ORIGINAL ARTICLE
Temperament and Character Traits in Patients With Epilepsy
Epileptic Personality
Esra Yazici, MD,* Ahmet Bulent Yazici, MD,Þ Nazan Aydin, MD,þ Asuman Orhan, MD,§
Ismet Kirpinar, MD,|| and Hamit Acemoglu, MD¶
Abstract: Personality and behavioral changes in epilepsy are well documented.
However, neither the quantitative characteristics nor the etiology of these
changes is clear yet. Cloninger has developed a psychobiological personality
model that provides a way to evaluate personality in a dimensional way. This
study examined the relationship between epilepsy and Cloninger’s dimensional
psychobiological personality model. A total of 73 epilepsy outpatients and
79 healthy controls were examined using the Structured Clinical Interview for
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I
Disorders, the Turkish version of the Temperament and Character Inventory, and
an epilepsy questionnaire. Epilepsy patients had higher harm avoidance (HA)
and lower persistence, self-directedness (SD), and cooperativeness scores than
healthy controls did. In epileptic subjects, there was no correlation between age
and duration of epilepsy. Subjects with partial seizures had higher HA scores and
lower SD scores than generalized ones. Comorbid depression was represented
with lower SD scores. In multiple linear regression models, only major depres-
sive disorder predicted lower scores of SD. This study confirms specific per-
sonality changes among epileptics according to Cloninger’s dimensional
personality model and indicates a relationship between the characteristics of
epilepsy and psychiatric comorbidity.
Key Words: Epilepsy, temperament, personality
(J Nerv Ment Dis 2013;201: 365Y370)
P ersonality is the sum of the physical, social, emotional, and mental
properties of individuals (Sadock and Sadock, 2004). Personality
can also be described as the sum of personal understanding, intelli-
gence, decision making, and behavioral characteristics that develop at
a young age through the interaction of nature (occurring at birth),
nurture (obtained by treatment, training, cultivation, etc.), and cultural
(obtained by social and environmental influences) factors and is quite
resistant to alterations. Although there are many personality tests, the
Temperament and Character Inventory (TCI), which was developed by
Cloninger, differs from others because it provides a biological model in
addition to a descriptive model. This model of personality provides a
profile of four dimensions of temperament and three dimensions of
character (Cloninger et al., 1993). In recent studies, the genetic, bio-
logical, and social aspects of these ‘‘temperament and character’’ traits
*Department of Psychiatry, Kocaeli Derince Training and Research Hospital,
Kocaeli; †Department of Psychiatry, Kocaeli Seka State Hospital, Kocaeli;
‡Department of Psychiatry, Faculty of Medicine, Atatürk University, Erzurum;
§Department of Neurology, Selçuklu Faculty of Medicine, Selçuk University,
Konya; ||Department of Psychiatry, Faculty of Medicine, Bezmialem University,
l̇stanbul; and ¶Department of Medical Education, Faculty of Medicine, Atatürk
University, Erzurum, Turkey.
A preliminary form of this study was previously presented as poster presentation in
EPA-2010 in Munich, Germany.
Send reprint requests to Esra Yazici, MD, Kocaeli Derince Research and Education
Hospital, Department of Psychiatry, Kocaeli, Turkey 41000. E-mail:
dresrayazici@yahoo.com.
Copyright * 2013 by Lippincott Williams & Wilkins
ISSN: 0022-3018/13/20105Y0365
DOI: 10.1097/NMD.0b013e31828e0e3d
The Journal of Nervous and Mental Disease & Volume 201, Number 5, May 2013
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
have been studied in detail, and data supporting this model have been
obtained (Cloninger et al., 1993; Kose et al., 2009; Nery et al., 2009).
Some brain disorders can lead to personality impairments that
are related to disease pathology and/or the harmful effects of disease.
One of these is epilepsy, in which we can frequently see personality
disorders. Epilepsy is a common chronic neurological disorder char-
acterized by seizures and can lead to structural and neurochemical
alterations in the brain. In epileptic patients, factors resulting in epi-
lepsy and recurrent seizures and also neurobiological parameters oc-
curring after epilepsy treatment can affect the neural circuits mediating
personality (Brandt et al., 1985). Epileptic personality, which occurs in
patients with epilepsy seizures, has been known for a long time and
has been described with subjective properties such as ‘‘egocentricity
and impulsivity’’ (Bear et al., 1989).
This study aimed to investigate the temperament and character
traits of epilepsy patients through a dimensional and topical approach.
Furthermore, the sociodemographic data related to these traits and their
correlation to the clinical properties of epilepsy have been investigated.
Thus, this study may contribute to the mutual etiology, diagnosis, treat-
ment, and prognosis process of epilepsy and its effects on personality.
METHODS
Patients
This study included epilepsy patients at Atatürk University
Hospital, an epilepsy polyclinic, who agreed to participate in this study
and signed a written consent form. The patients who were not dis-
qualified by the exclusion criteria were consequently selected. Healthy
volunteers, who were matched by age and sex and had no neurologi-
cal or chronic diseases, constituted the control group. A total of 152
people, 73 of them with epilepsy (36 men and 37 women) and 79 in
the control group (43 men and 36 women), were included in this
study. This study was approved by the local ethics committee of Ataturk
University, Faculty of Medicine, and Health Science Institute.
First, a psychiatric interview was performed with both epilepsy
patients and the control group. This interview was conducted using the
Structured Clinical Interview for Diagnostic and Statistical Manual
of Mental Disorders, Fourth Edition (SCID-I). Then, a TCI form and a
survey form including the sociodemographic data and clinical charac-
teristics of the patients were administered. In the epilepsy group, 15- to
65-year-old literate patients with an epilepsy diagnosis for more than
6 months were selected. In accordance to the Diagnostic and Statistical
Manual of Mental Disorders, Fourth Edition (DSM-IV), patients with
certain disorders that would limit their responses to the scales were
disqualified. These included patients with mental retardation, demen-
tia, and others; patients with organic disorders that directly interact
with epilepsy and the patient’s personality (e.g., tumor on frontal lobe);
and patients with alcohol and/or drug addiction. In addition, the fol-
lowing materials were used to obtain data from patients.
Epilepsy Information Form
The form included questions requesting the patient’s sex, age,
marital status, education level, place of residence, age at first epileptic
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Yazici et al. The Journal of Nervous and Mental Disease
seizure, duration of epilepsy disease, frequency and types of epileptic
seizures, presence of aura and seizures while sleeping, relationships,
and the medications being used.
SCID-I: Structured Clinical Interview For
Diagnosis of Axis-I Disorders
Corapcioglu (1999) has confirmed the validity and reliability of
a Turkish translation of the test. The test included a semistructured
diagnostic intervention scale and a DSM-IV diagnosis. It started with a
sociodemographic data guide and covered seven diagnostic groups,
including temperament disorders, psychotic disorders, disorders related
to alcohol and/or drugs, anxiety disorders, somatoform disorders, eat-
ing disorders, and adjustment disorders. Its reliability for serious psy-
chiatric disorders is high. It is being used as standard intervention to
confirm diagnoses in clinical studies (Bostanci et al., 2011).
Temperament and Character Inventory
The TCI form, which includes 240 items, was used to measure
Cloninger’s seven-category personality model. TCI is a self-evaluation
scale that evaluates four temperament and three character components
of personality through ‘‘true’’ or ‘‘false’’ answers. The validity and
reliability of the Turkish translation of the test were confirmed by
Kose et al. (2009). As a result of consistency, validity, and reliability
studies on Turkish TCI scales and subscales, the Cronbach’s alpha
value was determined to be between 0.60 and 0.85 for temperament
and 0.82 and 0.83 for character (Kose et al., 2009). It included results
for the four dimensions of temperament: novelty seeking (NS), harm
avoidance (HA), reward dependence (RD), and persistence (P); and
three dimensions of character: self-directedness (SD), cooperative-
ness (C), and self-transcendence (ST).
Statistical Analyses
We used the Statistical Package for Social Sciences 13.0 for
Windows for all analyses. The chi-square test was used to compare sex,
job, martial status, education level, history of drug use, and psychiatric
analyses of epilepsy and control groups. The mean ages of sexes and
groups, age at first epileptic seizure, frequency of epileptic seizures,
and TCI scores of groups were compared using the Student’s t-test. The
Pearson’s correlation analysis was performed to evaluate the relation-
ship between age and TCI scores. Regression analysis was used to
evaluate whether TCI scores are predictors of temperament and char-
acter traits in the epilepsy process. For all tests, p G 0.05 was accepted
as statistically significant.
FIGURE 1. Comparison of TCI scores of epilepsy and control groups. TCI indicates Temperament and Character Inventory; NS,
novelty seeking; HA, harm avoidance; RD, reward dependence; P, persistence; SD, self-directedness; C, cooperativeness; ST,
self-transcendence. *p G 0.05.
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& Volume 201, Number 5, May 2013
RESULTS
Sociodemographic Data
The educational status of the epilepsy group was lower ( p G 0.05)
than that of the control group. In women, HA scores were higher than
in men.
Comparison of TCI Scores of the Epilepsy
and Control Groups
When the groups were compared for their TCI scores, the HA
score was significantly high, but RD, P, SD, and C scores were sig-
nificantly low in the epilepsy group ( p G 0.05) (Figure 1).
The Distribution of Psychiatric Diagnosis in Epilepsy
and Control Groups
As a result of SCID-I performed on epilepsy and control
patients, the number of patients with major depressive disorder (MDD)
( p = 0.035, W2 = 4.455), social phobia ( p = 0.002, W2 = 9.941), and any
psychiatric diagnosis (epilepsy, n = 27, and control, n = 9; p = 0.000,
W2 = 13.750) was significantly higher in the epilepsy group compared
with the control group.
Relationship Between Psychiatric Diagnosis
and TCI Scores
When we evaluated the patients, MDD predominated in both
groups. When we evaluated the total TCI scores of each group, pa-
tients with an MDD diagnosis had high HA and low SD scores.
Evaluation of TCI-Related Factors With Multiple
Linear Regressions in the Total Group
It was determined that the personality traits of the epilepsy and
control groups may be related to the differences between both inter-
group and intragroup sociodemographic data. In this case, multiple
linear regression models were performed to determine values pre-
dicting TCI scores for all participants (Table 1).
In the model, it was determined that the presence of epilepsy is
an independent predictor for HA, P, SD, and C. In addition, female
sex was a predictor for high HA scores; educational level was a
predictor for high SD and C scores; and the presence of MDD was a
predictor for high HA and low SD scores (Figure 2).
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The Journal of Nervous and Mental Disease & Volume 201, Number 5, May 2013 Temperament in Epilepsy Patients

TABLE 1. Regression Analyses for Predictability of TCI Traits

Group Age Sex Marital Status Educational Level MDD
Novelty seeking t 0.762 j1.639 j0.306 j0.714 0.056 j0.148
p 0.447 0.103 0.760 0.476 0.956 0.883
Harm avoidance t j3.601 0.524 j2.798 0.443 j0.693 3.237
p 0.000 0.601 0.006 0.658 0.490 0.001
Reward dependence t 1.658 1.122 j1.719 j0.715 0.896 j0.504
p 0.099 0.264 0.088 0.476 0.371 0.615
Persistence t 2.478 1.304 0.987 j0.470 0.500 j0.234
p 0.014 0.194 0.325 0.639 0.618 0.815
Self-directedness t 3.762 j0.677 1.524 0.060 3.194 j2.778
p 0.000 0.500 0.130 0.953 0.002 0.006
Cooperativeness t 2.384 1.743 j1.216 j0.449 3.298 j1.407
p 0.018 0.083 0.226 0.654 0.001 0.162
Self-transcendence t j1.673 1.086 j0.280 j0.948 j0.013 0.047
p 0.097 0.279 0.780 0.345 0.990 0.962
Predictors: group, age, sex, marital status, educational level, MDD.
TCI indicates Temperament and Character Inventory; MDD, major depressive disorder.

Evaluation of the Factors Effecting Personality Seizure Type

Traits in the Epilepsy Group
When the TCI scores of the study groups were evaluated
according to sex, HA scores were significantly high in women in the
epilepsy group ( p G 0.05).
Comorbid Psychiatric Diagnoses
When we evaluated the groups for distribution of psychiatric
diagnoses, we determined that MDD and social phobia diagnoses
were significantly high in the epilepsy group.
Relation of Depression With TCI Scores in the
Epilepsy Group
In the epilepsy group, when the TCI scores of the patients with
(n = 14) and without (n = 59) MDD diagnosis were compared, it was
determined that SD scores for MDD patients were significantly low
( p G 0.05) (Figure 3).
When the mean TCI scores were evaluated according to sei-
zure type, there was a significant difference between the HA and SD
scores of patients with partial seizures (n = 7) and patients with
generalized seizures (n = 66) ( p G 0.05). The patients with partial
seizures had higher HA and lower SD scores (partial seizure group:
24.29 T 5.25 and 19.86 T 5.37, respectively; generalized seizure
group: 18.53 T 6.24 and 25.33 T 6.98, respectively).
A one-way analysis of variance was performed to evaluate
the relationship between seizure frequency and the personality traits
of epilepsy patients. There was a significant difference in ST scores
( p = 0.003 and 0.028, respectively) from TCI results, but not in other
scores. In the advanced analyses performed with post hoc Scheffe, it
was determined that there was a significant difference in depressive
temperament, where the epilepsy group reported depression ‘‘More
than once a fortnight (G15 days)’’ and the control group reported
‘‘Once a year or less’’ (p G 0.05). There were no significant results for
ST scores in the post hoc Scheffe test.

Clinical Symptoms of Epilepsy Disease Evaluation of the Data With Multiple Linear
Table 2 shows the clinical symptoms of epilepsy in epileptic Regression Models
patients. There was a negative correlation between duration of illness We performed multiple linear regression analyses to confirm
and NS (r = j0.25, p G 0.05). the independent efficacies of the parameters that were determined to

FIGURE 2. The scheme for the predictors of TCI scores. TCI indicates Temperament and Character Inventory; MDD, major
depressive disorder; NS, novelty seeking; HA, harm avoidance; RD, reward dependence; P, persistence; SD, self-directedness; C,
cooperativeness; ST, self-transcendence.

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Yazici et al. The Journal of Nervous and Mental Disease & Volume 201, Number 5, May 2013

FIGURE 3. Comparison of mean TCI scores of patients with or without MDD diagnosis in the epilepsy group. TCI indicates
Temperament and Character Inventory; MDD, major depressive disorder; MDDj, no depression; MDD+, depressive. *p G 0.05.
affect personality traits in the epilepsy group. First, we selected sei- suggested a relationship between TCI scores and response to
zure type, seizure frequency, and duration of illness as independent antidepressive medication (Hruby et al., 2009). In Turkey, a study of
variables. These were considered the clinical traits with significant 81 depression patients determined that HA and ST scores are in-
effects only on epilepsy. dicators for depression, or are at least factors related to depression
(Celikel et al., 2009). An increase in the symptoms of anxiety and
Regression Model for TCI Parameters in depression in epilepsy patients has been reported, particularly with
Epilepsy Patients complex and partial seizures (Schoenfeld et al., 1999). In light of
We selected duration of illness, seizure type, seizure fre- these common properties, high HA and low ST scores can reflect
quency, sex, MDD, and marital status, which had significant results a predisposition to epilepsy.
among the clinical traits of epilepsy, as independent variables and In our study, RD was significantly high in epilepsy patients.
evaluated whether they were predictors for personality traits. Epi- This result suggests that in our group, RD is related to other accom-
leptic seizure type (t = j2.028, p = 0.047) and presence of MDD panying factors such as depression, rather than to epilepsy. In addition,
(t = 2.079, p = 0.041) were determined as predictors for high HA in other studies, subscale scores for RD have been found to be related
levels (Figure 4). Existing variables were not predictors for other per- to depressive disorder (Celikel et al., 2009; Nery et al., 2009).
sonality traits. P indicates an inherited predisposition to insist despite the
presence of prevention, fatigue, and award withdrawal; individuals
DISCUSSION with low P scores tend to be lazy, inactive, unstable, and sometimes
In this study, we evaluated TCI scores in patients with epilepsy unpredictable (Cloninger et al., 1993). Low P is a temperament trait of
and compared them with that of controls. Our results showed that HA bipolar patients in remission and is closely related to poor drug com-
scores were higher and RD, P, ST, and C scores were lower for epi- pliance (Osher et al., 1996, 1999). Patients with seizures have more
lepsy patients. In the multiple linear regression analyses, the presence emotional problems than healthy individuals do because of the close
of epilepsy was a predictor for HA, P, ST, and C scores. relationship between the seizure-affected and emotion-modulating re-
In line with our study, in Turkey, a study including 78 patients gions of the brain, such as the medial temporal lobe (Austin and Dunn,
and 85 controls determined higher HA and lower P and ST scores in 2002; Post, 2004). In addition, the major cognitive effects of anticon-
epilepsy patients (Bostanci et al., 2011). In a study performed in vulsant drugs include a decline in attention, vigilance, and psycho-
Korea regarding personality traits of epileptic children, t-test results motor speed (Meador, 2002), which may appear as lazy and sedentary
showed that NS and HA scores were higher and P, SD, and C scores
were lower in the epilepsy group. In addition, linear regression TABLE 2. Clinical Symptoms of Epilepsy Disease
analyses indicated that the presence of epilepsy was a predictor for
HA, P, ST, and C scores (Park et al., 2007). This study supports our Mean T SD (Range) or n (%)
results in terms of data obtained from regression analyses. In another Age at first seizure, yrs 18.1 T 10.6 (1Y63)
study performed on 34 epilepsy patients and 34 controls, authors Aura
could not determine any significant differences among the TCI pa- Have 35 (47.9)
rameters (Nubukpo et al., 2006). However, in that study, there were
None 38 (52.1)
some limitations: the sample size was smaller than that of our study
and the control group consisted of the relatives of patients, who may Frequency of seizures
have had some of the same personality features as the epilepsy pa- G15 days 16 (21.9)
tients owing to genetic factors. Once per month 8 (11)
When the traits, which significantly differ between the epi- Once per 3 months 12 (16.4)
lepsy group and the control group, were separately evaluated, high Once per 6 months 7 (9.6)
HA scores were especially noteworthy between the groups in both Once a year or less 28 (38.2)
previous studies and our study. HA is related to pessimism, fearful- Duration of illness, yrs 7.72 T 7.82 (1Y32)
ness, and fatigue and co-occurs with depression. In the same way, Seizure type
low scores in ST are related to depression, and there is 25% co- Partial seizure 7 (9.5)
occurrence with depressive symptoms (Celikel et al., 2009; Dunn
Generalized seizure 66 (90.5)
et al., 1999; Ettinger et al., 1998; Nery et al., 2009). Some studies

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The Journal of Nervous and Mental Disease & Volume 201, Number 5, May 2013
FIGURE 4. Predictors for TCI traits in epilepsy patients. TCI indicates Temperament and Character Inventory; NS, novelty seeking;
HA, harm avoidance; RD, reward dependence; P, persistence; C, cooperativeness; ST, self-transcendence.
behavior symptoms. Thus, low P scores in epilepsy patients may
originate from organic brain changes because of epilepsy and/or
antiepileptic medications.
Patients with low C scores prefer solitude rather than friendship
and have poor social skills (Cloninger et al., 1993). In epilepsy patients,
strange and noticeable symptoms of epilepsy may socially stigmatize
them (Jacoby et al., 2005). Stigmatization can disturb self-concept
(Hoare and Mann, 1994) and the development of social compliance
(Noeker et al., 2005) in epilepsy patients. This may be one of the expla-
nations for low C scores. Low scores for SD and C are closely related to
personality disorders (Svrakic et al., 1993). Personality changes, often
seen in temporal lobe epilepsy, such as increased viscosity, opportunism,
and religiosity (Brandt et al., 1985; Feichtinger et al., 2001), can result in
low scores in SD and C.
In our study, the distribution of MDD, social phobia, and any
psychiatric diagnosis was significantly higher in the epilepsy group
compared with the control group. The most common comorbid dis-
eases were depressive disorders and anxiety disorders, but MDD was
the most prevalent in the epilepsy group. This result is in line with
previous literature (Kanner, 2007; Mendez, 1988). When we com-
pared TCI scores for epilepsy patients with or without depression,
depressive patients expressed lower SD scores. SD is lower in depres-
sive individuals and generally co-occurs with depression-related bad-
compliance personality. In comparative studies, HA scores had a high
positive correlation with depression incidence and a high negative cor-
relation with SD scores (Pelissolo and Corruble, 2002). In studies
evaluating temperament and character traits in MDD patients, high
HA scores were found, as well as low SD scores. In studies examin-
ing the relationship between low SD scores and depression, a 25%
co-occurrence of depressive symptoms was reported (Dunn et al.,
1999; Ettinger et al., 1998). Our results were in line with these
studies in terms of the relationship between SD scores and depression
in epilepsy patients. However, the same significance could not be
determined for HA scores. We suggested that HA scores are already
increased as a result of epilepsy, and this may be why there was no
difference when compared with depressive patients.
When we analyzed the relationship between clinical findings of
the epilepsy group and personality traits, we observed that there was
no significant correlation between first seizure age and TCI scores in
accordance with the Pearson correlation analyses. However, there was
a negative correlation between duration of illness and NS. A previous
study compared the personality traits of 65 epileptic and 65 control
children; however, that study could not determine a relationship be-
tween duration of illness and personality (Park et al., 2007), but we
were able to determine a negative correlation between duration of ill-
ness and NS. This may be because our patients were older, so the
duration of illness was sufficient to cause changes in personality traits.
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Temperament in Epilepsy Patients
In a study performed in Egypt, duration of epilepsy showed a positive
correlation with psychotic personality (Shehata and Bateh, 2009). In
patients with mesiotemporal epilepsy, long-lasting resistant epilepsy
was related to more intense hippocampal and extra-hippocampal atro-
phy (Bonilha et al., 2006; Cascino, 1995). In a high-resolution mag-
netic resonance imaging study, a positive correlation was determined
between right hippocampal volume and NS scores (Martin et al., 2007).
In our study, a negative relationship between duration of illness and NS
scores may be related to decreased hippocampal volume during a long
period of illness, resulting in decreased NS scores. However, further
examination is required to confirm this hypothesis.
When we evaluated the TCI scores of the patients according to
seizure types, HA and SD scores were significantly different between
the patients with partial seizures and those with generalized seizures.
Patients with partial seizures had higher HA and lower SD scores. That
is, patients with partial seizures had more personality changes. In a
study performed on 65 Korean children, the SD and C scores of patients
with partial seizures were lower than those of patients with generalized
seizures (Park et al., 2007). This study is similar to ours in terms of
showing negative effects on personality traits in patients with partial
seizures. Nuffield (1961) reported that children with complex partial
seizures were more prone to antisocial and aggressive behaviors,
whereas children with primary generalized seizures had fewer neurotic
tendencies. In contrast to this study, it was reported that neurosis, ex-
traversion, psychosis and liar personality properties were more preva-
lent in patients with generalized seizures than in patients with focal
seizures (Shehata and Bateh, 2009).
In epilepsy with complex partial seizures, an increase was
reported in anxiety and depression symptoms (Schoenfeld et al.,
1999). There is literature demonstrating the relationship between
depression symptoms and high HA and low SD scores, as we dem-
onstrated in patients with partial seizures. This suggests the impor-
tance of an organic source, which interacts with partial seizures in
terms of changes in personality traits, anxiety, and depression scores.
In our study, the source of the seizures was not determined; however,
the findings that personality changes were greater in patients with
partial seizures lead us to suggest that focal neuropsychiatric deficits
are more important for character changes in epilepsy than general
brain functions. A future study that considers the seizure source may
provide more information about this topic.
CONCLUSIONS AND RECOMMENDATIONS
The presence of some personality changes was previously known
in epilepsy patients; these findings originated from observations by
physicians. Our study reveals the effects of epilepsy on personality
through contemporary approaches to personality.
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Yazici et al. The Journal of Nervous and Mental Disease
We found higher HA scores and lower RD, P, SD, and C scores
in epilepsy patients. Some of these personality traits were also related
to parameters such as the patient’s age, sex, duration of illness, fre-
quency of seizures and type of seizures.
This study provides a basis for understanding personality traits
in epilepsy. Neuronal circuits and mechanisms included in person-
ality structuring and occurrence of epilepsy have not been clarified
yet. Future studies may clarify common etiology and may thus pro-
vide new approaches for treatment and even for prevention.
DISCLOSURES
The authors declare no conflict of interest.
REFERENCES
Austin JK, Dunn DW (2002) Progressive behavioral changes in children with
epilepsy. Prog Brain Res 135:419Y427.
Bear D, Hermann B, Fogel B (1989) Interictal behavior syndrome in temporal lobe
epilepsy: The views of three experts. J Neuropsychiatry Clin Neurosci 1:308Y318.
Bonilha L, Rorden C, Appenzeller S, Coan AC, Cendes F, Li LM (2006) Gray mat-
ter atrophy associated with duration of temporal lobe epilepsy. Neuroimage
32:1070Y1079.
Bostanci B, Konuk N, Kiran S, Kokrek Z, Yeni SN (2011) The evaluation of per-
sonality of epileptic patients by using Cloninger’s Temperament and Character
Inventory. Anadolu Psikiyatr De 12:13Y23.
Brandt J, Seidman LJ, Kohl D (1985) Personality characteristics of epileptic pa-
tients: A controlled study of generalized and temporal lobe cases. J Clin
Exp Neuropsychol 7:25Y38.
Cascino GD (1995) Clinical correlations with hippocampal atrophy. Magn Reson
Imaging 13:1133Y1136.
Celikel FC, Kose S, Cumurcu BE, Erkorkmaz U, Sayar K, Borckardt JJ, Cloninger
CR (2009) Cloninger’s temperament and character dimensions of personality
in patients with major depressive disorder. Compr Psychiatry 50:556Y561.
Cloninger CR, Svrakic DM, Przybeck TR (1993) A psychobiological model of
temperament and character. Arch Gen Psychiatry 50:975Y990.
Corapcioglu A (1999) SCID-I Klinik versiyon. Ankara, Turkey: Hekimler Yayin
Birligi Matbaasi.
Dunn DW, Austin JK, Huster GA (1999) Symptoms of depression in adolescents
with epilepsy. J Am Acad Child Adolesc Psychiatry 38:1132Y1138.
Ettinger AB, Weisbrot DM, Nolan EE, Gadow KD, Vitale SA, Andriola MR, Lenn
NJ, Novak GP, Hermann BP (1998) Symptoms of depression and anxiety in
pediatric epilepsy patients. Epilepsia 39:595Y599.
Feichtinger M, Pauli E, Schafer I, Eberhardt KW, Tomandl B, Huk J, Stefan H
(2001) Ictal fear in temporal lobe epilepsy: Surgical outcome and focal hippo-
campal changes revealed by proton magnetic resonance spectroscopy imaging.
Arch Neurol 58:771Y777.
Hoare P, Mann H (1994) Self-esteem and behavioural adjustment in children with
epilepsy and children with diabetes. J Psychosom Res 38:859Y869.
Hruby R, Nosalova G, Ondrejka I, Preiss M (2009) Personality changes during
antidepressant treatment. Psychiatr Danub 21:25Y32.
370 www.jonmd.com
Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
& Volume 201, Number 5, May 2013
Jacoby A, Snape D, Baker GA (2005) Epilepsy and social identity: The stigma of
a chronic neurological disorder. Lancet Neurol 4:171Y178.
Kanner AM (2007) Epilepsy and mood disorders. Epilepsia 48(Suppl. 9):20Y22.
Kose S, Sayar K, Kalelioglu U, Aydin N, Celikel FC, Gulec H, Ak I, Kirpinar I,
Cloninger CR (2009) Normative data and factorial structure of the Turkish
version of the Temperament and Character Inventory. Compr Psychiatry
50:361Y368.
Martin SB, Covell DJ, Joseph JE, Chebrolu H, Smith CD, Kelly TH, Jiang Y, Gold
BT (2007) Human experience seeking correlates with hippocampus volume:
Convergent evidence from manual tracing and voxel-based morphometry.
Neuropsychologia 45:2874Y2881.
Meador KJ (2002) Cognitive outcomes and predictive factors in epilepsy. Neurol-
ogy 58:S21YS26.
Mendez MF (1988) Psychopathology in epilepsy: Prevalence, phenomenology and
management. Int J Psychiatry Med 18:193Y210.
Nery FG, Hatch JP, Nicoletti MA, Monkul ES, Najt P, Matsuo K, Cloninger CR,
Soares JC (2009) Temperament and character traits in major depressive disor-
der: Influence of mood state and recurrence of episodes. Depress Anxiety
26:382Y388.
Noeker M, Haverkamp-Krois A, Haverkamp F (2005) Development of mental
health dysfunction in childhood epilepsy. Brain Dev 27:5Y16.
Nubukpo P, Grunitzky EK, Pelissolo A, Radji A, Preux PM, Clement JP (2006)
Epilepsy and personality study among the Tamberma of Togo based on a gen-
eral population survey using the Cloninger’s Temperament and Character In-
ventory. Encephale 32:1019Y1022.
Nuffield EJ (1961) Neuro-physiology and behaviour disorders in epileptic chil-
dren. J Ment Sci 107:438Y458.
Osher Y, Cloninger CR, Belmaker RH (1996) TPQ in euthymic manic-depressive
patients. J Psychiatr Res 30:353Y357.
Osher Y, Lefkifker E, Kotler M (1999) Low persistence in euthymic manic-
depressive patients: A replication. J Affect Disord 53:87Y90.
Park S, Yoo HK, Kim JY, Jeon J, Choi SH, Wang HR, Sung Ko T (2007) Temper-
ament and character factors in Korean children with seizure disorders. J Nerv
Ment Dis 195:470Y476.
Pelissolo A, Corruble E (2002) Personality factors in depressive disorders: Contri-
bution of the psychobiologic model developed by Cloninger. Encephale
28:363Y373.
Post RM (2004) Neurobiology of seizures and behavioral abnormalities. Epilepsia
45(suppl 2):5Y14.
Sadock BJ, Sadock VA (2004) Kaplan & Sadock’s comprehensive textbook of
psychiatry (8th ed). Philadelphia, PA: Lippincott Williams & Wilkins.
Schoenfeld J, Seidenberg M, Woodard A, Hecox K, Inglese C, Mack K, Hermann
B (1999) Neuropsychological and behavioral status of children with complex
partial seizures. Dev Med Child Neurol 41:724Y731.
Shehata GA, Bateh AA (2009) Cognitive function, mood, behavioral aspects, and
personality traits of adult males with idiopathic epilepsy. Epilepsy Behav
14:121Y124.
Svrakic DM, Whitehead C, Przybeck TR, Cloninger CR (1993) Differential diag-
nosis of personality disorders by the seven-factor model of temperament and
character. Arch Gen Psychiatry 50:991Y999.
* 2013 Lippincott Williams & Wilkins