|Year : 2021 | Volume
| Issue : 2 | Page : 89-95
Temperament and character relations in borderline personality disorder
Gonca Gül Yilmaz1, Meltem Sen2, Süleyman Dönmezler2, Habib Erensoy3, Tonguç Demir Berkol2
1 Department of Psychology, Institute of Social Sciences, Üsküdar University, Istanbul, Turkey
2 Psychiatry Clinic, Bakırköy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Education and Research Hospital, Istanbul, Turkey
3 Department of Psychiatry, Üsküdar University, Istanbul, Turkey
|Date of Submission||03-Feb-2021|
|Date of Decision||08-Jun-2021|
|Date of Acceptance||14-Jul-2021|
|Date of Web Publication||13-Aug-2021|
Psychiatry Clinic, Dr. Mazhar Osman Mental Health and Neurological Diseases Education and Research Hospital, Istanbul
Source of Support: None, Conflict of Interest: None
Aim: Understanding human behavior is a common struggle among psychology researchers and clinicians. One of the mysteries in psychology is the relation of temperament with a psychiatric disorder. In this study, it is aimed to evaluate this association with other perspectives. Materials and Methods: The present study was conducted between 2017 and 2018. Participants consisted of 88 people, who were freely selected and separated as treated and untreated from NP Istanbul Hospital and Polyclinics. There are two groups of paticipants who have borderline personality disorder; 48 untreated patients which are 24 men and 24 women and 40 treated patients which are 20 men and 20. The evaluations were made through the Demographic Information Form, Temperament and Character Inventory, and Borderline Personality Inventory prepared by the researcher. Results: People under treatment had different scores than the control group. It could be thought that it is evidence that treatment is effective and it may change the temperamental dimensions for people with borderline personality disorder. Many of the results came significantly different between the groups after temperament and character inventory had been applied. The dimensions had differed between the groups. Discussion: People with scores below borderline personality inventory's cutoff value had higher scores with the features that might be helpful for a person to cope with their problems in social and occupational life and to persist in their projects. Patients under treatment had been found to have more features that might negatively affect one's life. It could be thought that people under treatment might have more severe symptoms or might have additional psychiatric problems. Conclusion: This study revealed a few contradictions between DSM-5 and Borderline Personality Inventory and between Borderline Personality Inventory and Temperament and Character Inventory. This study may lead practitioners and researchers to further investigate the field.
Keywords: Borderline, personality, temperament and character features
|How to cite this article:|
Yilmaz GG, Sen M, Dönmezler S, Erensoy H, Berkol TD. Temperament and character relations in borderline personality disorder. J Neurobehav Sci 2021;8:89-95
|How to cite this URL:|
Yilmaz GG, Sen M, Dönmezler S, Erensoy H, Berkol TD. Temperament and character relations in borderline personality disorder. J Neurobehav Sci [serial online] 2021 [cited 2022 Sep 28];8:89-95. Available from: http://www.jnbsjournal.com/text.asp?2021/8/2/89/323812
| Introduction|| |
One of the major struggles in psychology is to understand and treat personality disorders properly. The treatment modalities are in the process of development. In this study, understanding the personalities of the patients under psychological treatment with the aspect of the uniqueness of a human and improving the treatment techniques have been aimed. Patients with personality disorders commonly have some struggles in their social and occupational lives. This situation is similar during the psychological therapy process. They usually have difficulties continuing the treatment.
Borderline personality disorder is characterized by instability with interpersonal relationships, social life, occupational life, and self-thoughts. The patients diagnosed with borderline personality disorder may have difficulties to identify themselves. Their thoughts about themselves or other people may change and it makes them stabilize their relationship with people and even with themselves is difficult. Suicidal tendency is very common among patients with borderline personality disorder. They also may tend to injure themselves. With psychological therapy, they may improve insight. The remission may have been expected after proper psychological therapy.
Temperament is defined as primary emotions. One may have different dimensions of his personality and every dimension may belong to a temperamental diversification. Seeking joy, fear, rage, sexual lust, care, separation distress, and play are primary emotions according to Panksepp's style. Although there is no definite explanation of temperament, this is one of the most accepted approaches. Patients with borderline personality disorder may have difficulties controlling their anger. Their interpersonal relationships are unsteady because of this temperamental tendency. Inappropriate intense anger is one of the temperamental features associated with borderline personality disorder.
Temperament and character inventory is based on the psychobiological theory which is a new and multidisciplinary theory. In literature, temperament and character inventory has been used in many types of research. It helps to categorize and understand human behavior and human nature.
It is known that there is a possibility that a person may have a personality disorder without loss of functionality. In addition, a personality disorder may trigger another psychiatric disorder.
Borderline Personality Inventory is based on the theory which is described by Otto F. Kernberg and is aimed to evaluate borderline personality disorder. Using this inventory, this study aimed to understand if there is a relation between borderline personality inventory score and temperament and character of people who have borderline personality disorder. This relation had been evaluated between the two groups. One group was under treatment for borderline personality disorder and additional psychiatric disorders if they had. With the help of this evaluation about temperament and character of borderline personalities, there may be a chance to help people solve their interpersonal relations and in their social lives. Therefore, this may help people with borderline personality disorder creating insight about themselves.
In this study, it is thought that patients under treatment may improve their temperamental g-features to cope with their problems in their social and occupational lives. They may have an insight into their unresolved personality issues and they may learn to control their emotions and impulsivity. In this research, two groups which are the patients under treatment and the control group had been evaluated to differentiate their temperamental features and to reveal the effect of treatment on them.
Besides, it is expected that patients with borderline personality disorder may have difficulty to persist in their plans, projects or their opinions about people or events around them in this study. Temperament and character inventory is questioning patients' persistence. One of the purposes of this study is to reveal the relation between persistence and borderline personality disorder with the help of the inventory.
| Materials and Methods|| |
This study was performed in line with the principles of the declaration of Helsinki. Approval was granted by the Ethics Committee of Üsküdar University noninterventional studies ethics committee on August 14, 2017 with the number B.08.6.YÖK.2.ÜS.0.05.0.06/2017/199.
Study participants included 88 patients who are followed in the outpatient clinics in NP Istanbul Hospital. Forty patients of 88 are diagnosed with borderline personality disorder by using borderline personality inventory as a diagnostic instrument. The participants of the control group included 48 people under no psychiatric treatment, and they were selected randomly from a group of people with borderline personality disorder. The participants in the treated group were received cognitive behavioral therapy and symptomatic treatment including pharmaceuticals. The data of these participants were collected between August 2017 and January 2018. This study is a cross-sectional research.
The inclusion criteria include voluntary participation. The exclusion criteria include the ability to fill the inventories by having no mental or physical impairment to prevent reading and writing properly.
This research has ethical committee approval from Üsküdar University observational ethical committee with the number of B.08.6.YÖK. 2.ÜS.0.05.0.06/ 2017/199 in the 8 Meeting on August 14, 2017. The study was carried out in accordance with the Helsinki Declaration of Principles. The study was carried out in accordance with the Helsinki Declaration of Principles. Participants were informed, and they signed an informed consent form before they were applied to the sociodemographic form, Temperament and Character Inventory, and Borderline Personality Inventory.
Socidemographic form has been questioning demographic characteristics and such as age, sex, education, occupation, psychiatric treatment status, drug use, and medical comorbidities.
Temperament and Character Inventory is an inventory improved by Cloninger to define the normal and abnormal variations of character and temperament components based on a psychobiological personality dimension. It consists of 240 items that people could answer with “yes” and “no.” This inventory is a self-evaluation instrument and is improved to describe the nature and development of personalities. This inventory applied in Turkish to the patients after validity and reliability in Turkish had been established.
Borderline Personality Inventory is based on Kernberg's definition of borderline personality organization. It includes 53 items for a self-evaluation. This inventory is used as a diagnostic method for the differentiation of borderline personality disorder. This inventory applied in Turkish to the patients after validity and reliability in Turkish had been established.
IBM SPSS Statistics 20.0 (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.) was used to analyze the data in this study. The statistical techniques applied after the data had been grouped in two and two categories. Frequency analysis had been done to determine the distribution of demographic data. Inventory scores for both the group under treatment and the control group and their average scores had been evaluated with a t-test for independent groups. P scores had been obtained from each test.
| Results|| |
The demographic data of participants have been applied to frequency analyses. Fifty percent of 88 participants were women. Nine percent, 2 of them were between 19 and 25 years old where 44%, 8 of them were between 26 and 35, 29%, 9 of them were 36 and 45 and 16%, 1 of them were above 46 years old. Six percent, 9 of the study group graduated from primary school, 20%, 7 of them from high school, 6%, 9 of them from an associate degree program, 56%, 3 of them from university and 9%, 2 of them from a master's degree program. Forty-five percent, 5 of the participants had been under treatment for their psychiatric disorder. Twenty-one percent, 3 of them had other chronic diseases.
T-test scores for independent groups have resulted in the difference of the borderline personality inventory scores between people under psychiatric treatment and people under no treatment was statistically significant while the averages of the scores of people under the treatment is significantly higher.
All items of the Temperament and Character Inventory were analyzed, and the scores were calculated. The statistically significant items and their scores between the group under treatment and the group without treatment are shown in [Table 1]. Feeling excited by discovery item under novelty-seeking subscale, fear of uncertainty, and shyness with strangers items under harm avoidance subscale, any item of reward dependence subscale, persistence subscale, taking responsibility and self-acceptance items under self-management subscale, social approval, empathy, charitableness and virtuousness under collaboration subscale, and any item of getting over oneself subscale did not show statistically significant differences between the study groups.
|Table 1: Temperament and Character Inventory Scores of Group Without Treatment and Group With Treatment|
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Eighty-eight participants took the Borderline Personality Inventory and 59 of them got a score above the cutoff value for borderline personality disorder according to the inventory. In this study, the scores of temperament and character inventory were evaluated and compared between the group of 59 participants who got scores above cutoff value and the group of 29 participants who got scores below cutoff value. Items with statistically significant differences between these two groups are shown in [Table 2]. Feeling excited by discovery item under novelty-seeking subscale, fear of uncertainty and shyness with strangers items under harm avoidance subscale, any of the 3 items of reward dependence subscale, self-acceptance items under self-management subscale, 3 items other than the self-loss item of getting over oneself subscale did not show statistically significant differences between two groups.
In the group of 48 participants who were under no treatment, this study evaluated 6 participants who got Borderline Personality Inventory scores above the cutoff value and 42 participants who got scores below the cutoff value as subgroups. Between these two subgroups, the items with significantly different scores are shown in [Table 3]. The items not listed on the table were not significantly different between the subgroups. They were feeling excited by discovery, impulsivity and extravagance item under novelty-seeking subscale, any item of harm avoidance subscale, all items of reward dependence subscale, persistence subscale, taking responsibility, intentionality, skillfulness and self-acceptance items under self-management subscale, empathy and virtuousness under collaboration subscale and any item of getting over oneself subscale did not show statistically significant differences between study groups.
On the other hand, in the group of 40 participants who were under no treatment, this study evaluated 23 participants who got Borderline Personality Inventory scores above the cutoff value and 17 participants who got scores below the cutoff value as subgroups. Between these two subgroups, the items with significantly different scores are shown in [Table 4].
Any item of the novelty-seeking subscale, any item of harm avoidance subscale, any item other than commitment item under reward dependence subscale, persistence subscale, self-acceptance under self-management subscale, social approval under collaboration subscale and any item under getting over oneself subscale did not show statistically significant differences between these substudy groups.
| Discussion|| |
”Turkey Mental Health Profile Study,” which is one of the comprehensive studies in the field, was held in 1998 and it showed that at least 18% of the Turkish population had undergone a mental health disorder. By predicting that a group of these people from 18% of the population could not receive proper psychiatric treatment, this study tried to evaluate people by grouping with their treatment status.
Borderline Personality Inventory was used as a treatment instrument compatible with Diagnostic and Statistical Manual of Mental Disorders. According to Cloninger's psychobiological theory, it could be expected that higher scores with novelty seeking and harm avoidance subscales and lower scores with reward dependence and self-management subscales in Temperament and Character Inventory may lead practitioners to make a borderline personality disorder diagnosis.
Self-management which is one of the dimensions of a personality could be seen as a common feature between people with Borderline Personality Disorder according to the inventory, although there could not be seen any significant difference with their temperament and character evaluation. This result was not expected considering the previous researches.
When the results were compared between the group under treatment and the other group, it could be concluded that impulsivity, extravagance, disorder, concern of expectation, fear of uncertainty, and easy fatigability could be listed around the common futures of people diagnosed with borderline personality disorder under psychiatric treatment. The group of people with borderline personality disorder who had not been taking any psychiatric treatment could have higher levels of self-management and collaboration skills. This result may be due to the situation that people under treatment might have additional psychiatric disorders such as obsessive-compulsive disorder, depression, and bipolar disease.
It is thought that people with borderline personality disorder had higher levels of reward dependence as a temperamental dimension. Conversely, this study showed no significant difference between the groups in the reward dependence aspect. Similarly to this result, in the group under treatment, there was no significant difference on the dimensions of reward dependence, persistence, harm avoidance and novelty seeking, although in previous studies there could be expected that the levels of these dimensions might be higher in the group under treatment.
However, the self-management dimension of temperament was found to be lower with people who could be diagnosed with borderline personality disorder according to borderline personality inventory.
Persistence scores have been found higher in people who do not meet the criteria for borderline personality disorder. This result is expected in the beginning of the study because of the instability that patients with borderline personality disorder had. Instability affects their actions and thoughts and this makes them have difficulties to persist in their plans.
Temperament and character have different dimensions and it is very difficult to group them for a person or evaluate them as a whole. Some of the features seem to be beneficial for a person to cope with their problems and some of them seem to be a feature that might create stress in one's life. Impulsivity, extravagance, and disorder seem to be features that might negatively affect one's life. The patient might have difficulties and might want to control these features. Inventory results showed that people under treatment had higher scores with these dimensions of temperament. It had been thought that the treatment might improve these negative features at the beginning of the study. Conversely, the results showed that the control group had been more successful in controlling their actions. This situation may be affected by the fact that people under treatment might have an additional psychiatric disorder and they might have more severe symptoms that force them to seek treatment.
| Conclusion|| |
As can be seen, this study revealed a few contradictions between DSM-5 and Borderline Personality Inventory and between Borderline Personality Inventory and Temperament and Character Inventory. This could have arisen from some reasons such as the size of the study group, incomprehensive demographic features of the group. In addition, Borderline Personality Inventory could be reviewed and revised with future researches. This study may lead practitioners and researchers to further investigate the field.
Patient informed consent
Informed consent was obtained.
Ethics committee approval
This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Üsküdar University noninterventional studies ethics committee on 14/08/2017 with the number B.08.6.YÖK.2.ÜS.0.05.0.06/2017/199.
Financial support and sponsorship
No funding was received.
Conflicts of interest
There are no conflicts of interest to declare.
Author contribution subject and rate
- Gonca Gül Yılmaz (%25): data acquisition, analysis interpretation
- Meltem Şen (%24): conception/design of the work, data acquisition, analysis interpretation
- Süleyman Dönmezler (%17): involved in refining the conception of the work, the interpretation of data for the work and revising it critically for important intellectual content
- Habib Erensoy (%17): conception/design of the work, data acquisition, analysis interpretation
- Tonguç Demir Berkol (%17): involved in refining the conception of the work, the interpretation of data for the work and revising it critically for important intellectual content.
| References|| |
Leichsenring F, Leibing E, Kruse J, New AS, Leweke F. Borderline personality disorder. Lancet 2011;377:74-84. doi: 10.1016/S0140-6736 (10) 61422-5.
Karterud SW, Kongerslev MT. Atemperament-attachment-mentalization-based (TAM) theory of personality and ıts disorders. Front Psychol 2019;10:518. doi: 10.3389/fpsyg. 2019.00518.
Köse S, Sayar K, Ak I, Aydın N, Kalelioğlu Ü, Kırpınar I, et al. Turkish version of the TCI: Reliability, validity, and factorial structure. Bull Clin Psychopharmacol 2004;14:107-131. In Turkish.
Leichsenring F. Development and first results of the borderline personality ınventory: A self-report instrument for assessing borderline personality organization. J Pers Assess 1999;73:45-63. doi: 10.1207/S15327752JPA730104.
Calvo N, Valero S, Sáez-Francàs N, Gutiérrez F, Casas M, Ferrer M. Borderline Personality Disorder and Personality Inventory for DSM-5 (PID-5): Dimensional personality assessment with DSM-5. Compr Psychiatry 2016;70:105-11. doi: 10.1016/j.comppsych.2016.07.002.
Cloninger CR, Svrakic DM, Przybeck TR. A psychobiological model of temperament and character. Arch Gen Psychiatry 1993;50:975-90. doi: 10.1001/archpsyc.1993.01820240059008.
Aydemir O, Demet MM, Danacı AE, Deveci A, Taşkın EO, Mızrak S, et al. 2006. Adaptation into Turkish, reliability and validity of borderline personality inventory. Psychiatry in Türkiye. 2006:8;6–10. In Turkish.
Keskini A, Ünlüoğlu İ, Bilge U, Yenilmez Ç. Investigation of People's Knowledge and Attitudes Towards Childhood Psychiatric Disorders and Specialists Who Work in This Field. Archives of Neuropsychiatry 2013; 50: 154-160.
Zanarini MC, Frankenburg FR, Dubo ED, Sickel AE, Trikha A, Levin A, et al
. Axis I comorbidity of borderline personality disorder. Am J Psychiatry 1998;155:1733-9. doi: 10.1176/ajp. 155.12.1733.
Maldonato NM, Sperandeo R, Moretto E, Dell'Orco S. A non-linear predictive model of borderline personality disorder based on multilayer perceptron. Front Psychol 2018;9:447. doi: 10.3389/fpsyg. 2018.00447.
Rao S, Broadbear J. Borderline personality disorder and depressive disorder. Australas Psychiatry 2019;27:573-7. doi: 10.1177/1039856219878643.
[Table 1], [Table 2], [Table 3], [Table 4]