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Temperament and character in primary insomnia

Published online by Cambridge University Press:  16 April 2020

Zara de Saint Hilaire*
Sleep Laboratory, University Hospital of Geneva, Belle-idée, 2 chemin Petit Bel-Air, 1225, Chêne-Bourg, Switzerland
Judith Straub
Sleep Laboratory, University Hospital of Geneva, Belle-idée, 2 chemin Petit Bel-Air, 1225, Chêne-Bourg, Switzerland
Antoine Pelissolo
Service de psychiatrie adulte, Groupe Hospitalier Pitié-Salpêtrière, 47-83, bd de l'Hopital, 75651Paris, France
*Corresponding author. E-mail address: (Z. de Saint Hilaire).
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Recent studies by Cloninger suggest that the temperament dimension of harm avoidance might be related to serotonergic activity. Since serotonergic mechanisms equally play a major role in sleep regulation, we decided to use Cloninger’s psychobiological model of temperament and character to assess whether there is a link between psychophysiologic insomnia and specific personality traits. Chronic insomnia is a common complaint in modern society, and it is still controversial whether insomniacs share specific personality traits. Thirty-two chronic insomniacs (<50 years) were studied. They underwent polysomnography for two consecutive nights and filled out the 226-item self-questionnaire of Temperament and Character Inventory as well as the Hospital Anxiety and Depression scale. (1) Harm avoidance for all subscores was significantly higher in insomniac patients when compared with controls; (2) self-directedness scores were lower in insomniacs; (3) sleep latency was positively correlated to harm avoidance; (4) HA1 (anticipatory worry) was negatively correlated to REM latency. Temperament and Character Inventory is a useful tool in the investigation of chronic insomnia. Serotonergic mechanisms might explain the high incidence of harm avoidance as personality trait in psychophysiologic insomniac patients. Further studies are needed to see whether harm avoidance could be a psychological vulnerability marker for primary insomnia and be used as predictor of SSRI treatment responders.

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Allgulander, C, Cloninger, CR, Przybeck, TR, Brandt, LChanges on the temperament and character inventory after paroxetine treatment in volunteers with generalized anxiety disorder. Psychopharmacol Bull 1998;34 165166.Google ScholarPubMed
American Psychiatric Association Diagnostic and statistical manual of mental disorders DSM-IV. 4th edWashington (DC): 1994Google Scholar
Berger, M, Rieman, DREM sleep in depression—an overview. J Sleep Res 1993;2 211223.CrossRefGoogle ScholarPubMed
Black, KJ, Sheline, YLPersonality disorder scores improve with effective pharmacotherapy of depression. J Affect Disord 1997;43 1118.CrossRefGoogle Scholar
Bonnet, MH, Arand, DLThe consequences of a week of insomnia II: patients with insomnia. Sleep 1998;21 359368.Google ScholarPubMed
Cloninger, CR, Bayon, C, Svrakic, DMMeasurement of temperament and character in mood disorders: a model of fundamental states as personality types. J Affect Disord 1998;51 2132.CrossRefGoogle Scholar
Cloninger, CR, Svrakic, DM, Przybeck, TRA psychobiological model of Temperament and Character Inventory (TCI). Arch Gen Psychiatry 1993;50 975990.CrossRefGoogle Scholar
Cloninger, CRA systematic method for clinical description and classification of personality variants. Arch Gen Psychiatry 1987;44 573588.CrossRefGoogle ScholarPubMed
Cloninger, CRA unified biosocial theory of personality and its role in development of anxiety states. Psychiatr Dev 1986;3 167226.Google Scholar
Costa e Silva, JA, Chase, M, Sartorius, N, Roth, TSpecial report from a symposium held by the World Health Organization and the World Federation of Sleep Research Societies: an overview of insomnias and related disorders-recognition, epidemiology, and rational management. Sleep 1996;19 412416.CrossRefGoogle ScholarPubMed
Dorsey, CM, Bootzin, RRSubjective and psychophysiologic insomnia: an examination of sleep tendency and personality. Biol Psychiatry 1997;41 209216.CrossRefGoogle Scholar
Edinger, JD, Stout, AL, Hoelscher, TJCluster analysis of insomniacs’ MMPI profiles: relation of subtypes to sleep history and treatment outcome. Psychosom Med 1988;50 7787.CrossRefGoogle ScholarPubMed
Ford, DE, Kamerow, DBEpidemiologic study of sleep disturbance and psychiatric disorders: an opportunity for prevention?. JAMA 1989;262 14791484.CrossRefGoogle Scholar
Gaillard, JMPsychopathologie et psychothérapie de l'insomnie chronique. Psychothérapies 1994;3 147152.Google Scholar
Hansenne, M, Reggers, J, Pinto, E, Kjiri, K, Ajamier, A, Ansseau, MTemperament and character inventory (TCI) and depression. J Psychiatr Res 1999;33 3136.CrossRefGoogle ScholarPubMed
Harvey, BHThe neurobiology and pharmacology of depression: a comparative review of serotonin selective antidepressants. S Afr Med J 1997;87 540552.Google ScholarPubMed
Hauri, P, Fisher, JPersistent psychophysiologic insomnia. Sleep 1986;9 3853.CrossRefGoogle Scholar
Jouvet, MSleep and serotonin: an unfinished story. Neuropsychopharmacology. 21 Suppl 2 1999 24S27S.Google Scholar
Kales, A, Caldwell, AB, Preston, TA, Healey, S, Kales, JDPersonality patterns in insomnia: theoretical implications. Arch Gen Psychiatry 1976;33 11281134.CrossRefGoogle ScholarPubMed
Kales, A, Vgontas, APredisposition to and development and persistence of chronic insomnia: importance of psychobehavioral factors. Arch Intern Med 1992;152 15701572.CrossRefGoogle ScholarPubMed
Kupfer, DJREM latency: a psychobiological marker for primary depressive disease. Biol Psychiatry 1976;11 159174.Google Scholar
Landolt, H-P, Meier, V, Burgess, HJ, Finelli, L, Cattelin, F, Achermann, Pet al.Serotonin-2 receptors and human sleep: effect of a selective antagonist on EEG power spectra. Neuropsychopharmacology 1999;21 455466.CrossRefGoogle ScholarPubMed
Le Bon, O, Staner, L, Murphy, JR, Hoffmann, G, Pull, CH, Pelc, ICritical analysis of the theories advanced to explain short REM latencies and other sleep anomalies in several psychiatric conditions. J Psychiatry Res 1997;31 433450.CrossRefGoogle ScholarPubMed
Levin, D, Bertelson, AD, Lacks, PMMPI differences among mild and severe insomniacs and good sleepers. J Pers Assess 1984;48 126129.CrossRefGoogle ScholarPubMed
Marchini, E, Coates, T, Magistad, JG, Waldum, SJWhat do insomniacs do, think and feel during the day? A preliminary study. Sleep 1983;6 147155.CrossRefGoogle ScholarPubMed
Mc Carley, RW, Hobson, JANeuronal excitability modulation over the sleep cycle: a structural and mathematical model. Science 1975;189 5860.CrossRefGoogle Scholar
Mellinger, GD, Balter, MB, Uhlenhuth, EHInsomnia and its treatment: prevalence and correlates. Arch Gen Psychiatry 1985;42 225232.CrossRefGoogle ScholarPubMed
Nowell, PD, Buysse, DJ, Reynolds, CF III, Hauri, PJ, Roth, T, Stepanski, EJet al.Clinical factors contributing to the differential diagnosis of primary insomnia and insomnia related to mental disorders. Am J Psychiatry 1997;154 14121416.Google ScholarPubMed
Ohayon, M, Caulet, M, Guilleminault, CHow a general population perceives its sleep and how this relates to the complaint of insomnia. Sleep 1997;20 715723.CrossRefGoogle ScholarPubMed
Ohayon, MEpidemiological study on insomnia in a general population. Sleep 1996;19 S7S15.CrossRefGoogle Scholar
Peirson, AR, Heuchert, JW, Thomala, L, Berk, M, Plein, H, Cloninger, CRRelationship between serotonin and the Temperament and Character Inventory. Psychiatr Res 1999;89 2937.CrossRefGoogle ScholarPubMed
Pellissolo, A, Lépine, JNormative data and factor structure of the Temperament and Character Inventory (TCI) in the French version. Psychiatry Res 2000;94 6776.CrossRefGoogle Scholar
Perlis, ML, Giles, DE, Buysse, DJ, Thase, ME, Tu, X, Kupfer, DJWhich depressive symptoms are related to which sleep electroencephalographic variables?. Biol Psychiatry 1997;42 904913.CrossRefGoogle ScholarPubMed
Rechtschaffen, A, Kales, AAA manual of standardized terminology, techniques and scoring systems for sleep stages of human subjects. Rechtschaffer A, Kals A (Eds.).. Rechtschaffer, AKals, Aet al. 1968 UCLA, Brain Information ServiceGoogle Scholar
Reynolds, C, Kupfer, DJ, Buysse, DJ, Coble, PA, Yeager, ASubtyping DSM-III-R primary insomnia: a literature review by the DSM-IV work group on sleep disorders. Am J Psychiatry 1991;148 432438.Google Scholar
Soldatos, CRInsomnia in relation to depression and anxiety: epidemiologic considerations. J Psychosom Res 1994;38 38.CrossRefGoogle ScholarPubMed
Thase, ME, Kupfer, DJ, Spiker, DGElectroencephalographic sleep in secondary depression: a revisit. Biol Psychiatry 1984;19 805814.Google ScholarPubMed
Thase, MEAntidepressant treatment of the depressed patient with insomnia. J Clin Psychiatry 1999;60 2831.Google ScholarPubMed
The International Classification of Sleep Disorders, revised: diagnostic and coding manual Rochester American Sleep Disorders Association 1997Google Scholar
Zigmond, AS, Snaith, RPThe Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 1983; 67:361370.CrossRefGoogle ScholarPubMed
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