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WCPCG-2011

Pattern of temperament and character factors in hospitalized patients

with Borderline Personality Disorder
Maryam Atefia, Behrooz Dolatshahia*, Abbas PourShahbaza, Mohammad Reza Khodaieb
a

University of Social Walfare and Rehabilitaion Science, Depatment of clinical psychology, Tehran,3834198571 ,Iran
b
University of Social Walfare and Rehabilitaion Science,Depatment of psychiatry, Tehran, 3834198571 ,Iran

Abstract

The aim of this study is to investigate Temperament and Character Inventory (TCI-125) profiles in hospitalized
patients with borderline personality disorder. BPD patients (29) were assessed using the SCID-II and were compared
with healthy control group (30). Patients scores on self-directedness and cooperativeness were significantly lower
compared with controls. Individuals with BPD exhibited statistically significant higher scores on harm avoidance
and novelty seeking. BPD participants did not differ from the control group in terms of reward dependency,
persistence and self-transcendence. The results indicate that personality profiles of patients with BPD are
significantly different from those of healthy individuals.
Keywords: TCI-125; temperament; character; Cloningers theory; borderline personality disorder (BPD)

1. Introduction
Borderline personality disorder (BPD) is a complex and serious mental disorder. Among all patients diagnosed
with a cluster B personality disorder, patients with BPD experienced the greatest suffering. It is the most common
personality disorder in clinical settings, estimated to be present in 10% of all psychiatric outpatients and 15%-30%
of inpatients (Torgersen, 2001; Skodol et al. 2002). Of individuals with a personality disorder, 30% to 60% are
diagnosed with BPD (APA, 2000). The prevalence of BPD among general population is roughly 1%-2% (Cloninger
et Svarkic, 2005).
Although BPD is one of the most widely researched and written about, it is still a major concern for clinician and
yet one of the most controversial diagnosis. These diagnostic dilemmas are rooted in the origin of this concept in
one hand, and the descriptive criteria in fourth edition of Diagnostic and Statistical Manual of Mental Disorder
(DSM-IV) in the other hand.
According to DSM-IV-TR, BPD is defined as pervasive pattern of instability in interpersonal relationship, selfimage, impulse control, interpersonal relationships and affects. Since five criteria from nine bring the diagnosis,
there are 154 conditions that make this diagnosis. This makes the heterogeneity and high rate of co-morbidity. In
addition, categorical classification doesnt get any hint to aetiology.

* Maryam Atefi. Tel.:+98-21- 221800148.

E-mail address: dolatshahee@yahoo.com.
1877-0428 2011 Published by Elsevier Ltd. Open access under CC BY-NC-ND license. Selection and/or peer-review under responsibility of the 2nd
World Conference on Psychology, Counselling and Guidance.
doi:10.1016/j.sbspro.2011.10.113

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To solve these problems, dimensional theories focus on common factors between normal people and personality
disorders. Empirical data suggested that dimensional approach provides more adequate representation of personality
disorder. One of the precise comprehensive theories is Cloningers psychobiological model which described
personality based on four temperaments and three character dimensions. Temperament is a heritable and stable
pattern of stimulus response which is foundation of the personality traits. The four temperament dimensions, being
novelty seeking (NStendency toward exhilaration in response to novel stimuli or cues which represents behavioral
activation), harm avoidance (HA bias in the inhibition or cessation of behavior which reflects behavioral
inhibition), reward dependence (RDtendency to maintain or pursue ongoing behavior that reflects behavioral
maintenance), and persistence (PSperseverance in behavior despite frustration and fatigue) are defined as
genetically homogenous and independently inherited. The character dimensions self-directedness (SD),
cooperativeness (CO), and self-transcendence (ST) are defined as reflecting individual differences in self-concepts
according to the extent of identification with themselves as autonomous individuals, with the humanity and with the
whole universe. Temperament and character inventory (TCI) which is derived from Cloningers psychobiological
theory is a practical and useful means in PD diagnostics in combination with a categorical approach. Personality
disorders have been reported to be a combination of extreme temperament expressions and immature character
(Cloninger et al., 1993; 1994).Whereas the maturity of the character provides an indication of whether an individual
has a PD or not, the temperament configuration determines the type of PDs. The temperament dimension of novelty
seeking, a tendency towards excitement in response to cues of novelty or potential reward, is high in subjects with
cluster B personality disorders (Svrakic et al., 1993; Fossati et al., 2007).
Although, studies have shown that BPD is valid construct in the view of categorical classification, researchers
have suggested that dimensional approach is more applicable for BPD. However, there are not sufficient researches
about BPD utilizing dimensional approach. Regarding the heterogeneity and co-morbidity of this category, more
research is needed to get the exact profile of BPD.
In the current study, we aimed to evaluate differences in TCI personality dimensions between inpatients with BPD
and health subjects, while controlling the confounding variables; also, we measured IQ, general anxiety symptoms
and depression symptoms to examine whether the TCI characteristics were influenced by IQ, depression or anxiety.
2. Methods
2.1 Participants
Twenty-nine patients with BPD were enrolled to our study from patients who were admitted at the psychiatric
inpatients service of Psychiatric hospital Rouzbeh and Psychiatric Hospital Razi from January 2010 to October
2010. Participants were diagnosed with BPD based on the Structured Clinical Interview for DSM-IV Axis II
Personality Disorders (SCID-II; First et al., 1996). The minimum IQ for admission was 85 and at least 8 grades
education was required. Control group was consisted of thirty healthy individuals without past and present Axis-I
and Axis-II disorders. All subjects had to be between age 20 and 35. General exclusion criteria were neurological
disorders, serious medical illness, active substance abuse, head injury with loss of consciousness, active psychotic
symptoms and lifetime psychotic disorders. Patients who reported receiving a history of Electroconvulsive Therapy
during the previous 90 days were excluded as well.
All patients were undergoing pharmacotherapy for BPD at the time of testing. Most patients qualified for other
Axis I disorders: Obsessive-Compulsive Disorder (10.34%), Bipolar Disorder (41.38%), Bipolar-Mood Disorder
(34.48%), Major Depressive Disorder (17.24%), Attention-Deficit Hyper Activity (10.34%); Anxiety Disorders
(80.3%), major depressive disorder (77.8%); about 58.7% of patients were diagnosed with an Axis II disorder other
than BPD.
2.2 Procedure
Patients were referred by their psychiatrist if they had BPD criteria. All patients completed the questionnaire of
SCID-II just after 14 days after being admitted at hospital. BPD and other PDs diagnosis were made by a psychiatric
and trained clinical psychologist using SCID-II. Thirty patients were considered for the project. One patient who
refused to take part in the study was excluded. The healthy control group was recruited by local advertisement. They

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were screened clinically for PD by SCID II.

To assess Axis I disorders, SCID I was administered. Patients were allowed to have comorbid personality
disorders and/or axis I disorders except substance abuse disorder or psychotic disorders. Non-patient could not have
psychological complaints and could not have any lifetime or present axis I or axis II.
All subjects provided written informed consent after the procedures were clearly explained to them. Subjects
were assessed by the Ravan Intelligence task to estimate IQ level. All participants fulfilled the demographic
questionnaire, temperament-character inventory-125 (TCI-125), Beck depression inventory (BDI) and (Beck anxiety
inventory (BAI).
2.3 Instruments
2.3.1 Temperament Character Inventory
Personality was assessed using the Persian version of Temperament and Character Inventory-125 (TCI-125)
(Cloninger et al.1993, 1994). The TCI is a self-report, paper-pencil and true/false test and can be completed by
persons over the age of 15. This inventory evaluates seven higher-order temperament (NS, HA, RD, P) and character
(SD, C, ST) dimensions. Some psychometric properties of the Persian version of the TCI-125 in normal Iranian
community have been described by Kaviani et al. (2007). They reported that the Persian version of inventory has a
reliable factor structure and testretest properties.
2.3.2 Beck Inventory Depression
Depressive symptoms were assessed using the Persian version of the Beck Depression Inventory (BDI) (Gharai
et al, 2002). The inventory consists of 21 items scored on a four-point scale (03). The items include cognitive,
affective, somatic, and vegetative aspects of depression. A total score is determined by aggregating the item
responses. The BDI has demonstrated good test-retest reliability (r=0.73) and Chronbachs alpha (0.78) in Iranian
normal population (N=125, M=9.79, SD=7.96).
2.3.3 Beck Anxiety Inventory
The current level of anxiety was assessed using the state scale of the Persian version of the Beck Anxiety
Inventory (BAI). This scale is a well-validated, 21-item questionnaire addressing the somatic, emotional and
cognitive aspects of anxiety targeted to the individuals present feelings. Subjects rate their feelings on a four-point
intensity scale. A total score is determined by aggregating the item responses. The BDI has demonstrated good testretest reliability (r=0.91) and Chronbachs alpha (0.92) in Iranian normal population.
2.3.4 Structured Clinical Interview for DSM-IV Axis II Personality Disorder
Axis II disorders were assessed using the Structured Clinical Interview for DSM-IV Personality Disorders
(SCID-II; First et al., 1997). The SCID-II is an efficient, user-friendly instrument that helps researchers and
clinicians to make standardized, reliable, and accurate diagnoses of the DSM-IV PDs. It consists of a 120-item
questionnaire to be completed by the participant, followed by an interview.
2.3.5 Structured Clinical Interview for DSM-IV
The Persian Structured Clinical Interview for DSM-IV Axis I disorders was administered to assess Axis I
disorders. Kappa coefficient of Persian version of SCID-I was reported 0.6.
2.3.6 Intelligence
Raven's Progressive Matrices (often referred to simply as Raven's Matrices) are multiple choice intelligence tests
of abstract reasoning, (Raven, 1936). In each test item, the subject is asked to identify the missing item that
completes a pattern. The booklet comprises five sets (A to E) of 12 items each, with items within a set becoming

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increasingly difficult, requiring ever greater cognitive capacity to encode and analyze information. It assesses the
ability to think clearly and make sense of complexity, which is known as eductive ability.
2.4. Statistical analysis
SPSS for Windows 14.0 version (SPSS Inc, Chicago, IL) was performed for all statistical analyses in this study.
Two tailed p values less than 0.05 and a confidence interval of 95% was considered statistically significant for all
analyses. T-tests for continuous variables and 2 for categorical variables were used for a comparison of socio
demographic characteristics of two groups. Patients scores on seven dimensions of TCI-125 were compared with
controls by using t test for independent samples. A univariate analysis of covariance was then carried out to examine
the difference between borderline patients and healthy subjects on the dimensions of TCI-125, co-varying for the
effects of depression (scores on BDI), anxiety (scores on BAI) and intelligence (scores on Ravan).
3. Results
3.1. Demographic features
A total of 29 patients with BPD (18 women and 11 men) and 30 healthy controls (19 women and 11 men)
completed the study (2 =0.10, df=1, p=0.92). The mean age of patients was (24.48 1.94 years) lower than control
group (28.20 1.65) (t=-2.81, P <0.05). Also, two groups differed significantly on education and IQ. Control
subjects were more highly educated than patients (means 11.79 years vs. means 14.30 years, p=0.00).
3.2. Depression, anxiety and IQ
We compared the results between BPD and control group for the BAI and the BDI. BPD patients obtained
significantly higher scores than healthy controls across BAI and BDI (t= 4.34, df=41.74, p=0.00 ; t=5.95, df=41.90,
p=0.00). Patients, however, had lower scores on IQ scale (100.45 means vs.115.83 means, p=0.00).
3.3 Temperament and character personality dimensions
TCI-R results for the BPD and control group are presented in Table 1. Patients scored significantly higher than
healthy controls in temperament dimensions including novelty seeking (NS) and harm avoidance (HA). As for the
other temperament dimensions, reward dependence (RD) and persistence (P) the mean scores for both groups were
within the normal-range (Kaviani, 2002) and the mean difference was not statistically different, meaning that this
temperament dimension does not appear to be appreciably altered in BPD patients.
For Character dimensions, the significant difference was observed at self-directedness (SD) and cooperation
(CO), both of which were lower for BPD patients than controls. There was no significant difference between groups
with regard to self-transcendence (ST).
Table 1. Comparison of TCI dimensions in 29 patients and 30 controls
BPD

Control

Mean (SD)

Mean (SD)

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Novelty seeking (NS)

6.62 (3.63)

4.73 (1.9)

0.01

Harm avoidance (HA)

5.38 (2.15)

3.03 (2.4)

0.00

Reward dependence (RD)

3.48 (1.50)

3.17 (1.46)

0.41

Persistence (P)

2.14 (1.20)

2.53 (1.36)

0.22

Self-directedness

1.45 (1.10)

2.43 (0.86)

0.00

Cooperativeness

6.60 (3.96)

9.63 (1.81)

0.00

Self-transcendence

5.93 (3.95)

7.23 (4.12)

0.22

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3.4 The confront variables on TCI

The personality profiles of patients were compared with controls by means of an ANCOVA and using IQ,
anxiety and depression as covariates. There were no significant relationships between the TCI dimensions and
anxiety (table 3) , depression (table 4) and IQ (table 5) factors. It means that the significant difference between
patients and normal individual is not due to the influence of depression, anxiety and IQ.
Table 2. Analyses of covariance with covariates depression (BDI scores) comparing patients and controls
F(df=1)

Novelty seeking (NS)

0.155

0.70

Harm avoidance(HA)

2.856

0.10

Self-directedness(SD)

0.419

0.52

Cooperativeness (CO)

0.990

0.32

Table 3. Analyses of covariance with covariates anxiety (BAI scores) comparing patients and controls
F(df=1)

Novelty seeking (NS)

1.681

0.20

Harm avoidance

0.032

0.859

Self-directedness(SD)

0.771

0.384

Cooperativeness (CO)

1.90

0.173

Table 3. Analyses of covariance with covariates IQ comparing patients and controls

F(df=1)

Novelty seeking (NS)

2.677

0.177

Harm avoidance

0.217

0.463

Self-directedness(SD)

0.146

0.703

Cooperativeness (CO)

1.120

0.295

4. Discussion
The primary purpose of the present study was to find temperament and character dimensions of BPD patients
compared to healthy subjects. The main finding of this study are generally consistent with previous findings,
(Barnow et al., 2005, Joyce et al., 2003 and Pukrop, 2002) that among the temperament dimensions, patients with

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BPD had significantly elevated NS score and HA score, compared to psychiatrically healthy individuals. The
combination of these extreme traits could be an indicator of a biological predisposition towards a behavioural
disturbance and be related to the highly conflictive approach-avoidance patterns of behaviour in borderline
pathology.
Also, BPD patients exhibit low traits character dimensions of self-directedness and cooperativeness and is
keeping with previous studies (Barnow et al., 2005, Joyce et al., 2003 and Svrakic et al., 2002) which is in line with
Cloninger et al (1993). In self-directedness, related to individuals maturity and the ability of behavioural control
(Cloninger et al., 1993), BPD patients scores on this character dimension were extremely low, indicating
chronically low self-esteem, lack of long-term goals and difficulties in accepting responsibility, which is more
consistent with BPD pathology. In addition, low scores on cooperativeness shows the deficit in relating to others.
Low SD and CO are substantial and common constituents of PDs corresponds with the suggestion of Fonagy et
al (2008) that individuals with a PD are characterized by an impaired mentalizing capacity implying an impaired
ability to make sense of their own mental states and that of others, causing problematic interpersonal relationships
and impairments in the development of the self.
Our results regarding with confront variables are not consistent with previous studies (Hirano et al., 2002;
Conrad et al., 2007) which have shown that depression and anxiety influence the personality profiles. This lack of
replication might be due to the limited sample sizes used in this study.
The interpretation of the results of our study is restricted because of several methodological limitations. The first
is the small sample size, which is, however, comparable to samples reported previously in BPD studies (Kunert et
al., 2003, Lampe et al., 2007 and Lenzenweger et al.,2004). A second limitation is that it was not possible to address
possible gender differences; future studies should explore possible gender differences in impulsivity in BPD.
Another limitation would be that we did not exclude BPD subjects with current psychotropic treatment at the time of
assessment. However, due to the severity inherent to this disorder, hardly a BPD patient is medication-free that is the
reason why the majority of studies in BPD do not exclude patients under medication. Nevertheless, we cannot rule
out the possibility that personality dimensions might be influenced by this effect. Another limitation is that we did
not attend to differences in comorbidity in BPD patients because any samples which are limited to patients with a
sole BPD diagnosis of BPD is not considered as representative of BPD as it is diagnosed in clinical population. A
clinical comparison group, which should be included in futures studies in order to define the specificity of our
findings. Finally, it is worth noting that there was a significant age difference and years of education between both
groups, however, we did not control the effect of age and years of education to overcome this limitation of the study.
Our results support previous findings suggesting the Cloningers psychobiological model as a useful model to
describe the dimensional personality profile in BPD patients, characterized by high scores on temperament
dimensions of novelty seeking and harm avoidance, and low character dimensions of self-directedness and
cooperativeness.
Acknowledgements
We appreciate the great help of Dr. Salavati to bring us the opportunity of doing this study at Rouzbeh Hospital.
References
American Psychiatric Association. (2000). Diagnostic and statistic manual for mental disorders, 4th edition, text revision. Washington, DC:
American Psychiatric Press
Barnow, S. , Ruge, J. , Spitzer, C. , et al. (2005). Temperament and character in persons with borderline personality disorder. [Temperament
und Charakter bei Personen mit Borderline -Personlichkeitsstorung], Der Nervenarzt, 76 83940, 8424, 8468
Cloninger, C. R. (1986). A unified biosocial theory of personality and its role in the development of anxiety states. Psychiatric Development,
4, 167226
Cloninger, C.R., Svrakic, D. M., Przybeck, T. (1993). A psychobiological model of temperament and character. Arch Gen Psychiatry, 50,97590
Cloninger. C.R., Przybeck, T., Svrakic, D.M., Wetzel, R.D.(1994). The Temperament and Character Inventory (TCI): a guide to its
development and use. St Louis (Mo): Center for Psychobiology of Personality
Cloninger, C. R., & Svrakic, D. M. (2005). Personality disorders. In Sadock, B. J., Sadock, V. A. (Eds.) Comprehensive textbook of
psychiatry, Page: 2063-2105, Lippincott Williams & Wilkins
Conrad, C., Schilling, G., Bauscha, C., Nadstawek, J., Wartenberg, H. C., Wegener, I., Geisera, F., Imbierowicz, K., Liedtke, R. (2007).
Temperament and character personality profiles and personality disorders in chronic pain patients. Pain, 133, 197209
First, M. B., Spitzer, R. L.,Gibbon, M., et al.(1997). Structured clinical interview for DSM-IV Axis II personality disorders. Washington, DC:

Maryam
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et al.Procedia
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andBehavioral
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Social

American Psychiatric Association

Fonagy, P., Gergely, G., Jurist, E. L., Target, M. (2008). Affect regulation, mentalization, and the development of the self. New York: Other
press
Fossati, A., Cloninger, C. R., Villa, D., et al. (2007). Reliability and validity of the Italian version of the Temperament and Character
Inventory-Revised in an outpatient sample. Comprehensive Psychiatry, 48, 380387
Gharai,B. (2002). Determining identity styles and its relationship with depression in adolescents in Tehran. Doctoral Dissertation, Iran
University
Hirano, S., Sato, T., Narita, T., Kusunoki, K., Ozaki, N., Kimura, S., et al.(2002). Evaluating the state dependency of the temperament and
character inventory dimensions in patients with major depression: a methodological contribution. Journal of Affective Disorders, 69,
318
Joyce, P. R., McKenzie, J. M., Luty, S. E., et al. (2003). Temperament, childhood environment and psychopathology as risk factors for
avoidant and borderline personality disorders, The Australian and New Zealand Journal of Psychiatry, 37, 756764
Kaviani,H., Poor Naseh,M. (2007). Validation and normative data of the temperament and character inventory in Iranian population, Journal
of Tehran Medical university, 63, 89-98
Kunert, H. J., Druecke, H.W., Sass, H., et al. (2003). Frontal lobe dysfunctions in borderline personality disorder: Neuropsychological
findings, Journal of Personality Disorders, 17, 497509
Lampe, K., Konrad, S., Kroener, K., et al.(2007). Neuropsychological and behavioural disinhibition in adult ADHD compared to borderline
personality disorder, Psychological Medicine, 113
Lenzenweger, M.F., Clarkin, J.F., Fertuck, E.A. and Kernberg, O.F. (2004). Executive neurocognitive functioning and neurobehavioral
systems indicators in borderline personality disorder: A preliminary study, Journal of Personality Disorders, 18, 421438
Pukrop, R. (2002). Dimensional personality profiles of borderline personality disorder in comparison with other personality disorders and
healthy controls, Journal of Personality Disorders. 16, 135147
Svrakic, D. M., Deaganic, S., Hill, K., Bayon, C., Cloninger, C. R. (2002). Temperament, character and personality disorders: etiologic,
diagnostic, treatment issues. Acta psychiatrica Scandinavia, 106,182-195
Svrakic, D. M., Whitehead, C., Przybeck, T. R., & Cloninger, C. R. (1993). Differential diagnosis of personality disorder by the seven-factor
model of temperament and character. Archives of General Psychiatry, 50, 991-999
Torgersen, S., Kringlen, E., Cramer, V. (2001).The prevalence of borderline personality disorder in a community sample. Archives of General
Psychiatry, 58, 590-596

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