Brewerton Lisa D. Hand Emmett R. Bishop, Jr. Patients with eating disor- ders have been reported to have abnormalities in all of these systems, as well as personality variants described by these dimensions.
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Brewerton Lisa D. Hand Emmett R. Bishop, Jr. Patients with eating disor- ders have been reported to have abnormalities in all of these systems, as well as personality variants described by these dimensions. In addition, AN patients had significantly higher RD2 persis- tence vs. These data support a theory of 5-HT dysregulation in both types of eating disorders and suggest that further research be done on the role of DA and NE in BN.
Psychiatrists and psychologists have long sought a tool that would not only character- ize behavioral aspects of personality in certain diagnostic groups but also provide leads to the neurobiological system involved. One such tool is the Tridimensional Personal- ity Questionnaire TPQ that was developed to measure three fundamental dimensions of personality suggested to correlate with specific neurotransmitter functions.
These di- Timothy D, Brewerton, M. Lisa D. Hand, M. Emmett R. Address repriiU requests to Dr. International loumat of tating Disorders, Vol, 14, No. Cloninger details these personality dimensions as well as the neurochemical and psychopharmacological studies that support their correlation with specific neurotransmitter systems in his proposal.
He suggests that individuals with high scores on NS tend to be impulsive, excitable, extravagant, quickly bored, and ready to engage in new activities. This dimension is thought to be associated with low dopaminergic DA activity. Those who score high on the HA dimension are character- ized as cautious, tense, inhibited, shy, and easily fatigable and are theorized to have increased activity in the serotonin 5-HT system. High scores on RD are suggested to be sensitive to social cues, persistent, sentimental, and prone to delay gratification if eventual reward is expected.
These traits are associated with low activity in the norad- renergic system NE Cloninger, b. When integrated, these dimensions would reflect a constellation of personality traits and their neurotransmitter correlates that should be able to delineate characteristic be- havioral differences between a defined patient population and normal controls.
If this theory is valid, results of the TPQ might aid in both clarifying personality characteris- tics of certain diagnostic groups as well as suggesting the potential involvement of spe- cific neurotransmitter systems. Waller et al. We extended these observations to a larger sample of bulimic and ano- rexic patients as well as women with both disorders in order to further determine the relationship between eating disorder subgroups and TPQ scores.
The TPQ is a item, self- administered, true-false questionnaire that measures three higher-order personality di- mensions as described above, including HA, NS, and RD. Each of these dimensions has four subscales that are shown in Table 1.
No demographic differences were seen between the two groups, so they were combined into one group. One hundred ten had BN, 27 had AN, and 10 had both disorders. The demographic characteristics are shown in Table 1. The scores for each parameter and its subscale were compared by diagnosis using an analysis of variance ANOVA when appropriate.
Post hoc comparisons were performed using Bonferroni t tests. Given the significant difference in age between patients and Tridimensional Personality Table 1. However, this could not be done because the individual data points for the controls were not available. Correlations between age and TPQ scales are reported for the patients. Normal controls were significantly older than the patients, regardless of diagnosis. In addition, AN patients scored signifi- cantly higher than controls on RD2 subscale scores.
Other differences in TPQ subscale scores are shown in Table 2. Most no- tably, the significantly greater age of the controls is problematic given that the three dimensions, especially NS, correlate with age Cloninger et al.
In addition, data were collected at intake and could be influenced by acute illness. Repeat assessments at weight restoration and at clinical recovery is necessary to determine state vs.
Patients with AN, BN, or both disorders appear to differ significantly from the con- trol population and from each other on the major dimensions of the TPQ. This is con- sistent with clinical presentation in which the disorders have some shared Brewerton et al. Table 2. Mean TPQ Scores. Our finding of high HA scores in all eating disorder patients is interesting, given that they often appear to have clinical features suggestive of OCD George et al.
Given that HA scale scores slightly increase with age, the dif- ference in age between patients and controls is inconsequential. The patients with BN alone are characterized by high total NS scores, which theoret- ically may contribute to tendencies toward binge eating, purging, and perhaps other impulsive behaviors.
These findings are consistent with reports of NE abnormalities in bulimic patients George et al. The age difference between patients and controls is more likely to have influenced this difference in NS. However, NS scores decrease on the average by only 1 point per decade Cloninger et al. Therefore, age alone is un- likely to account for group differences.
Our results support Waller et al. Although we did not find a significantly different total RD score in BN, RD3 scores were significantly lower and RD4 scores were significantly higher in BN patients compared to controls. In addition, AN patients had significantly higher RD2 scores than controls. Using a related instrument, Casper reported high HA scores and low NS scores in a group of recovered restrictor AN patients at 8-year follow-up, which is what Strober predicted in his theoretical discussion of neuroadaptive traits.
The reasons for these apparent differences following weight restoration are un- known but may reflect starvation-induced changes in personality, possibly mediated via the NE system and others. It would be interesting to study other diagnostic groups such as affective and anxiety disorders and compulsive overeaters in order to compare these personality dimensions with those of anorexic and bulimic patients.
The authors would like to gratefully thank Dr. Cloninger for providing normative data and Lou Frye for performing the statistical analyses. Diagnostic and statistical manual 3rd ed. Washington, DC: Author. Asberg, M. Psychobiology of suicide, impulsivity, and related phenomena.
Meltzer Ed. New York: Raven Press. Brewerton, T. Serotonin in eat- ing disorders. Murphy Eds. Neuroendocrine responses to m-chlorophenylpiperazine and L-tryptophan in bulimia.
Archives of General Psychiatry, 49, Serotonin dysreg- ulation in bulimia nervosa: Neuroendocrine and headache responses. Brown Eds. Casper, R. Personality features of women with good outcome restricting anorexia nervosa. Psycho- somatic Medicine, 52, Cloninger, C. A unified biosocial theory of personality and its role in the development of anxiety states.
Psychiatric Development, 3, A systematic method for clinical description and classification of personality vari- ants. Archives of General Psychiatry, 44, The Tridimensional Personality Questionnaire: U. Psychological Reports, 69, George, D. Altered norepi- nephrine regulation in bulimia: Effects of pharmacological challenge with isoproterenol.
Psychiatry Research, 33, George, M. New England Journal of Medi- cine, , Hollander, E. Symptom relapse in bu- limia nervosa and obsessive compulsive disorder after treatment with serotonin antagonists. Journal of Clin- ical Psychiatry. Jimerson, D. C , George, D. Norepinephrine regulation in bulimia. Pope Eds. C , Lesem, D. Low serotonin and dopamine me- tabolite concentrations in CSF from bulimic patients with frequent binge episodes.
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Tridimensional Personality Questionnaire
Abstract Background The validity of traditional categorical personality disorder diagnoses is currently re-evaluated from a continuous perspective, and the evolving DSM-V classification may describe personality disorders dimensionally. The utility of dimensional personality assessment, however, is unclear in violent offenders with severe personality pathology. Methods The temperament structure of alcoholic violent offenders with antisocial personality disorder ASPD was compared to 84 offenders without ASPD, and healthy controls. Inclusion occurred during a court-ordered mental examination preceded by homicide, assault, battery, rape or arson.
Tridimensional Personality Questionnaire
As this finding could be of great clinical importance, we attempted to replicate these findings. Results: There was a significant correlation between pre-treatment scores on the TPQ subscale of harm avoidance and severity of depression at baseline as determined by Hamilton Depression Rating Scale HAM-D scores. There was no correlation of harm avoidance scores and percent improvement of HAM-D after treatment with fluoxetine. There was also no correlation of baseline HAM-D scores or percent improvement with the subscales of reward dependence and novelty seeking.