A psychobiological approach to personality: examination within anxious outpatients Susan Ball*, James Smolin, Anantha Shekhar 550 N. University Boulevard, Suite 3124, Indianapolis, IN 46202, USA Received 8 February 2001; received in revised form 14 July 2001; accepted 2 November 2001 Abstract Objective: To examine Cloninger’s psychobiological personality model among different anxiety and depressive outpatie as normalhealthy comparisons. In addition,the relationship between the underlying temperament dimensions and behavioral coping strategies was also studied using the tri-axial modelof coping.Methods: Subjects were 120 outpatients presenting to an anxiety disorders specialty clinic and 17 normal comparisons. They underwent a semi-structured clinical interview and co battery ofquestionnaires, including the Temperament and Character Inventory and the Strategic Approach to Coping Scale. Results: On the temperament dimensions, the patients were elevated on the harm avoidance scale relative to the normal compa isons;the temperament substrate was not differentiated by the anxiety or affective diagnostic types nor was there differences between groups on the other temperament dimensions. Both severity of illness and the presence of a comorbid depressiv each contributed independently to harm avoidance scores. Hypotheses regarding the association between underlying tem and behavioral coping strategies were supported for the dimensions of reward dependence and harm avoidance, but not seeking. Conclusions: Cloninger’s psychobiological model is supported with the temperament of harm avoidance being th dimension for anxiety and affective disorders. The underlying temperament structure also has clinical relevance for the type of coping strategies that are utilized by an individual. # 2002 Elsevier Science Ltd. All rights reserved. The substrate of personality and the development of psychopathology have been areas of intense investiga- tion. Competing models attempt to define and charac- terize the basic dimensionsof human personality development that allow for the expression of normal behavior as well as both affective and behavioral dysregu- lation.In Cloninger etal.’s (1993)model,personality development integrates biopsychosocial factors that are manifested through temperament and character dimen- sions.Temperament represents automatic responses in information processing and learning, presumed to be heritable,whereas character reflects personality devel- opment in the context of insight learning and environ- mentalexperiences. Basic temperament dimensions are novelty seeking, harm avoidance, reward dependence, and persistence. Each dimension isproposed to be modulated bya differentprimary neurotransmitter. Psychopathology is then associated with dysregulation among these systems reflective of the type ofthe dis- order. Among the temperament dimensions, novelty seeking describes the initiation of behaviors, such as exploratory and impulsivity, and is putated to be regulated by the dopamine system. The maintenance and continuation of ongoingbehaviors,such as social attachmentand dependence, is captured by reward dependence, which is modulated by norepinephrine. Harm avoidance refers to the bias in the inhibition or cessation of behaviors, such asfatigability and anticipation of harm, and is associated with the serotonin system (Pierson et al., 1999).Cloninger and colleagues’ validity studies have also demonstrated a fourth dimension of personality referred to as persistence that was initially considered a subsystem of reward dependence, but has been demon- strated to be a separate dimension that shows genetic heritability,especially among women (Stallings et al., 1996). Upon this foundation of basic temperament, Clo- ninger’stheory accountsfor characterdevelopment though the organization of experience and relationships 0022-3956/02/$ - see front matter # 2002 Elsevier Science Ltd. All rights reserved. P I I : S 0 0 2 2 - 3 9 5 6 ( 0 1 ) 0 0 0 5 4 - 1 Journal of Psychiatric Research 36 (2002) 97–103 www.elsevier.com/locate/jpsychires * Corresponding author. Tel.: +1-317-274-7422; fax: +1-317-274- 1497. E-mail address: suball@iupui.edu (S. Ball).