The relationship between temperament and character in conversion disorder and comorbid depression Evrim Erten ⁎ , Yelda Yenilmez, Nurhan Fistikci, Omer Saatcioglu Bakirkoy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey Abstract Aims: The aim of this study was to compare conversion disorder patients with healthy controls in terms of temperament and character, and to determine the effect of these characteristics on comorbid depression, based on the idea that conversion disorder patients may have distinctive temperament and character qualities. Methods: The study involved 58 patients diagnosed with conversion disorder, based on the DSM-IV diagnostic criteria, under observation at the Bakırköy Psychiatric and Neurological Disorders Outpatient Center, Istanbul. The patients were interviewed with a Structured Clinical Interview (SCID-I) and 57 healthy volunteers, matched for age, sex and education level, were interviewed with a Structured Clinical Interview for people without a psychiatric disorder (SCID-I/NP). All the participants completed a sociodemographic form, the Hamilton Depression Rating Scale, the Hamilton Anxiety Scale and the Temperament and Character Inventory. Results: The conversion disorder patients displayed more harm avoidance (P b .001), more impulsivity (P b .01) and more sentimentality (P b .01) than the healthy controls, but were less persistent (P b .05). In terms of character qualities, conversion disorder patients had high self-transcendence (P b .05), but were inadequate in terms of self-directedness (P b .001) and took on less responsibility (P b .05) than the healthy controls. Conclusion: Conversion disorder patients are significantly different from healthy controls on temperament and character measures of harm avoidance, persistence, self-transcendence and self-directedness. © 2013 Elsevier Inc. All rights reserved. 1. Introduction Conversion disorder is the term used to describe physical function loss or variation that cannot be explained by a general medical or neurological condition and that sub- stitutes for a psychological need or conflict [1]. Conversion disorder is listed under the somatoform disorders cluster, and presents a dysfunction of the neural system in the motor areas, sensory areas or, less frequently, the areas involved with consciousness. It is the result of an unresolved psychological conflict being brought to the level of consciousness through a function loss in an organ that is associated with the dynamics of the conflict [2-4]. It has been reported that 1%–3% of all the outpatients at mental health clinics suffer from conversion disorder [5]. Temperament, character and personality are distinct concepts. Temperament is the inclination to respond automatically to certain stimuli, and its structure is determined at birth. Some temperament traits show little or no change with increasing age. Character consists of the relatively changeable, objectively observable behaviors and subjectively reportable internal experiences of an individual. It includes the reaction and response behaviors of the individual, which have been developed, consciously or unconsciously, to maintain reciprocal relationships with the environment throughout life. Personality, according to structural theory, appears to be the joint product of genetically derived temperament and acquired intelligence, and develops until maturity in adulthood [6-8]. Cloninger has developed a general psychobiological model to describe the structure and development of personality [6,7]. The model includes four dimensions of temperament (novelty seeking, harm avoidance, reward dependence and persistence), which are assumed to be independent, generally stable throughout life, unaffected by Available online at www.sciencedirect.com Comprehensive Psychiatry 54 (2013) 354 – 361 www.elsevier.com/locate/comppsych ⁎ Corresponding author. Fulya mah, Akincibayir sok, 27/17, Mecidiyekoy- Istanbul, Turkey. E-mail address: evrimerten@yahoo.com.tr (E. Erten). 0010-440X/$ – see front matter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.comppsych.2012.10.007