325 Arch Neuropsychiatry 2018;55:325−329 RESEARCH ARTICLE https://doi.org/10.5152/npa.2017.20576 Does Personality Matter? Temperament and Character Dimensions in Panic Subtypes Antonio BRUNO1 , Maria Rosaria Anna MUSCATELLO1 , Gianluca PANDOLFO1 , Giulia LA CIURA1 , Diego QUATTRONE2 , Giuseppe SCIMECA1 , Carmela MENTO1 , Rocco A. ZOCCALI1 1Department of Psychiatry, University of Messina, Messina, Italy 2MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom ABSTRACT Introduction: Symptomatic heterogeneity in the clinical presentation of and 12.78% of the total variance. Correlations analyses showed that Panic Disorder (PD) has lead to several attempts to identify PD subtypes; only “Somato-dissociative” factor was significantly correlated with however, no studies investigated the association between temperament T.C.I. “Self-directedness” (p<0.0001) and “Cooperativeness” (p=0.009) and character dimensions and PD subtypes. The study was aimed to variables. Results from the regression analysis indicate that the predictor verify whether personality traits were differentially related to distinct models account for 33.3% and 24.7% of the total variance respectively symptom dimensions. in “Somatic-dissociative” (p<0.0001) and “Cardiologic” (p=0.007) factors, while they do not show statistically significant effects on “Respiratory” Methods: Seventy-four patients with PD were assessed by the factor (p=0.222). After performing stepwise regression analysis, “Self- Mini-International Neuropsychiatric Interview (M.I.N.I.), and the directedness” resulted the unique predictor of “Somato-dissociative” Temperament and Character Inventory (T.C.I.). Thirteen panic symptoms factor (R²=0.186; β=-0.432; t=-4.061; p<0.0001). from the M.I.N.I. were included in a factor analysis with varimax rotation. A correlation analysis (Pearson’s correlation), a linear regression analysis, Conclusion: Current results, although preliminary, suggest the and a forward stepwise regression analysis between the identified importance of assessing personality and temperament features that factors and T.C.I. variables were performed for evaluating the association may be potentially related to poor treatment response for a better between panic subtypes and personality features. understanding and characterization of PD subtypes. Results: Three factors were obtained: “Somato-dissociative”, Keywords: Panic disorder; panic dimensions; temperament; character; “Respiratory”, and “Cardiologic” explaining respectively 18.31%, 13.71%, personality. Cite this article as: Bruno A, Muscatello MRA, Pandolfo G, LA Ciura G, Scimeca G, Mento C, Zoccali RA, Quattrone D. Does Personality Matter? Temperament and Character Dimensions in Panic Subtypes. Arch Neuropsychiatry 2018;55:325-329. https://doi.org/10.5152/npa.2017.20576 INTRODUCTION Panic disorder (PD), whose lifetime prevalence estimates in the general biological, innate part of personality, is four-dimensional, and it comprises population are about 4.7% (1), is characterized by a substantial degree of Novelty Seeking (NS), Harm Avoidance (HA), Reward Dependence (RD), symptomatic heterogeneity. Variations from typical panic attacks are well and Persistence (P), whereas character, modeled by experience and acknowledged, whereas the core features of unexpectedness, recurrence, learning, is three-dimensional, and consists of Self-Directedness (SD), and associated distress are usually maintained (2). As a consequence, the Cooperativeness (C), and Self-Transcendence (ST). Main findings from diagnostic process may be affected by a substantial variability in clinical these studies are congruent in establishing significant associations among presentation. For these reasons, several studies have investigated possible PD, higher levels of HA, and lower levels of SD. Interestingly, a study symptom subtypes of panic disorder (2, 3), identifying up to six potential that evaluated temperament and character dimensions in PD patients panic subtypes: respiratory (4), cardiac (5), nocturnal (6), nonfearful (7), before and after 1 year of pharmacological treatment showed that higher cognitive (8), and vestibular/somatic (5). Nevertheless, current evidence levels of HA persisted even after a complete symptomatic remission in does not reach univocal conclusions, due to methodological differences treatment-responder PD patients, whereas low SD levels characterized in measuring panic symptoms, samples selection, and to the lack of only non-responders (13). These results seem to support the hypothesis reliable and sufficient external validation (9). that HA might be a stable temperamental dimension predisposing individuals to PD; nevertheless, it must be kept in mind that in most studies Moreover, an additional source of symptomatic heterogeneity may heterogeneous samples of patients with psychiatric comorbidities, such depend on the possible association of PD with personality traits and as mood, anxiety, and personality disorders were enrolled (13–14). At the constellations (10). A number of studies in the literature (11–15) have present, these evidences are not strong enough to affirm that high HA examined the relationship between PD and personality traits according and low SD indicate vulnerability to PD, and further studies are needed to the psychobiological model developed by Cloninger et al. (16). This to better understand this association (11). To best of our knowledge, model attributes to temperament and character dimensions the role of no studies specifically investigated the association between Cloninger’s essential foundations of personality. Temperament, which reflects the temperament and character dimensions and PD subtypes. The objectives Correspondence Address: Maria Rosaria Anna Muscatello, University of Messina, Italy, Psychiatry, Messina, Italy • E-mail: [email protected] Received: 23.01.2017, Accepted: 09.07.2017, Available Online Date: 06.07.2018 ©Copyright 2017 by Turkish Association of Neuropsychiatry - Available online at www.noropskiyatriarsivi.com 325 Bruno et al. Personality Dimensions in Panic Subtypes Arch Neuropsychiatry 2018;55:325−329 of the present study were to identify the potential subtypes of PD with RD2-Attachment vs. Detachment; RD3-Dependence vs. Independence; the related clinical features, and to explore possible relationships among Persistence (P). The three dimensions of character are: Self-directedness temperament and character features and the identified PD subtypes. (SD): S1-Responsibility vs. Blaming; S2-Purposefulness vs. Lack of goal- direction; S3-Resourcefulness; S4-Self-acceptance vs. Self-striving; S5- Enlightened second nature; Cooperativeness (C): C1-Social acceptance METHODS vs. Social intolerance; C2-Empathy vs. Social disinterest; C3-Helpfulness Subjects vs. Unhelpfulness; C4-Compassion vs. Revengefulness; C5-Pure- All subjects consecutively admitted to the Outpatient Psychiatry Unit of hearted conscience vs. Self-serving advantage; Self-Transcendence (ST): the University Hospital of Messina, Italy, between February 2014 and ST1-Self-forgetful vs. Self-conscious experience; ST2-Transpersonal April 2015, were screened for the study by a senior psychiatrist using the identification vs. Self-differentiation; ST3-Spiritual acceptance vs. Italian versions of the Structured Clinical Interviews for DSM-IV Axis I and Rational materialism. Axis II Disorders (SCID-I, SCID-II) (17–18). Statistical Analysis/Methods Inclusion criteria were age 18–65, and Diagnostic and Statistical Manual Data obtained from the study underwent check and quality control by of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnosis the Kolmogorov-Smirnov test for data distribution and the Levene’s test of panic disorder. for homoscedasticity, and subsequently, to descriptive and inferential statistical analysis. Continuous data were expressed as mean ± standard Patients with any other major psychiatric disorder, personality disorder, deviation (S.D.); non-continuous data were expressed as percentages. significant concurrent medical illnesses, organic brain disorder, history Thirteen panic symptoms presented on the M.I.N.I. were used for of substance and alcohol abuse, and mental retardation were excluded. the factor-analytic study. The factors with an Eigen value over 1 were obtained at the end of the principal component analysis and varimax All the patients provided written informed consent after a full explanation rotation in the factor analysis. of the protocol design, which had been approved by the local ethics committee and was conducted according to the Declaration of Helsinki. Further, a correlation analysis (Pearson’s correlation), a linear regression analysis and a forward stepwise regression analysis between the Instruments identified factors and T.C.I. variables were performed in order to evaluate Mini-International Neuropsychiatric Interview (M.I.N.I.)-Italian version the association between panic subtypes and personality features. (19): a diagnostic structured interview developed to provide diagnoses for the main Diagnostic and Statistical Manual, Revised Third Edition / To lessen the risk of Type 1 errors, a p value <0.01 was considered Fourth Edition disorder categories. The M.I.N.I. includes 23 disorders statistically significant, and the statistical analysis was performed with from the tenth revision of the International Classification of Diseases and Statistical Package for the Social Sciences-SPSS 16.0 software (SPSS