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 DOI: 10.1177/1073191113490791

published online 3 June 2013AssessmentPaul T. van der Heijden, Jos I. M. Egger, Gina M. P. Rossi, William M. van der Veld and Jan J. L. Derksen

PersonalityPersonality and Psychopathology : Mapping the MMPI-2-RF on Cloninger's Psychobiological Model of

  

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Article

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher et al., 2001) has been the most com-monly used psychological measure for the clinical assess-ment of psychiatric symptoms and personality characteristics worldwide (Camara, Nathan, & Puente, 2000). The latest renewal of the MMPI-2 is the development of the MMPI-2-Restructured Form (MMPI-2-RF) by Ben-Porath and Tellegen (2008). The Restructured Clinical scales (RC scales; Tellegen et al., 2003) and three Higher Order (H-O) scales based on them form the heart of the MMPI-2-RF. In addition, the MMPI-2-RF contains one new and seven revised validity scales, 23 Specific Problem Scales, two Interest Scales, and revised PSY-5 scales.

The RC scales have been related to several models of adaptive (Sellbom & Ben-Porath, 2005; Sellbom, Ben-Porath & Bagby, 2008) and nonadaptive personality (e.g., Van der Heijden, Egger, Rossi, & Derksen, 2012), but no study has related the RC scales to the Temperament and Character Inventory (TCI; Cloninger, Przybeck, Svrakic, & Wetzel, 1994) yet. This can be considered a lack in the growing MMPI-2-RF literature for several reasons. First of all, the TCI is a well known and broadly used inventory measuring both adaptive and maladaptive personality fea-tures, with good predictive validity (Grucza & Goldberg, 2007). Second, the TCI is a theory-driven instrument, other than factor analytically derived measures such as the Multidimensional Personality Questionnaire (Tellegen, 1982) and the Schedule for Nonadaptive and Adaptive

Personality (Clark, 1993). Correlations between the MMPI-2-RF scales and these latter types of measurements may be artificially inflated because they share theoretical assump-tions or were constructed similarly. Third, from a theoreti-cal point of view, relating the MMPI-2-RF RC scales and H-O scales to Cloninger’s psychobiological model of tem-perament and character can provide insight in spectrum relations concerning the continuity of adaptive and mal-adaptive personality features and current hierarchical mod-els of psychopathology. Also, it would be of interest to map the PSY-5-r Scales onto Cloninger’s psychobiological model given the DSM-5 proposal for a trait specified per-sonality diagnosis (Krueger et al., 2011) that will be included in Section 3 of the DSM-5 manual for further research (American Psychiatric Association, 2012). For all these reasons, we decided to investigate the TCI correlates of MMPI-2-RF scales.

490791 ASMXXX10.1177/1073191113490791Assessmentvan der Heijden et al.research-article2013

1Reinier van Arkel Mental Health Institute, ‘s-Hertogenbosch, Netherlands2Radboud University Nijmegen, Nijmegen, Netherlands3Vincent van Gogh Institute for Psychiatry, Venray, Netherlands4Pompe Institute for Forensic Psychiatry, Pro Persona, Nijmegen, Netherlands5Vrije Universiteit Brussel, Brussels, Belgium

Corresponding Author:Paul T. van der Heijden, Reinier van Arkel Groep, PO Box 70058, NL-5201 DZ ‘s-Hertogenbosch, Netherlands. Email: P.T.vander.Heijden@RvAGroep.nl

Personality and Psychopathology: Mapping the MMPI-2-RF on Cloninger’s Psychobiological Model of Personality

Paul T. van der Heijden1,2, Jos I. M. Egger2,3,4, Gina M. P. Rossi5, William M. van der Veld2 and Jan J. L. Derksen2

AbstractThis study investigates the relationship between the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) and the Temperament and Character Inventory (TCI) in a combined data set (N = 491) of patients with a broad range of psychiatric disorders (n = 286) as well as alcohol use disorder (n = 205). We examined bivariate correlations between both measures. The MMPI-2-RF scales relate to the TCI dimensions as was hypothesized, and relationships between both measurements were largely similar for psychiatric patients and alcohol-dependent patients. Theoretical and clinical implications are considered.

KeywordsMMPI-2-RF, TCI, personality, psychopathology

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2 Assessment XX(X)

Cloninger’s Psychobiological Model of Temperament and Character

Cloninger’s psychobiological model (as well as its related measurement instrument the TCI) distinguishes four tem-perament dimensions defined as Harm Avoidance (HA; associated with anxious and pessimistic worrying), Novelty Seeking (NS; related to anger-prone and impul-sive behavior), Reward Dependence (RD; viewed as indi-vidual differences in the maintenance or continuation of behavior as reflected by warm and sociable versus cold and aloof), and Persistence (PE; being ambitious and per-fectionistic; Cloninger, 2006). These temperament dimen-sions represent etiologically distinct components of personality and are hypothesized to have genetic anteced-ents and a neurobiological basis in that they are associated with neurotransmitter systems (Cloninger, Svrakic, & Przybeck, 1993).

Besides these temperament dimensions, Cloninger iden-tifies three character dimensions, which are defined as “the attitudes and higher cognitive processes that regulate con-flicts among temperament dimensions so that a person can achieve meaningful goals and maintain human relationships in accordance with his values and needs” (Cloninger, 2006, p. 67). These dimensions are named Self-Directedness (SD; being autonomous, purposeful, resourceful, and able to demonstrate goal directed behavior), Cooperativeness (CO; legislative functions, being helpful, agreeable, acceptable, and tolerant of others), and Self-Transcendence (ST; judi-cial functions, intuitive, insightful, and a sense of connect-edness to all living things).

There is much empirical research linking the TCI to spe-cific DSM-IV classifications (e.g., Celikel et al., 2009; Conrad et al., 2007; Faytout et al., 2007), but no research has related Cloninger’s model as measured by the TCI to integrated higher-order domains of psychopathology such as the H-O scales.

Hypotheses for the H-O Scales, RC Scales, and SP Scales

The MMPI-2-RF has a hierarchical structure. Three H-O scales representing Emotional/Internalizing Dysfunction (EID), Behavioral/Externalizing Dysfunction (BXD), and Thought Dysfunction (THD) are at the top of this hierarchy. The H-O scales were derived from items of the RC scales that were the primary markers of these dimensions (Tellegen & Ben-Porath, 2008). EID was based mainly on the items from Demoralization (RCd), Low Positive Emotions (RC2), and Dysfunctional Negative Emotions (RC7); BXD was based on items from Antisocial Behavior (RC4) and Hypomanic Activation (RC9); and, finally, THD was based on items from the Ideas of Persecution (RC6) and Aberrant Experiences (RC8) scales. The H-O scales parallel the

classical MMPI code types 2/7, 4/9, and 6/8 and correspond with the higher-order factors found among common mental disorders (e.g., Markon, 2010). Beyond the RC scales, at a more specific level, one can consider the Specific Problem (SP) scales that measure additional problems and some fac-ets of the RC scales that require separate assessment such as substance abuse and juvenile conduct problems which are part of RC4 (Ben-Porath & Tellegen, 2008). Our hypothe-ses are drawn along these lines: from higher order domains to SP scales. We specified additional hypotheses for the PSY-5-r scales.

Concerning the internalizing spectrum, we expected EID, RCd, RC2, RC7, and the internalizing SP scales to be primarily related with HA. HA is defined as an inhibitory system characterized by pessimistic worrying in anticipa-tion to problems. The relation between HA and measures of anxiety and depression has been confirmed in several empirical studies (e.g., Celikel et al., 2009). Demoralization (i.e., RCd) represents a “pervasive and affective laden dimension of unhappiness and dissatisfaction with life” (Ben-Porath, 2012, p. 282). High scores reflect feelings of helplessness and ineffectiveness. As such, RCd resembles (inverse) SD (being purposeful, resourceful and hopeful). Therefore, we hypothesized that RCd (and consequently EID, RC2, and RC7 and the Internalizing SP scales) would demonstrate strong relations (i.e., |r| ≥ .50; Cohen, 1992) with SD.

Conceptually, there is some overlap between RC2 and RD, but results for RD in relation to psychopathology (i.e., mood disorders) are inconsistent. For example, in a meta-analysis by Kampman and Poutanen (2011), low RD was sometimes associated with current symptoms of depression, but only in the minority of studies reviewed (4/12). Celikel et al. (2009) found that Sentimentality (RD1) and Dependence (RD4) subscale scores of RD were signifi-cantly higher in depressed patients, as measured with the Hamilton Depression Rating Scale (HDRS; Hamilton, 1960) and the Beck Depression Inventory (BDI; Beck, Steer, & Brown, 1996). At the same time, they did not find a correlation between RD and the BDI or the HDRS scale. Therefore, we expect a medium (i.e., |r| ≥ .50; Cohen, 1992) relation between RC2 and RD (e.g., Stepp et al., 2012). In addition, we expect medium relations between the Interpersonal SP scales and RD since RD refers to behav-ioral maintenance and involves sentimentality, social attachment, and dependence on approval of others.

We hypothesize a small (i.e., |r| ≥ .10; Cohen, 1992) negative relation between RC2 and PE and a small positive relation for RC7 and PE. High PE is associated with resil-ience and positive emotionality (Cloninger, Bayon, & Svrakic, 1998) whereas other work has associated it with compulsiveness and negative emotionality, particularly in patients with eating disorders (e.g., Fassino, Amianto, Gramaglia, Facchini, & Abbate Daga, 2004).

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For RC1, we hypothesized a medium relation with HA (e.g., Conrad et al., 2007). Of all somatic/cognitive SP scales, Malaise (MLS) is hypothesized to exemplify the strongest relation with HA as it demonstrates the strongest relation with depression-related variance (Tellegen & Ben-Porath, 2008).

Concerning the externalizing scales, BXD and conse-quently RC4 and RC9 are hypothesized to be related pri-marily to NS, which is defined as an activation system. In addition, we hypothesized medium relations for Activation (ACT), Aggression (AGG), and Juvenile Conduct Problems (JCP) with NS. For example, Hofvander et al. (2011) reported a medium correlation between NS and the Life History of Aggression Scale (LHA; Coccaro, Berman, & Kavoussi, 1997). In addition, we expect a strong negative relation for RC9 with CO, which reflects individual differ-ences in the identification with and acceptance of other people. Sellbom et al. (2008) and Van der Heijden et al. (2012) demonstrated that high scores on RC9 reveal an antagonistic interpersonal style. In addition, we hypothesize strong negative relations for RC3 with CO (Ingram, Kelso, & McCord, 2011) and medium negative relations for RC4 (Hofvander et al., 2011), RC6, ANP, and Aggressiveness (AGGR; Ben-Porath, 2012).

With respect to the thought dysfunction scales, we expect RC8 to exemplify strong relations with ST. THD and RC6 are hypothesized to demonstrate medium correlations with ST. High ST reflects openness to unusual and divergent feelings, thoughts, and behaviors. Bayon, Hill, Svrakic, Przybeck, and Cloninger (1996) define ST as a “facility in giving unusual meanings and imaginative connections to experiences” (p. 350). In combination with healthy devel-opment of the other character dimensions, it is associated with mature creativity (Cloninger, Svrakic, Bayon, & Pryzbek, 1999). However, in combination with low SD and low CO, ST is associated with proneness to psychosis (Hori et al., 2008).

Hypotheses for the PSY-5-r Scales

Conceptually, the PSY-5-r scales can be linked to the TCI dimensions as follows: AGGR relates to CO (−) and to a lesser extent to RD (−); Psychoticism (PSYC) can be linked to ST; Disconstraint (DISC) relates primarily to NS and PE (−) and to a lesser extent to SD; Negative Emotionality/Neuroticism (NEGE) overlaps with HA and to a lesser extent with SD; and Introversion/Low Positive Emotionality (INTR) relates to RD (cf., Widiger & Simonsen, 2005). In addition, Cloninger et al. (1993) indicated SD as a major determinant of the presence or absence of (any) personality disorder (see also Gutiérrez et al., 2008), reason why sig-nificant correlations can be expected between SD and all PSY-5-r scales. Gutiérrez-Zotes, Cortés, Valero, Peña, and Labad (2005) partially confirmed these hypothesized

relations between both measures with the Spanish version of the TCI-R and MMPI-2 PSY-5 scales in a clinical sam-ple. In their study, AGGR related to PE, PSYCH was related to SD (−) and CO (−), DISC was related to CO (−), NEGE was related to HA and SD, and INTR was related to HA (−), PE, and SD.

Method

Participants

The study was carried out in accordance with the Declaration of Helsinki and the guidelines for Good Clinical Practice established by the International Conference on Harmonization (CPMP/ICH/135/95). Data were collected as part of the clinical routine and the confidentiality of par-ticipants’ identities was maintained throughout the study process. Part of the data (subsample of alcohol dependent inpatients, n = 205) were collected in the course of MMPI-2 basic scale validity research (Egger et al., 2007). All these patients were classified as alcohol dependent according to DSM-IV criteria, mean age was 42.5 years (range = 21-65; SD = 9.54) and 156 (76%) of them were men. Patients were assessed only after detoxification. They completed the Dutch versions of the MMPI-2 and TCI questionnaires, as a part of the regular diagnostic process. Patients participated only after detoxification and after obtaining informed con-sent. The rest of the participants (n = 286) were recruited in an outpatient mental health institute in the middle of the Netherlands. MMPI-2 administration is not part of a stan-dard procedure at this hospital, so only the most complex cases with multiple DSM-IV diagnoses were referred for assessment. This subsample consisted of 154 men (54%) and 129 women (45%), with a mean age of 33.4 years at day of testing (SD = 11.42; range = 18-65 years).

Measures

MMPI-2-RF. Although there is no commercial Dutch Lan-guage version of the MMPI-2-RF available yet, scores were computed from administration of the MMPI-2 booklet. Tel-legen and Ben-Porath (2008) and Van der Heijden, Egger, and Derksen (2010) confirmed comparability of scores derived from both booklets. The Dutch-Flemish adaptation of the MMPI-2 (which has its own normative sample, N = 1,244) was developed by Derksen, De Mey, Sloore, and Hellenbosch (1993). Detailed information about psycho-metric properties of the Dutch language version of the MMPI-2-RF was provided by Van der Heijden, Egger, and Derksen (2008) and Van der Heijden et al. (2010).

TCI. The Dutch language version of the TCI was trans-lated by Duijsens, Spinhoven, Goekoop, Spermon, and Eurelings-Bontekoe (2000) and has its own normative

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sample (N = 399). Detailed information about the psycho-metric properties of the Dutch language version of the TCI was provided by Duijsens et al. (2000).

Procedure and Analyses

The instruments were administered in accordance with the described procedures in the manuals. The MMPI-2 and TCI were administered simultaneously (i.e., within a time period of 2 days) but not counterbalanced. However, in both treat-ment centers, there is no standard sequence in administering the tests so this varies at random. All MMPI-2-RF profiles met the following inclusion criteria: Cannot Say raw scores < 14, VRIN-r and TRIN-r T score ≤ 80, Fp-r T score < 100, and L-r ≤ 80 (Ben-Porath & Tellegen, 2008). Because of these newly defined, more stringent MMPI-2-RF validity criteria, the protocols of 17 participants had to be excluded from the original alcohol-dependent subsample of Egger et al. (2007), and 24 protocols had to be deleted from the ini-tial psychiatric sample. Zero-order correlations were calcu-lated between TCI dimensions and the MMPI-2-RF scales. Only correlations that reached at least a medium effect size (e.g., |r| ≥ .30; Cohen, 1992) were interpreted.

Results

Table 1 presents the mean T scores on the MMPI-2-RF H-O scales and RC scales and the mean raw scores on the TCI dimensions. Table 2 presents correlations for the MMPI-2-RF scales with the TCI dimensions. We analyzed differ-ences in correlations between MMPI-2-RF and TCI for both subgroups. Only 27 of 280 (10%) correlations between both measures differed significantly (p < .05, two sided) in both subsamples. Only 4 of these differences (1%) reached at least a medium effect size (Cohen’s q ≥ .30, see Table 2).

Discussion

Overall, the results fit very well with our hypotheses: the MMPI-2-RF scales relate to the TCI dimensions as hypoth-esized and relationships between both measures are largely similar for both subsamples. RCd demonstrates equal rela-tions with HA and SD, which is consistent with the defini-tion of demoralization as a “trait like characteristic” (Tellegen et al., 2003, p. 13) that involves at least two dimensions: distress and subjective incompetence to deal with the distress. RC2 and RC7 exemplify equal relations with HA. These findings are consistent with research by, for example, Jylha and Isometsa (2006), who demonstrated equally strong correlations for HA with mood and anxiety disorders in a normal population. However, in studies inte-grating different models of personality, HA typically loads on the Negative Affectivity factor (as does SD) whereas RD loads on the Positive Affectivity factor (e.g., Stepp et al.,

2012). In our study, RC2 demonstrates a small relation with RD. It is remarkable, however, that none of the Interpersonal SP scales except Disaffiliativeness (DSF; disliking people and being around them, which is conceptually closest to RD) exemplified a medium relation with RD. However, Social Avoidance (SAV) almost exemplified a medium size correlation with RD (i.e., r = .29).

Contrary to expectations, RC2 and RC7 did not demon-strate a meaningful correlation with PE. Highly persistent people can be seen as perfectionists who often experience several personal and social problems such as anxiety, com-pulsivity, and depression (Cloninger, Zohar, Hirschmann, & Dahan, 2012). On the other hand, individuals who score low in PE are described as changeable, irresolute, and easily discouraged (Cloninger et al., 1993). The mean score on PE in the combined sample (psychiatric and SUD) was signifi-cantly higher than in the normative sample, but effect sizes were small (T = 3.46; p < .001; Cohen’s d = .25), which is remarkable given the fact that almost half of the sample consists of patients with alcohol use disorder. Nonetheless, mean scores for PE are comparable with findings in another Dutch psychiatric sample (Duijssens et al., 2000). A more meaningful relation for PE with psychopathology would probably be found if scores on HA and SD were also taken into account (Cloninger et al., 2012). On the other hand, findings for PE in relation with several forms of psychopa-thology might be inconsistent because of the relatively low reliability of this scale (e.g., Duijssens et al., 2000).

As hypothesized, RC1 demonstrated a medium relation with HA. Elevated scores on RC1 may reflect genuine health problems, but with higher scores, the likelihood increases that psychological factors play a significant role (Ben-Porath, 2012). Our findings are also consistent with research by Segarra et al. (2007), who linked the MMPI-2 to Gray’s (1987) two-factor sensitivity theory and found medium correlations for Hs (Hypochondriasis, r = .48) and HEA (Health Concerns, r = .44) with the behavioral inhibi-tion system, the latter resembling HA in the TCI.

Correlations for the externalizing spectrum are as expected. BXD, RC4, and RC9 demonstrate equal relations to NS and reversed CO. NS itself is not conceptualized as unsocialized impulsive sensation seeking, although it con-tains some items with antisocial content (e.g., Items 110 and 183). Interestingly, JCP demonstrates a stronger correlation with NS than Substance Abuse (SUB), both facets of RC4 (i.e., r = .37 vs. r = 15, Z = 3.71, p < .05, Cohen’s q = .24). JCP contains items that are formulated in past tense and refer to juvenile conduct problems such as difficulties at school and at home. These findings are consistent with research by Hofvander et al. (2011), who demonstrated a correlation of .36 for NS and the LHA scale that measures different aggressive behaviors (e.g., temper tantrums, phys-ical fights) and school disciplinary problems since adoles-cence. Moreover, these findings are consistent with the

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van der Heijden et al. 5

conceptualization of NS as a temperament that is observ-able early in the life span. In line with expectations, Aggression (AGG; physically aggressive, violent behav-ior), which is a facet of RC9, demonstrates a stronger rela-tion to CO (−) than to NS (r = .48 vs. r = .27; Z = −3.84, p < .01, Cohen’s q = .25).

Correlations for the psychotic spectrum are in the expected direction. However, we expected a strong relation between RC8 and ST, but the observed correlation is .45. Nonetheless, RC8 demonstrates a stronger correlation with ST than RC6 (i.e., r = .45 vs. r = .33, Z = 2.22, p < .05) although the effect size is small (Cohen’s q = .14). In line with findings from Bayon et al. (1996) and Hori et al. (2008) scores in our sample on SD and CO were generally low (i.e., T = −11.15, p < .001, d = −.84, and T = −8.14, p < .001, d = −.61, for SD and CO, respectively, in our total sample compared with the Dutch normative sample).

Correlations for PSYC and NEGE were as hypothesized, but correlations for AGGR, DISC, and INTR with TCI dimensions only partly meet our expectations. For example, AGGR refers to antagonism, dominance, aggressive tenden-cies, and ambition (Harkness, Finn, McNulty, & Shields, 2012). The observed negative correlation with HA is not illogical, but we expected a more apparent correlation with (reversed) CO (cf. Widiger & Simonsen, 2005) and PE (Gutiérrez-Zotes et al., 2005). On the other hand, Ben-Porath (2012) indicates that AGGR refers to behavior designed to

accomplish a desired goal and is itself most strongly (nega-tively) correlated with MMPI-2-RF scale IPP. CO refers to helpful, forgiving, and loving behavior (Cloninger, 2006). CO demonstrates a predominant correlation with AGG (i.e., r = .48) that refers to physical aggressive behavior, which is indeed (more explicitly) its opposite. PE does not demon-strate a medium correlation with DISC, nor with any of the MMPI-2-RF scales. This finding is comparable to findings with the Millon Clinical Multiaxial Inventory-III (MCMI-III; Millon, 2006) Compulsive scale that does not relate to psychopathology as measured with the MMPI-2 either (Rossi, Van den Brande, An, Sloore, & Hauben, 2003).

INTR is related to HA and (reversed) NS, but not to RD in the combined sample. In other studies, INTR scores dem-onstrate strong relationships with other personality mea-sures of sociability, energy, and positive emotions (e.g., NEO-PI-R Extraversion, Multidimensional Personality Questionnaire Positive Emotionality, and the Behavioral Activation scales; Harkness et al., 2012). Gutiérrez-Zotes et al. (2005) found an association between RD and INTR using a Spanish version of the original MMPI-2 PSY-5 Scales and a short version of the Spanish TCI (140 items). However, the correlation between INTR and SD differed significantly in both subsamples in the psychiatric sample; we observed a medium correlation between INTR and RD (i.e., r = .34 in the psychiatric sample and r = .17 in the SUD sample, Z = 2.02; p < .05; Cohen’s q = .19).

Table 1. Differences in Mean Scores on Both Instruments for Two Subsamples.

Psychiatric SUD

M SD M SD T p

Novelty Seeking (NS) 19.75 6.46 20.23 5.82 −0.85 .39Harm Avoidance (HA) 20.96 7.79 19.62 7.17 1.94 .05Reward Dependence (RD) 15.30 4.07 14.87 3.33 1.24 .21Persistence (PE) 4.80 1.92 4.52 1.85 1.62 .12Self-Directedness (SD) 25.99 8.41 26.67 8.07 −0.90 .37Cooperativeness (CO) 30.57 6.91 29.58 6.48 1.61 .72Self-Transcendence (ST) 19.75 6.46 12.08 5.82 13.52 .00Emotional/Internalizing Dysfunction (EID) 68.04 13.82 66.62 13.28 1.14 .25Thought Dysfunction (THD) 58.55 14.36 61.00 13.58 −1.91 .06Behavioral/Externalizing Dysfunction (BXD) 57.13 13.08 63.64 13.74 −5.32 .00Demoralization (RCd) 69.92 13.19 67.93 12.56 1.68 .09Somatic Complaints (RC1) 60.61 13.97 59.59 13.67 0.81 .42Low Positive Emotions (RC2) 63.36 14.20 59.28 13.82 3.17 .00Cynicism (RC3) 51.93 11.37 55.51 12.23 −3.33 .00Antisocial Behavior (RC4) 62.43 13.13 71.94 13.30 −7.87 .00Ideas of Persecution (RC6) 57.93 13.76 60.44 13.28 −2.02 .04Dysfunctional Negative Emotions (RC7) 62.41 15.67 62.23 15.02 0.13 .90Aberrant Experiences (RC8) 60.87 13.82 63.25 11.61 −2.01 .04Hypomanic Activation (RC9) 52.73 12.76 56.34 13.51 −0.302 .00

Note. Mean scores on TCI dimensions are raw scores; mean scores on H-O scales and RC scales are T scores. SUD = substance use disorders.

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6 Assessment XX(X)

Table 2. Correlations for TCI Dimensions With MMPI-2-RF Scales for the Total Sample (N = 491).

Novelty Seeking

Harm Avoidance

Reward Dependence Persistence

Self-Directedness Cooperativeness

Self-Transcendence

H-O and RC Scales Emotional/Internalizing

Dysfunction (EID)−.11 .75 −.17 −.06 −.66 −.28 .03

Thought Dysfunction (THD)

.04 .17 .02 .18 −.32 −.19 .45

Behavioral/Externalizing Dysfunction (BXD)

.45 −.13 −.22 −.03 −.22 −.40 .14

Demoralization (RCd) −.03 .69 −.11 −.08 −.68 −.26 .09 Somatic Complaints

(RC1)−.01 .50 −.01 .01 −.39 −.15 .22

Low Positive Emotions (RC2)

−.24 .61 −.28 −.16 −.44 −.21 −.25

Cynicism (RC3) .07 .13 −.17 .06 −.36 −.43 .23 Antisocial Behavior

(RC4).36 .03 −.20 −.07 −.31 −.34 .13

Ideas of Persecution (RC6)

.04 .14 .04 .11 −.32 −.21 .33

Dysfunctional Negative Emotions (RC7)

.01 .61 −.07 .03 −.60 −.25 .23

Aberrant Experiences (RC8)

.08 .25 −.03 .10 −.33 −.21 .45

Hypomanic Activation (RC9)

.39 −.11 −.06 .13 −.23 −.38 .33

Somatic/Cognitive Scales Malaise (MLS) −.03 .54 −.08 −.11 −.40 −.13 .05 Gastrointestinal

Complaints (GIC).00 .34 −.02 .01 −.29 −.11 .18

Head Pain Complaints (HPC)

−.02 .39 .03 .03 −.31 −.10 .14

Neurological Complaints (NUC)

.07 .32 −.07 −.03 −.28 −.17 .24

Cognitive Complaints (COG)

.05 .47 −.10 −.10 −.50 −.25 .14

Internalizing Scales Suicidal/Death Ideation

(SUI).01 .30 −.02 −.01 −.35 −.15 .13

Helplessness/Hopelessness (HLP)

−.06 .51 −.14 −.09 −.54 −.25 −.01

Self-Doubt (SFD) −.07 .62 −.08 −.09 −.59 −.17 .05 Inefficacy (NFC) .02 .62 −.11 −.18 −.63 −.29 .16 Stress/Worry (STW) .00 .60 −.04 .01 −.56 −.22 .14 Anxiety (AXY) −.02 .46 −.01 .06 −.39 −.09 .18 Anger Proneness

(ANP).17 .34 −.08 .07 −.38 −.41 .15

Behavior-Restricting Fears (BRF)

−.04 .38 −.01 .10 −.31 −.13 .13

Multiple Specific Fears (MSF)

−.10 .28 .09 −.04 −.13 −.06 .08

Externalizing Scales Juvenile Conduct

Problems (JCP).37 −.06 −.16 −.07 −.23 −.28 .09

(continued)

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van der Heijden et al. 7

Our study supports construct validity of both instru-ments, demonstrating meaningful relations between the MMPI-2-RF scales and TCI dimensions. A possible limita-tion from the current research is that both models of per-sonality and psychopathology were derived via self-report. Correlations between both measures may therefore be arti-ficially inflated due to shared method variance. However, we only interpreted medium size correlations to correct for this bias. In addition, the use of self-reports makes it pos-sible to collect large databases to increase power. Another limitation of the current research could be that we did not include nonpatients in our sample. Cloninger’s model assesses adaptive as well as nonadaptive dimensions and some character dimensions like ST could have another function in normal people than in psychiatric patients.

As to theory, obviously, our research allows no state-ments about causal relations between temperament dimen-sions and (higher-order dimensions of) psychopathology. Therefore, it remains unclear if spectrum associations or pos-sible predisposition/vulnerability associations between per-sonality and psychopathology are revealed in the current investigation. HA can explain 56% in the variance of the internalizing disorders and NS explains 29% in the external-izing disorders. These findings may suggest a vulnerability

association as one would expect larger effects if tempera-ment and psychopathology were two extremes of the same dimension (Nigg, 2006). Cloninger’s temperament dimen-sions are hypothesized to play a role in individual differ-ences in vulnerability to psychopathology (Cloninger, 2008), but others have been very critical about these assumptions. For example, Farmer and Goldberg (2008a, 2008b) state that “overall, several core theoretical assumptions and predic-tions associated with the psychobiological model and TCI-R assessment are either nonfalsifiable, in conflict with each other, or not supported by empirical evidence” (Farmer & Goldberg, 2008b. p. 303).

Clearly, more research is needed to reveal the role that temperament (particularly in terms of the TCI) plays in psy-chopathology. Nigg (2006) suggests that “it is important that temperament be studied in conjunction with ecological and contextual moderators, rather than viewed as a single explanatory paradigm in itself for the development of psy-chopathology” (p. 413). Psychopathology is always the result of an interaction between biologically rooted aspects such as temperament and environmental challenges during the life course (Ingram & Luxton, 2005). Therefore, entan-gling the relative influence of both aspects for the develop-ment of specific pathology remains the ultimate challenge.

Novelty Seeking

Harm Avoidance

Reward Dependence Persistence

Self-Directedness Cooperativeness

Self-Transcendence

Substance Abuse (SUB)

.15 .05 −.11 −.11 −.16 −.11 .12

Aggression (AGG) .27 .04 −.20 .02 −.24 −.48 .12 Activation (ACT) .27 .05 .03 .04 −.26 −.18 .36Interpersonal Scales Family Problems (FML) .10 .33 .04 .05 −.43 −.24 .22 Interpersonal Passivity

(IPP)−.24 .44 −.13 −.21 −.30 .02 −.19

Social Avoidance (SAV)

−.36 .45 −.29 −.03 −.11 −.12 −.13

Shyness (SHY) −.27 .59 −.21 −.05 −.42 −.14 −.01 Disaffiliativeness (DSF) −.12 .30 −.37 −.09 −.32 −.29 .03PSY-5-r Scales Aggressiveness

(AGGR).29 −.41 .002 .19 .18 −.21 .21

Psychoticism (PSYC) .04 .21 -.003 .15 −.36 −.19 .49 Disconstraint (DISC) .43 −.19 −.19 −.04 −.16 −.27 .13 Negative Emotionality/

Neuroticism (NEGE).08 .62 −.03 .02 −.58 −.27 .20

Introversion/Low Positive Emotionality (INTR)

−.38 .47 −.28 −.10 −.14 −.08 −.29

Note. r ≥ |.30| are italicized; r ≥ |.50| are boldface; rs that showed a significant difference in both subsamples with Cohen’s q ≥ |.30| are underlined. r ≥ .13 is significant at p < .01.

Table 2. (continued)

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8 Assessment XX(X)

AcknowledgmentWe thank Nora Vaal and Dr. Inge Duijsens for their participation in this research project.

Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

FundingThe authors received no financial support for the research, author-ship, and/or publication of this article.

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