Temperament and character were evaluated in patients with panic disorder (PD) before and after 1 year of pharmacological therapy to verify whether personality characteristics change after treatment. Therefore, 65 PD patients and 71 healthy subjects participated in the study. All subjects were evaluated with the SCID-IV, the Temperament and Character Inventory (TCI), the SCL-90, the Ham-A and the Ham-D. Patients were treated with paroxetine or citalopram. The TCI was re-administered to the patients at the end of the study. At the end of the study, complete remission was achieved by 31 patients (R), whereas symptoms did not disappear in the remaining 34 patients (NR). Before treatment, NR patients showed higher levels of harm avoidance (HA) and lower levels of persistence (P), self-directedness (SD) and cooperativeness (C) than healthy controls. Only HA levels were higher than normal in R, although they were significantly lower in R than in NR patients. These differences persisted after treatment. However, in NR patients the levels of SD and C worsened, whereas the difference between R patients and controls in HA levels (higher in R patients than in controls) disappeared after controlling the effect of residual phobic anxiety (higher than normal in R patients). Our data suggest that the high levels of HA found after remission may depend on the subsyndromal residual phobic symptoms, observed in R patients. Moreover, the persistence of anxious symptoms may have worsened the low levels of SD and C observed before treatment in patients who did not achieve remission.
Personality disorders (PersDs) are commonly observed in patients affected by panic disorder (PD) with a prevalence rate ranging from 20% to 86% (Hoffart et al., 1994, Ampollini et al., 1997, Ampollini et al., 1999, Langs et al., 1998, Dyck et al., 2001, Iketani et al., 2002, Massion et al., 2002 and Grant et al., 2005).
On the one hand, PersDs are supposed to predispose people to suffer from PD (Cloninger, 1986 and Brooks et al., 1989), to increase the severity of anxious symptoms (Mavissakalian and Hamman, 1987, Wittchen et al., 1991, Hofmann et al., 1998 and Ozkan et al., 2005), to predict the pattern of comorbidity, particularly the co-occurrence of major depression (Hoffart and Martinsen, 1993, Langs et al., 1998, Ongur et al., 2005 and Ozkan et al., 2005) and to influence negatively the response to treatment (Dreessen and Arntz, 1998 and Slaap and den Boer, 2001). On the other hand, PD may worsen personality functioning, particularly by increasing the avoidant and dependent traits (Mavissakalian and Hamman, 1987, Noyes et al., 1991, Hoffart and Hedley, 1997 and Hofmann et al., 1998).
In most studies in which personality characteristics were evaluated in PD patients, the categorical approach was utilized. However, this approach has been criticized (Widiger and Sanderson, 1995 and Westen and Arkowitz-Westen, 1998) and dimensional models of PersDs are thought to be superior to categorical models, especially for research purposes (Widiger, 1992). Among the variety of alternative dimensional models proposed for DSM-IV PersDs, Cloninger's psychobiological model (Cloninger, 1987 and Cloninger et al., 1993) has received considerable empirical support. The most recent conceptualisation of this model (Cloninger et al., 1993) consists of four dimensions of temperament (novelty seeking (NS), harm avoidance (HA), reward dependence (RD) and persistence (P)) and three dimensions of character (self-directedness (SD), cooperativeness (C) and self-transcendence (ST)).
In PD, Cloninger's model has been tested almost exclusively in the acute phase, and most studies used the Tridimensional Personality Questionnaire (TPQ), which refers to the first conceptualisation of Cloninger (Cloninger, 1987) and evaluates only the temperament dimensions. In these studies, high levels of HA were found in PD patients (Saviotti et al., 1991, Starcevic et al., 1996, Ampollini et al., 1997 and Ampollini et al., 1999), particularly in those with depressive comorbidity. Some authors suggested that high HA in acutely ill PD patients might be related to the severity of symptomatology, because the severity of the anxiety state changes HA score (Brown et al., 1992 and Svrakic et al., 1993); in contrast others posited that high HA is a personality dimension related to vulnerability to PD (Cloninger, 1987 and Saviotti et al., 1991). This controversy might be resolved by longitudinal studies that evaluate personality dimensions before and after remission. Nevertheless, to our knowledge only one study (Saviotti et al., 1991) assessed temperament in remitted patients. In these patients, HA was higher than normal, suggesting that this temperament dimension is a trait that predisposes people to suffer from PD.
To our knowledge, no previous study evaluated temperament and character dimensions in PD patients both in the acute phase and after complete remission of symptoms. Therefore, in this study PD patients were evaluated with the Temperament and Character Inventory (TCI) (Cloninger et al., 1994), before and after medication treatment, to verify whether an alteration of temperament and/or character dimensions represents a stable personality characteristic in PD. A group of age- and sex-matched healthy subjects served as controls.
