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Alcohol & Alcoholism Vol. 36, No. 6, pp. 584–587, 2001
TEMPERAMENT AND CHARACTER INVENTORY (TCI) PERSONALITY PROFILE
AND SUB-TYPING IN ALCOHOLIC PATIENTS: A CONTROLLED STUDY
2 1 1 1
P. BASIAUX*, O. LE BON, M. DRAMAIX , I. MASSAT , D. SOUERY , J. MENDLEWICZ ,
I. PELC and P. VERBANCK
Free University of Brussels, Brugmann University Hospital, Psychiatry and Medical Psychology Department, Place Van Gehuchten 4, 1020 Brussels,
1 2
Free University of Brussels, Erasme University Hospital, Psychiatry Department, Route de Lennik 808, 1070 Brussels and Free University of Brussels,
Erasme University Hospital, Public Health Department, Route de Lennik 808, 1070 Brussels, Belgium
(Received 27 November 2000; in revised form 29 April 2001; accepted 4 June 2001)
Abstract — Cloninger’s Temperament and Character Inventory (TCI) personality profile was used to compare alcohol-dependent
patients with non-psychiatric control subjects, and a search made for sub-types of alcoholics with different TCI profiles, using the criteria
age of onset of alcohol-related problems, paternal dependence on alcohol and familial antecedents of alcohol dependence. Alcohol-
dependent patients (n = 38) were characterized by higher Novelty-Seeking [corresponding to Diagnostic and Statistical Manual of
Mental Disorders (4th edition) group B personality type] and lower Self-Directedness than non-psychiatric control subjects (n = 47).
Lower Self-Directedness indicates a higher probability of personality disorder in the alcohol-dependent population. Only age of onset
of alcohol-related problems delineated the two sub-populations with different TCI profiles: early-onset alcoholics (≤25 years of age,
n= 19), but not late-onset ones (n = 16), in comparison with control subjects, were associated with higher Novelty-Seeking. Both early
and late-onset patients scored lower on Self-Directedness than control subjects. Self-Directedness and Cooperation scores were lower
in early-onset than in late-onset patients. These results in part support Cloninger’s typology, and the TCI data add to evidence concerning
a higher probability of personality disorder in alcohol-dependent patients, particularly those with early-onset.
INTRODUCTION profile proposed by Cloninger using the TPQ is higher Novelty-
Seeking, lower Harm Avoidance and lower Reward Depend-
Numerous studies have shown relationships between ence in type 2 alcoholics. This typology has been criticized in
personality, predisposition traits and typologies of alcoholism several aspects in different studies. Nixon and Parsons (1990)
(Buydens-Branchey et al., 1989; Irwin et al., 1990; Nixon and did not observe the relationship between TPQ scores and
Parsons, 1990; Schuckit et al., 1990; Peterson et al., 1991; type 1 or 2. Family or paternal history of alcoholism were not
Zaninelli et al., 1992; Cloninger et al., 1995; Ades and linked to TPQ scores in at least two studies (Peterson et al.,
Lejoyeux, 1997; Howard et al., 1997; Lejoyeux and Ades, 1991; Zanelli et al., 1992). Irwin et al. (1990) underscored
1997; Masse and Tremblay, 1997). Cloninger has proposed the importance of age of onset and suggested that type 2 might
a method to investigate personality using a dimensional represent a separate diagnosis, antisocial personality disorder,
approach. The first version of the self-evaluation personality and not alcoholism itself.
questionnaire was the TPQ (Cloninger, 1987a), yielding We used the TCI (Cloninger et al., 1993; Svrakic et al.,
scores for the Temperament part of personality. Temperament 1993), a more precise and complete version of the TPQ, for
can be linked with personality type in categorical classifica- assessing Temperament and Character. Character may be deter-
tion. The TPQ has been used in several studies on personality mined by genetic and biological factors but is more influenced
and alcoholism typology (Cloninger, 1987a,b; Nixon and by environmental factors than Temperament, and is therefore
Parsons, 1990; Schuckit et al., 1990; Peterson et al., 1991; less stable over time. It is divided into three independent
Zaninelli et al., 1992). High Novelty-Seeking has often been dimensions: Self-Directedness, which is the main predictive
implicated as a trait predisposing to addictive behaviour element of the presence of personality disorder, Cooperation,
(Cloninger et al., 1995; Howard et al., 1997; Lejoyeux and which modulates the probability of personality disorder obtained
Ades, 1997). Typology models of alcoholic patients tend from Self-Directedness, and Self-Transcendence. The present
to have some common features: age of onset, personality study attempts first to show personality traits that differentiate
characteristics (for example, antisocial personality disorder), an alcohol-dependent population from a non-psychiatric control
and familial or genetic predisposition (Ades and Lejoyeux, population using the TCI. A second component of this work
1997). Cloninger’s typology postulates two types of alcoholics examines subgroups of alcohol-dependent patients through
(Cloninger et al., 1981; Cloninger, 1987b): type 1 or ‘milieu- evaluation of several typology aspects of Cloninger’s hypothesis.
limited’, defined as late onset, few familial alcohol-dependency The criteria used in our search for subgroups based on TCI
antecedents, slower progress, milder alcoholism, important scores are age of onset, paternal dependence on alcohol, and
environmental influence and minimal criminality; and type 2 familial antecedents of alcohol dependence.
or ‘male-limited’ with characteristics including early onset,
paternal type 2 alcoholism, severe alcoholism, little environ-
mental influence, and frequent criminality. The personality SUBJECTS AND METHODS
For 3 months, all in-patients at the Brugmann University
*Author to whom correspondence should be addressed. Hospital alcohol detoxification centre were invited to be
584
©2001 Medical Council on Alcohol
PERSONALITY AND ALCOHOLIC PATIENT SUB-TYPES 585
considered for the study. A small number declined. Those RESULTS
who accepted were screened with a semi-structured interview TCI scores: comparison of the alcohol-dependent population
based on the Structured Clinical Interview for Diagnostic and and the non-psychiatric control population
Statistical Manual of Mental Disorders (edition III-R), axis I
(SCID, axis I) (Spitzer et al., 1992). Inclusion criteria were: Patients and controls were similar on mean age, and male/
DSM-III-R (American Psychiatric Association, 1987) alcohol female ratio, but scored more highly on Novelty-Seeking and
dependence (severe and chronic) with physiological depend- lower on Self-Directedness (Table 1). Lower Self-Directedness
ence, as evidenced by withdrawal symptoms in preceding scores suggest, with respect to Cloninger’s theory, a higher
attempts to strongly reduce or interrupt alcohol consumption. probability of the presence of personality disorder in the alcohol-
Exclusion criteria were: present or previous other substance dependent population (Svrakic et al., 1993). For the above
misuse or dependence, schizophrenia and other psychotic two significant variables, the group effect still remained after
disorders. One patient who met the diagnostic criteria for adjustment for age and gender.
schizophrenia was excluded. No patient met diagnostic criteria TCI scores: comparison between early-onset and late-onset
for major depressive disorder at the time of evaluation, but alcoholics and non-psychiatric control subjects
alcohol-induced depressive disorders in partial remission
were frequent. We did not exclude patients with axis II present Nineteen subjects were classified as early-onset and 16 as
psychiatric co-morbidity, even at the expense of homogeneity, late-onset alcoholics (three were not classified in either of these
in order to reflect the typical population of hospitalized alcohol- two subgroups. Table 2 shows that current age and the male/
dependent patients. Those recruited consisted of 29 males and female ratio did not differentiate significantly between the three
nine females, of mean ( ± SD) age 44 ± 9 years. groups, represented by early-onset patients, late-onset patients
Controls, recruited using a public announcement in a general and the controls, despite a tendency for early-onset patients to
hospital, consisted of 47 healthy volunteers (27 male and be male. Novelty-Seeking was significantly higher in the early-
20 female). They had been screened using the same semi- onset group in comparison with the non-psychiatric subjects.
structured interview (Spitzer et al., 1992). Exclusion criteria There was no significant difference in Novelty-Seeking between
were present or previous alcohol dependence or misuse, sig- the late-onset patients and the non-psychiatric control subjects.
nificant somatic or psychiatric disorder at the time of the The higher Novelty-Seeking scores of the total alcohol-dependent
study, significant psychiatric disorder in the past and familial population compared to the control subjects (see Table 1
antecedents of affective or psychotic disorders. The mean age above) are therefore mainly due to the early-onset alcoholics.
of this sample was 44 ± 13 years. Self-Directedness was significantly lower in early-onset alco-
Patients taking part underwent the unit’s standard regimen. holics than in either late-onset alcoholics or control subjects,
This included tapered, individually titrated, doses of diazepam and was also significantly lower in late-onset alcoholics than
(up to 120 mg per day in severe cases), vitamin B complex and in controls. Cooperation in early-onset alcoholics was also
large amounts of sugared fluids, in order to keep the withdrawal significantly lower than in late-onset patients or controls. As
process under control. Patients were requested to stop all described above, lower Self-Directedness coincides with a
consumption of alcoholic beverages and non-prescribed drugs higher probability of personality disorder (Svrakic et al., 1993).
from their first hospital day. Lower Cooperation increases this difference by modulating
They were asked to fill in a written TCI Self-evaluation the predictive value of Self-Directedness (Svrakic et al., 1993).
questionnaire (226 questions with forced binary answer) at No relationship was seen between age of onset and familial or
the end of the second week of abstinence. At that time, they paternal antecedents of alcohol dependence.
were fully abstinent and no longer needing medication to TCI scores: relation to familial alcohol dependence
control withdrawal symptoms. We used a French translation
of this test checked by retro-translation. Patients were asked No significant difference was observed in TCI scores,
about their age at the onset of alcohol-related problems, defined age of onset, or current age or male/female proportion between
as their recall of the first occurrence of alcohol-related prob-
lems. Early onset was defined as ≤25 years, late onset as >25.
Patients were asked whether alcohol-dependence had affected Table 1. Temperament and Character Inventory (TCI) scores
other family members. of alcohol-dependent patients and non-psychiatric controls
Statistics Alcohol- Non-psychiatric
We used the program SPSS 7.5 for Windows. All dimension dependent controls Significance
scores were normally distributed for all groups and subgroups Variable (n = 38) (n = 47) (P)
of subjects (the Kolmogorov–Smirnov test was not significant % as males 76 57 n.s.
for any main dimension). We applied unpaired t-test and Age 44.0 ± 9.0 43.7 ± 13.1 n.s.
2 Novelty-Seeking 21.7 ± 4.3 19.0 ± 6.6 <0.05
χ -tests to compare dependent and non-psychiatric groups, Harm Avoidance 20.8 ± 8.1 19.5 ± 7.9 n.s.
alcoholics with and without paternal dependence on alcohol Reward Dependence 13.8 ± 3.9 14.8 ± 3.8 n.s.
and with and without familial antecedents of alcohol depend- Persistence 4.3 ± 2.2 4.2 ± 2.1 n.s.
ence. To compare early-onset alcoholics, late onset alcoholics Self-Directedness 19.1 ± 7.0 28.4 ± 8.0 <0.01
and non-psychiatric subjects, global one-way analysis of Cooperation 28.6 ± 7.7 30.5 ± 6.0 n.s.
variance for the three groups was used and sex adjustment was Self-Transcendence 15.9 ± 7.6 13.2 ± 6.6 n.s.
tested. For multiple comparisons, the Scheffé procedure at the Values are means ± SD unless otherwise stated.
5% significance level was applied (Scheffé, 1959). n.s., not significant.
586 P. BASIAUX et al.
Table 2. Temperament and Character Inventory (TCI) scores of early- and late-onset alcoholics
Onset ≤25 Onset >25 Non-psychiatric
years years controls Significance
Variable (n = 19) (n = 16) (n = 47) (P)
% as males 84 69 57 n.s.
Age 41.5 ± 9.2 47.5 ± 8.4 43.7 ± 13.1 n.s.
Novelty-Seeking 23.1 ± 4.4 19.8 ± 3.7 19.0 ± 6.6 <0.05
• •
Harm Avoidance 21.4 ± 8.7 19.2 ± 8.0 19.5 ± 7.9 n.s.
Reward Dependence 14.0 ± 3.6 13.7 ± 4.3 14.8 ± 3.8 n.s.
Persistence 4.6 ± 2.3 4.3 ± 2.2 4.2 ± 2.1 n.s.
Self-Directedness 15.9 ± 6.8 22.6 ± 6.3 28.4 ± 8.0 <0.01
• • • •
• •
Cooperation 25.4 ± 8.5 31.8 ± 5.6 30.5 ± 6.0 <0.01
• •
• •
Self-Transcendence 17.6 ± 7.2 15.3 ± 7.1 13.2 ± 6.6 n.s.
Values are means ± SD unless otherwise stated.
For global comparisons, one-way analysis of variance was applied. n.s., not significant.
Statistically significant results were further explored using multiple comparisons test (Scheffé) at the 5% significance level ( ).
• •
subgroups with and without family or paternal history of In this relatively small study, our search for sub-types of
alcohol-dependence. alcoholics with different TCI personality profiles yielded only
two subgroups, early-onset and late-onset. In our data, high
Novelty-Seeking scores characterized early-onset patients and
DISCUSSION can be seen as predisposing to early-onset alcoholism. Lower
character scores (Self-Directedness and Cooperation) indicating
Alcohol-dependent patients in general scored higher on a higher probability of personality disorder were present in
Novelty-Seeking and lower on Self-Directedness than con- both subgroups, but more so in the early-onset subgroup.
trols. Lower Self-Directedness indicates a higher probability These results agree partly with the Cloninger’s typology
of personality disorder according to Cloninger’s hypothesis. (I and II), in that we found an association between early-onset
It could therefore be postulated to be a predisposing factor and high Novelty-Seeking. However, our TCI data give new
for alcohol dependence, but Character scores are not stable information suggesting more frequent personality disorder in
with respect to time (Cloninger et al., 1993) and low Self- early-onset alcoholism (in addition to that already published
Directedness could therefore be seen as either preceding or using the TPQ) and, as already found in previous studies
consequent upon alcohol dependence. Higher Novelty-Seeking (Irwin et al., 1990; Peterson et al., 1991; Zaninelli et al., 1992),
is linked with higher impulsiveness, exploratory excitability, we found no influence of paternal or family history of alcohol
extravagance and disorderliness, and in categorical evaluation dependence on personality profile or on the age of onset of
with DSM-IV group B personalities (antisocial, borderline, alcohol-related problems.
narcissitic, histrionic) (Cloninger, 1987a; Svrakic et al., 1993; A possible limitation of our study was that the TCI data were
American Psychiatric Association, 1994). Novelty-Seeking not corrected for the influence of residual depressive symptoms,
scores are more stable with time (Cloninger et al., 1991) which may still be present after alcohol withdrawal, even when
(slightly decreasing) and high Novelty-Seeking is therefore patients with major depressive disorder have been excluded.
probably present before the onset of alcoholism. Novelty- If depressive symptoms had been commoner in the late-onset
Seeking correlates with Sensation-Seeking (Earleywine et al., group, this could have exaggerated some of the TCI differ-
1992; Lejoyeux and Ades, 1997), as proposed by Zuckerman ences we have reported. Our sample would, unfortunately,
(Zuckerman and Link, 1968). Both have often been proposed have been too small to make the appropriate adjustments.
as predisposing factors of addictive behaviour (Cloninger
et al., 1995; Howard et al., 1997; Lejoyeux and Ades, 1997),
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