Psychobiological Model of Temperament and Character (1)

8/20/2019 Psychobiological Model of Temperament and Character (1)

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A Psychobiological Model of Temperamentand CharacterC. Robert Cloninger, MD; Dragan M. Svrakic, MD, PhD; Thomas R. Przybeck, PhD

Inthis study, we describe a psychobiological model of the structure and development of

personality that accounts for dimensions of both temperament and character. Previous re-search has confirmed four dimensions of temperament: novelty seeking, harm avoidance,reward dependence, and persistence, which are independently heritable, manifest early in

life, and involve preconceptual biases in perceptual memory and habit formation. For the first time,we describe three dimensions of character that mature in adulthood and influence personal andsocial effectiveness by insight learning about self-concepts. Self-concepts vary according to the extentto which a person identifies the self as (1) an autonomous individual, (2) an integral part of hu-

manity, and (3) an integral part of the universe as a whole. Each aspect of self-concept correspondsto one of three character dimensions called self-directedness, cooperativeness, and self-transcendence, respectively. We also describe the conceptual background and development of aself-report measure of these dimensions, the Temperament and Character Inventory. Data on 300individuals from the general population support the reliability and structure of these seven person-ality dimensions. We discuss the implications for studies of information processing, inheritance,

development, diagnosis, and treatment. (Arch Gen Psychiatry. 1993;50:975-990)Several lines of research are converging tofacilitate the integration of categorical anddimensional methods for diagnosing per¬sonality disorder. First, explicit diagnosticcriteria were developed to define tradi¬tional categories of personality disorders,1and structured interviews were developedthat make such diagnoses reliably.2·3 Sec¬ond, self-report scales for rating quantita¬tive dimensions of personality were devel¬oped using factor analysis of traits observedin individuals with personality disor¬ders4"6 or in the general population'^; thesewere shown to be reliable and to correlate

highly with one another.3·10 Third, self-reported dimensional measures were shownto explain much of the reliable variance ininterview diagnoses of personality disor¬ders11 and to agree closely with indepen-

dent reports of spouses and other collat¬eral informants.10

Despite this progress in assessmentmethods, no consensus has been reachedon the number or content of the dimen¬sions needed to describe personality dis¬order.5·12·13 Five factors, plus or minus two,account for most variation in personalitybetween individuals in the general popu¬lation.12·13 When observer-rated or self-

reported behavior is factor analyzed, twofactors like neuroticism (vs stability) andextraversion (vs introversion) are consis¬

tently described. There is less consistencyin the content of the third factor; Eysenckand Eysenck7 described tough-mindedness;Tellegen,9 constraint; and Costa and McCrae,10openness to experience. In a popular five-factor model, two additional factors are con¬scientiousness and agreeableness, but theoptimal rotation and content of alternativefive-factor models remain

subjects ofactive-

From the Department of Psychiatry, Washington University School of Medicine,St Louis, Mo.

wnloaded From: http://archpsyc.jamanetwork.com/ by a University of Virginia User on 07/27/2012


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debate.1014 Furthermore, the five-factor model does not capture somedomains ofpersonality relevant to per¬sonality disorders, such as indi¬vidual autonomy, traditional moral

values, and other aspects of matu¬rity and self-actualization describedin humanistic and transpersonal psy¬

chology.13 Studies of natural lan¬guage provide evidence of seven d i¬mensions of personality, including twoself-evaluative dimensions for goodand bad self-concepts that arelabeled positive and negativevalence.12

Nevertheless, as the number ofmeasured factors increases in avail¬able instruments, the cumulative pro¬portion of shared variance is likelyto increase between alternative mod¬

els. In other words, what is left outof one model can be added until acomprehensive set is accumulated.However, factor analysis of indi¬vidual case descriptions can only de¬termine the minimum number ofmeasured dimensions, and cannot de¬compose their underlying causal struc¬ture. Extrastatistical information isneeded to specify the structure of theunderlying biologic and social vari¬ability in personality traits. In other

words, descriptive data about indi¬vidual behavior are not sufficient to per¬mit any strong preference among al¬ternative ways of summarizingpersonality traits. Advocates of a par¬ticular model derived by factor analy¬sis must ultimately base their pref¬erence on authority or tradition if theyeschew external etiologic criteria.8 Anexample of utmost importance in theassessment of personality disorder isthe content of the factor called neu-

roticism. According to the authors ofa popular five-factor inventory, neu-roticism measures adjustment com¬pared with emotional instability andidentifies individuals who are proneto psychological distress, unrealisticideas, excessive cravings or urges, andmaladaptive coping responses.15 ft isa clinically heterogeneous compos¬ite of anxiety, hostility, depression,self-consciousness, impulsiveness, and

general emotional vulnerability.

High

neuroticism scores are frequent in in¬dividuals with personality disor¬der,11 but are not diagnostically spe¬cific; many psychiatric patientswithout personality disorder also havehigh neuroticism scores and some in¬dividuals with high neuroticism scoreshave no psychiatric disorder.13 Ac¬

cordingly, the use of the five-factormodel for clinical diagnosis has beencriticized in part because the con¬tent of its individual factors is clini¬

cally heterogeneous.12In addition, the content of fac¬

tors defined by factor analysis of in¬dividual case descriptions is also etio-logically heterogeneous. Gray16·17 usedobservations about the effects of an-

tianxiety drugs on personality to ar¬gue that the behavioral factors of

neuroticism and extraversion-introversion do not correspond to theirunderlying biologic variation. Heshowed that drugs that reduce scoreson measures of neuroticism, such asalcohol and benzodiazepines, alsoconsistently reduce scores on mea¬sures of introversion, suggesting thatthese dimensions are not etiologi-cally independent, but rather sharebiological determinants. Likewise,Cloninger1819 showed that the phe-notypic structure of personality maydiffer from the underlying bioge-netic structure because the observedbehavioral variation is the result ofthe interaction of genetic and envi¬ronmental influences. For example,extraversion and tough-mindednessare composed of elements that aregenetically independent but sharecommon environmental factors.20"22Such experimental information onetiologic factors helps to chooseamong an infinite set of alternativemodels of personality structure.

To test hypotheses about thecausal structure of personality, a gen¬eral psychobiological model of per¬sonality was developed and de¬scribed by Cloninger18 in two stages.The model was initially based on asynthesis of information from twinand family studies, studies of longi¬tudinal development, neuropharma-

cologic and neurobehavioral studies

of learning in humans and other ani¬mals, as well as psychometric stud¬ies of personality in individuals andin twin pairs.18 The original modeldescribed three dimensions of per¬sonality that were postulated to begenetically independent of one an¬other. The dimensions were called nov¬

elty seeking, harm avoidance, and re¬ward dependence, and were measuredwith a 100-item self-report inventorycalled the Trimensional PersonalityQuestionnaire (TPQ).23 Recently themodel was extended to measure sevendimensions of personality with theaddition of measures of persistence, self-directedness, cooperativeness, andself-transcendence. This extension isbased on a synthesis of informationabout social and cognitive develop¬ment and descriptions of personalitydevelopment in humanistic andtranspersonal psychology. This seven-factor model supersedes models withfewer factors and is formulated to al¬low differential diagnosis of personal¬ity disorder subtypes from one an¬other and from other psychiatricdisorders.

The model was extended to bemore comprehensive and to im¬prove the diagnosis of personality dis¬order. We observed that the originalthree dimensions distinguished amongsubtypes of personality disorders, butdid not consistently differentiate in¬dividuals with personality disordersor poor social adjustment from otherwell-adapted individuals with ex¬treme personality profiles.24 Further¬more, coverage of the personalitydomain was incomplete with a three-dimensional model: some DSM-lll-R personality disorders such as

paranoid and schizotypal personal¬ity had been neglected, and some per¬sonality factors measured in other di¬mensional models could not be

explained by the TPQ. In a compan¬ion article25 we show that the pres¬ence of an interview diagnosis of per¬sonality disorder by DSM-U1-R criteriais consistently predicted by low scoreson two personality dimensions: self-directedness and cooperativeness. De¬pending on these scores, the risk of



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personality disorder in a clinicalsample varied from 11% to 94%, sothat the relationship to diagnosis isstrong. In addition, the other five di¬mensions permit differential subtyp-ing of all the individual DSM-III-Rpersonality disorder categories.

Next, we briefly summarize the

development of the model and thendescribe the structure and content ofthe factors to inform clinicians abouttheir practical clinical use. Samplequestions are provided.

MATERIALS AND METHODS

Development of thePsychobiological Model

Personality has been defined as "the

dynamic organization within the in¬dividual of those psychophysical sys¬tems that determine his unique ad¬

justments to his environment."26

Learning has been likewise definedas "the organization of behavior as aresult of individual experience."27Therefore, differences between indi¬viduals in the adaptive systems in¬volved in the reception, processing,and storing of information about ex¬perience define personality in gen¬eral. Two types of memory systemshave been distinguished in pri¬mates.28"30 Conscious experiences arerepresented as words, images, or sym¬bols about facts and events that have

explicit meanings and functional re¬lations with one another that we can

consciously retrieve, declare ver¬bally, and act on intentionally. In con¬trast, unconscious, implicit, or pro¬cedural memories involve presemanticperceptual processing that encodesconcrete visuospatial structural in¬formation and affective valence; such

perceptual processing can operate in¬dependent of abstract conceptual, in¬tentional, or declarative pro¬cesses.31·32 For example, individualswith amnesia who cannot recognizeor recall prior exposure to particularpairs of words may have long-lasting affective responses and im¬provement of their ability to com¬

plete the word from

partial letter

fragments.33"33 In other words, con¬scious memories are concept-basedwhereas unconscious memories are

percept-driven.Hippocampal processing and

long-term storage in association cor¬tex appear to be essential for con¬solidation of explicit memories that

can be intentionally retrieved; in con¬trast hippocampal processing is notrequired for retention of implicitmemories that are unintentionally re¬trieved without any conscious recallof the original experiential events.31·32·36Lesion studies in humans and other

primates show that conceptual in¬formation is processed and stored ina cortico-limbo-diencephalic systemthat includes the higher order sen¬sory areas of the cortex, the entorhi-

nal cortex, the amygdala, hippocam¬pal formation, the medial thalamicnuclei, ventromedial prefrontal cor¬tex, and the basal forebrain. In con¬

trast, perceptual memories underly¬ing unconscious habits are stored ina cortico-striatal system, which in¬cludes the sensory cortical areas, andthe caudate and putamen.28·30 An ex¬ample of the anatomical separationof these two memory systems is that

monkeys with combined amygdalo-

hippocampal removal show severe im¬pairments in conceptual memory tasks(such as visual recognition) after de¬lays of only a minute, but they learnperceptual memory tasks (such asconcurrent visual discrimination

habits) as quickly as normalanimals.28·37

Associative learning, such as op¬érant conditioning of habits and af¬fective responses, requires direct per¬ceptual experience of the events butdoes not involve conscious recall or

recognition of the contingencies thatmodify behavior.16 In contrast, con¬ceptual learning is conscious and ab¬stractly symbolic, as is verbal learn¬ing in which symbolic communicationcan alter expectancies about the en¬vironment and behavior.38

Prior personality models failedto distinguish between distinct as¬pects of memory because they werederived

by factor

analysis of behav-

ior, not by consideration of its un¬derlying biologic and social deter¬minants. In this psychobiologicalmodel, four dimensions of person¬ality involve automatic, preconcep-tual responses to perceptual stimuli,presumably reflecting heritable bi¬ases in information processing by the

perceptual memory system. These fourdimensions will be referred to as tem¬perament factors, in contrast to thethree factors that appear to be concept-based. The three personality factorsbased on differences in self-

concepts will be denoted as charac¬ter dimensions.

The temperament dimensionswere defined in terms of individualdifferences in associative learning inresponse to novelty, danger or pun¬

ishment, and reward. They have beendescribed previously in detail.18 Onetemperament factor, novelty seeking,is viewed as a heritable bias in theactivation or initiation of behaviorssuch as frequent exploratory activityin response to novelty, impulsive de¬cision making, extravagance in ap¬proach to cues of reward, and quickloss of temper and active avoidanceof frustration. A second tempera¬ment factor, harm avoidance, is viewedas a heritable bias in the inhibitionor cessation ofbehaviors, such as pes¬simistic worry in anticipation of fu¬ture problems, passive avoidant be¬haviors such as fear of uncertaintyand shyness of strangers, and rapidfatigability. The third temperamentfactor, reward dependence, is viewedas a heritable bias in the mainte¬nance or continuation of ongoingbehaviors, and is manifest as senti¬mentality, social attachment, and

dependence on approval of others.Differences between individuals

based on these dimensions are observ¬able in early childhood and are mod¬erately predictive of adolescent andadult behavior.39 Accordingly, theseaspects ofpersonality denote traits thatare usually considered temperamentfactors because they are heritable, mani¬fest early in life, and apparently in¬volve preconceptual or unconsciousbiases in

learning.



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The structure of temperamentin this model was inferred largelyfrom genetic studies of personalityin humans and neurobiologicalstudies of the functional organiza¬tion of brain networks regulatingclassic and opérant learning re¬sponses of rodents to simple ap¬

petitive or

aversive stimuli.18·40·41As is typical of complex systemsthat are usually hierarchical anddecomposable into stable sub¬systems that evolved sequentially,42ethologic studies also suggestedthat the phylogeny of tempera¬ment began with a behavioral in¬hibition (harm avoidance) systemin all animals, next added an acti¬vation (novelty seeking) system inmore advanced animals, and then

added subsystems for behavioralmaintenance (reward dependence)in reptiles and later phyla.43

Normative studies using theTPQ, a self-report inventory mea¬suring the three dimensions of tem¬perament described here, con¬firmed the proposed structure oftemperament with the exception thatpersistence emerged as a distinct fourthdimension.22·23·44 Persistence, origi¬nally thought to be a component ofreward dependence, was measuredin terms ofperseverance despite frus¬tration and fatigue; it was uncorre-lated with other aspects of reward de¬

pendence (sentimentality, socialattachment, and dependence on ap¬proval). A large-scale twin study con¬firmed that each of these four tem¬

perament factors had heritabilitybetween 50% and 65% and was ge¬netically homogeneous and indepen¬dent of the others.22 In contrast, per¬

sonality factors derived by factoranalysis, such as neuroticism and ex¬traversion, are composites of etio-logically heterogeneous items, withheritable variation in at least two d i¬mensions besides the four TPQ tem¬perament dimensions. In other words,there are more than five heritable di¬mensions of personality.22

Ethological studies also sug¬gested that conceptual or insight-based

learning evolved after the pre-

conceptual learning biases involvedin temperament.43 Hence we extendour theory of personality to allowfor the development of concept-based character traits. Character

development is defined here interms of insight learning or reorga¬nization of self-concepts. Insight

involves the conceptual organiza¬tion of perception and is definedas the apprehension of relation¬ships. Insight learning involves thedevelopment of a new adaptiveresponse as a result of a sudden

conceptual reorganization ofexperience.27·43 In human beings,insight learning includes verballearning, the acquisition of learn¬ing sets or how to learn, and ab¬stract conceptualization that influ¬ences behavioral goals andexpectancies.

Human beings process orconvert some sensory inputs (ie,percepts) into abstract symbols (ie,concepts). Consequently in humanbeings, stimulus-response charac¬teristics depend on the conceptualsignificance and salience of per¬ceived stimuli.38 Hence charactermay be described in terms of the

response biases related to different

concepts of the self, ie, who andwhat we are, and why we arehere. Our unconscious automatic

responses to initiate, maintain, or

stop behavior are initially deter¬mined by temperament factors,but these can be modified andconditioned as a result of changesin the significance and salience ofstimuli that are determined by ourconcept of our identity. From thisperspective, personality develop¬ment is seen as an iterative epige-netic process in which heritable

temperament factors initially moti¬vate insight learning of self-concepts, which in turn modifythe significance and salience ofperceived stimuli to which theperson responds. In this way, bothtemperament and character devel¬

opment influence one another andmotivate behavior.

Three aspects of the

develop-

ment of self-concepts (ie, charactero-logical response sets) are distin¬guished according to the extent towhich a person identifies the self as

(1) an autonomous individual, (2) an

integral part of humanity or society,or (3) an integral part of the unity ofall things (ie, the universe, which de¬

notes everything turned into one in¬terdependent whole). Each aspect ofself-concept corresponds to one ofthree character dimensions that wecall (1) self-directedness, (2) coop¬erativeness, and (3) self-transcen¬dence, respectively.

Empirical Dimensionsof Character

After the genetic structure of the four

temperament dimensions was con¬firmed, other studies were carried outto identify aspects of self-reported orobserver-rated personality that are notcorrelated with temperament as mea¬sured by the TPQ. First, in factor-analytic research on personality in 11-year-old children, a factor defined byadjustment problems was found tobe largely uncorrelated with noveltyseeking, harm avoidance, and re¬ward dependence.24·39 Observationswere based on behavioral adjust¬ment ratings obtained in clinical in¬terviews of the children's teachers. The

adjustment problem factor was la¬beled "unpopularity" because it washighly correlated with frequent peerconflicts (re.75), being unpopular(r=.70), and bullying or being bul¬lied (r=.64). The temperament and

popularity factors were uncorre¬lated with intelligence and aca¬demic achievement.

In studies of self-reported per¬sonality by adults, we observed thatvarious measures of social coopera¬tion and compassion were not wellexplained by the TPQ. Specifically,the temperament factors of the TPQwere largely uncorrelated with somemeasures of social cooperation, suchas the agreeability scale of the Neu-roticism-Extraversion-Openness per¬sonality inventory,46 the aggressionscale of the Multidimensional Per-



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sonality Questionnaire (MPQ),18-47 andthe hostility scale of the Profile ofMood States.48

Furthermore, measures of indi¬vidual self-acceptance and esteem werenot well explained by the TPQ. Thisincluded the alienation scale of the

MPQ, in which individuals view them¬

selves as victims of other people andcircumstances.18·47 Italso includes therepression factor of the MinnesotaMultiphasic Psychological Inven¬tory, in which individuals have dif¬

ficulty admitting to faults about them¬selves.49 Acceptance of individualresponsibility, positive self-regard, andleadership have been found to be cor¬related with the ability to endorse un¬flattering statements about self in otherwork.50

Finally, absorption in the MPQis also not well correlated with anyTPQ factors or with any of the three

higher order dimensions of theMPQ.18·47 The absorption scale hasbeen associated with differential re-sponsivity to hypnosis, meditation,biofeedback, and with increased ca¬pacity for vivid imagery.31 Absorp¬tion or self-forgetful concentration hasbeen described as a stage in insightmeditation that leads to self-

transcendence.52 It is also describedas a correlate ofself-actualization, self-transcendence, and loving fascina¬tion with nature.53·54

These observations suggestedthat aspects of personality unmea¬sured by the TPQ include dimen¬sions of character related to accep¬tance of the individual self, acceptanceof other people, and acceptance ofnature in general. Individuals withmature

personalities (ie, effective ad¬

aptation and self-satisfaction) are self-reliant, cooperative, and possibly self-transcendent. In contrast, those with

personality disorders have difficuttywith self-acceptance, are intolerantand revengeful toward others, andmay feel self-conscious and unful¬filled. This suggested the hypothesisthat subtypes of personality disor¬der can be defined in terms of tem¬

perament variables,18 whereas the

presence or absence of

personality dis-

order may be defined in terms of thecharacter dimensions of self-

directedness, cooperativeness, and self-transcendence.

Description of Character

To develop explicit self-reportmeasures of self-directedness, co-o pe ra t i vene ss , and self-

transcendence, prior descriptionsof related psychological conceptswere reviewed. These provided de¬scriptions of specific componentfactors for each of the three pro¬posed dimensions of character.

Self-Directedness

Our interview studies indicate that

self-directedness is the major deter¬minant of the presence or absenceof personality disorder.25 Accord¬ingly, we will consider this dimen¬sion in the most detail because of itsclinical importance.

The basic concept ofself-directed¬ness refers to self-determination and

"willpower," or the ability of an in¬dividual to control, regulate, and adaptbehavior to fit the situation in ac¬cord with individually chosen goalsand values.55 Popular concepts about"willpower" can be confusing, how¬ever, because willpower or the "will"is not an entity, but a metaphoricalabstract concept to describe the ex¬tent to which a person identifies the

imaginai self as an integrated, pur¬poseful whole individual, rather thana disorganized set of reactive im¬pulses. A more neutral and informa¬tive term than willpower may be torefer to the intentional force of in¬dividuals to affirm or commit to par¬ticular goals or purposes. Accordingto humanists, human beings differfrom other animais in terms of their

ability to make choices among alter¬native responses, to "change theirmind," and to tell lies; therefore, hu¬man beings can be considered to beresponsible for what they do.56

On the positive side, individu¬als who are mature, effective, and well-

organized leaders are described as hav-

ing good self-esteem, able to admitfaults and accept themselves as theyare, feel that their lives have mean¬

ing and purpose, delay gratificationto achieve their goals, and show ini¬tiative in overcoming challenges. Onthe negative side, "borderline" indi¬viduals have low self-esteem, blame

others for their problems, feel un¬certain of their identity or purpose,and are often reactive, dependent, andresourceless. Such low self-esteem and

feelings of inferiority have been sug¬gested to be immature or "childish"characteristics.37 However, many chil¬dren show positive self-esteem at anearly age, particularly when their par¬ents show consistent affection and en¬

courage autonomy.58,59More specifically, Rotter60 de¬

scribed the notion of locus of con¬trol, differentiating those with an in¬ternal locus of control (who believetheir success is controlled by theirown efforts) from those with an ex¬ternal locus of control (who believetheir success is controlled by factorsother than themselves). Studies of thismeasure showed that those with in¬ternal locus of control are more re¬

sponsible and resourceful problem-solvers, whereas others are morealienated and apathetic, tending toblame other people and chance cir¬cumstances for problems.61 Somemeasures of locus of control are con¬founded with other aspects of tem¬

perament and mood (eg, depres¬sion, high harm avoidance, anddependence on approval and per¬suasion), but a factor of responsibil¬ity vs blaming appears to be distinctfrom other aspects of temperamentand related to the more

general con¬

cept of self-directedness.Frankl62 has emphasized the

importance of purpose fulness andmeaningful goal-direction as a moti¬vating force in mature people. Hesuggested that man's main concernis to fulfill meaning, rather than togratifyimpulses and avoid conflicts. Suchpurposefulness varies widely amongindividuals.63 Rogers64 and Covey65 haveemphasized initiative and resource¬ful

problem solving in effective



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schoolchildren and business lead¬

ers, respectively, as an importantaspect of mature character. Bandura66and Bandura and Cervone67 de¬scribed self-efficacy, which is re¬lated to resourcefulness and initia¬tive in goal-directed behavior.According to some Yoga practition¬ers, after someone has cultivated cleargoals and values for a long time, whatwas initially an effort becomes "sec¬ond nature."68 In other words, such

integrated individuals expect their au¬tomatic responses to be congruentwith their goals and values, and theytrust themselves to act spontane¬ously without any feeling of sup¬pressed conflict.

Self-esteem and the ability to ac¬cept one's limitations unapologeticallywithout fantasies ofunlimited abilityand ageless youth are crucial aspectsof the development of mature self-directed behavior.53·57·58·64 individualswith poor adjustment and feelings ofinferiority or inadequacy are often re¬active and deny, repress, or ignore theirfaults, wishing to be best at everythingalways, whereas well-adjustedchildrenare able to recognize and admit un¬

flattering truths about themselves.50Such positive self-esteem and abilityto accept individual limitations has beenfound to be strongly correlated withresponsibility and resourcefulness.50

In summary, self-directedness can

be formulated as a developmental pro¬cess with several stages oraspects. Theseinclude (1) acceptance of responsibil¬ity for one's own choices instead ofblaming other people and circum¬stances, (2) identification of individu¬ally valued goals and purposes vs lackof goal direction, (3) development ofskills and confidence in solving prob¬lems (resourcefulness vs apathy), (4)self-acceptance vs self-striving, and fi¬nally (5) congruent second nature vspersonal distrust. Sample questionsfrom the Temperament and Charac¬ter Inventory (TCI) are listed inTable 1alongwith theirendorsement frequencyin a community sample described later.The assessment ofself-directedness iscrucial for diagnosis because low self-directedness is the common character¬istic of all categories of personality dis¬orders, as shown in our companion ar¬ticle.25 Regardless ofother personalitytraits or circumstances, personality dis¬order is likely to be present if self-directedness is low, and vice versa.

Cooperativeness

The second higher order characterfactor of cooperativeness was formu¬lated to account for individual dif¬ferences in identification with and ac¬

ceptance of other people. This factor

was designed to measure different as¬pects of character related to agree-

ability vs self-centered aggression andhostility. In our companion article,we found that low cooperativenessscores contribute substantially to thelikelihood of concomitant personal¬ity disorder.23 Particularly in indi¬

viduals who are high or only mod¬erately low in self-directedness, theprobability of a diagnosis of person¬ality disorder was increased by lowcooperativeness. All categories of per¬sonality disorder are associated with lowcooperativeness.

Cooperative individuals are de¬scribed as socially tolerant, em¬pathie, helpful, and compassionate,whereas uncooperative individuals aredescribed as socially intolerant, dis¬interested in other people, unhelp¬ful, and revengeful. Rogers64 has de¬scribed facilitative people who showunconditional acceptance of others,empathy with others' feelings, andwillingness to help others achieve theirgoalswithout selfish domination. Suchsocial acceptance, helpfulness, andconcern for the rights of others areoften correlated with one another andwith positive self-esteem.69 Empa¬thy, defined as a feeling of unity oridentification with other people, issaid to allow improved communica¬tion and compassion for others.70



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Helpful generativity and compas¬sion are frequently noted as signs ofmaturity in developmental psychol¬ogy.71 Such compassion involves thewillingness to forgive and be kind toothers regardless of their behavior,rather than to seek revenge or to en¬

joy their embarrassment or suffer¬

ing; it involves feelings of brotherlylove and the absence of hostility.53·72

Effective business leadership of¬ten involves helpfulness, ie, skill infinding mutually satisfying ("win-win") solutions to problems, ratherthan looking out only for personalgain.63 Religious traditions from Bud¬dhism to Judeo-Christianity also em¬phasize the concept of "pure-hearted" acceptance of principles ornatural laws that cannot be broken

without inevitable bad conse¬

quences for the individual, society,and nature.65·73 Belief in such natu¬ral principles, as opposed to imme¬diate self-advantage or social con¬ventions, represents an advanced levelof moral or character development,as described by Kohlberg74·75 andBaruk.76

In summary, cooperativeness canbe formulated as a developmental pro¬cess with several

aspects or stages.

These include (1) social acceptancevs intolerance, (2) empathy vs socialdisinterest, (3) helpfulness vs un-

helpfulness, (4) compassion vs re-vengefulness, and (5) pure-heartedprinciples vs self-advantage. Samplequestions about cooperativeness arelisted in Table 2. Uncooperative in¬dividuals tend to see the world and

others as hostile and alien to them.In contrast, cooperative individuals

feel they are synergistic componentsof a mutually supportive and help¬ful community that is motivated bycompassion and reciprocal respect.

Self-Transcendence

Most people meditate or pray daily,which is more frequent than sexualintercourse according to populationsurveys.77 Frequent meditation orprayer is often associated with en¬

hanced life satisfaction and personaleffectiveness, particularly in olderadults.78 Nevertheless, self-transcendence and character traits as¬

sociated with spirituality have usu¬ally been neglected in systematicresearch and omitted from person¬ality inventories that purport to becomprehensive, including the five-factor model. However, much infor¬mation about the observable behav¬ior of self-transcendent individualshas been written based on the livesof mystics and saints79·80 and self-actualizing individuals.53·54 Also

transpersonal psychology has re¬cently provided descriptions of thesubjective experiences and changesin behavior of people who attain thestate of "nirvana" or self-transcen¬dence as a result of insight medita¬tion techniques.81·82 Self-transcen¬dence refers generally to identificationwith everything conceived as essen¬tial and consequential parts of a uni¬fied whole. This involves a state of

"unitive consciousness" in which ev¬

erything is part ofone totality. In uni¬tive consciousness, there is no indi¬

vidual self because there is no

meaningful distinction between selfand other—the person is simply awareof being an integral part of the evo¬lution of the cosmos. This unitive per¬spective may be described as accep¬tance, identification, or spiritual unionwith nature and its source.79

We found that self-transcendencewas lower in psychiatric inpatientsthan adults in the general commu¬nity, but did not differentiate mostpatients with personality disordersfrom those without such disor¬ders.25 In the clinical setting of ourinterview studies with psychiatricpatients, self-transcendence was

significantly low only in patientswith many symptoms of schizoid

personality disorder.23 In contrast,self-directedness and cooperative-



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ness were low in all personalitydisorders. Self-transcendence can

be particuiarly useful in differenti¬ating schizoid from schizotypal pa¬tients because the latter tend toendorse questions about extrasen¬sory perception and other aspectsof self-transcendence.

The stable self-forgetfulness ofself-transcendent people has been de¬scribed as the same as experiencedtransiently by people when they aretotally absorbed, intensely concen¬trated, and fascinated by one thing.54In such one-pointed concentrationpeople may forget where they are andlose all sense of the passage of time.

Such absorption often leads to"transpersonal" identificationwith thingsoutside the individual self. The per¬sonmay identify (or feel a sense ofspiri¬tual union) with anything or every¬thing. They may experience the feel¬ing that they are part oforbeing guidedby a wonderful intelligence, which ispossibly the divine source of all phe¬nomena. Ultimately, there maybe lossofall distinctions between selfand other

by identifying with the concept of animmanent God as one-in-all.

Such transpersonal identificationleads to spiritual acceptance, or the

apprehension of relationships that can¬not be explained by analytical reason¬ing or demonstrated by objective ob¬servation to others. Spirituality has beendefined as our inner craving to be im-

mortal,83 which leads us to identifywith nature as a whole or with its source.Such arguably metaphorical conceptsas extrasensory perception or reincar¬nation of souls can be understood as

attempts to describe the experienceof transpersonal identification usingwords, which unavoidably denote

things and events. Use of language todescribe self-transcendent experienceis difficult at best because self-transcendentcognition is intuitive ratherthan analytical and deductive.83

Considered as a developmentalprocess, self-transcendence has mul¬

tiple aspects or stages. These stagescan be simplified into some basic ex¬periences and behaviors that have beendescribed in abroad spectrum ofpeopleand cultures, not just rare mystics: (1)

self-forgetful vs self-conscious expe¬rience, (2) transpersonal identification(ie, identification with nature) vs self-differentiation, and (3) spiritual ac¬ceptance vs rational materialism. Some

examples ofquestions about these fac¬tors are listed in Table 3. In our clini¬cal studies only the symptoms ofschiz¬oid personality disorder were signifi¬cantly correlated with low self-transcendence, so it is not a commoncharacteristic of traditional conceptsofpersonality disorder.25 Nevertheless,current DSM-U1-R definitions of per¬

sonality disorder may be too narrowbecause spiritualityand other phenom¬ena measured by this dimension are

important for the adjustment and per¬sonal satisfaction ofmany people, par¬ticularly those over 35 years of age.84Self-transcendence merits further sys¬tematic study in samples from bothclinical and general populations to clarifyits clinical s ignificance.

Empirical Testing of thePersonality Model

A sample of 300 adults, 150 womenand 150 men, completed the TCI,which is a 226-item, true-false ques¬tionnaire measuring seven dimen¬sions of personality. These include a107-item version of the TPQ, mea¬suring the temperament dimensionsof novelty seeking, harm avoidance,and reward dependence and persis¬tence, ft also includes a 119-item char¬acter inventory measuring self-directedness, cooperativeness, and self-transcendence. These 119 items were

selected from 195 items obtained bygenerating 15 questions for each ofthe 13 rationally defined characterfactors. This included measures of thefive aspects of self-directedness, fiveaspects of cooperativeness, and fiveaspects of self-transcendence de¬scribed in the prior section. Thesemeasures were pretested in a sampleof 212 college students, discardingquestions that had extreme re¬sponse frequencies (generally out¬side 20% to 80% endorsement) or



9/16

were weakly correlated with the otherretained items on each factor. No se¬

lection was made based on intercor-relations between factors. This yielded13 scales that are internally consis¬tent and face-valid measures of theconstructs to be tested here.

Subjects were solicited for par¬ticipation in the study as they en¬tered a shopping mall whose cus¬tomers were thought to be fairlyrepresentative of the general popu¬lation of St Louis, Mo. Subjects aged

18 years or older were recruited se¬

quentially, and were excluded onlyif they were in an oversampled gender-age group. The recruiters and ad¬ministrators of the test were blind tothe personality model measured bythe TCI. The mean (±SD) age of thesample was 34.1 ± 12.9 years (range,18 to 91 years). The women (mean[±SD], 35.5±13.7 years; range, 18to 91 years) were slightly older thanthe men (mean [±SD], 32.7±11.9

years; range, 18 to 84 years). The

sample consisted of 114 white (62men and 52 women) and 186 non-white (88 men and 98 women) sub¬

jects.To test for representativeness of

the sample, the results of the TPQwere compared with those obtainedin a national area probability sampleof 1019 noninstitutionalized adults.23

Statistical analyses were car¬ried out using version 6.03 of the SASstatistical software (SAS Institute, Cary,NC).85



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* Correlations above .40 are indicated in bold. S1 indicates responsibility vs blaming; S2, purposefulness vs lack of goal direction; S3, resourcefulness; S4,self-acceptance vs self-striving; S5, congruent second nature; C1, social acceptance vs social intolerance; C2, empathy vs social disinterest; C3, helpfulnessvs unhelpfulness; C4, compassion vs revengefulness; C5, pure-hearted principles vs self advantage; ST1, self-forgetful vs self-conscious experience; ST2,

transpersonal Identification vs self-differentiation; and ST3, spiritual acceptance vs rational materialism.

RESULTS

Variability of Personality Traits

The means, SDs, and internal con¬

sistency (Cronbach a) for each scaleand subscale are shown in

Tables 4 and 5 for the tempera¬ment and character scales, respec¬

tively. The results for the tempera¬ment scales were similar to thoseobtained in a national area probabil¬ity sample,23 suggesting that thesample was representative of the gen¬eral adult population. All the scalesshowed substantial variability amongindividuals. The internal consis¬

tency of the composite scales was high,ranging from .76 to .87 for the tem¬perament scales and .84 to .89 forthe character scales.

Structure of Character Scales

The correlations among the 13

character subscales are summa¬rized in Table 6. Principal com¬ponent analysis identified threefactors with eigenvalues greaterthan 1.0. These accounted for

35%, 16%, and 8% of the variance(59% cumulatively). The standard¬ized factor

loadings following Pro-

max rotation (that is, allowing fornonindependence of factors) areshown in Table 7. The highestloadings of all the cooperativenessscales and self-acceptance are onfactor 1. In other words, the abil¬ity to accept limitations about one¬self is associated with the ability totolerate and accept limitations in

other people as well. The highestloadings of all the self-directednesssubscales except self-acceptanceare on factor 2. The highest load¬ings of all the self-transcendencescales are on factor 3. The vari¬ances explained by each factor af¬ter rotation were 30%, 27%, andi5%, respectively. Interfactor cor¬relations were .52 for factors fand 2, —.16 for factors 2 and 3,and .06 for factors 1 and 3. The

derived three-factor solution forthe f3 character scales corre¬

sponds closely with the rationallydefined dimensions of self-

directedness, cooperativeness, andself-transcendence.

Structure of Temperamentand Character

The correlations among the four

dimensions of temperament

and

three dimensions of character aresummarized in Table 8. The onlycorrelations above .40 relate harmavoidance with self-directedness

( —

.47) and cooperativeness withreward dependence (.54) and self-directedness (.57).

Principal component analysisidentified seven factors with eigen¬values greater than 1. fn the vari-max solution the variances ex¬

plained by each factor were14.2%, 12.0%, 10.1%, 9.0%,7.6%, 6.0%, and 5.7%, accountingfor 65.0% of the total variance.

The standardized factor loadingsfollowing Promax rotation areshown in Table 9. Ignoring cor¬relations with other factors, thevariances explained by each ro¬tated factor ranged from 4.4% to2.0%, which is 17.7% to 8.0% ofthe total variance in the 25 factors.The correlations among the seven

empirically derived factors corre¬sponded closely to those summarizedin Table 8 for the rationally definedfactors.

The persistence factor appearsto be a fairly distinct seventh dimen¬sion of personality, but it has sig¬nificant relations to other aspects ofboth

temperament and character. It



11/16

*The highest loadings are indicated in bold. S1 indicates responsibility vs blaming; S2, purposefulnessvs lack of goal direction; S3, resourcefulness; S4, self-acceptance vs self-striving; S5, congruent secondnature; C1, social acceptance vs social intolerance; C2, empathy vs social disinterest; C3, helpfulness vsunhelpfulness; C4, compassion vs revengefulness; C5, pure-hearted principles vs self advantage; ST1,self-forgetful vs self-conscious experience; ST2, transpersonal identification vs self-differentiation; andST3, spiritual acceptance vs rational materialism.

*Correlations above .40 are indicated in bold. NS indicates novelty seeking; HA, harm avoidance; P,persistence; RD, reward dependence; SD, self-directedness; C , cooperativeness; and ST,self-transcendence.

has positive correlations greater than.20 with three self-directedness com¬

ponents: resourcefulness (.36), con¬gruent second nature (.28), and pur¬posefulness (.24). However, it is not

strongly correlated with other as¬

pects of self-directedness such as re-

sponsibility (.14) and self-acceptance (.08). Persistence hasnegative correlations less than —.20with three temperament factors: fa-

tigability ( —

.29), impulsiveness( —

.21), and disorderliness ( —

.21).In this sample, it was not signifi¬cantly correlated with reward-dependence measures such as sen¬timentality (.09), attachment (.03),or

dependence ( — .07).

We tenta-

tively consider persistence to be a tem¬perament factor because of its promi¬nent development in early childhood.

Effects of DemographicVariables on Character

The effects of gender, ethnicity, andage were examined on the characterscales. Women had higher scores ontotal cooperativeness (81% vs 72%as proportion of total items; P


12/16

*Highest loadings are given in bold; postulated factors, in italics. NS1 indicates exploratory excitability; NS2, impulsiveness; NS3, extravagance; NS4,disorderliness; HA1, worry/pessimism; HA2, fear of uncertainty; HA3, shyness with strangers; HA4, fatigability and asthenia; RD1, sentimentality vsinsensitivity; RD2, persistence; RD3, attachment vs detachment; RD4, dependence vs independence; S1, responsibility vs blaming; S2, purposefulness; S3 ,resourcefulness; S4, self-acceptance vs self-striving; S5, congruent second nature; C1, social acceptance vs social intolerance; C2, empathy; C3, helpfulness;04, compassion vs revengefulness; C5, pure-hearted principles; ST1, self-forgetful vs self-conscious experience; ST2, transpersonal identification vsself-differentiation; and ST3, spiritual acceptance vs rational materalism.

development of increasingly inclu¬sive concepts of the self: identifica¬tion as an autonomous individual

(self-directedness), as an integralpart of human society (coopera¬tiveness), and as an integral part ofthe universe (self-transcendence).This supports the hypothesis thatpersonality is a complex hierarchicsystem that can be naturally decom¬posed into distinct psychobiologicaldimensions of temperament andcharacter.

Alternative Models

We do not assume that the psy¬chobiological model presentedherein provides the only way toderive a description and understand¬ing of character traits. In fact, psy-

chodynamic theories

suggest that

character traits arise as stable resi¬

dues of normal defense mecha¬

nisms, such as anticipation, altru¬ism, and sublimation. Anticipation,which enables people to work forlong-term goals, can lead to someself-directed behaviors like pur-

posefulness. Likewise altruism canlead to cooperative traits, such as

helpfulness and compassion. De¬spite such parallels in content,psychodynamic concepts of char¬acter are categorical constructs thatemphasize the uniqueness of eachindividual. In contrast, we empha¬size the consistent quantitativestructure of the differences amongindividuals. This dimensionalstructure facilitates the testing ofquantitative, falsifiable hypothesesrelating psychological variation toits

biological and social causes.

Development

The finding of three distinct charac¬ter dimensions has strong implicationsfor models of longitudinal develop¬ment. The findings of Erikson71·86and others are often interpreted tomean that there is a fixed stepwisesequence in which development ofone factor necessarily precedes thedevelopment of the next. Bowlby87has suggested an alternative epige-netic model in which personalitydevelopment of each individualcan proceed along any one of a setof potential paths, depending oninitial temperament and initial ex¬

perience. According to thismultiple-path epigenetic model,each subsequent step in develop¬ment is a motivated effort to adaptto current circumstances, given



13/16

85

g 75

65

55

45

Resourceful

Congruent

Responsible

Purposeful

Self-accepting

15 20 —

25 —

30 —

35 — -

40 — "

45 — "

50 — -

55 —I

60

Age, y

SD1

SD 2

SD 3

SD 4•SD 5

Figure 1. Relationship of age to self-directedness (SD) subscale scores in quintiles of 300 individualsfrom the general community.

Age, y

C1

C2

C3

C4

C5

Figure 2. Relationship of age to cooperativeness (C) subscale scores in quintiles of 300 individualsfrom the general community.

current

personality. However, if there

really were a fixed developmentalsequence for character traits, then ma¬

turity could be adequately de¬scribed on a single scale. The obser¬vation of three character dimensions

suggests that there are multiple as¬pects of character development, eachhaving unique antecedents. Never¬theless, the joint staging and inter¬action of these multiple dimensionshas received little study because of

the absence of comprehensive quan-

titative measures of the

multiple fac¬

tors of temperament and character.Some sequences in character devel¬

opment may be more frequent or op¬timal than others, and the correla¬tions among the character and

temperament dimensions suggestsome reciprocal interaction. Our find¬ings about longitudinal develop¬ment should be considered illustra¬tive and tentative because this is across-sectional study of people ofvary¬

ing age. In

this study we cannot

dis-

tinguish developmental effects fromcohort effects. Nevertheless, our find¬ings suggest the importance of ageand/or cohort effects in the unfold¬

ing of character and encourage fu¬ture longitudinal research.

DIAGNOSIS

These character scales may help toclarify current concepts ofwhat a per¬sonality disorder is in contrast to moreoptimal adaptation. That is, indi¬viduals with extreme variants of tem¬

perament maybe well-adapted, depend¬ing on their character and circum¬stances. However, anyone who is lowin self-directedness and cooperative¬ness is likely to have a personality dis¬order, and vice versa. The importanceof self-transcendence in character de¬

velopment is arguable in early life, butit becomes a major concern as we facedeath and misfortune. The availabil¬

ity of this set of personality measuresshould facilitate evaluation and clas¬sification of personality and its disor¬ders, as well as studies of inheritance,information processing, and develop¬ment (cognitive, personal, social, moral,and spiritual).

The three dimensions of char¬acter are distinct from previously de¬scribed measures of temperament.Overall, our results support a seven-dimensional model ofpersonality; fourtemperament factors and three char¬acter factors. The temperament fac¬tors appear to be more directly tiedto neurobiological and genetic de¬terminants of behavior, in contrastto the epigenetic development of self-

concepts in character. Furthermore,

the temperament dimensions ap¬pear to be more closely related to sus¬ceptibility to different neurotic syn¬dromes, such as anxiety andsomatoform disorders, rather than tothe presence or absence of person¬ality disorders or psychoses.40 Eat¬ing disorders and substance abuse dis¬orders appear to involve differencesin both temperament and character

development, but this requires fur¬

ther systematic study.19



14/16

75

70-

65

60

55·

50

45 — -20

— ~25 30

— -35

— -

40 — ~

45 — -

50~ "

55

ge, y

—

60

ST 1

ST 2

' ST 3

Figure 3. Relationship of age to self-transcendence (ST) subscale scores in quintiles of 300individuals from the general community.

INHERITANCE

It is likely that genetic factors areas important in character develop¬ment as they are for temperament.In fact, the heritability of charactermay explain why some individualsmaintain inflexible maladaptive be¬havior patterns whereas otherswith similar temperaments do not.

Conceptual learning, such as self-aware imitation, is an evolutionarydevelopment of mammals.43 Indi¬vidual differences in human twinsfor the MPQ primary factors ofalienation, aggression, and absorp¬tion are influenced by genetic fac¬tors as much as other aspects of

personality.88 However, if culturalperspectives89·90 and social learn¬ing39·64·66·91 are as important in theepigénesis of self-concepts as hasbeen

suggested, then environmen¬

tal effects associated with particu¬lar families and cultures should bemore important in character devel¬opment than has been observedfor temperament. Comparisons ofthe inheritance of temperamentand character should be useful for

testing sociocultural learning hy¬potheses. Likewise, the effect ofdifferent forms of psychotherapyon character development shouldbe a

controlled way of

assessing

the influence of environmental

change on personality.

MEMORY SYSTEMS

The most fundamental distinction be¬tween character and temperamenthere appears to be that character de¬

velopment is a concept-based pro¬cess whereas temperament involvesdifferences between individuals in per¬

ceptual processes and habit forma¬tion. This corresponds to the dis¬tinction of conceptual memory(regulated by the cortico-limbo-diencephalic memory system) andperceptual memory (regulated by thecortico-striatal memory system).

TREATMENT

Different pharmacological interven¬tions have been

proposed in the modi¬

fication of temperament.40·92 For ex¬ample, lithium therapy reduces fre¬quency of temper outbursts andincreases reflectiveness.93 However,lithium therapy does not change self-concepts or increase self-directedness,and compliance outside ofauthoritar¬ian controlled settings is poor.93 In con¬trast, different psychological treatmentsmay be relevant for the developmentof different aspects of character. For

example, particularcognitive-behavioral

techniques may facilitate learning self-directed behavior.53 Some other meth¬ods of psychological treatment, suchas psychoanalysis, transactional analy¬sis, and reality therapy, are also di¬rected primarily at development ofself-directed behavior.81 fn contrast, other

experiential techniques are designedto facilitate acceptance of others or de¬velopment of cooperative behavior;these include Rogerian counseling,64logotherapy,62 and interpersonal psy-chosynthesis.94 Finally, attainment ofself-transcendence is a goal ofJungiananalysis84 and insight meditation aspracticed in Mahayana Buddhism,Vedanta Hinduism, Taoism, and mys¬tical forms of other religions.32 Muchresearch is needed to explore the in¬teractions of specific drugs and psy¬chosocial interventions in treatmentof personality and its disorders.

Finally, assuming that charac¬ter and temperament involve concept-based and percept-driven memory,stable personality change probably re¬quires that conceptual insights modifyhabits by disciplined practice, per¬haps facilitated by combined phar-macotherapy. In other words, per¬sonality change has both rational andemotional components.95 Consciousintention is transient, effortful, andinefficient, whereas perceptual con¬ditioning is more long-lasting, auto¬matic, and efficient.34·96·97 A combi¬nation of cognitive-behavioraltreatments and, perhaps only ini¬tially, medications to alter indi¬vidual differences in temperamentshould be most effective.

Accepted for publication November

4,1992.This study was supported in part

by grant MH31302 from the NationalInstitute of Mental Health, and grantsAA07982 and AA08028 from the Na¬tional Institute on Alcoholism and Al¬

cohol Abuse, National Institutes of Health,Bethesda, Md, and a grant from the JohnD. and Catherine T. MacArthur Foun¬dation Mental Health Research Net¬work on the Psychoblology of Depres¬

sion, Chicago, III.



15/16

Helpful comments were receivedfrom many colleagues, particularly Sam¬uel Guze, MD, John Nemiah, MD, andNorman Sartorius, MD, and our de¬

partmental Personality Study Group(Kenneth Freedland, MD, Andrew Heath,MD, Kim McCaüum, MD, Joan Luby,MD, John Rohrbaugh, MD, and Rich¬ard Wetzel, PhD). We also appreciatethe comments of Mary Blehar, PhD,Michael Bohman, MD, Lindon Eaves,PhD, Peter Joyce, MD, Alex Kaplan,MD, Roger Mulder, MD, Gordon Parker,MD, and Soren Sigvardsson, PhD.

Reprint requests to Department ofPsychiatry, Washington University SchoolofMedicine, 4940 Children's Pi, St Louis,MO 63110 (Dr Cloninger).

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Psychobiological Model of Temperament and Character (1)

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