Temperament types are associated with weak self-construct, elevated distress and emotion-oriented coping in schizophrenia: evidence for a complex vulnerability marker? Michael Ritsner a,b, * , Ehud Susser a a Sha’ar Menashe Mental Health Center, Mobile Post Hefer 38814, Israel b Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel Received 24 February 2004; received in revised form 17 May 2004; accepted 11 June 2004 Abstract Knowledge concerning temperament factors involved in vulnerability to schizophrenia is limited. We hypothesized that temperament and self-variables (emotional distress, coping styles, self-efficacy and self-esteem) might present a complex trait marker for underlying vulnerability to schizophrenia. We sought to (1) assess temperament dimensions and types in schizophrenia patients and healthy controls using the Tridimensional Personality Questionnaire (TPQ), and (2) explore their association with symptom dimensions, emotional distress, coping styles, self-constructs, demographic and background variables. We evaluated 90 consecutively recruited DSM-IV schizophrenia patients and 136 healthy controls matched for gender and age. We found that the harm avoidance (HA) factor was higher, while reward dependence (RD) was lower in schizophrenia patients than in healthy controls. Relationships of negative symptoms to novelty seeking (NS) and general psychopathology with both NS and HA show a confounding relation to self-variables. TPQ temperament types were defined by dichotomization into high and low according to medians of the three TPQ temperament dimensions. The odds ratios for the HA and HA/NS temperament types were significantly higher, while the NS/RD type was lower in schizophrenia patients than in healthy controls. HA/NS, HA/RD and high-HA/NS/RD types revealed higher scores for emotional distress, emotion-oriented coping and lower scores on self-constructs. No links were found between temperament types and schizophrenia symptom dimensions, task and avoidance oriented coping, or demographic and background variables. Thus, our findings strengthen the hypothesis that temperament types, when associated with elevated emotional distress, emotion-oriented coping and weak self- constructs, might represent a complex trait marker for underlying vulnerability to schizophrenia. D 2004 Elsevier Ireland Ltd. All rights reserved. Keywords: Temperament factors; Personality traits; Psychiatric disorders; Trait markers; Symptoms 1. Introduction Recent studies into the etiology of schizophrenia have yielded both promising leads and disappointing dead ends that indicate the multifactorial and complex nature of the disorder. The focus has subsequently shifted back to refining the phenotype and identifying clinical and 0165-1781/$ - see front matter D 2004 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.psychres.2004.06.007 * Corresponding author. Sha’ar Menashe Mental Health Center, Mobile Post Hefer 38814, Israel. Tel.: +972-4-6278750; fax: +972- 4-6278045. E-mail address: ritsner@shaar-menashe.org.il (M. Ritsner). www.elsevier.com/locate/psychres Psychiatry Research 128 (2004) 219 – 228