Comments on the Role of the Character Dimension Self-Transcendence in Suicidal Phenomena

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Comments on the Role of the Character Dimension Self-Transcendence in Suicidal Phenomena

To the Editor: We were fortunate enough to read the article by Jylhä and colleagues1 describing lifetime and prospective associations between temperament and character dimensions (within the framework of Cloninger’s psychobiological model of personality) and suicide attempts in a large sample of mood disorder patients. The character dimension self-transcendence was one of the traits positively associated with the total number of suicide attempts, which is a common finding in psychiatric patients suffering from psychotic and mood disorders.2 However, self-transcendence is probably scientifically and clinically the most controversial of all of the temperament and character dimensions,3 which in itself prevents experts from making clear and definite conclusions about its role in suicidal phenomena. Unfortunately, we believe the complex and seemingly contradictory nature of self-transcendence has not been adequately addressed in most prior publications on the topic of personality and suicidality in psychiatric patients.

In Cloninger’s theory of personality, self-transcendence is a trait associated with experiencing spiritual ideas, such as searching for something elevated and considering oneself an integral part of the universe. Persons scoring high on this dimension can be described as self-forgetful, enlightened, humble, and creative.4 In light of all of these appreciated aspects of self-transcendence, a question remains: Why do several empirical reports indicate a predisposing role of self-transcendence to suicidal ideas and behaviors in psychiatric patients?

It seems that one explanation might lie in the complex and dynamic structure of individuals’ personality, consisting of various interrelated temperament and character dimensions that set the stage for different developmental outcomes. In the case of self-transcendence, it has been demonstrated in other, albeit related, research areas that it promotes one’s subjective well-being and maturity only when coupled with highly developed self-directedness and cooperativeness character dimensions.5 Conversely, when a highly self-transcendent person is simultaneously low on the other 2 character dimensions, he or she becomes susceptible to various forms of mental illness, such as dissociative states, psychotic episodes, and symptoms of personality disorders.6 For example, one study7 found that this particular combination of 3 character traits is associated with illogical/magical and paranoid thinking and unusual perceptions, increasing the risk of overall schizotypy. Keeping in mind that self-directedness and cooperativeness are often underdeveloped among mood disorder patients, it might now be more evident why high self-transcendence is usually associated with suicidality in this population. Indeed, the combination of these character dimensions could indirectly exert an influence on suicidal risk by predisposing to comorbid psychiatric disorders, psychotic symptoms, or interpersonal disturbances, in line with the current understanding of a mediation-based relationship between personality and suicidality.1

Finally, we would like to encourage future researchers in this area to apply configural analyses of temperament and character profiles in order to account for their distinct interactions within the individual. Such person-centered analyses do not assume simple linear relations but are able to assess dynamic configurations of multiple personality traits that possibly promote and serve as predictors of complex psychopathological entities like suicidal ideation and attempts among psychiatric patients.

References

1. Jylhä PJ, Rosenström T, Mantere O, et al. Temperament, character, and suicide attempts in unipolar and bipolar mood disorders. J Clin Psychiatry. 2016;77(2):252-260. PubMed doi:10.4088/JCP.14m09472

2. Woo YS, Jun TY, Jeon YH, et al. Relationship of temperament and character in remitted depressed patients with suicidal ideation and suicide attempts—results from the CRESCEND study. PLoS One. 2014;9(10):e105860. PubMed doi:10.1371/journal.pone.0105860

3. MacDonald DA, Holland D. Examination of the psychometric properties of the Temperament and Character Inventory self-transcendence dimension. Pers Individ Dif. 2002;32(6):1013-1027. doi:10.1016/S0191-8869(01)00107-6

4. Cloninger CR, Svrakic DM, Przybeck TR. A psychobiological model of temperament and character. Arch Gen Psychiatry. 1993;50(12):975-990. PubMed doi:10.1001/archpsyc.1993.01820240059008

5. Cloninger CR, Zohar AH. Personality and the perception of health and happiness. J Affect Disord. 2011;128(1-2):24-32. PubMed doi:10.1016/j.jad.2010.06.012

6. Svrakic DM, Cloninger CR. Pharmacotherapy and the psychobiological model of personality: implications for DSM-5. Curr Psychopharmacol. 2012;1(2):122-136. doi:10.2174/2211556011201020122

7. Daneluzzo E, Stratta P, Rossi A. The contribution of temperament and character to schizotypy multidimensionality. Compr Psychiatry. 2005;46(1):50-55. PubMed doi:10.1016/j.comppsych.2004.07.010

Nenad Jakšić, MAa

[email protected]

Branka Aukst Margetić, MD, PhDa,b,c

aDepartment of Psychiatry, University Hospital Center Zagreb, Zagreb, Croatia

bSchool of Medicine, University of Zagreb, Zagreb, Croatia

cSchool of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina

Potential conflicts of interest: None.

Funding/support: None.

J Clin Psychiatry 2017;78(2):e161

https://doi.org/10.4088/JCP.16lr11229

© Copyright 2017 Physicians Postgraduate Press, Inc.