Temperament and Character in Psychosomatic Disorders

Abstract

Personality plays an important role in the etiology of psychosomatic disorders. The studies investigating personality features with Temperament and Character Inventory according to psychobiological model is considered to have a major role in understanding the relationship between personality and psychosomatic disorders. We have done a database search in Pubmed and Turk Psikiyatri Dizini (Turkish Psychiatry Directory) for the time period between 1991 and 2009 to determine and evaluate the articles conducted among somatization, dermatologic illness, headache, physical medicine, angina, irritable bowel syndrome and asthma patients using Temperament and Character Inventory. The most significant consistent result of these studies was elevated harm avoidance scores. Harm avoidance scores still remain high even after controlling for the effect of depression and anxiety. Thus this temperament dimension is possibly an important state and trait feature for development of psychosomatic illnesses. These findings also confirmed that serotonergic systems get involved in the process of psychosomatic organization. In many studies, the mean scores of self direction sub-dimension of Temperament and Character Inventory which has been considered as fundamental dimension to achieve mature personality, was found to be lower in psychosomatic patient groups than normal healthy control. Overall the research studies support the notion that course of the diseases clearly affect the personality features among these patients. Detailed evaluation of temperament and character profiles of psychosomatic patients would contribute much into understanding the etiology of these disorders.

Keywords

• Psychosomatic disorders, somatization, temperament and character

Psikosomatik Hastalıklarda Mizaç ve Karakter

Öz

Psikosomatik hastalıkların etiyolojisinde kişiliğin önemli bir rol oynadığı düşünülmektedir. Bu ilişkinin anlaşılabilmesi için kişiliği psikobiyolojik modele göre değerlendirme olanağı veren Mizaç ve Karakter Envanteri ile yapılan çalışmaların önemli katkılar sağlayabileceği öne sürülmüştür. Bu konudaki literatürü irdelemek amaçla 1991–2009 yılları arasında Mizaç ve Karakter Envanteri ile yapılmış tüm çalışmalar Medline (Pubmed) ve Türk Psikiyatri Dizini veritabanlarında taranmış ve somatizasyon, dermatolojik hastalıklar, baş ağrısı, fiziksel tıp, göğüs ağrısı, irritabl barsak sendromu, astımlı hastalarda yapılmış çalışmalar incelenmiştir. Çalışmaların sonuçlarına bakıldığında en önemli ortak sonuç zarardan kaçınma puanlarının yüksek bulunmasıdır. Depresyon ve anksiyetenin etkisi kontrol edildiğinde de zarardan kaçınma puanlarının halen yüksek olması bu mizaç boyutunun psikosomatik hastalıkların gelişimi için hem durumsal hem de süreklilik gösteren bir özellik taşıdığını ve serotonerjik sistemin bu sürece katıldığını doğrulamaktadır. Kişiliğin bir olgunluk düzeyine erişmesinde temel unsur kabul edilen kendine yetmenin birçok çalışmada normal sağlıklı kontrollerden düşük düzeyde bulunması, bu hastalarda sürecin kişiliği etkilediğini düşündürmektedir. Psikosomatik hastalıklarda mizaç ve karakter özelliklerinin ayrıntılı değerlendirilmesi etiyolojik açıdan bu hastalıkların daha iyi anlaşılmasına katkıda bulunacaktır

Anahtar Kelimeler

• Psikosomatik hastalık, somatizasyon, mizaç ve karakter

Kaynakça

1. Ferrari S, Galeazzi GM, Mackinnon A, Rigatelli M. Frequent attenders in primary care: impact of medical, psychiatric and psychosomatic diagnoses. Psychother Psychosom 2008; 77:306–314.
2. Koptagel-İlal G. Psikosomatik: Psikonevroz Psikosomatik Psikoterapi, AB Ofset, Ankara, s.72–114.
3. Smulevich AB, Syrkin AL, Kozyrev VN, Drovizhev MIu, Ibanov S, Zelenina EV et al. Psychosomatic disorders clinical picture, epidemiology, therapy and models of health services. Zh Nevrol Psikhiatr Im S S Korsakova. 1999; 99:4–16.
4. Stoudemire A. Tıbbi sorunları etkileyen psikolojik faktörler Özet: Tıbbi sorunları etkileyen psikolojik faktörler, Ed. Stoudemire A. Compos Mentis Yayınları, Ankara, 1997. s.179–183.
5. Stoudemire A, Hales RE. Tıbbi sorunları etkileyen psikolojik etkenler ve DSM-IV Genel bir bakış: Tıbbi sorunları etkileyen psikolojik faktörler, Ed. Stoudemire A. Compos Mentis Yayınları, Ankara, 1997. s.1–15.
6. Kose S, Sayar K, Kalelioglu U, Aydın N, Celikel FC, Güleç H et al. Normative data and factorial structure of the Turkish version of the Temperament and Character Inventory (TCI). Compr Psychiatry 2009; 50:361–368.
7. Cloninger CR. A systematic method for clinical description and classification of personality variants. A proposal. Arch Gen Psychiatry 1987; 44: 573–588.
8. Cloninger CR, Svrakic DM, Przybeck TR. A psychobiological model of temperament and character. Arch Gen Psychiatry 1993; 50: 975–989.

9. Cloninger CR, Przybeck TR, Svrakic DM, Wetzel RD. The Temperament and Character Inventory (TCI): a guide to its development and use. Washington University, St. Louis: Center for Psychobiology of Personality, 1994.
10. Cloninger CR. The genetics and psychobiology of the seven factor model of personality. The biology of personality disorders. American Psychiatric Press: Washington: DC 1998; 63–84.
11. Peirson AR, Heuchert JW, Thomala L, Berk M, Plein H, Cloninger CR. Relationship between serotonin and the temperament and character inventory. Psychiatry Res 1999; 13:29–37.
12. Allgulander C, Cloninger CR, Przybeck TR, Brandt L. Changes on the Temperament and Character Inventory after paroxetine treatment in volunteers with generalized anxiety disorder. Psychopharmacol Bull 1998; 34:165–166.
13. Tse WS, Bond AJ. Serotonergic involvement in the psychosocial dimension of personality. J Psychopharmacol. 2001; 15:195–198.
14. Ampollini P, Marchesi C, Signifredi R, Ghinaglia E, Scardovi F, Codeluppi S, et al. Temperament and personality features in patients with major depression, panic disorder and mixed conditions. J Affect Disord 1999; 52:203–207.
15. Chien AJ, Dunner DL. The Tridimensional Personality Questionnaire in depression: State versus trait issues. J Psychiatr Res 1996; 30:21–27.
16. Hansenne M, Reggers J, Pinto E, Kjiri K, Ajamier A, Ansseau M. Temperament and character inventory (TCI) and depression. J Psychiatr Res 1999; 33:31–36.
17. Marijnissen G, Tuinier S, Sijben AE, Verhoeven WM. The temperament and character inventory in major depression. J Affect Disord 2002; 70:219–223.
18. Richter J, Eisemann M, Richter G. Temperament and character during the course of unipolar depression among inpatients. Eur Arch Psychiatry Clin Neurosci 2000; 250:40–47.
19. Svrakic DM, Draganic S, Hill K, Bayon C, Przybeck TR, Cloninger CR. Temperament, character, and personality disorders: etiologic, diagnostic, treatment issues. Acta Psychiatr Scand 2002; 106:189–195.
20. Russo J, Katon W, Sullivan M, Clark M, Buchwald D. Severity of somatization and its relationship to psychiatric disorders and personality. Psychosomatics. 1994; 35:546–556.
21. Battaglia M, Bertella S, Bajo S, Politi E, Bellodi L. An investigation of the co-occurrence of panic and somatization disorders through temperamental variables. Psychosom Med 1998; 60:726–729.
22. Jiang N, Sato T, Hara T, Takedomi Y, Ozaki I, Yamada S. Correlations between trait anxiety, personality and fatigue: study based on the Temperament and Character Inventory. J Psychosom Res 2003; 55:493– 500.
23. Grabe HJ, Spitzer C, Freyberger HJ. Alexithymia and personality in relation to dimensions of psychopathology. Am J Psychiatry 2004; 161:1299–1301.
24. Karvonen JT, Veijola J, Kantojärvi L, Miettunen J, Ekelund J, Lichtermann D, et al. Temperament profiles and somatization--an epidemiological study of young adult people. J Psychosom Res 2006; 61:841–846.
25. Hakala M, Vahlberg T, Niemi PM, Karlsson H. Brain glucose metabolism and temperament in relation to severe somatization. Psychiatry Clin Neurosci 2006; 60:669–675.
26. Güler Ö, Emül M, Özbulut Ö, Geçici Ö, Kulaç M, Karaca S. A temperament and character profile in patients with psoriasis, vitiligo and neurodermatitis. NöroPsikiyatri Arşivi 2007; 44:139–144.
27. Kılıç A, Güleç YM, Gül Ü, Güleç H. Temperament and character profile of patients with psoriasis. J Eur Acad Dermatol Venerol 2008; 22:537–542.
28. Kim TS, Pae CU, Jeong JT, Kim SD, Chung KI, Lee C. Temperament and character dimensions in patients with atopic dermatitis. J Dermatol 2006; 33:10–15.
29. Boz C, Sayar K, Velioğlu S, Hocaoğlu Ç, Alioğlu Z, Yalman B ve ark. Kronik gerilim tipi baş ağrılı hastalarda mizaç ve karakter profili. Türk Psikiyatri Derg 2004; 15:105–111.
30. Di Piero V, Bruti G, Venturi P, Talamonti F, Biondi M, Di Legge S et al. Aminergic tone correlates of migraine and tension-type headache: a study using the tridimensional personality questionnaire. Headache 2001; 41:63– 71.
31. Boz C, Velioglu S, Ozmenoglu M, Sayar K, Alioglu Z, Yalman B et al. Temperament and character profiles of patients with tension-type headache and migraine. Psychiatry Clin Neurosci 2004; 58:536–543.
32. Nylander PO, Schlette P, Brändström S, Nilsson M, Forsgren T, Forsgren L et al. Migraine: temperament and character. Psychiatr Res 1996; 30:359– 368.
33. Mongini F, Fassino S, Rota E, Deregibus A, Levi M, Monticone D et al. The temperament and character inventory in women with migraine. J Headache Pain 2005; 6:247–249.
34. Abbate-Daga G, Fassino S, Lo Giudice R, Rainero I, Gramaglia C, Marech L, et al. Anger, depression and personality dimensions in patients with migraine without aura. Psychother Psychosom 2007; 76:122–128.
35. Sánchez-Román S, Téllez-Zenteno JF, Zermeño-Phols F, García-Ramos G, Velázquez A, Derry P et al. Personality in patients with migraine evaluated with the "Temperament and Character Inventory". J Headache Pain 2007; 8:94–104.
36. Malmgren-Olsson EB, Bergdahl J. Temperament and character personality dimensions in patients with nonspecific musculoskeletal disorders. Clin J Pain 2006; 22:625–631.
37. Conrad R, Schilling G, Bausch C, Nadstawek J, Wartenberg HC, Wegener I, et al. Temperament and character personality profiles and personality disorders in chronic pain patients. Pain 2007; 133:197–209.
38. Van Campen E, Van Den Eede F, Moorkens G, Schotte C, Schacht R, Sabbe BG, et al. Use of the Temperament and Character inventory (TCI) for assessment of personality in chronic fatigue syndrome. Psychosomatics 2009; 50:147–154.
39. Mazza M, Mazza O, Pomponi M, Di Nicola M, Padua L, Vicini M et al. What is the effect of selective serotonin reuptake inhibitors on temperament and character in patients with fibromyalgia? Compr Psychiatry 2009; 50:240–244.
40. Gulec MY, Hocaoglu C, Gokce M, Sayar K. Temperament and character profile in patients with noncardiac chest pain. Neurology, Psychiatry and Brain Research 2008; 15:127–132.
41. Borkowska A, Pulkowska J, Pulkowski G, Rybakowski F. Association of temperament, character and depressive symptoms with clinical features of the ischaemic heart disease. Wiad Lek 2007; 60:209–214.
42. Taymur İ, Özen NE, Boratav C, Güliter S. İrritabl barsak sendromlu hasta- ların aleksitimi, mizaç, karakter özellikleri ve psikiyatrik tanı açısından değerlendirilmesi. Klinik Psikofarmakoloji Bülteni 2007; 17:186–194.
43. Gulec MY, Gulec H, Oztuna F, Kose S. Cloninger’s Temperament and Char- acter Dimension of personality in patients with asthma. Int J Psychiatry Med 2010; 40:273-287.
44. Cloninger CR. A unified biosocial theory of personality and its role in the development of anxiety states. Psychiatr Dev 1986; 4:167–226.
45. Svrakic DM, Przybeck TR, Cloninger CR. Differential diagnosis of person- ality disorder by the seven-factor model of temperament and character. Arch Gen Psychiatry 1993; 50: 991–999.
46. Watson DL, Tharp RG. Self–directed behavior: self–modification for personal adjustment. 5 th ed. Pacific Grove, CA: Brooks/Cole Publishing, 1989; 33– 34.
47. Psikiyatride Güncel Yaklaşımlar – Current Approaches in Psychiatry
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