Trait and state aspects of harm avoidance and its implication for treatment in major depressive disorder, dysthymic disorder, and depressive personality disorder

Abstract

The authors evaluated the trait/state issues of harm avoidance in depressive-spectrum disorders and its predictive potential for antidepressant response. Subjects with Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) major depressive disorder ( n = 39), dysthymic disorder ( n = 37), depressive personality disorder ( n = 39), and healthy control subjects ( n = 40) were evaluated with the Temperament and Character Inventory and the 17-item Hamilton Depression Rating Scale (HDRS-17) at baseline and after a 12 week antidepressant treatment period. Higher harm avoidance scores predicted lesser improvement in subjects with dysthymic disorder and major depressive disorder, as determined by lesser decrease in HDRS-17 scores. Mean harm avoidance scores in depressed subjects were consistently greater than those in healthy controls, controlling for age, gender and diagnosis. Mean harm avoidance scores decreased significantly in all depressive-spectrum disorders after treatment, but still remained higher than harm avoidance scores in control subjects. The present study reports that harm avoidance is a reliable predictor of antidepressant treatment in subjects with major depressive disorder and dysthymic disorder and that harm avoidance is both trait-and state-dependent in depressive-spectrum disorders.

Current suicidality and previous suicidal attempts in patients with schizophrenia are associated with different dimensions of temperament and character

“…They had higher scores in the dimension Harm avoidance and lower scores in the dimension Self-directedness. Such findings have been described in many previous studies with patients suffering from depression (Corruble et al, 2002;Abrams et al, 2004;Calati et al, 2008). Although our patients were clinically stable, and low in suicidality scores, the presence of higher Harm avoidance in this group reflected the patients' proneness to anxiety, pessimism and depressive symptoms.…”

“…This dimension reflects personality features such as responsibility, purposefulness, resourcefulness and self-acceptance (Cloninger et al, 1993). Self-directedness is typically low in patients with depression and in patients with schizophrenia (Abrams et al, 2004;Smith et al, 2008). Moreover, it is the most significant predictor of the patients' level of functioning (Eklund et al, 2004).…”

Shame, sensitivity to punishment and psychiatric disorders

“…There was a significant difference higher Sensitivity to Punishment in patients with Major Depression than in control subjects. This could be explained in line with Gray's theory of the existence of specific neurophysiologic system influencing sensitivity to inhibiting events and the findings relating sensitivity to punishment 22 to neuroticism.…”

Interaction between Brain-Derived Neurotrophic Factor Val66Met Polymorphism and Recent Negative Stressor in Harm Avoidance

“…Although HA is generally considered to be trait dependent as a heritable temperament, it also has a statedependent portion that changes with nongenetic factors [13] . It seems that HA could be under the influence of gene-environment interaction.…”

“…With a similar biogenetic view on personality, Cloninger [12] has developed a concept of personality composed of 2 dimensions: temperament as a genetic factor and character as an environmental factor. Among 4 heritable temperaments, harm avoidance (HA), which is hypothetically related to serotonin, is closely associated with anxiety or mood disorders [13][14][15] .…”