Higher Harm Avoidance Scores Research Articles

History of suicide attempts among patients with depression in the GENDEP project

BackgroundIt has been proposed that a history of suicide attempts could be a correlate of severe depressive disorder and that suicide attempters (SA) could represent a particular subtype of subjects suffering from major depressive disorder. We investigated clinical and demographic characteristics associated with SA and tested the hypothesis that a history of suicide attempts predicts poor response to antidepressants. MethodsOne-hundred-and-forty-one SA and 670 non-SA subjects with major depressive disorder (MDD) were treated for twelve weeks with escitalopram or nortriptyline in GENDEP, a part-randomized multi-center clinical and pharmacogenetic study. Baseline characteristics were compared using linear and logistic regression. Linear mixed models were used to analyse continuous outcomes during the twelve weeks of follow-up. ResultsAt baseline, SA subjects suffered from more severe depression (mean Montgomery-Asberg Depression Rating Scale: 30.29 (7.61) vs 28.43 (6.54), p=0.0002), reported higher level of suicidal ideation (1.21 (0.82) vs 0.73 (0.48), p<0.0001), had a younger age of onset and experienced more depressive episodes, had higher harm avoidance scores and poorer socio-demographic environment than non-SA individuals. However, during the twelve weeks of treatment and after adjustment for baseline severity of depression there was no difference in treatment response between SA and non-SA. LimitationsDue to its retrospective design, it is possible that more severely depressed subjects might report more suicide attempts than less depressed individuals. ConclusionsWhile SA differed from non-SA in several clinical and demographic characteristics, the antidepressants were similarly effective in SA as in comparably severely depressed subjects without a history of suicide attempts.

Association study between the −1021C/T polymorphism of the dopamine-β-hydroxylase gene promoter and personality traits in healthy subjects

Dopamine and norepinephrine are implicated in the characterization of personality traits. Dopamine-β-hydroxylase (DBH) is the enzyme responsible for conversion of dopamine to norepinephrine, and thus plays an important role in controlling dispositions of these neurotransmitters. Previous studies have shown that the −1021C/T polymorphism of the DBH gene promoter influences plasma DBH activity. Therefore, we examined the association between the −1021C/T DBH polymorphism and personality traits in 627 Japanese healthy volunteers. The DBH genotypes were identified by a PCR-RFLP method, and personality traits were assessed by the Temperament and Character Inventory (TCI). In the two-factor analysis of covariance with the DBH genotype and sex as factors and with age as a covariate, there was no main effect of the DBH genotype on any TCI score, while the interaction between the factors was significant in harm avoidance. In the post hoc analysis, the group with the T allele predictive of lower DBH activity had higher scores of harm avoidance than that without the T allele in females ( p = 0.006), but not in males. The present study suggests that the −1021C/T DBH polymorphism affects the personality trait of harm avoidance in healthy females.

The temperament and character profile of a body dysmorphic disorder outpatient sample

AbstractBackground Given the paucity in research investigating personality in body dysmorphic disorder (BDD), this study examined the temperament and character profile of BDD outpatients, and explored the relationship between BDD symptom severity and the temperament and character dimensions.Method Thirty‐three consecutive BDD outpatients completed the Temperament and Character Inventory (TCI), Dysmorphic Concern Questionnaire (DCQ), Self‐Rating Depression Scale (SDS) and the Social Interactional Anxiety Scale (SAIS). Thirty non‐clinical controls completed the TCI, DCQ and Body Dysmorphic Disorder Questionnaire.Results Compared with non‐clinical controls, BDD patients reported significantly higher Harm Avoidance (HA) scores (p &lt; 0.001) and significantly lower Self‐Directedness (SD; p &lt; .001) and Cooperativeness (C) scores (p = 0.04). The finding for C, however, may be confounded by age. For the BDD sample, DCQ scores were positively related to HA scores and negatively related to SD scores.Discussion Results suggest a temperament and character profile for BDD comprising high HA, low SD and possibly low C. High HA and low SD may represent non‐specific risk factors in the development of BDD. Further research with siblings of cases and controls is required to demonstrate the causal role of antecedent personality traits. Additional research with larger samples is also required to investigate the possible confounding effects of delusionality, depression and social anxiety in the relationship between BDD and temperament and character. Copyright © 2009 John Wiley &amp; Sons, Ltd.

Association Between Personality Traits and ALDH2 Polymorphism in Japanese Male Alcoholics

Alcoholics who have developed alcoholism despite a strong negative risk factor, that is, the inactive form of aldehyde dehydrogenase-2 (ALDH2), are considered advantageous for studying predisposing factors for alcoholism. This study aimed to compare personality profiles and clinical characteristics between alcoholics with active and inactive ALDH2. Subjects were 460 male Japanese alcoholics hospitalized in Kurihama Alcoholism Center. All patients underwent Cloninger's Tridimensional Personality Questionnaire and semi-structured interviews 4 to 8 weeks after admission to obtain data on personalities and clinical characteristics. ALDH2 genotypes were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Sixty-six patients had the inactive form of ALDH2 (ALDH2*1/2*2) and 394 had the active form (ALDH2*1/2*1). Alcoholics with inactive ALDH2 had significantly higher novelty-seeking (NS) and lower harm-avoidance (HA) scores compared with those with active ALDH2. The inactive ALDH2 group experienced delirium tremens significantly less frequently than the active ALDH2 group. These results suggest that high NS and low HA scores in alcoholics with inactive ALDH2 are associated with an increased risk for developing alcoholism, despite a low enzymatic ability to eliminate toxic acetaldehyde in these subjects. A study of alcoholics with inactive ALDH2 is useful for detecting environmental or personality factors related to alcoholism.

Temperament and character in subjects with obsessive-compulsive disorder

Background The aims of this study were to evaluate the differences between personality traits of patients with obsessive-compulsive disorder (OCD) and normal controls using the Temperament and Character Inventory (TCI) and to examine the relationship of personality traits and the severity of obsessive-compulsive (OC) symptoms. We also aimed to examine the influence a particular personality trait might have on the 5 factor-analyzed symptom dimension scores of OCD. Method We recruited 130 patients with OCD and 185 age- and sex-matched normal controls. All subjects completed the TCI. Patients with OCD were assessed with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Hamilton Depression Rating Scale, and the factor-analyzed symptom dimension scores from the Y-BOCS checklist. Results Patients with OCD had higher harm avoidance scores and lower self-directedness (SD), reward dependence (RD), and cooperativeness (C) scores than the controls. Lower SD scores and lower C scores were associated with OC symptom severity measured by the Y-BOCS after adjusting for age and depression severity. Hoarding dimension of OC symptoms was associated with lower SD scores and higher persistence (P) scores after adjusting for age, OC symptom severity, and depression severity. Conclusions There were significant differences in TCI subscales between patients with OCD and controls. Particular personality traits may have an influence on the severity and the dimensions of OC symptoms.

Increased Body Mass Index Associated With Increased Harm Avoidance and Decreased Self-Directedness in Japanese Women

Previous studies have suggested that body mass index (BMI) is related to personality traits, and that there may be gender specificity in this relationship. In the present study, the association between BMI and the 7 dimensions of the Temperament and Character Inventory was investigated in 567 Japanese healthy volunteers, with special attention on gender effects. Height and weight were self-reported, and BMI was calculated from these values. In the multiple regression analyses, higher BMI was related to higher scores of harm avoidance (p < 0.05) and lower scores of self-directedness (p < 0.01) in women, whereas BMI was not related to any Temperament and Character Inventory dimension in men. The present study suggests that increasing BMI is associated with increased harm avoidance and decreased self-directedness in women but not in men in healthy subjects.

Cloninger's temperament and character dimensions of personality in patients with major depressive disorder

In this present study, we examined the relationship between the Cloninger's dimensional psychobiologic model of personality and depression in an outpatient population with major depressive disorder. Eighty-one depressed outpatients (67 women, 14 men) and 51 healthy controls (35 women, 16 men) filled out the Turkish version of the Temperament and Character Inventory (TCI). Depression severity was evaluated by using the 17-item Hamilton Depression Rating Scale and the 21-item Beck Depression Inventory. Depressed patients exhibited statistically significant higher scores for harm avoidance and lower scores for self-directedness compared to healthy controls. Sentimentality (RD1) and dependence (RD4) subscale scores of reward dependence and spiritual acceptance (ST3) subscale of self-transcendence were significantly higher; attachment (RD3) subscale of reward dependence, responsibility (SD1), purposefulness (SD2), resourcefulness (SD3), and congruent second nature (SD5) subscales of self-directedness were significantly lower in the depressed group. In the depressed patient group, main effects of sex were significant for reward dependence and cooperativeness; the scores of both dimensions were higher for women. The Beck Inventory was positively correlated with harm avoidance and negatively correlated with novelty seeking and self-directedness dimensions ( P < .05). The duration of depression (16.33 ± 20.18 months) or the mean onset age of depression (28.68 ± 8.11 years) did not show significant correlations with TCI scales. This study confirms the relationship between harm avoidance and depression and suggests a relationship between self-directedness and depression.

P03-38 Dissociation is related to self-directedness and self-transcedence character traits in obsessive-compulsive disorder

Introduction:The purpose of this study was to investigate the temperament and character patterns in patients with obsessive-compulsive disorder (OCD) and to determine whether any presupposed relationship between harm avoidance, self-directedness, self-transcedence scores and dissociation in patients with OCD is present.Methods:The study sample comprised of 43 patients with OCD (26 females) and 44 healthy controls (29 females). All subjects were assessed with the Temperament and Character Inventory (TCI), Beck Depression Inventory-II (BDI-II), and Beck Anxiety Inventory (BAI). Dissociation was quantified by the Dissociative Experiences Scale (DES). Obsessive-compulsive symptoms in OCD group were assessed with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Correlation, unpaired t-test with Bonferroni correction for seven comparisons, and multiple linear regression analyses were performed.Results:OCD patients had significantly higher scores of harm avoidance and self-directedness compared with healthy comparison subjects. Dissociative experiences were more frequent in OCD patients comparing with controls. DES scores had negative correlation with self-directedness and positively correlated with self-transcedence scores, as well as with BDI-II and BAI scores in OCD group. Multiple regression analyses revealed that the severity of depressive symptoms, self-directedness and self-transcedence scores predicted the DES score. There was no significant correlation between severity of OCD symptoms and patterns of temperament and character.Conclusion:Dissociation is associated with self-directedness and self-transcedence dimensions of the Temperament and Character Inventory in OCD subjects. It emphasize the importance of considering the influence of dissociation in further studies of personality factors in neuropsychiatric conditions.This research was supported by grant MZ ČR IGA 9323-3/2007.

Effects of the “affectionless control” parenting style on personality traits in healthy subjects

The effects of the affectionless control (AC) parenting style on personality traits were studied in 414 Japanese healthy subjects. Perceived parental rearing was assessed by the Parental Bonding Instrument, which comprises care and protection factors, and personality traits were assessed by the Temperament and Character Inventory, which has seven dimensions. Parental rearing was classified into four types, i.e., optimal parenting (high care/low protection), affectionate constraint (high care/high protection), neglectful parenting (low care/low protection), and AC (low care/high protection). Males with maternal AC showed significantly higher harm avoidance (HA) scores and lower scores of persistence and cooperativeness than those with maternal optimal parenting. Females with maternal AC showed significantly higher HA scores and lower self-directedness scores than those with maternal optimal parenting. Paternal AC was not significantly related to any personality score. In females, the interaction between paternal rearing and maternal rearing was significant; the effect of maternal AC on HA scores was strongest when combined with paternal neglectful parenting. The present study suggests that the AC type parenting by mothers is associated with specific personality traits, especially high HA, in healthy subjects.

Sex differences among treatment-seeking adult pathologic gamblers

Objective The purpose of this study is to explore the effect of sex as a moderator variable for gambling and clinical profiles in a large sample of Spanish treatment-seeking patients for pathologic gambling (PG). Method Clinical and personality profiles were compared between 143 male and 143 female pathologic gamblers who sought consultation at a specialized hospital unit. Multiple regressions explored the incremental predictive accuracy of sex on PG severity in consideration of sociodemographic and psychologic characteristics. Results Men gambled most frequently using slot machines and lotteries, spent more money, and had most arguments with family and friends. Although the age of onset of PG was 7.1 years higher for females, the severity was equal for both sexes. Women evidenced more general psychopathology, with higher mean scores in all the Symptom ChekList-90 items scales (except for hostility and psychoticism), and had significantly higher scores for harm avoidance and lower scores for self-directedness than the male group. However, sex alone did not obtain a significant incremental validity for PG severity. Conclusions These results may provide guidance for obtaining accurate diagnostic information about PG, properly identifying patients with specific needs and planning sex-specific targets.

Temperament and character profile of patients with psoriasis

Psychosocial factors have been implicated as being important in the onset and/or exacerbation of psoriasis.(1) The aim of this study is to examine both the personality factors of patients with psoriasis and the correlations between temperament and character dimensions. A total number of 105 psoriasis patients and 109 healthy individuals were enrolled in the study. Questionnaires including Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Temperament and Character Inventory (TCI) were administered individually. Both groups were evaluated in terms of depression, anxiety and characteristic features by using these psychological tests and compared statistically. The relationship between psoriasis area and severity index (PASI) score and the BDI, BAI and TCI scales were also evaluated. The mean BDI score of the psoriasis group were significantly higher than the control group. The psoriasis group had significantly higher scores of harm avoidance and lower scores of being self-directedness than the control group. The duration of psoriasis and the PASI scores were not correlated with BDI and BAI scores. The current study shows that psoriasis patients have distinctive temperament and character dimensions when compared with the control group. We suggest that evaluation and treatment of psoriasis should also include psychosomatic approaches in clinical practice.

Personality dimensions in obsessive–compulsive disorder: Relation to clinical variables

Research on the relationship between personality factors and obsessive–compulsive disorder (OCD) has proved difficult to interpret due to conceptual problems including a lack of consensus on the model of personality employed as a framework as well as a failure to consider the clinical heterogeneity of the disorder. The aim of this study was to examine the dimensional personality profile associated with OCD and to determine whether any relationship exists between personality factors and clinical variables in a sample of 60 OCD outpatients who were administered Cloninger's Temperament and Character Inventory (TCI). The Yale–Brown Obsessive–Compulsive Scale (Y-BOCS), the Hamilton Depression Rating Scale (HDRS) and the Y-BOCS symptom checklist were used to assess the severity of obsessive–compulsive and depressive symptoms and the presence of the main OCD symptom dimensions. OCD patients showed significantly higher scores in harm avoidance and lower scores in novelty-seeking, self-directedness and cooperativeness than healthy subjects. These results remained unchanged when only pure OCD patients without comorbid psychiatric conditions were considered. Comorbid depressive symptoms and hoarding obsessions and compulsions were significantly associated with high harm avoidance scores. These results support the existence of a dimensional personality profile associated with OCD and characterized by high harm avoidance and low novelty-seeking, self-directedness and cooperativeness scores, but also emphasize the importance of considering the influence of comorbid clinical conditions or symptom subtypes in addressing the role of personality factors in OCD.

Harm avoidance in subjects with obsessive-compulsive disorder and their families

IntroductionThis study investigates the role of harm avoidance (HA) as a possible risk factor in the familiality of obsessive-compulsive disorder (OCD). HA is considered to be a genetically influenced personality trait with an increasingly understood neuroanatomical basis. Method75 subjects with OCD from hospital sites and a community sample and their 152 first degree relatives and 75 age and sex matched controls with their 143 first degree relatives were evaluated with structured clinical interviews (DSM-IV). HA was assessed with Cloninger's Tridimensional Personality Questionnaire (TPQ). ResultsSubjects with OCD had higher scores of HA than controls (p≤0.001). First degree relatives of OCD cases also showed higher HA than relatives of control subjects (p=0.001).These results remained stable when comparing only OCD subjects versus controls (p≤0.001) and relatives of OCD cases versus relatives of controls (p=0.005) without current comorbid disorders. LimitationsThe investigation of HA alone does not allow to disentangle the transmission of biological versus psychological factors related to an elevated level of anxiety in families of OCD cases. ConclusionThis is the first study to extent previous findings of elevated HA in OCD cases to their first degree relatives. Thus, HA may partially mediate the familial risk for OCD.

Self-injurious behavior and attempted suicide in purging bulimia nervosa: Associations with psychiatric comorbidity

Background Few studies, to date, have investigated the relationship between self-damaging behavior and the presence of comorbid psychiatric diagnoses in eating disorders. The aim of the present study was to investigate the axis I and II comorbidity in subjects with bulimia nervosa who report self-injurious behavior and/or suicide attempt. Methods The subjects were 95 patients with purging type bulimia nervosa who underwent a clinical evaluation assessing the presence of self-injurious behavior and suicide attempts, comorbidity for axis I and II psychiatric disorders and temperament. Results No axis I diagnosis was associated with any type of self-injurious behavior, whereas social phobia and bipolar disorder were linked to attempted suicide. Significant independent predictors of impulsive self-injurious behavior were the presence of childhood sexual abuse, high harm avoidance scores, and high self-transcendence scores, whereas childhood sexual abuse, the presence of a cluster B personality disorder, and a low self-directedness were predictors of suicide attempts. Compulsive self-injurious behavior was significantly associated with harm avoidance and cluster C personality disorders. Harm avoidance was also associated with skin picking. Conclusions Personality disorders are a frequent correlate of the presence of SIB in purging bulimia nervosa. However, temperament seems to play a more important role. Further studies on larger samples are necessary to confirm our findings in bulimia nervosa and to extend them to other patient populations.

Association between A218C polymorphism of the tryptophan-hydroxylase-1 gene, harm avoidance and binge eating behavior in bulimia nervosa

Genes involved in serotonin transmission are likely involved in the biological predisposition to bulimia nervosa. We investigated whether the A218C polymorphism of the tryptophan-hydroxylase-1 gene was associated to bulimia nervosa and/or to some phenotypic aspects of the disorder. One hundred eighty Caucasian women (91 patients with bulimia nervosa and 89 healthy controls) were enrolled into the study. They underwent a blood sample collection for A218C polymorphism of the tryptophan-hydroxylase-1 genotyping and a clinical evaluation assessing comorbidity for Axis I and II psychiatric disorders, harm avoidance personality dimension and bulimic symptoms. The distribution of both tryptophan-hydroxylase-1 A218C genotypes and alleles did not significantly differ between patients and controls. Bulimic women with the AA genotype exhibited a more severe binge eating behavior and higher harm avoidance scores than those with CC genotype. These findings support the idea that tryptophan-hydroxylase-1 A218C polymorphism does not play a part in the genetic susceptibility to bulimia nervosa, but it seems to be involved in predisposing bulimic patients to a more disturbed eating behavior and higher harm avoidance.

Cloninger’s Temperament Dimensions, Socio-economic and Lifestyle Factors and Metabolic Syndrome Markers at Age 31 Years in the Northern Finland Birth Cohort 1966

The aim of this study was to assess the association between temperament and metabolic syndrome markers. Cloninger's Temperament and Character Inventory and clinical examination were carried out in 1997 in the Northern Finland Birth Cohort 1966 (N = 4364 respondents). Novelty seeking was positively associated with waist circumference in both genders. Systolic blood pressure was highest in men with high harm avoidance and low persistence scores and lowest in women with high reward dependence and high persistence scores. Childhood socio-economic status did not confound these associations. Smoking and alcohol consumption were associated with higher novelty seeking. Our results suggest that temperament is associated with metabolic syndrome markers and this association may be partly mediated by lifestyle factors and socio-economic status in adulthood.

Tridimensional Personality of Adolescents with Internet Addiction and Substance Use Experience

This study aimed to examine the differences in personality characteristics between adolescents with and without Internet addiction and substance use experience as defined by the Tridimensional Personality Questionnaire (TPQ), and to compare personality characteristics among groups of adolescents with both Internet addiction and substance use experience (comorbid group), those with only Internet addition (Internet addiction group), those with only substance use experience (substance experience group), and those without Internet addiction or substance use experience (control group). In the cross-sectional investigation, we recruited 3662 students (2328 boys and 1334 girls) from high schools in southern Taiwan. Our investigation was conducted using the TPQ, the Chen Internet Addiction Scale, and Questionnaires for Experience in Substance Use. Adolescents with Internet addiction were more likely to have substance use experience. High novelty seeking (NS), high harm avoidance (HA), and low reward dependence (RD) predicted a higher proportion of adolescents with Internet addiction. High NS, low HA, and low RD predicted a higher proportion of adolescents with substance use experience. Of the 4 groups, the Internet addiction group had the highest HA scores and the comorbid group had the lowest HA scores. Adolescents with high NS and low RD should be provided with effective strategies for preventing Internet addiction and substance use. In addition, the Internet addiction group and the comorbid group should be provided with different preventative strategies focused on HA.

Social phobia, fear of negative evaluation and harm avoidance

This naturalistic, prospective investigation examined the role of fear of negative evaluation and the personality trait of harm avoidance in the anxiety levels of treated social phobia patients. One hundred and fifty-seven patients with DSM-IV social phobia were assessed before starting treatment and were then followed for up to two years. As expected, greater fear of negative evaluation and higher scores of harm avoidance were associated with greater anxiety at the 6 month follow-up, and harm avoidance remained a significant predictor at 24 months. However, no evidence was found for an interaction between the personality and cognitive variables examined. The findings are discussed in terms of the relative independence of these factors, as well as their potential implications for the treatment of this disorder.

An interaction between the serotonin transporter promoter region and dopamine transporter polymorphisms contributes to harm avoidance and reward dependence traits in normal healthy subjects

There is evidence for an association between polymorphisms of serotonin- and dopamine-related genes and temperamental personality traits. Recent findings have shown that interactions between allelic variants of the different genes may contribute to personality traits. We examined the effects of serotonin transporter-linked promoter region (5-HTTLPR) and dopamine transporter (DAT1) gene polymorphisms for associations with the Temperament and Character Inventory (TCI) temperament subscales in 209 Koreans. We found that the variants of 5-HTTLPR interacted with the DAT1 gene polymorphism to influence the HA and RD temperament subscales of TCI. Neither of these two genes affected any subscales of TCI alone.Controlling for the effects of gender and age, we found significant interactions between 5-HTTLPR and DAT1 genes on Harm Avoidance (HA) and Reward Dependence (RD) as measured by the TCI (Hotelling's Trace = 3.0, P = 0.02). In the presence of the DAT1 10/10 genotype, subjects of group L of 5-HTTLPR had a significantly higher HA score and significantly lower RD score than those of group S (F = 5.04, df = 1, p = 0.03 and F = 8.35, df = 1, p = 0.004, respectively). These findings suggest that the variants of 5-HTTLPR interacted with the DAT1 gene polymorphism to influence the HA and RD temperament subscales of TCI.

Six Months of Treatment for Depression: Outcome and Predictors of the Course of Illness

The goals of this study were to determine the course of illness in a cohort of depressed patients undergoing treatment for 6 months and whether there are clinically useful predictors of their course of illness. A cohort of 175 depressed outpatients undergoing drug treatment were followed prospectively for 6 months. Patients were initially randomly assigned to fluoxetine or nortriptyline. Those who responded were encouraged to continue taking their drugs for the 6 months. Those who did not were switched to other drugs or drug combinations. Of the 175 patients, 101 (58%) had a good outcome (achieved recovery and remained well), 54 (31%) had a fluctuating outcome (achieved recovery or remission but suffered a relapse or recurrence), and 20 (11%) had a poor outcome (remained depressed for the 6 months). Factors predicting good outcome included early response and a low level of schizoid personality disorder symptoms, and variables predicting poor outcome included a high score for harm avoidance and the absence of an early response. Depression is a recurring and chronic disorder. Personality factors such as a high harm avoidance score and schizoid traits were associated with a worse outcome, but demographic features, depression characteristics, depression subtypes, and comorbidity were not. Early response was strongly associated with the course of illness, but none of these features added significantly to the clinicians' ability to predict outcome.