obese individuals with no psychiatric disorder and the correlation between these characteristics and body image and self-esteem. Sixty-nine obese individuals and 69 healthy controls, matched in age, sex and marital status, were included in the study. Psychiatric disorders were excluded for all participants using SCID-I and II. Obese and healthy volunteers were compared in terms of body image, self-esteem and personality characteristics. TCI harm avoidance scores were higher in obese individuals compared to healthy controls. Harm avoidance scores were also higher in individuals with morbid obesity compared to non-morbid individuals, while self-directedness and persistence scores were lower. Body image dissatisfaction was higher in obese individuals. There was a negative correlation in obese individuals between body image and self-esteem scale scores and harm avoidance scores, and a positive correlation with self-directedness scores. An elevated harm avoidance temperament characteristic may be correlated with obesity. Furthermore, high harm avoidance, low self-directedness and low persistence may be significant personality characteristics in a process leading to morbid obesity. In addition, harm avoidance temperament and self-directedness personality characteristics may be correlated with body image dissatisfaction and self-esteem in obese individuals.