Temperament and character inventory (TCI) and depression
Introduction
Over the past decade, Cloninger and his colleagues have developed a biosocial model of personality based on three fundamental dimensions: novelty seeking, harm avoidance and reward dependence (Cloninger, 1986, Cloninger, 1987). Novelty seeking is defined as the tendency to respond actively to novel stimuli leading to pursuit of rewards and escape from punishment. Harm avoidance corresponds to the tendency toward an inhibitory response to signals of aversive stimuli that lead to avoidance of punishment and non-reward. Reward dependence is defined as the tendency for a positive response to signals of reward to maintain or resist behavioral extinction. According to this model, the three dimensions have been postulated to be inheritable and independent. Moreover, each dimension has been related to a specific central neurotransmitter; novelty seeking to dopaminergic activity; harm avoidance to serotonergic activity; and reward dependence to noradrenergic activity. Factorial analysis reported a good validation of novelty seeking and harm avoidance, but a poorer validation for reward dependence (Cloninger et al., 1991; Svrakic et al., 1991; Wetzel et al., 1992; Lépine et al., 1994). The Tridimensional Personality Questionnaire (TPQ) has been developed by Cloninger to assess these temperaments (Cloninger et al., 1991).
Recent work from Cloninger et al. (Cloninger et al., 1991, Cloninger et al., 1993) have suggested that reward dependence must be separated in two dimensions; isolating persistence dimension and regrouping the three other subscales in a reward dependence dimension. Moreover, the model was recently extended to measure seven dimensions of personality with the addition of three measures of character: self-directedness, cooperativeness and self-transcendence (Cloninger et al., 1993; Svrakic et al., 1993). This extension is based on a synthesis of information about social and cognitive development and descriptions of personality development in humanist and transpersonal psychology. The seven-factor model supersedes models with fewer factors like the big-five model of personality (Digman, 1990) or the classic three model of Eysenck (1991)as well as the model of Zuckerman (1994). Self-directedness refers to the ability of an individual to control, regulate and adapt his behavior to fit the situation in accord with individually chosen goals and values. The second character dimension of cooperativeness was formulated to account for individual differences in identification with and acceptance of other people. Cooperative individuals are described as socially tolerant, empathic, helpful and compassionate, whereas uncooperative individuals are described as socially intolerant, disinterested in other people, unhelpful and revengeful. Self-transcendence is a character associated with spirituality, and refers generally to identification with everything conceived as essential and consequential parts of a unified whole. The Temperament and Character Inventory (TCI) is a 226-item self-questionnaire developed by Cloninger et al. (1994)to assess the seven dimensions of personality.
The relationship between personality and depression is extremely complex: Personality features may predispose an individual to depression; the personality can be modified after a depression; the personality can modify the clinical presentation of a depressive disorder; and finally the personality can be considered like a subclinical manifestation of a depressive disorder (Akiskal et al., 1983; Hirschfeld et al., 1997).
Concerning the TPQ, several studies have demonstrated that harm avoidance, but not novelty seeking and reward dependence dimensions, may be related to depression (Strakowski et al., 1992, Strakowski et al., 1995; Brown et al., 1992; Wetzel et al., 1992; Joffe et al., 1993; Lépine et al., 1994; Nelson and Cloninger, 1995; Chien and Dunner, 1996, Hansenne et al., 1997). Recently we have reported that the novelty seeking subscale exploratory excitability (NS1) score was lower in depressive inpatients as compared to controls (Hansenne et al., 1998). However, little is known about the role played by the character dimensions proposed by the seven-factor model of Cloninger in depression. Black and Sheline (1997)have reported that the self-directedness score increase after successful pharmacotherapy of the depressive disorder, and the results of the study of Tome et al. (1997)have suggested that temperament factors of the TCI may influence the outcome of antidepressant treatment. Bayon et al., 1996have demonstrated that the TCI self-directedness scores of a sample of psychiatric outpatients were lower as compared to the scores of a general community sample. These results suggest that the self-directedness character could be, like harm avoidance, state-dependent. However, these studies did not include a control group. Therefore, we carried out a systematic evaluation of TCI scores in depressive inpatients and controls.
Section snippets
Methods
The study was conducted in 40 depressive inpatients admitted in the Psychiatric Unit of the University Hospital of Liège (Belgium). The sample comprised 23 women and 17 men with a mean age of 35.7 years (SD = 9.6). All diagnostic assessments were performed by two psychiatrists (EP and KJ), and clinical ratings by the same psychologist (MH). All patients met the criteria for major depressive disorder according to the DSM-IV (APA, 1994), with a score of at least 18 on the 17-item Hamilton
Results
The mean scores for each of the seven personality scales and their subscales are presented in Table 1 for both depressed and control groups. Multivariate analysis showed that depressed patients exhibited statistically significant higher scores for harm avoidance and self-transcendence dimensions and lower scores for self-directedness and cooperativeness dimensions as compared to controls. For harm avoidance and self-transcendence dimensions, all the subscale scores were higher, whereas that for
Discussion
The main findings of the present study are that depressed patients exhibit lower self-directedness and co-operativeness scores and higher harm avoidance and self-transcendence scores as compared to healthy controls. In addition, their levels of self-directedness, cooperativeness, and harm avoidance appear to be related with the severity of depressive symptomatology. These results confirm an association between self-directedness dimension and depressive state reported in a recent study by Black
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