Temperament and character traits in patients with bipolar disorder and associations with attempted suicide
Introduction
Studies investigating temperament and character traits in bipolar disorder patients have grown rapidly in recent years. The Temperament and Character Inventory (TCI) is frequently used in these studies. The most frequently identified temperament traits in bipolar disorder measured by this inventory are high harm avoidance (HA) and low persistence (PS) [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11]. Findings regarding novelty seeking (NS) and reward dependence (RD) temperament traits are contradictory [1], [2], [3], [5], [6], [7], [8], [9], [11], [12]. The most commonly determined character traits are low self-directedness (SD), low cooperativeness (CO), and high self-transcendence (ST) [4], [5], [6], [7], [8], [9], [11], [12]. Axis I and II disorders accompanying bipolar disorder may affect temperament and character traits [8], [12]. Axis I and II disorders accompanying bipolar disorder were not excluded in any of the previous studies in question.
Suicide ideation, attempted suicide, and completed suicide are frequently seen in bipolar disorder. Eighty percent of bipolar patients have suicidal ideation during their lives, 25% to 50% attempt suicide, and 4% to 19% lose their lives as the result of suicide [13], [14], [15]. Suicidal ideation is a risk factor for attempted suicide and attempted suicide for completed suicide [14], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25]. Studies of social sampling and psychiatric diseases have determined a correlation between suicidal behavior (ideation, attempted, or completed suicide) and several personality traits, such as neuroticism, openness, psychoticism, perfectionism, dependency, cyclothymic temperament, perceptual aberration, interpersonal aversiveness, unconventionality, hopelessness, self-criticism, extroversion, irritability, aggression, hostility, impulsivity, high NS, high HA, high PS, low RD, low SD, low CO, and high ST [13], [16], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35].
In addition to Axis I and II comorbidity, early sexual and physical abuse; a family history of suicidal behavior; rapid cycling; depressive and mixed episodes; insomnia; anxiety; female sex; and past suicide attempts and personality traits such as impulsivity, anger, aggressiveness, hopelessness, and pessimism are also risk factors for suicide attempts and ideation [15], [17]. The number of studies in the literature investigating the temperament and character traits of bipolar disorder patients with a history of attempted suicide using TCI is limited [12], [36], [37]. Engström et al [36] determined high HA and high RD in bipolar patients with previous attempted suicide compared with those with no such history. They determined no difference in terms of character traits. In comparison with healthy controls, they determined high HA, low PS, and low SD in bipolar patients with a history of attempted suicide and low RD and low CO in bipolar patients with no such history. They concluded that HA and PS temperament traits were a risk factor for attempted suicide, whereas Sayin et al [12] and Joyce et al [37] reported high HA as a risk factor. To the best of our knowledge, there are no previous studies examining the correlation between current suicide ideation and temperament and character traits in bipolar disorder patients.
This study had 2 aims: the first was the determination of temperament and character traits of bipolar patients with or without a history of attempted suicide. The second was to examine the correlation between current suicidal ideation and temperament and character traits.
Section snippets
Sample and procedures
Two hundred twenty-two volunteers, 119 bipolar disorder patients, diagnosed based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnostic criteria and determined as euthymic at clinical examination, applying to the Ondokuz Mayıs University Faculty of Medicine Psychiatry Department Mood Disorders unit, Turkey, between July 2009 and December 2011, and 103 healthy controls were included in the study. Bipolar patients who met criteria for a manic, mixed, hypomanic, or
Comparison of the bipolar disorder and control groups in terms of sociodemographic characteristics
There was no difference between the bipolar disorder and control groups in terms of sociodemographic variables (age, sex, years spent in education, marital status, socioeconomic level, and place of residence) (P > .05) (Table 1). At least 1 previous suicide attempt was determined in 25.2% (n = 30) of the patients with bipolar disease. No difference in terms of sociodemographic variables was determined between bipolar disorder patients with or without a history of attempted suicide (P > .05).
Comparison of the bipolar disorder and control groups in terms of temperament and character traits
Discussion
The most frequently repeated finding, in terms of temperament characteristics, in bipolar patients in comparative studies with healthy controls is high HA [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11]. Individuals high in HA tend to be cautious, careful, fearful, tense, apprehensive, nervous, timid, doubtful, discouraged, insecure, passive, negativistic, or pessimistic, even in situations that do not normally worry other people [49]. We also determined higher HA in bipolar disorder
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