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06-apsychobiological

CLONINGER’IN PSIKOBIYOLOJIK MIZAÇ (HUY) VE KARATER Cloninger kiflili¤in iki temel bilefleni olan mizaç ve karakterdeki normal ve anormal varyas- yonlar› aç›klayan boyutsal bir psikobiyolojik kiflilik modeli gelifltirmifltir. Cloninger, mizac›n temelini ve karakterin geliflmesini aç›klayarak, kiflili¤in ikisi aras›ndaki etkileflimin son ürü- nü oldu¤unu öne sürdü. Mizaç ve Karakter Envanteri (TCI) kiflili¤in yedi temel boyutunu ölçmeye yarayan bir kendini de¤erlendirme ölçe¤idir. TCI önceden gelifltirilmifl kiflilik mo- dellerini kuramsal ve ampirik aç›dan desteklerken, klinik kullan›mdaki baz› s›n›rl›l›klar› or- tadan kald›rm›flt›r. Cloninger’in kiflilik kuram› kiflili¤in genetik temelinden, davran›fl›n nöro-biyolojik temellerine, kiflili¤in biliflsel ve emosyonel yap›s› ve gelifliminden, kiflilik boyutla- r›nda bireysel farkl›l›klar›n davran›flsal ba¤lar›na, kiflilik yap›lar›n›n geliflimsel etmenlerle etkilefliminden, psikiyatrik bozukluklara yol açmas›na uzanan çok say›da alanda kapsam-l› bilgi sa¤lama potansiyeline sahiptir. Geliflmekte olan beyin görüntüleme yöntemlerinin katk›s›yla, Cloninger’in kiflilik kuram› kiflili¤in beyindeki ba¤lant›lar›n› aç›kl›¤a kavufltura-rak, normal ve patolojik durumlar›n daha iyi anlafl›lmas›na katk›da bulunacakt›r. Bu yaz›da THEORETICAL DEVELOP-
Cloninger’in kiflilik modeli ve TCI’nin kuramsal altyap›s› ampirik bulgular ›fl›¤›nda sunul- MENT OF THE TCI
mufl, genel toplumda ve psikiyatrik hastalarda potansiyel klinik kullan›m› tart›fl›lm›flt›r.
Keywords: kiflilik, mizaç, karakter, TCI The Model of Tempera-
A PSYCHOBIOLOGICAL MODEL OF TEMPERAMENT AND the structure of personality todevelop a general model to Cloninger developed a dimensional psychobiological model of personality that accounts for both normal and abnormal variation in two major components of personality, tempera- ment and character. The Temperament and Character Inventory (TCI) is a self-administe- red dimensional questioannaire constructed to assess the seven basic dimensions of per- sonality. TCI maintains the strong theoretical and empirical support of previously develo- ped psychobiological models while overcoming some of their limitations for clinical use.
Cloninger’s model of personality has a tremendous potential to provide comprehensive in- sight into human personality at multiple levels of analysis, including including the genetics of personality, neurobiological foundations of behavior, the cognitive emotional structure and development of personality, the behavioral correlates of individual differences in per- sonality dimensions, and the interactions of personality constellations with developmental factors in relation to the vulnerability to psychiatric disorders. Within emerging neuroima- ging technology, Cloninger’s model of personality will provide novel opportunities for elu- cidating the characterization of neural correlates of personality, and enable a better un-derstanding of normal and pathological states. In this article, both underlying theory and empirically valiated findings along with its potential use in in both general population and psychiatric patient population were reviewed.
Keywords: personality, temperament, character, TCI ribed as neurotic introvertsusing the Eysenck Personality and Extraversion had been specified on the basis of Questioannaire (Eysenck and Eysenck 1976).
factor analyses of the phenotypic (observed) structure Cloninger sought a general model that may be app- of personality. Phenotypic variation is the product of lied to both normal and abnormal personality like the interaction of both genetic and environmental factors, model of Eysenck, but concluded that Eysenck’s mo- and Eysenck assumed that the phenotypic and genoty- del was unacceptable. The dimensions of Neuroticism pic structures were the same. However, this assumpti- * Psikiyatri Uzman›; From the Brain Stimulation Laboratory and the Center for Advanced Imaging Research, Department of Psychiatry, Medical University of SouthCarolina, Charleston, SC / Medical University of South Carolina Center for Advanced Imaging Research 67 President Street Room No: 502 N Charleston, SC 29425e-posta: kose@musc.edu S Y M P O S I U M
on was questionable. In particular, it was already that was previously rewarded was later maintained known that extraversion is genetically heterogenous for a while without continued reinforcement, and an (Eaves and Eysenck 1975). It is composed of two fac- individual differences in such maintenance was cal- tors that are largely genetically independent-impulsi- led “Reward Dependence”. Reward Dependence ini- vity and sociability-and appears to be a single behavi- tially included the sociability and persistence descri- oral dimension because of shared environmental influ- bed by Sjobring as aspects of low stability. However, ences. In other words, genetic and environmental inf- recent work has shown that dependence on warm so- luences do not influence behavior in the same way, cial attachments and persistence despite intermittent which is contrary to Eysenck’s assumption. Besides, reinforcement are usually dissociated and are inde- Gray (1982) had shown that anti-anxiety drugs affec- pendently inherited (Cloninger et al. 1993).
ted both neuroticism (decreases) and extraversion TPQ was developed to test these hypotheses and (increases), suggesting that anxiety was more parsimo- to evaluate their adequacy as a general model of per- niously defined by a single dimension combining the sonality. Each of the three major dimensions had four two, that is, by a dimension corresponding to neurotic subscales, including Persistence as one subscale of introvert. Likewise “impulsivity” was defined as a di- Reward Dependence. Subsequent factor analysis sup- mension independent of anxiety, that is, by neurotic ported the proposed factor structure with Persisten- extraverts. In addition, he showed that the rate of ope- ce as a fourth dimension (Nixon & Parsons 1989, Clo- rant learning in response to signals of punishment was maximal along the “anxiety” or compulsivity dimensi- In both normal and abnormal samples, the putati- on, not Eysenck’s neuroticism factor.
ve dimensions were highly reliable and stable despite Two dimensions were too few to provide a comp- mood state; only Harm Avoidance was transiently inc- rehensive model of personality. Eysenck’s psychoti- reased when individuals were agitated or depressed cism dimension was genetically heterogeneous and (Cloninger 1987, Cloninger et al. 1991, Brown et al.
was an unsatisfactory scale to measure a third dimen- 1992, Svrakic et al. 1992, Perna et al. 1992, Joffe et al.
sion of heritable personality traits (Heath et al. 1994).
1993), and Novelty Seeking may be transiently incre- Other models derived by factor analysis of behavioral ased when bipolar patients are subclinically hypoma- phenotypes, such as the so-called Five Factor model, include neuroticism and extraversion factors; accor- Most importantly, recent large scale twin studies dingly, they suffer the same inadequacies as the mo- have confirmed that the four dimensions of tempera- del of Eysenck. Fortunately, the Swedish psychiatrist ment, Novelty Seeking, Harm Avoidance, Reward De- Henrick Sjobring had described a model of persona- pendence (now limited to social sensitivity) and Per- lity in terms of its underlying neurogenetic basis that sistence are genetically homogenous and independent provided clues to the content of a third dimension.
of one another (Heath et al. 1994, Stallings et al. 1996).
Sjobring (1973) called his three dimensions as solidity It is remarkable that the four factor model of tem- (vs impulsivity), validity (vs compulsivity), and stabi- perament can, in retrospect, be seen as a modern in- lity (vs moody sociability). He modelled the descripti- terpretation of the ancient four temperaments: indivi- on of the low variants of these three on impulsive duals differ in the degree to which they are melanc- hysterics, compulsive psychasthenics, and sociable holic (Harm Avoidance), choleric (Novelty Seeking), depressives, respectively (Schalling 1978). Therefore, sanguine (Reward Dependence), and phlegmatic Sjobring’s description stability provided a tentative (Persistence). However, now the four temperaments construct for a third heritable dimension of tempera- are understood to be genetically independent dimen- ment. Because of the ambiguity of such descriptive sions that occur in all factorial combinations, rather adjectives, Cloninger next developed a neurobiologi- than mutually exclusive categories. The four tempe- cally based operant learning model to guide the rati- raments can also be seen to correspond to the four onal development of descriptors for temperament basic emotions of fear (Harm Avoidance), anger (No- velty Seeking), love (Reward Dependence), and tena- Cloninger initially hypothesized that the tempera- ment systems in the brain were functionally organi-zed as independently varying systems for the activati- The Model of Character
on, maintenance, and inhibition of behavior in res- The model of four temperaments provided an ex- ponse to specific classes of stimuli. Behavioral activa- cellent description of traditional subtypes of persona- tion involved the activation of behavior in response lity disorder (Cloninger 1987), but proved unable to to novelty and signals of reward or relief of punish- distinguish whether someone has a personality disor- ment; accordingly, individual differences in such acti- der (Cloninger et al. 1993). Fortunately, studies com- vatability were called “Novelty Seeking”. Behavioral paring the TPQ to other personality inventories help inhibition occurred in response to signals of punish- to identify additional aspects of personality that were ment or nonreward, so individual differences in inhi- not accounted for by its temperament dimensions.
bitability were called “Harm Avoidance”. Behavior These included measures of mature Self-Directed be- S Y M P O S I U
havior. Cooperativeness, and Self-Transcendence Individuals high in HA tend to be cautious, care- ful, fearful, tense, apprehensive, nervous, timid, do- The characterologic aspects of personality involve ubtful, discouraged, insecure, passive, negativistic, or individual differences in self-concepts about goals pessimistic even in situations that do not normally and values, in contrast to the temperaments that in- worry other people. These individuals tend to be in- volve differences in automatic emotional reactions hibited and shy in most social situations. Their ener- and habits. Such self-concepts modify the significan- gy level tends to be low and they feel chronically ti- ce or meaning of what is experienced, hence also red or easily fatigued. As a consequence they need changing emotional reactions and habits. Such self- more reassurance and encouragement than most pe- concepts modify the significance or meaning of what ople and are usually sensitive to criticism and punish- is experienced, thereby also changing emotional re- ment. The advantages of of high Harm Avoidance are actions. Accordingly, the three character dimensions the greater care and caution in anticipating possible involve both an intellectual perspective about danger, which leads to careful planning when danger self/nonself boundaries and an emotional perspecti- is possible. The disadvantages occur when danger is ve. Self-directedness is based on the concept of the unlikely but still anticipated, such pessimism or inhi- self as an autonomous individual; from this self-con- cept are derived feelings of personal integrity, honor, In contrast, individuals with low scores on this self-esteem, effectiveness, leadership, and hope. Like- temperament dimension tend to be carefree, relaxed, wise, cooperativeness is based on the concept of self daring, courageous, composed, and optimistic even as an integral part of humanity or society; from this in situations that worry most people. These individu- self-concept are derived feelings of community, com- als are described as outgoing, bold, and confident in passion, conscience, and charity. Futhermore, self- most social situations. Their energy level tends to be transcendence is based on the concept of self as an high, and they impress others as dynamic, lively, and integral part of the universe and its source; from this vigorous persons. The advantages of low Harm Avo- self-concept are derived feelings of mystical participa- idance are confidence in the face of danger and un- tion, religious faith, and unconditional equanimity certainty, leading to optimistic and energetic efforts and patience (Cloninger et al. 1993).
with little or no distress. The disadvantages are rela- Individuals with the same temperament may beha- ted to unresponsiveness to danger, which can lead to ve differently as a result of character development.
reckless optimism (Cloninger 1987, Cloninger et al.
For example, an individual high in Novelty Seeking and low in Harm Avoidance may have an impulsivepersonality disorder if they are low in Self-Directed- Harm Avoidance Facets
ness and Cooperativeness, or they may be a mature Anticipatory Worry and Pessimism vs Uninhibited and daring explorer, inquisitive scientist, or acquisiti- ve businessman. Accordingly, a comprehensive ques- High scorers on this subscale manifest two distinc- tioannaire for measuring all seven dimensions of per- tive behavioral tendencies. First, these people are sonality, called the Temperament and Character In- pessimistic worriers who tend to anticipate harm and ventory (TCI), was developed for clinical and rese- failure. This tendency is especially pronounced in ha- zardous, unfamiliar, or realistically difficult difficult si-tuations. But, it also occurs during harmless situati- BASIC DESCRIPTION OF THE PERSONALITY
ons, and even with reassurance and supportive cir- cumstances. Second, these people have difficulties The Temperament and Character Inventory (TCI) getting over humiliating and embarrassing experien- evaluates seven higher order temperament and three ces, rather they tend to ruminate about these experi- higher order character traits. Each of the seven tem- perament and character traits is multifaceted, consis- In contrast, individuals who score low on the ting of several facets or lower order components.
Worry and Pessimism subscale are described as posi- Twenty five facets altogether (12 facets of tempera- tive-thinking optimists. These persons typically do ment and 13 facets of character) make up the TCI.
not worry in facing the difficulties. The tend to be uninhibited, indifferent, and carefree, with minimal Harm Avoidance (HA) is multifaceted, higher or- reluctance to jeopardize even their physical well be- der temperament trait consisting of four aspects or lo- ing. When embarrassed and humiliated, these people tend to overcome it very quickly (Cloninger 1987, • Anticipatory Worry and Pessimism versus Uninhi- Individuals who score high on this subscale can- not tolerate uncertainty or unfamiliar circumstances • Fatigability and Asthenia versus Vigor (HA4) that are potentially dangerous. They often feel tense S Y M P O S I U M
and anxious in unfamiliar or uncertain situations, derly. The advantages of high Novelty Seeking are even when there is little to worry about. Consequ- enthusiastic and quick engagement with whatever is ently, they rarely take take any risks, have difficulty new and unfamiliar, which leads to exploration of po- adapting to changes in routine, and prefer to stay qu- tential rewards. The disadvantages are related to ex- cessive anger and quick disengagement whenever In contrast, low scorers on the Fear of Uncertainty their wishes are frustrated, which leads to inconsis- subscale tend to be confident, calm, and secure in al- tencies in relationships and instability in efforts.
most all situations, even situations most people find In contrast, individuals low in Novelty Seeking are unfavorable or hazardous. Hence, these individuals described as slow tempered, indifferent, uninquisiti- prefer to take risks, such as driving an automobile fast ve, unenthusiastic, umemotional, reflective, thrifty, on an icy road, rather than having to stay quiet and reserved, tolerant of monotony, systematic, and or- inactive for a few hours. These people tend to adapt to changes in routine easily (Cloninger 1987, Clonin-ger et al. 1994).
Novelty Seeking Facets
Exploratory Excitability vs Stoic Rigidity (NS1) Individuals who score high on this subscale are Individuals who score high on the Exploratory Ex- described as unassertive and shy in most social situati- citability subscale enjoy exploring unfamiliar places ons. They often actively avoid meeting strangers be- and situations even if most people think it is a waste cause they lack confidence with people they don’t of time. They get excited about new ideas and activi- know very well. They are usually unwilling to enter ties easily, for they tend to seek thrills, excitement, into relationships with people they don’t know un- and adventures. They are easily bored and hence avo- less given a strong guarantee of acceptance. In gene- id monotony. These people are typically intolerant of ral, any initiative they may have is easily inhibited by routine and try to introduce a change. Hence, they are sometimes described as inconventional or innovative.
In contrast, low scorers on the Shyness subscale In contrast, individuals who score low on the Exp- are described as daring, forward, and outgoing. They loratory Excitability subscale have little or no need for tend to speak without hesitation and readily engage novel stimulation. They do not derive special satisfac- in social activities. They are not shy with strangers at tion from exploration and consequently are conten- all. Their initiative is almost never inhibited by unfa- ded with or prefer familiar places, people, and situati- miliar people or situations (Cloninger 1987, Clonin- ons. They are resistant or slow to engage in new ide- as and activities. These people are rarely bored and thus tend to stick with familiar “tried and true” routi- Individuals who score high on this subscale appe- nes even if there are new and better ways to do the ar to be asthenic and to have less energy than most same thing (Cloninger 1987, Cloninger et al. 1994).
people. They often need naps or extra rest periods because they get very easily tired. These people typi- Individuals who score high on the Impulsiveness cally recover more slowly than most people from mi- subscale tend to be excitable, dramatic, impressionis- tic, and moody individuals who make decisions qu- Individuals who score low on the Fatigability subs- ickly on incomplete information and control their im- cale tend to be highly energetic and dynamic. They pulses poorly. Typically, these persons act on their can usually stay “on the go” for long periods or ha- momentary instincts and instinctive premonitions.
ving to “push” themselves. In other words, only few Hence, they have to revise their decisions and opini- things influence these people as difficult or tiring.
ons frequently when unanticipated events or infor- They typically recover more quickly than most peop- mation develop. They are often distractable and have le from minor illnesses or stress (Cloninger 1987, Clo- In contrast, individuals who score low on the Im- pulsiveness subscale are described as reflective. They Novelty Seeking
rarely act on guesses or hunches. Rather, they tend to Novelty Seeking is a multifaceted higher order be analytical and require detailed information when temperament trait consisting of the following four as- making a decision or forming an opinion. These indi- viduals rarely break rules. They are not easily distrac- • Exploratory Excitability vs Stoic Rigidity (NS1) ted and can stay focused for long periods of time (Clo- ninger 1987, Cloninger et al. 1994).
• Disorderliness vs Regimentation (NS4) Individuals who score high on the Extravagance Individuals high in Novelty Seeking tend to be qu- subscale tend to be extravagant with their money, ick-tempered, excitable, exploratory, curious, enthu- energy, and feelings. They may impress others as gal- siastic, ardent, easily bored, impulsive, and disor- lant, flamboyant, and unrestrained. For example, they S Y M P O S I U
prefer spending money rather than saving it. Conse- leads to practical and objective views that are not ro- quently, it is hard for them to save money, even for manticized by wishful thinking or efforts to please ot- special plans or vacations. They like to live “at the ed- hers. This social detachment can also be a disadvanta- ge”, that is pushing at the limits of their resources and ge when lack of sensitivity in social communication interferes with the cultivation of beneficial social affi- In contrast, individuals who score low on the Ext- liations (Cloninger 1987, Cloninger et al. 1994).
ravagance subscale are described as reserved, cont-rolled, or restrained. These individuals typically do Reward Dependence Facets
not waste their money, energy, and feelings. Rather, they may impress others as frugal or stingy because High scorers on the Sentimentality subscale are they are slow to become interested in spending or ac- described as sentimental, symphatetic, understanding quiring things or giving them up (Cloninger 1987, individuals who tend to be deeply moved by sentimen- tal appeals. They tend to show their emotions easily in presence of others. They report that they experience High scorers on this subscale tend to be quick delegated emotions intensely, that is, they personally tempered and disorderly. In other words, they are qu- experience what others around them are feeling.
ick to lose their temper, so they often show and exp- In contrast, individuals who score low on this ress anger outwardly when they don not get what subscale are described as practical. These people they want when they want it. They typically prefer tend to be tough minded and coolly detached. They activities without strict rules and regulations. They do are rarely moved by sentimental appeals, and impress not like fixed routines and rules. They run away from others as odd, cold or aloof. These individuals find whatever is frustrating, boring or uncomfortable for sad songs and movies pretty boring. They are not sen- sitive to feelings of other people, so that it is difficult In contrast, individuals who score low on this subs- for them to establish social relationship (Cloninger cale tend to be organized, orderly, methodical, and systematic. They typically prefer activities with strict rules and regulations. They are able to delay gratificati- High scorers on the Attachment subscale prefer on when frustrated longer than most people. They are intimacy over privacy. They like to discuss their ex- slow to lose their temper, that is, to show anger out- periences and feelings openly with friends instead of wardly (Cloninger 1987, Cloninger et al. 1994).
keeping them to themselves. These persons tend toform warm and lasting social attachments. As a re- Reward Dependence
sult, they tend to be sensitive to rejection and insults.
Reward Dependence is a multifaceted higher or- In contrast, low scorers on the Attachment subs- der temperament trait consists of the following three cale manifest more or less pronounced detachment and disinterest in social relationships. They prefer • Sentimentality vs Tough Mindedness (RD1) privacy over intimacy and are thus often described as self contained. These individuals typically do not share their intimate feelings with others. They imp- Individuals who score high in Reward Dependence ress others as alienated, detached, and distant “lo- tend to be tender-hearted, loving and warm, sensitive, ners” who are usually indifferent to rejection and in- dedicated, dependent, and sociable. They seek social sults (Cloninger 1987, Cloninger et al. 1994).
contact and are open to communication with other people. Typically, they find people they like everyw- Individuals with high scorers on this subscale are here they go. A major advantage of high Reward De- dependent on emotional support and approval from ot- pendence is the sensitivity to social cues, which facili- hers. They care deeply how other people regard them, tates warm social relations and understanding of ot- and may even seek or stimulate overprotection and do- hers’ feelings. A major disadvantage of high Reward minance in others. They may be reluctant to make de- Dependence involves the ease with which other peop- cisions or do things on their own. Dependent individu- le can influence the dependent person’s views and fe- als seek support or protection and thus usually go out elings, possibly leading to loss of objectivity.
of their way to please other people. As a consequence, Individuals low on the Reward Dependence are they are easily hurt by criticism and disapproval. De- often described as practical, tough minded, cold, and pendent individuals tend to be preoccupied with fears socially insensitive. They are content to be alone and of being abondened.Thus they are very sensitiveto so- rarely initiate open communication with others. They cial cues and highly responsive to social pressure.
prefer to keep their distance and typically have diffi- In contrast, low scorers on this subscale neither culties in finding something in common with other depend on nor actively seek emotional support and people. An advantage of low Reward Dependence is approval from other people. These individuals are that independence from sentimental considerations not sensitive to social pressure and criticism. They ra- S Y M P O S I U M
rely yield to the wishes of others and typically do not when rewards are infrequent but occur in the long try to please others in order to get protection or emo- run (Cloninger et al. 1993, Cloninger et al. 1994).
tional support. Rather, they impress others as inde-pendent, self-sufficient, and unresponsive to social Self-Directedness
pressure (Cloninger 1987, Cloninger et al. 1994).
Self-Directedness is a multifaceted, higher order character trait consisting of the following five lower Persistence
In the present version of TCI (Cloninger et al.
1993), this temperament dimension is represented • Purposefulness vs Lack of goal direction (SD2) with a single 8 item scale which describes to some extent four distinct behavior paradigms that can exp- • Congruent Second nature vs Bad Habits (SD5) lain maintenance of a behavior. These includes eager- Highly self-directed persons are described as matu- ness of effort in response to signals of anticipated re- re, strong, self-sufficient, responsible, reliable, goal- ward versus laziness, work hardened in response to oriented, constructive, and well-integrated individuals intermittent punishment versus spoiled by consistent when they have the opportunity for personal leaders- rewards and non punishment, ambitious overachi- hip. They have good self-esteem and self-reliance. The eving in response to intermittent frustrative non re- most distinctive characteristics of self-directed indivi- ward versus underachieving, and perfectionistic per- duals is that they are effective, able to adapt their be- severation in response to intermittent reward versus havior in accord with individualy chosen, voluntary pragmatic quitting when not consistently rewarded.
goals. When a self-directed individual is required to Individuals high in Persistence tend to be industri- follow the orders of others in authority, they may be ous, hard-working, persistent, and stable despite viewed as rebellious trouble maker because they chal- frustration and fatigue. They typically intensify their lenge the goals and values of those in authority.
effort in response to anticipated reward. They are re- In contrast, individuals who are low in Self-Direc- ady to volunteer when there is something to be done, tedness are described as immature, weak, fragile, bla- and are eager to start work on any assigned duty. Per- ming, destructive, ineffective, irresponsible, unreliab- sistent persons tend to perceive frustration and fati- le, and poorly integrated when they are not confor- gue as a personal challenge. They do not give up ea- ming to the direction of a mature leader. They are fre- sily and, in fact, tend to work extra hard when critici- quently decsribed by clinicians as immature or having zed or confronted with mistakes in their work. Highly a personality disorder. They seem to be lacking an in- persistent persons tend to be ambitious overachi- ternal organizational principle, which renders them evers who are willing to make major sacrifices to be unable to define, set, and pursue meaningful goals.
a success. A highly persistent individual may tend to Instead, they experience numerous minor, short be a perfectionist and a workaholic who pushes term, frequently mutually exclusive motives, none of him/herself far beyond what is necessary to get by.
which can develop to the point of long lasting perso- High Persistence is an adaptive behavioral strategy nal significance and realization (Cloninger et al. 1993, when rewards are intermittent but the contingencies remain stable. However, when the contingencieschange rapidly, perseveration becomes maladaptive.
Self-Directedness Facets
When reward contingencies are stable, individu- als low in Persistence are viewed as indolent, inacti- Individuals who are high on this subscale typically ve, unreliable, unstable and erratic on the basis of feel free to choose what they will do. They recognize both self-reports and interviewer ratings. They rarely that their attitudes, behaviors, and problems gene- intensify their effort even in response to anticipated rally reflect their own choices. They tend to accept reward. These persons rarely volunteer for anything responsibility for their attitudes and behavior. These they do not have to do, and typically go slow in star- individuals impress others as reliable and trustworthy ting work, even if it is easy to do. They tend to give up easily when faced with frustration, criticism, obs- In contrast, individuals who score low on the Res- tacles, and fatigue. These persons are usually satisfied ponsibility subscale tend to blame other people and with their current accomplishments, rarely strive for external circumstances for what is happening to bigger and better things, and are frequently described them. They feel that their attitudes, behavior, and as underachievers who could probably accomplish choices are determined by influences outside their for than they actually do, but do not push themselves control or against their will. They tend not to accept harder than it is necessary to get by. Low scorers ma- responsibility for their actions. These individuals imp- nifest a low level of perseverance and repetitive beha- ress others as unreliable and irresponsible persons viors even in response to intermittent reward. Low (Cloninger et al. 1993, Cloninger et al. 1994).
Persistence is an adaptive strategy when reward con- Purposefulness vs Lack of Goal Direction (SD2) tingencies change rapidly and may be maladaptive Individuals who score high on this subscale are S Y M P O S I U
usually described as goal-oriented or purposeful.
confuse their priorities and thus feel safe and self trus- They have a clear sense of meaning and direction in their lives. Typically, they have developed the ability In contrast, low scorers on this subscale manifest to delay gratification to achieve their goals. Their ac- habits that are inconsistent with and make it hard for tivities are guided by their long-term goals and values.
them to accomplish worthwile goals (“goal-incongru- In contrast, low scorers on the Purposefulness ent habits”). These people sometimes are perceived by subscale struggle to find direction, purpose, and me- others as self-defeating and weak-willed. Their will po- aning in their lives. They are uncertain about long- wer appears to be too weak to overcome many strong term goals, and thus feel driven to react to current cir- temptations, even if they know they will suffer as a con- cumstances and immediate needs. They may feel that sequence (Cloninger et al. 1993, Cloninger et al. 1994).
their life is empty and has little or no meaning beyondthe reactive impulses of the moment. They are usu- Cooperativeness
ally unable to delay gratification to achieve their goals Cooperativeness is a multifaceted higher order (Cloninger et al. 1993, Cloninger et al. 1994).
character trait that consists of the following five as- High scorers on this subscale are usually descri- • Social Acceptance vs Social Intolerance (C1) bed as resourceful and efficient. They impress other people as productive, proactive, competent, and in- novative individuals who rarely lack ideas on how to solve problems. These individuals tend to look at a • Pure Hearted Principles (Integrated Conscience) difficult situation as a challenge or an opportunity.
In contrast, low scorers on the Resourcefulness Cooperativeness has been formulated to account subscale impress others as helpless, hopeless, and inef- for individual differences in identification with and fective. These individuals have not developed skills acceptance of other people. Highly cooperative pe- and confidence in solving problems and thus feel unab- ople are described as empathetic, tolerant, compassi- le and incompetent when faced with obstacles. They onate, supportive, fair, and principled individuals tend to wait others to take the lead in getting things do- who enjoy being of service to others and try to co- ne (Cloninger et al. 1993, Cloninger et al. 1994).
operate with others as much as possible. They un- derstand and respect the preferences and needs of ot- High scorers on this subscale are described as self- hers as well as their own. This capacity is important confident individuals who recognize and accept both in teamwork and social groups for a harmonius and their strengths and limitations. These individuals try to balanced relationships to flourish, but is not needed do the best that they can without pretending to be so- mething they are not. Rather, they seem to accept and In contrast, low scorers on the Cooperativeness di- feel very comfortable with their actual mental and mension are described as self absorbed, intolerant, cri- physical capacities, although they may try to improve tical, unhelpful, revengeful, and opportunistic. These these shortfalls by constructive training and effort.
individuals primarily look out for themselves. They In contrast, low scorers on the Self-Acceptance tend to b e inconsiderate of other’s rights or feelings.
subscale are described as self-striving. These individu- If a social leader is self-directed but uncooperative, als tend to manifest low self-esteem. They neither ac- they are likely to be described as tyrant or jerk, beca- cept nor enjoy their actual mental and physical capa- use of a lack of empathy, compassion, and ethical prin- cities. They rather often pretend to be different than ciples (Cloninger et al. 1993, Cloninger et al. 1994).
they really are. They tend to fantasize about unlimitedwealth, importance, beauty, and eternal youth. When Cooperativeness Facets
confronted with evidence to the contrary, they may Social Acceptance vs Social Intolerance (C1) become severely disturbed rather than trying to revi- Individuals who score high on this subscale are desc- se their goals and habits constructively (Cloninger et ribed as tolerant and friendly. They tend to accept other people as they are, even people with very different be- Congruent Second Nature vs Bad Habits (SD5) haviors, ethics, opinions, values, or appearances.
Individuals who score high on this subscale have In contrast, low scorers on this subscale are desc- developed a spectrum of goal-congruent, good habits ribed as intolerant and unfriendly. They are typically so that they automatically act in accord with their impatient with and critical of other people, especially long-term values and goals. This is achieved gradually with people who have different goals and values (Clo- as a consequence of self-discipline, but eventually be- ninger et al. 1993, Cloninger et al. 1994).
comes automatic (“second nature”). These habits usually develop through repeated practice and are High scorers on Empathy subscale typically try to typically stronger than most momentary impulses or imagine themselves “in other people’s shoes”. These persuasion. In other words, these individuals rarely individuals are highly attuned to and considerate of S Y M P O S I U M
other people’s feelings. They tend to treat others • Creative Self-Forgetfulness vs Self-Conscious Expe- with dignity and respect and often put aside their own judgement initially so they can better unders- • Transpersonal Identification vs Personal Identifi- tand what other people are experiencing.
In contrast, low scorers on this subscale are desc- • Spiritual Acceptance vs Rational Materialism (ST3) ribed as insensitive. These individuals do not seem to Self-transcendent individuals are described as unp- be concerned about other’s feelings. Rather, they se- retentious, satisfied, patient, creative, selfless, and em to be unable to share in another’s emotions, suf- spiritual. In Eastern societies, they are described as fering, or hardship, or at least are unwilling to respect enlightened and wise, whereas in Western societies for, the goals and values of other people (Cloninger the same traits may be described as naive. These indi- et al. 1993, Cloninger et al. 1994).
viduals seem to tolerate ambiguity and uncertainty.
They can fully enjoy most of their activities without High scorers on this subscale are described as having to know the outcome and without feeling the helpful, supportive, and encouraging, or reassuring.
urge to control it. Self-transcendent individuals imp- These individuals enjoy being in service to others.
ress others as humble and modest persons who are They often share their skills and knowledge so that content to accept the failure even of their best efforts everyone comes out ahead. They like to work as part and who are thankful for both their failures and their of a team, usually prefering this to working alone.
successes. High Self-Transcendence has adaptive ad- In contrast, low scorers on this subscale are desc- vantages when a person is confronted with suffering ribed as self-centered, egoistic, or selfish. These pe- and death, which is inevitable with advancing age.
ople tend to be inconsiderate of other people and In contrast, low scorers in Self-Transcendence typically look out only for themselves, even working tend to be proud, impatient, and unimaginative, in a team of highly cooperative collaborators. They unappreciative of art, self-aware, materialistic, and prefer to work alone or to be in charge of what is do- unfulfilled. They cannot tolerate ambiguity, uncerta- ne (Cloninger et al. 1993, Cloninger et al. 1994).
inty, and surprises. Instead, they strive for more cont- rol over almost everything. Low scorers on this di- Individuals who score high on this subscale are mension may impress others as pretentious persons described as compassionate, forgiving, charitable, who seem to be unable to be satisfied with what they and benevolent. They do not enjoy revenge and usu- have. Individuals low in Self-Transcendence are often ally do not try to get even if they were treated badly.
admired in Western societies for their rational, scien- In contrast, low scorers on this subscale enjoy get- tific, and materialistic success. But, they may have dif- ting revenge on people who hurt them. Their reven- ficulty accepting suffering and death which leads to geful triumph can be either overt or disguised. The difficulties in adjustment with advancing age (Clonin- former is observed as active-aggressive behavior, ger et al. 1993, Cloninger et al. 1994).
such as hurting others physically, emotionally, and fi-nancially. The latter is observed as passive-aggressive Self-Transcendence Facets
behaviors, such as holding grudges, deliberate forget- Creative Self-Forgetfulness vs Self-Consciousness fulness, stubbornness, and postponement (Cloninger et al. 1993, Cloninger et al. 1994).
High scorers on this subscale tend to transcend Integrated Conscience vs Self-Serving (C5) their self-boundaries when deeply involved in a relati- Individuals who score high on this subscale are onship or when concentrating on what they are doing.
described as honest, genuinely conscientious, and They tend to forget where they are for a while and to sincere persons who treat others in a consistently fa- lose awareness of the passage of time. They may appe- ir manner. These persons have incorprated stable et- ar “in another world” or “absent minded”. Such ab- hical principles and scruples in both their professi- sorbtion is characteristic of “flow states”, “peak expe- onal and their social and interpersonal relationships.
riences”, or higher levels of insight meditation. Indivi- In contrast, low scorers on this subscale are desc- duals who experience such self forgetfulness often are ribed as opportunistic. They would do whatever they usually described as creative and original.
can get away with to reach their goals without get- In contrast, low scorers on the Creative Self-For- ting in immediate trouble. These individuals tend to getfulness subscale are characterized by their ten- treat others unfairly, in a biased, self-serving manner dency to remain aware of their individuality in a rela- that usually reflects their own profit. They are thus tionship or when concentrating on their work. These frequently described as manipulative and deceitful individuals are rarely deeply moved by art or beauty (Cloninger et al. 1993, Cloninger et al. 1994).
(Cloninger et al. 1993, Cloninger et al. 1994).
Transpersonal Identification vs Personal Identifi- Self-Transcendence
Self-Transcendence is a multifaceted higher order High scorers on this subscale tend to experience trait with following aspects or lower order traits: and extraordinarily strong connection to nature and S Y M P O S I U
the universe as a whole. They report feeling that ach avoidance conflicts that make it difficult to be everything seems to be part of one living organism.
happy and hopeful. This combination also impedes These individuals are often willing to make real per- mature character development, so these individuals sonal sacrifices in order to make the world better pla- tend to be immature and dysthymic. The prediction ce. They may be regarded as fuzzy-thinking idealists that individuals with personality disorders or low Self- by some people (Cloninger et al. 1993).
Directedness are expected to have frequent comor- In contrast, low scorers on the Transpersonal Iden- bid dysthymia and depression has been confirmed tification subscale rarely experience strong connecti- and replicated in clinical and student population ons to nature or people. They tend to be individualists (Svrakic et al 1993). In all four available studies of mo- who feel that they are neither directly nor indirectly od disorders, Harm Avoidance scores are much hig- responsible for what is going on with other people or her before treatment for depression than in the gene- the rest of the world. They are rarely willing to make ral population (Brown et al. 1992, Strakowski et al.
sacrifices in order to make the world a better place un- 1992, Joffe et al. 1993, Joyce et al. 1994). A crucial less they can document objectively some practical ad- question about the elevation in these scores involves vantage (Cloninger et al. 1993, Cloninger et al. 1994).
the extend to which the deviations reflect lifelong Spiritual Acceptance vs Rational Materialism (ST3) personality traits versus effects of transient mood sta- Individuals who score on this subscale often beli- tes. Harm Avoidance scores are less stable in depres- eve in miracles, extrasensory experiences, and other sed patients than in the general population and have spiritual phenomena and influences such as telepathy been shown to covary with changes in depression and sixth sense. They are described as showing magi- cal thinking. They may be vitalized and comforted by Eating disorders may provide another clinical gro- spritual experiences, they may deal with suffering up in which personality assessment is important be- and even death through faith they have and which cause different subtypes have impulsive vs compulsi- ve patterns of motivated behavior. All eating disorder In contrast, low scorers on theis subscale accept patients are high in Harm Avoidance, bulimics are al- only materialism and objective empiricism. These in- so high in Novelty Seeking, whereas anorexics are dividuals are generally unwilling to accept things that high in Persistence (Bulik et al. 1992, Brewerton et al.
cannot be scientifically explained. The disadvantage 1993, Kleifield et al. 1993, Waller et al. 1993).
is in facing situations over which there is no control The personality profiles of alcoholics are clearly or possibility for evaluating by rational objective me- heterogenous. Available studies show that adolescent ans as when confronted by inevitable death, suffe- onset alcohol abuse is often associated with antisoci- ring, or unjust punishments (Cloninger et al. 1993, al temperament traits, especially high Novelty Se- eking and low Harm Avoidance (Cloninger at al.
1987, Wills et al. 1994).
CLINICAL APPLICATIONS OF TCI
The classification of personality disorders using the The TCI has proven useful in practical clinical TCI indicates that the presence of a personality disor- work, notably in diagnosis, diferential diagnosis and der is likely if a person scores low on both Self-Direc- treatment planning of psychiatric disorders including tedness and Cooperativeness. Social aloofness is indi- anxiety, mood, eating, substance abuse disoders.
cated by low Reward Dependence, impulsivity by According to Biosocial Learning Theory of Perso- high Novelty Seeking, and anxiety-proneness by Harm nality (Cloninger 1986), individuals with various anxi- Avoidance (Svrakic et al. 1993, Goldman et al. 1994).
ety disorders are all expected to be high on Harm Since personality is only moderately heritable we Avoidance. All available studies conform that indivi- can only test if the genetic antecedents of each perso- duals with all types of anxiety disorders are high in nality dimension are independent of those of the ot- Harm Avoidance (Pfohl et al. 1990, Saviotti et al.
her dimensions by doing large scale twin studies. He- 1991, Perna et al. 1992, Cowley et al. 1993, Richter et ath et al. (1994) demonstrated that scores on the four al. 1993, Tancer et al. 1994). The converse statement TPQ temperament dimensions were significantly he- is not necessarily true: individuals who are high on ritable. Stallings et al (1996) demonstrated that herita- Harm Avoidance do not necessarily have an anxiety bility of each trait is substantial in both sexes but fo- disorder. They may have other forms of psychopatho- ur dimensions of temperament have little or no gene- logy or may be healthy despite tendency to worry and tic correlations with one another, that shows they are to be fearful, shy, and fatigable if they are mature in character and/or protected by a reassuring supporti- Brain imaging provides the most direct way of eva- luating regional brain activity. George et al. (1994), According to Cloninger’s theory of personality, all using PET scan, studied the correlations of TCI with aspects of personality interact in influencing suscep- regional brain activity in healthy volunteers and fo- tibility to depression. Being high in both Harm Avo- und that Harm Avoidance was positively correlated idance and Novelty Seeking produces internal appro- with blood flow in the brainstem, cerebellum, and S Y M P O S I U M
right temporal cortex. Reward Dependence is negati- lation was compared with the original version. Follo- vely correlated with prefrontal activity bilaterally and wing the revision of some items, a new version was there is a trend for Novelty Seeking to be positively back-translated again. The language was once again correlated with blood flow in the brainstem and left revised and reviewed by Kose S. and some items we- caudate (unpublished data, personal cummunicati- re changed to a more colloquial Turkish. To obtain on). Menza and Mark (1994) tested the predicted re- cross-cultural content validity of the Turkish version lations of dopamine uptake to temperament by me- of the TCI, the content of all items was examined in asuring the uptake of fluorodopa into the striatum of order to assess whether any items had difficult cultu- Parkinson’s disease patients and found a positive cor- ral connotations. None of the items was found to be relation between dopa uptake into the caudate.
irrelevant for the Turkish population. Careful scrutiny Other strategies that have been used to investiga- of the phrases used in the original version of the in- te the neurobiological theory underlying the TCI inc- ventory indicated no difficulties in using them within lude neurochemical and neuroendocrine challenge the context of current Turkish culture. The final ver- studies. Unfortunately all of these studies have used sion was verified and approved by Cloninger.
TPQ and not measured the character scales of the The study group comprised 689 subjects, 366 ma- TCI. As character at least partly reflects maturation of le and 323 female, with a mean age of 26.32 ± 10.69 the brain, the neglect of the character may explain so- (range of 18-75 years). Trabzon Technical University me inconsistencies between studies carried out so far group comprised 349 subjects, 165 male and 184 fe- (Pfohl et al. 1990, Simonsson et al. 1992, Joyce et al.
male, with a mean age of 20.76 ± 2.54 (range of 18-55 1994, Tancer et al. 1994, Ruegg et al. 1997).
years). Ataturk University (Erzurum) group compri- In Cloninger’s personality model following three sed 340 subjects, 201 male and 139 female, a mixtu- sets of transmitters and their behavioral manifestati- re of undergraduates and others, with a mean age of ons were hypothesized: (1) dopamine, Novelty Se- 32.03 ± 12.67 (range of 19-75 years). Subjects who ha- eking (behavioral activation), (2) serotonin, Harm ve a history of severe mental illness such as major Avoidance (behavioral inhibition), and (3) norepi- depressive disorder, psychosis, anxiety disorder, nephrine, Reward Dependence (behavioral mainte- OCD, autism, PTSD, mental retardation, suicide at- nance) (Cloninger 1987). Recently researchers repor- tempt, current substance abuse/dependence, history ted that scores on Novelty Seeking are related to the of neurological disease, or any psychotropic medica- dopamine receptor gene (Benjamin et al., 1996, Ebs- tion have been excluded. TCI scores were converted to raw scores for descriptive purposes in accordancewith Cloninger’s original normative data.
TRANSLATIONS OF THE TCI
Turkish sample mean scores on the Novelty Se- The TCI is a 240 items self-report inventory me- eking (except for the Exploratory/Excitability and Im- asuring the seven dimensions of personality. Each pulsiveness subscales), Reward Dependence, and scale has three to five subscales excpet for Persisten- Persistence scales were significantly lower than that ce, which has only one scale. Each item is rated with for the US sample, whereas mean scores on the Harm a two-point scale: “True” or “False”.
Avoidance (except for Shyness subscale, p=0.049) Cloninger’s TCI has been translated into several scale were significantly higher than that for the US languages and also validation studies were conduc- sample. Turkish sample mean scores on the Self-di- ted. So far; the Swedish version of the TCI (Brändst- rectedness (except for the Purposefulness subscale), röm et al., 1998), the Dutch version of the TCI (De la Cooperativeness (Integrated Conscience, p=0.038), Rie et al., 1998), the Japanese version of the TCI (Ki- and Self-transcendence scales (except for the Self-for- jima et al., 2000), and the Spanish version of the TCI getfulness subscale) were significantly lower than (Gutierrez et al., 2001) were developed and reliability that for the US sample. Pearson correlations between and validation studies showed sound psychometric Persistence and Harm Avoidance (-.84, p<0.05), Self- properties as in the original version.
directedness and Persistence (-.700, p<0.01), Coope-rativeness and Self-directedness (.680, p<0.01), Self- RELIABILITY AND VALIDITY OF THE TURKISH
transcendence and Cooperativeness (.762, p<0.01) all VERSION OF THE TCI
exceeded .50 Cronbach coefficients for all scales we- Kose at al (2002) examined the psychometric pro- re sufficiently high (.71 for whole scale) except tho- perties of the Turkish version of the TCI in a healthy se for Reward Dependence and Persistence.
Turkish population that is broadly representative of The reliability and validity of the Turkish version the general population in Turkey and obtained nor- of the TCI were supported by the distribution of sco- mative data for the Turkish TCI. The TCI was transla- res, high internal consistency, and construct validity.
ted to Turkish by a Turkish psychiatric researcher This study demonstrated that the Turkish TCI measu- (Kose S.). The blind back-translation was done by res the dimensions of Cloninger’s seven-factor model another Turkish psychiatric researcher (Sayar K.) who had not seen the original items. This back-trans- Kose et al (2002) conducted a two-stage design S Y M P O S I U
study and tested the predictive value of Turkish ver- The TCI can be useful aid in assessment of persona- sion of TCI in depression and anxiety in Turkish Col- lity disorders. The character scales are designed to dis- lege Students. Study group comprised 109 subjects, tinguish whether a person has any personality disor- 64 male and 45 female undergraduates with a mean ders, and the temperament scales allow the differenti- age of 20.34 ± 1.24 (range of 18-30 years). Subjects al diagnosis of categorical subtypes of personality di- were given the Hamilton Rating Scale for Depression, sorders. The TCI also helps to identify comorbid Beck Depression Inventory, the Hamilton Anxiety psychopathology since clinical differences between Scale, and Spielberger’s State-Trait Anxiety Inventory and within different types of psychopathological at two different time frames, three months after the syndromes (e.g., anxiety, mood, eating, substance abu- first administration. Subjects who have a history of se disorders) are related to differences in TCI profiles.
severe mental illness such as major depressive disor- The TCI is also widely being used in multiple ne- der, psychosis, anxiety disorder, OCD, autism, PTSD, uroimaging, neuropsychological, neurogenetic, ne- mental retardation, suicide attempt, current substan- uroendocrine studies assessing correlations of brain ce abuse/dependence, history of neurological dise- lesions, neuropsychiatric disorders, and also normal ase, or any psychotropic medication were excluded.
The Turkish sample mean scores on the Reward The availability of Turkish version of TCI will pro- Dependence and Persistence scales were significantly vide significant data for a better understanding of the lower than that for the US sample, whereas mean sco- temperament and character scales in both healthy res on most subscales of the Harm Avoidance scale and psychiatric population in Turkey and will also were significantly higher. Turkish sample mean sco- provide cross cultural data to compare the differen- res were significantly lower than the US sample on ces between Turkish and Western societies on perso- most subscales of the Cooperativeness scale, but we- re higher on most subscales of the Self-transcendencescale. Paired sample t test revealed a statistically signi- REFERENCES
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Cloninger CR (1991) Brain network underlying personality CONCLUSIONS
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ger CR (2002) Reliability and Validity of the Turkish Svrakic DM, Przybeck TR, Cloninger CR (1993) Differenti- Version of the Temperament and Character Inventory al Diagnosis of Personality Disorder by the Seven-factor (TCI). 38th National Psychiatry Congress, October 22- Model of Temperament and Character. Arch Gen Kose S, Kalelioglu U, Sayar K, Reeves RA, Cloninger CR Tancer ME, Ranc J, Golden RN (1994-95) Pharmacological (2002) Temperament and Character Inventory (TCI) as challenge test of the Tridimensional Personality Ques- a Predictor of Depression and Anxiety in Turkish Colle- tionnaire in patients with social phobia and normal vo- ge Students. 38th National Psychiatry Congress, Octo- Waller DA, Gullion CM, Petty F, Hardy BW, Murdock MV, Menza MA, Mark MH (1994) Parkinson’s disease and dep- Rush AJ (1993) Tridimensional Personality Questionna- ression: the relationship to disability and personality. J ire and serotonin in bulimia nervosa. Psychiatry Res; Neuropsychiatry Clin Neurosci; 6: 165-169.
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lescent substance use: an application of Cloninger’s Perna G, Bernarderschi L, Caldirola D, Garberi A (1992) S Y M P O S I U

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