Personality characteristics in obesity and relationship with successful weight loss.

OBJECTIVE: Personality influences lifestyle behaviors. Therefore, certain personality traits could contribute to obesity and the response to behaviorally based weight loss therapy. PURPOSE: The aims of this study were to test the hypothesis that personality characteristics differ between lean and obese persons in the community, obese persons in the community and obese persons seeking weight loss therapy by enrolling in a comprehensive weight loss program, and in obese persons who were successful and unsuccessful in achieving behavioral therapy-induced weight loss. METHODS: The Temperament and Character Inventory was administered to 264 lean (body mass index (BMI) <25 kg/m(2)) and 56 obese (BMI> or =35 kg/m(2)) subjects from the St Louis community and 183 obese patients (BMI=44+/-10 kg/m(2)) enrolled in the Washington University Weight Management Program (WUWMP), which involved weekly group behavioral therapy and diet education sessions for 22 weeks. RESULTS: Compared with lean subjects, obese subjects in the community scored higher in novelty seeking (19.7+/-5.9 vs 16.2+/-6.0, P<0.05), lower in Persistence (4.1+/-1.8 vs 4.8+/-1.7, P<0.05) and lower in self-directedness (32.1+/-7.6 vs 34.3+/-6.6, P<0.05.) Patients enrolled in the WUWMP scored higher than obese persons in the general population in both Reward Dependence (17.1+/-4.2 vs 15.7+/-4.3, P<0.05) and cooperativeness (36.9+/-5.4 vs 34.5+/-6.2, P<0.05). Patients who were successful in losing weight (>10% weight loss) after 22 weeks of behavioral therapy scored lower in novelty seeking than those who were unsuccessful in losing weight (<5% weight loss) (17.6+/-5.9 vs 20.2+/-5.9, P<0.05). DISCUSSION: These results suggest that personality traits differ between lean and obese persons, and between obese persons who enroll and who do not enroll in a comprehensive weight management program. Moreover, high scores in novelty seeking are associated with decreased success in achieving behavioral therapy-induced weight loss.

Temperament, character, and personality disorders: etiologic, diagnostic, treatment issues.

OBJECTIVE: In this paper, we explore the underlying dimensional structure of personality disorder, propose a novel approach to its diagnosis, and outline our concepts of its etiology and treatment based on the seven factor psychobiological model of temperament and character. METHOD: Temperament and character traits were evaluated in a consecutive series of 109 psychiatric out-patients, with or without personality disorder and varying mood and anxiety states. RESULTS: Low scores on character dimensions consistently correlated with high symptom counts for personality disorder. Each subtype of personality disorder created a unique combination of correlations with the four temperament traits. CONCLUSION: Temperament and Character Inventory (TCI) temperament and character traits efficiently diagnose personality disorder and differentiate its individual subtypes. Character traits are used to diagnose the presence and the severity of personality disorder, whereas temperament traits are used for differential diagnosis. The distinction between temperament and character provides an attractive theoretical basis for etiological postulates and treatment of personality disorder.

Cancer risk among Swedish female alcoholics by age, birth cohort and severity of alcoholism.

We have previously reported increased risk for cancer in 15508 alcoholic women registered in the Swedish Temperance Boards compared with individually matched controls. Age at first registration was found for 14818 of these women. The women were divided into early and late alcoholic onset groups. Age 45 was used as an approximation for reproductive senescence. For subjects < 45 years at first registration with the Temperance Board we found an increased relative risk (RR) of 1.8 (95% CI 1.5-2.0), whereas for the older age at onset group we found an RR of 1.5 (95% CI 1.3-1.7). Early onset was associated with higher risk of cancer at all sites studied and in all age cohorts. We used the number of Temperance Board registrations as an index of severity of alcoholism; this measure was not associated with risk for cancer.

The Junior Temperament and Character Inventory: preliminary validation of a child self-report measure.

A preliminary effort to validate the Junior Temperament and Character Inventory with a convenience sample of 322 children ages 9 to 12 years is described.

Anxiety proneness linked to epistatic loci in genome scan of human personality traits.

A genome-wide scan between normal human personality traits and a set of genetic markers at an average interval of 13 centimorgans was carried out in 758 pairs of siblings in 177 nuclear families of alcoholics. Personality traits were measured by the Tridimensional Personality Questionnaire. We detected significant linkage between the trait Harm Avoidance, a measure of anxiety proneness, and a locus on chromosome 8p21-23 that explained 38% of the trait variance. There was significant evidence of epistasis between the locus on 8p and others on chromosomes 18p, 20p, and 21q. These oligogenic interactions explained most of the variance in Harm Avoidance. There was suggestive evidence of epistasis in other personality traits. These results confirm the important influence of epistasis on human personality suggested by twin and adoption studies.

Swedish normative data on personality using the Temperament and Character Inventory.

The Temperament and Character Inventory (TCI) is a self-report personality questionnaire based on Cloninger's psychobiological model of personality, which accounts for both normal and abnormal variation in the two major components of personality, temperament and character. Normative data for the Swedish TCI based on a representative Swedish sample of 1,300 adults are presented, and the psychometric properties of the questionnaire are discussed. The structure of the Swedish version replicates the American version well for the means, distribution of scores, and relationships within the between scales and subscales. Further, the Swedish inventory had a reliable factor structure and test-retest performance. The results of this study confirm the theory of temperament and character as a seven-factor model of personality.

Changes on the Temperament and Character Inventory after paroxetine treatment in volunteers with generalized anxiety disorder.

Previously untreated symptomatic volunteers with generalized anxiety disorder (GAD) performed the Temperament and Character Inventory at baseline and after 4 to 6 months of paroxetine treatment. Scores from 29 volunteers were analyzed with paired t-tests. A marked reduction was noted in Harm Avoidance and a marked increase was noted in Self-Directedness. Smaller changes were noted in Cooperativeness and Novelty Seeking. Overall, treatment was associated with a reduction in maladaptive personality traits.

Dimensional assessment of personality in an out-patient sample: relations of the systems of Millon and Cloninger.

The Cloninger Temperament and Character Inventory (TCI) and the Millon Clinical Multiaxial Inventory (MCMI-II) are both self-report inventories that can be used to assess personality reliably in clinical samples. Both instruments were administered to 103 consecutive psychiatric out-patients with or without personality disorders. The goals were to assess the convergent validity of the two instruments, to replicate the findings of Svrakic et al. (1993) Archives of General Psychiatry, 50, 991-999, about the differential diagnosis of Axis II disorders, and to analyse the relations of Millon's measures of Axis I disorders with Cloninger's measures. We observed a strong convergent validity between the instruments; the seven dimensions of the TCI accounted for most of the variance in MCMI-II measures of both Axis 1 and Axis 2 disorders. As reported by Svrakic et al. (1993) Archives of General Psychiatry, 50, 991-999, in in-patients, low self-directedness and low cooperativeness were confirmed to be the essential features of all personality disorders in out-patients. In addition, self-transcendence, the third of Cloninger's character dimensions, was observed to be a strong correlate of severe Axis-1 psychopathology, including manic and delusional disorders.

Platelet serotonergic markers and Tridimensional Personality Questionnaire measures in a clinical sample.

A group of patients with major depressive disorder, with and without comorbid obsessive-compulsive disorder, completed the Tridimensional Personality Questionnaire (TPQ). Harm Avoidance scores were found to be high compared to published age-matched norms and to display a significant positive correlation with Hamilton Depression Rating Scale scores. Platelet 125I-lysergic acid diethylamide (125I-LSD) and 3H-paroxetine binding Bmax values were measured to test Cloninger's hypothesis that Harm Avoidance scores would correlate significantly with measures of serotonergic function. A significant inverse correlation was found between Harm Avoidance scores and 125I-LSD Bmax values. Correlations between 3H-paroxetine Bmax values and TPQ scale scores were not significant. These results suggest an alternative view of the literature relating platelet 5-hydroxytryptamine-2a receptors and mood disorders in that the temperament dimension, Harm Avoidance, may explain prior inconsistencies involving links with depression and suicidality.

Temperament dimensions explain the comorbidity of psychiatric disorders.

The comorbidity of DSM-III-R axis I and axis II disorders presents conceptual and nosological challenges to psychiatry. In a consecutive series of 164 psychiatric outpatients and 36 healthy controls in Milan, Italy, psychopathology was measured by structured interviews for DSM-III-R disorders and temperament was measured by the Tridimensional Personality Questionnaire (TPQ). Low reward dependence (RD) distinguished cluster A personality disorders and no axis I disorders. High novelty seeking (NS) characterized cluster B personality disorders and patients with eating disorders, alcohol abuse, or substance abuse. High harm avoidance (HA) characterized all cluster C personality disorders and patients with mood or anxiety disorders. The temperament dimensions were nearly independent of one another, but patients often had multiple DSM-III-R diagnoses. The joint relations of these disorders to multiple temperament dimensions accounted for their characteristic patterns of comorbidity. These findings support the hypothesis that interactions among temperament dimensions during development influence comorbidity between axis I and axis II disorders.

Increased cancer risk among Swedish female alcoholics.

We evaluated site-specific cancer risks in alcoholic women. We identified 15,508 alcoholic women from the records of the Temperance Boards in Sweden and obtained a comparison group by selecting for each alcoholic woman one female individual matched for region and day of birth. We obtained incidence data from the Swedish Cancer Registry. We found an increased relative risk (RR) for any cancer [RR = 1.6; 95% confidence interval (CI) = 1.5-1.8]; site-specific risks were increased for tongue (RR = 8.5; 95% CI = 2.0-37), mouth (RR = 12; 95% CI = 1.6-92), tonsil (RR = 11; 95% CI = 1.4-85), hypopharynx (RR = 9.0; 95% CI = 1.1-71), larynx (RR = 7.0; 95% CI = 0.9-57), liver (RR = 4.6; 95% CI = 1.8-12), pancreas (RR = 2.7; 95% CI = 1.6-4.6), lung (RR = 5.0; 95% CI = 3.3-7.5), breast (RR = 1.4; 95% CI = 1.2-1.7), cervix uteri (RR = 3.9; 95% CI = 2.8-5.4), and vulva, vagina, and unspecified female genital organs (RR = 4.0; 95% CI = 1.3-12). We found a decreased risk for malignant melanoma of the skin (RR = 0.5; 95% CI = 0.3-1.0). Since this was a register study, the results may be confounded by differences in smoking, dietary habits, and/or other factors in the cohort of alcoholic women and the comparison group.

Personality antecedents of alcoholism in a national area probability sample.

Kraepelin viewed alcoholism as a symptom complex caused by heritable individual differences in emotional predisposition and volitional control. Recent clinical and genetic research has distinguished subtypes of alcoholics with different personality traits, symptoms, course, mode of inheritance, and response to treatment. The heritable personality traits that influence the initiation, continuation, and severity of alcoholism were examined by interview of a national area probability sample of 1019 non-institutionalized adults across the continental United States of America. We found that harm avoidance inhibits the initiation and frequency of drinking, but increases the risk of developing problems once frequent drinking has begun. Novelty seeking increases the initiation of drinking and the probabilities of frequent and problem drinking. This supports Kraepelin's description of the etiology and course of alcoholism as a symptom complex related to individual differences in emotional predisposition.

Adult offspring of alcoholic women as family history informants.

Eighteen years after their mothers had been hospitalized for alcoholism, adult offspring were asked if any of their 1st-degree relatives had ever had a drinking problem. Proband and informant characteristics that affect the validity of reports of maternal drinking problems given by adult offspring of alcoholic women were identified. A history of alcohol-related medical problems in the mother was associated with reporting maternal alcoholism. Being African-American, having a history of suicide attempts in the mother, and having a good maternal posttreatment outcome were associated with false-negative reports. Adding multiple offspring informants increased sensitivity to 86%. Female alcoholic offspring tended to underreport maternal alcoholism.

A psychobiological model of temperament and character.

In this study, we describe a psychobiological model of the structure and development of personality that accounts for dimensions of both temperament and character. Previous research has confirmed four dimensions of temperament: novelty seeking, harm avoidance, reward dependence, and persistence, which are independently heritable, manifest early in life, and involve preconceptual biases in perceptual memory and habit formation. For the first time, we describe three dimensions of character that mature in adulthood and influence personal and social effectiveness by insight learning about self-concepts. Self-concepts vary according to the extent to which a person identifies the self as (1) an autonomous individual, (2) an integral part of humanity, and (3) an integral part of the universe as a whole. Each aspect of self-concept corresponds to one of three character dimensions called self-directedness, cooperativeness, and self-transcendence, respectively. We also describe the conceptual background and development of a self-report measure of these dimensions, the Temperament and Character Inventory. Data on 300 individuals from the general population support the reliability and structure of these seven personality dimensions. We discuss the implications for studies of information processing, inheritance, development, diagnosis, and treatment.

Differential diagnosis of personality disorders by the seven-factor model of temperament and character.

We used multiaxial structured interviews and questionnaires to evaluate the ability of self-reports on seven personality dimensions to predict independent interview diagnoses of DSM-III-R personality disorders. We studied 136 consecutive adult psychiatric inpatients, excluding those with psychosis, organic mental disorders, and severe agitation. Sixty-six patients had interview diagnoses of DSM-III-R personality disorders. Most also had mood disorders. We confirmed the hypotheses that self-reports of low self-directedness and cooperativeness strongly predicted the number of personality symptoms in all interview categories, whereas the other factors distinguished among subtypes as predicted. Self-directedness and cooperativeness also predicted the presence of any personality disorder by differentiating patients varying in risk from 11% to 94%. Patients in clusters A, B, and C were differentiated by low reward dependence, high novelty seeking, and high harm avoidance, respectively. We conclude that low self-directedness and cooperativeness are core features of all personality disorders and are validly measured by the seven-factor Temperament and Character Inventory, but not the five-factor Neuroticism-Extraversion-Openness inventory. Each DSM-III-R personality disorder category is associated with a unique profile of scores in the seven-factor model, providing an efficient guide to differential diagnosis and treatment.

The relationship of personality to mood and anxiety states: a dimensional approach.

This study evaluates the relationship of personality to mood and anxiety states in a sample of 50 psychiatric out patients. In order to overcome arbitrariness inherent in categorical diagnoses of affective, personality and anxiety disorders, we use a dimensional approach to personality, mood and anxiety. According to our results, mood and anxiety states affect personality domains differentially. Namely, relatively large portions of personality and behavior, such as higher-order traits of novelty seeking and reward dependence, seem independent from mood and anxiety states. In contrast, the higher-order dimension of harm avoidance and its corresponding lower-order traits reflect changes in mood and anxiety to a much greater extent. Both the likelihood that large portions of personality may be independent from current mood and the likelihood that some precisely delineated personality domains tend to change simultaneously with current mood may improve our understanding of the relationship of personality to emotionality and affective disorders.

Mood states and personality traits.

In this article we analyze the relationship between personality traits assessed by the Tridimensional Personality Questionnaire, and six mood states assessed by the Profile of Mood States-bipolar form. Our data suggest that large portions of personality and/or behavior, e.g., higher order dimensions of Novelty Seeking and Reward Dependence, can be relatively independent from current mood. In contrast, the Harm Avoidance dimension covaries with mood and anxiety. Also, we analyze the psychometric properties of the Profile of Mood States-bipolar form, and discuss some practical aspects of our findings.

Risk of suicide by psychiatric diagnosis in Stockholm County. A longitudinal study of 80,970 psychiatric inpatients.

The risk of suicide associated with different psychiatric diagnoses was estimated in 80,970 inpatients in Stockholm County (population 1.6 million). All patients discharged with at least one psychiatric diagnosis between 1973 and 1986 were followed by linkage with the cause-of-death registry through 1987. There were 1,115 definite suicides and 467 undetermined suicides among these during the 15-year follow-up. When 12 diagnostic categories were entered in a proportional hazards model, the highest relative risk (RR) of definite suicide, controlling for sex and age, was noted for affective disorders (RR 2.82), followed by unspecified psychoses (RR 2.69), paranoid psychoses (RR 2.60), addiction to prescription drugs (RR 2.38), neuroses and reactive psychoses (RR 1.96), and schizophrenia (RR 1.64). Alcoholism, personality disorders, organic psychoses, and street drug addiction did not have significantly increased risks of suicide. Male sex increased the risk for definite suicide by 1.56, while the risk was somewhat higher among the young. Having more than one diagnosis increased the relative risk by 1.42. When undetermined suicides were included in the analysis, to alcoholism and street drug abuse were attributed significantly increased risks of suicide, probably owing to the greater difficulty of verifying such cases. We conclude that several psychiatric disorders were conductive to suicide, but that the risk did not vary much with the type of diagnosis. Further studies of confounders are needed, such as the reasons for being admitted to inpatient care, and the impact of somatic and psychiatric comorbidity.

The Tridimensional Personality Questionnaire: U.S. normative data.

The Tridimensional Personality Questionnaire is a self-report personality inventory measuring three major personality dimensions: Novelty Seeking, Harm Avoidance, and Reward Dependence. Normative data, based on a U.S. national probability sample of 1,019 adults, are presented and the psychometric properties of the questionnaire are discussed.

Further contribution to the conceptual validity of the unified biosocial model of personality: US and Yugoslav data.

In this study, the conceptual validity of the unified model of personality, postulated by Cloninger (1987) and measured by the Tridimensional Personality Questionnaire (TPQ), is tested in diverse Yugoslav and American societies. The issue of cross-cultural sensitivity of personality studies and the methodology that minimizes distortions and alternative explanations are discussed in detail. Similar personality structures were observed in the Yugoslav and US samples. Differences in novelty seeking (NS, attributed to age differences between the two samples) and harm avoidance (HA, possibly due to long-standing socioeconomic instability in Yugoslavia) are consistent with the unified biosocial theory of personality. Also, the TPQ was found to be psychometrically sound and valid for further research, although some revision in the reward dependence (RD) scale is warranted.