Validating affective temperaments in their subaffective and socially positive attributes: psychometric, clinical and familial data from a French national study.
ABSTRACT One of the major objectives of the French National EPIDEP Study was to show the feasibility of systematic assessment of bipolar II (BP-II) disorder and beyond. In this report we focus on the utility of the affective temperament scales (ATS) in delineating this spectrum in its clinical as well as socially desirable expressions.
Forty-two psychiatrists working in 15 sites in four regions of France made semi-structured diagnoses based on DSM IV criteria in a sample of 452 consecutive major depressive episode (MDE) patients (from which bipolar I had been removed). At least 1 month after entry into the study (when the acute depressive phase had abated), they assessed affective temperaments by using a French version of the precursor of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS). Principal component analyses (PCA) were conducted on hyperthymic (HYP-T), depressive (DEP-T) and cyclothymic (CYC-T) temperament subscales as assessed by clinicians, and on a self-rated cyclothymic temperament (CYC-TSR). Scores on each of the temperament subscales were compared in unipolar (UP) major depressive disorder versus BP-II patients, and in the entire sample subdivided on the basis of family history of bipolarity.
PCAs showed the presence of a global major factor for each clinician-rated subscale with respective eigenvalues of the correlation matrices as follows: 7.1 for HYP-T, 6.0 for DEP-T, and 4.7 for CYC-T. Likewise, on the self-rated CYC-TSR, the PCA revealed one global factor (with an eigenvalue of 6.6). Each of these factors represented a melange of both affect-laden and adaptive traits. The scores obtained on clinician and self-ratings of CYC-T were highly correlated (r=0.71). The scores of HYP-T and CYC-T were significantly higher in the BP-II group, and DEP-T in the UP group (P<0.001). Finally, CYC-T scores were significantly higher in patients with a family history of bipolarity.
These data uphold the validity of the affective temperaments under investigation in terms of face, construct, clinical and family history validity. Despite uniformity of depressive severity at entry into the EPIDEP study, significant differences on ATS assessment were observed between UP and BP-II patients in this large national cohort. Self-rating of cyclothymia proved reliable. Adding the affective temperaments-in particular, the cyclothymic-to conventional assessment methods of depression, a more enriched portrait of mood disorders emerges. More provocatively, our data reveal socially positive traits in clinically recovering patients with mood disorders.
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ABSTRACT: Background As the result of extensive translational and cross-disciplinary research, attachment theory is now a construct with significant neuropsychiatric traction. The correlation of attachment with other influential conceptual models (i.e. temperament and personality) is therefore of interest. Consequently, we explored how two attachment dimensions (attachment anxiety and attachment avoidance) correlated with measures of temperament and personality in 357 psychiatric outpatients. Methods We performed a retrospective review of four questionnaires (the Experiences in Close Relationship scale (ECR-R), Temperament and Character inventory (TCI), Temperament Evaluation of the Memphis, Pisa, Paris and San Diego questionnaire (TEMPS-A), and Personality Self-Portrait Questionnaire (PSQ)). Frequency measures and correlations were examined, as was the predictive value of attachment security for a personality disorder (PD). Results Significant, robust correlations were found between attachment anxiety and (1) several negative affective temperaments (dysthymic and cyclothymic); (2) several indices of personality pathology (low self-directedness (TCI), DSM-IV paranoid, borderline, histrionic, avoidant and dependent personality traits). Attachment avoidance had fewer large correlations. In an exploratory model, the negative predictive value of attachment security for a PD was 86%. Limitations Subjects were a relatively homogeneous subset of ambulatory psychiatric outpatients. PD diagnoses were via self-report. Conclusions Clinically, these findings highlight the significant overlap between attachment, affective temperament, and personality and support the value of attachment as a screen for PDs. More broadly, given our growing understanding of the neurobiology of attachment (i.e. links with the oxytocin system), these results raise interesting questions about underlying biological systems and psychiatric treatment.Journal of Affective Disorders 12/2013; 151(3):932–941. DOI:10.1016/j.jad.2013.07.040
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ABSTRACT: BACKGROUND: Several complex mechanisms including biological, psychological and social factors may contribute to the development of bodily symptoms. Affective temperaments may represent heritable subclinical manifestations of mood disorders, and the concept of ego defense mechanisms has also provided a model for the comprehension of psychopathology. The relationship between affective temperaments, defensive functioning and somatic symptom severity remains unknown. METHODS: We obtained data from a subsample of the Brazilian Internet Study on Temperament and Psychopathology (BRAINSTEP). Participants completed the Affective and Emotional Temperament Composite Scale (AFECTS), the Defense Style Questionnaire (DSQ-40) and the Symptom Checklist-90-Revised (SCL-90-R). SCL-90-R Somatization scale was used as outcome variable. RESULTS: Among 9937 participants (4472 male; 45%), individuals with dysphoric, cyclothymic and depressive temperaments and those who adopted displacement, somatisation and passive aggression as their predominant defense mechanisms presented high somatic symptom severity. Participants with dysphoric temperament and those with higher displacement scores were more likely to endorse numerous bodily symptoms after controlling for age, gender, education and depressive symptoms. Moderator analysis showed that the relationship of dysphoric temperament with somatic symptom severity was much more powerful in people who adopted displacement as their predominant defense. LIMITATIONS: The data was collected from a convenience web-based sample. The study was cross-sectional. There was no information on the presence of established physical illness. CONCLUSIONS: Affective temperaments and defense mechanisms are associated with somatic symptom severity independently of depressive symptoms. These two personality theories provide distinct but interacting views for comprehension of somatic symptom formation.Journal of Affective Disorders 05/2013; DOI:10.1016/j.jad.2013.04.043
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ABSTRACT: Several measures have been proposed to evaluate temperament traits and their connection to psychopathology. One recent development in this area is the TEMPS-A (Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto-questionnaire). The purpose of this study is to psychometrically validate the Lebanese-Arabic version of TEMPS-A. The TEMPS-A was adapted to Lebanese-Arabic and administered to 1320 Lebanese (593 males, 727 females, mean age of 43+/-16 years) representing the adult population of Lebanon (total population: 4.2 million). This section was added by the Institute for Development Research and Applied Care (IDRAC) to the cross-national World Mental Health (WMH) initiative Lebanese chapter. Chronbach-alpha and Pearson's correlation were used to test the internal consistency and correlation among the subscales. Factor loadings were calculated using the principal component analysis with varimax rotation. Internal consistency varied between 0.66 (depressive) and 0.88 (anxious). As formulated by the originators of the instrument, five main factors emerged from the factor analysis, with some overlap between the depressive, the cyclothymic and the anxious temperaments, but almost none for the hyperthymic and irritable temperaments. The strongest correlation was observed between the anxious and the cyclothymic temperament subscales. Women had higher mean scores on the depressive, cyclothymic, and anxious subscales, whereas men scored higher on the hyperthymic subscale. There was a trend of increase by age in scores of the depressive subscale, and a trend of decrease in the cyclothymic and irritable subscales. The Lebanese-Arabic TEMPS-A has a good internal consistency, is easy to use, and opens new and interesting research avenues in large epidemiologic national studies on temperament.Journal of Affective Disorders 09/2005; 87(2-3):169-83. DOI:10.1016/j.jad.2005.02.010