European Psychiatry 31 (2016) 6065

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European Psychiatry
journal homepage: http://www.europsy-journal.com

Original article

The relationship between temperament and character and psychoticlike experiences in healthy children and adolescents
G.C. Nitzburg
P. DeRosse a,b

b,

*, C.B. Gopin b,e, B.D. Peters b, K.H. Karlsgodt b, A.K. Malhotra a,b,c,d,

Center for Translational Psychiatry, The Feinstein Institute for Medical Research, Manhasset, NY, USA
Division of Psychiatry Research, The Zucker Hillside Hospital, Division of the North Shore Long Island Jewish Health System, Glen Oaks, NY, USA
Department of Psychiatry and Behavioral Science, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
d
Hofstra North Shore LIJ School of Medicine, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA
e
Weill-Cornell Medical College, New York, NY, USA
b
c

A R T I C L E I N F O

A B S T R A C T

Article history:
Received 28 May 2015
Received in revised form 8 July 2015
Accepted 10 July 2015
Available online 14 September 2015

Background: Prior work by our group identied personality proles associated with psychotic-like
experiences (PLEs) in healthy adults that were strikingly similar to those found in schizophrenia
patients, with the exception of two key differences. Specically, higher levels of PLEs were linked to
higher persistence and cooperativeness, suggesting that these characteristics might represent
personality-based resilience factors. Notably, age and personality were signicantly correlated in these
data, raising questions about whether healthy children and adolescents would show similar results. To
date, no study has examined personality proles associated with both positive and negative PLEs in
healthy children and adolescents using Cloningers Temperament and Character Inventory (TCI). Thus,
this study examined the relationship between TCI dimensions and PLEs in healthy children and
adolescents.
Method: The TCI and the Community Assessment of Psychic Experiences (CAPE) were administered to
123 healthy children and adolescents aged 818. Multiple regression models were used to examine
personality dimensions associated with overall severity of PLEs as well as severity of positive and
negative PLEs separately.
Results: Positive, negative, and overall PLE severity were all associated with a personality pattern of
higher harm avoidance and lower self-directedness. Negative PLE severity was also associated with
lower persistence.
Conclusions: Personality correlates of PLEs in healthy children and adolescents were largely consistent
with our past work on PLEs in healthy adults. However, our previously identied resilience factors were
notably absent in this sample. These ndings may suggest that these personality characteristics have not
yet crystallized or emerged to aid in coping with PLEs.
2015 Elsevier Masson SAS. All rights reserved.

Keywords:
Temperament
Personality
Subclinical psychosis
Psychotic-like experiences
Children
Adolescents

Considerable data now support the continuity between

clinically signicant psychotic disorders and the manifestation of
psychotic-like experiences (PLEs) in otherwise healthy adults in
the general population. PLEs may include a range of unusual
thoughts and perceptual experiences that approximate the positive
and negative symptoms of psychosis but can be differentiated from
clinically signicant psychotic symptoms because they do not go on
to persist or impair functioning [32]. PLEs have been found to be
far more common in children than adults, with children and

* Corresponding author.
E-mail address: gnitzburg@nshs.edu (G.C. Nitzburg).
http://dx.doi.org/10.1016/j.eurpsy.2015.07.002
0924-9338/ 2015 Elsevier Masson SAS. All rights reserved.

adolescents reporting PLEs at rates of 17% and 7.5% respectively

[17] whereas PLEs in adults have a prevalence of 7.2% [18]. Despite
this relatively high prevalence in children, evidence suggests that
PLEs may help predict those at risk of later psychotic disorders, as
PLEs reported at age 11 resulted in a 16 times greater likelihood of
developing schizophreniform disorder by age 26 [23]. Such ndings
have prompted efforts to identify the premorbid risk factors that
overlap between PLEs and psychotic disorders, with the goal of
rening prediction for which children endorsing PLEs may be most
at-risk for later psychotic disorder onset. Substantial overlap in risk
factors has been found between healthy adults endorsing PLEs and
adult patients with clinically signicant psychotic disorders (for a
full review, see Linscott and van Os [18]). Recent evidence has

G.C. Nitzburg et al. / European Psychiatry 31 (2016) 6065

implicated personality as one of these overlapping premorbid risk

factors [20,12,13].
We recently investigated the relationship between temperament and character dimensions and PLEs in healthy adults to
determine whether the observed relationship paralleled the
association that emerged in studies of psychotic disorders.
Specically, we examined the relationship between PLEs, measured using the Community Assessment of Psychic Experiences
(CAPE), and personality traits measured using the Temperament
and Character Inventory (TCI) [6] in 415 healthy adults. The TCI is a
personality measure based on Cloningers [6] psychobiological
model, which reframes personality as behavioral learning responses to environmental adversities in an attempt to be more
proximate to the genetic and neurobiological variation seen in
psychiatric disorders [6]. We found that PLEs were associated with
higher harm avoidance and self-transcendence and lower selfdirectedness and reward dependence [20]. These results were
strikingly similar to the personality correlates of greatest effect
size found in a recent meta-analysis of adult schizophrenia
patients [21]. Our results were also largely conrmed by Gaweda
et al.s [13] study conducted in a largely university student sample,
which found PLEs to be signicantly associated with higher harm
avoidance, higher self-transcendence and lower self-directedness,
but not reward dependence. Notably, we also found evidence to
suggest personality-based resilience markers. Unlike ndings for
patients with schizophrenia spectrum disorders, PLE occurrences
in healthy adults were signicantly associated with higher
persistence and cooperativeness, which may help these healthy
adults overcome the adversity associated with positive psychotic
experiences, resist tendencies toward social withdrawal, and seek
support from caring others. These ndings were also partially
conrmed by Gaweda et al.s [13] study, which found cooperativeness, but not persistence, to be associated with PLEs in healthy
adults. Thus, despite some inconsistency about the role of reward
dependence and persistence, when considered inclusively, ndings have implicated harm avoidance, self-transcendence, selfdirectedness, reward dependence, persistence, and cooperativeness as possible risk factors for the manifestation as PLEs.
However, an unexpected secondary nding in our previous
study was the signicant relationship between age and the
temperament and character variables. Although personality has
been theoretically conceptualized as stable across the lifespan,
numerous past studies have found that personality dimensions
slowly change throughout childhood [15,7,8,14,15,22,24,25,27,
31,33,36], suggesting that while personality may be trait-like, it is
not fully stable. This evidence of relations between age and
personality in our study and the personality literature raises
questions about whether personality correlates of PLEs in healthy
children and adolescents will be consistent with those evidenced
in healthy adults.
To date, very little is known about the personality proles
associated with PLEs in healthy children and adolescents. One
recent study by Wiltink et al. [35] found a signicant positive
correlation between positive PLEs and the ve-factor model (FFM)
personality traits of higher neuroticism, higher openness to
experience and lower agreeableness, which is consistent with
prior literature on patients with psychotic disorders [21]. However,
the Wiltink et al. [35] study focused only on PLEs that approximate
positive, and not negative, psychotic symptoms. To the best of our
knowledge, no study has yet fully investigated the personality
correlates of both positive and negative PLEs or evaluated such
relations using Cloningers [6] model of temperament and
character. Identifying discontinuities between patient populations
and healthy children and adolescents experiencing PLEs may help
to illuminate how premorbid personality characteristics contribute to risk for clinically signicant psychotic disorders, which in

61

turn may aid in early identication of at-risk populations.

Moreover, the recognition of such discontinuities may help to
identify coping mechanisms that could be protective against a
transition from subclinical to clinically signicant psychosis.
Identifying children and adolescents lacking in protective personality traits may also aid in early intervention efforts. Specically,
even though the overall course of personality development may
not be subject to clinical intervention, clinicians may be able to
teach work-around strategies to, such as educating children with a
lack of cooperativeness or persistence about how to reach out for
personal support when encountering adversities.
In line with past research on temperament and character
proles of PLEs in healthy adults [12,13,20], which is consistent
with ndings in patients with psychotic disorders, we hypothesized that overall PLE severity would be associated with higher
harm avoidance, lower self-directedness, and lower reward
dependence. We also sought to determine whether the putative
resilience markers of higher persistence and cooperativeness
found in our previous study of healthy adults would be present in
our child and adolescent community sample.

1. Method
1.1. Participants
Our sample consisted of 123 healthy volunteers between the
ages of 8 and 18 (mean = 14.35  2.70) who were recruited using
Internet and newspaper advertisements, posted yers, and personal
referrals from the community in a geographic region bridging urban
New York City with suburban Long Island. Although we previously
conducted a similar study of the relations between PLEs and
temperament and character dimensions in a sample of adult
participants aged 1865 [20], there was no overlap between the
18 year-olds in this prior study and the 18 year-olds in our present
sample. The current sample was 49.6% female (n = 61) and 50.4%
Caucasian (n = 62), 26.8% African-American (n = 33), 9.8% Asian
(n = 12), 4.9% Latino(a) (n = 6), and 8.1% Other (n = 10). All
participants aged 18 provided written informed consent, and all
minors provided assent alongside parental written informed consent
to a protocol approved by the Institutional Review Board of North
Shore-Long Island Jewish Health System. Participants were excluded
if they had a past or present Axis-I diagnosis, rst-degree relatives
with known or suspected major depressive disorder, bipolar disorder,
or psychotic disorder, active or recent (within the past month)
substance abuse, intellectual disability, incidence of head injury with
loss of consciousness for any amount of time, medical illnesses that
could affect brain functioning, or were taking medications with
known cognitive effects (e.g. psychostimulants, antipsychotics,
cholinesterase inhibitors).
1.2. Clinical assessments
1.2.1. Diagnostic rule-out
To rule out Axis-I disorders, all participants aged 1618 were
administered the Structured Clinical Interview for the Diagnostic
and Statistical Manual of Mental Disorders, Non-Patient Version
(SCID-NP) [9], while all participants aged 815 were administered
the Kiddie-Schedule for Affective Disorders and Schizophrenia
Present and Lifetime Version (K-SADS-PL) [16]. SCID-NP and KSADS-PL assessments were conducted by licensed psychologists or
by trained graduate-level research assistants supervised by a
licensed psychologist. Each SCID-NP was supplemented with an
interview with family informants whenever possible, and all SCIDNP and K-SADS-PL information was compiled into narrative case
summaries. Absence of pathology was then determined by a

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G.C. Nitzburg et al. / European Psychiatry 31 (2016) 6065

consensus of at least two senior faculty members. The K-SADS-PL

and SCID-NP have demonstrated strong test-retest reliability, with
kappa coefcients ranging from 0.67 to 1.00 for K-SADS-PL [16]
and 0.92 for SCID-NP [29].

to identify their stage by pointing at the drawing most closely

resembling them, resulting in two subscales measuring: (1) body
structure and (2) pubic hair development.
1.3. Data analysis

1.2.2. Psychotic-like experiences

The Community Assessment of Psychic Experiences (CAPE) [28]
positive and negative experiences subscales (i.e. 20 and 14 selfreport items, respectively) were used to assess the lifetime
presence and severity of positive and negative PLEs. The CAPE
conceptualizes positive and negative PLEs as the occurrence of
experiences that approximate the positive and negative symptoms
of schizophrenia. For example, the positive PLE subscale includes
items such as, Do you ever see objects, people, or animals that
other people cannot see? and Do you feel as if the thoughts in your
head are not your own? while the negative PLE subscale includes
items such as, Do you ever feel that your emotions are blunted
and Do you ever feel that you are neglecting your appearance or
personal hygiene? For this study, the positive and negative
experiences subscales, as well as a summed score for positive and
negative PLEs together, were used as dependent variables. All
subscale scores were weighted to account for missing item
responses in accordance with Stefanis et al. [28], and only cases
that were at least 90% complete on both the positive and negative
experience CAPE subscales were included in the present study. In
the present sample, 33.3% (N = 41) reported repeated and persistent
positive PLEs (endorsing two or more positive PLEs occurring
often or nearly always), 13.8% (N = 17) reported repeated and
persistent negative PLEs, and 12.2% (N = 15) of participants
reported repeated and persistent PLEs on both the positive and
negative domains. All CAPE subscales demonstrated excellent
reliability in the present sample of children and adolescents, with a
Chronbachs alpha for the CAPE positive, negative and total
summed PLE subscales of a = 0.84, 0.86, and 0.91, respectively.
1.2.3. Temperament and character
Personality traits were assessed using the Junior Temperament
and Character Inventory (JTCI) [19], which consists of 108 true-orfalse self-report items and provides scores for 7 domains: novelty
seeking (NS), harm avoidance (HA), reward dependence (RD),
persistence (P), and self-directedness (SD), cooperativeness (C),
and self-transcendence (ST). NS measures the tendency to seek out
novel stimuli and experiences; HA measures the tendency to avoid,
anticipate, and worry about harm; RD measures the tendency to
have a marked response to and pursuit of reward stimuli, P
measures the tendency toward perseverance in the face of
adversity; SD measures the ability to use the willpower necessary
to achieve personal goals; C measures the ability to cooperate with
others. ST measures the ability to look beyond oneself and achieve
a sense of connectedness with society and the world-at-large
[6]. Notably, the authors who developed and validated the JTCI,
Luby et al. [19] voiced considerable concerns about the validity of
adapting the ST subscale for children, as the capacity to transcend
oneself is considered a marker of developmental maturity [6] that
may not be validly measured until adulthood. These validity
concerns were echoed by other authors who assessed the
psychometric properties of the JTCI [26]. Thus, despite our
previous results of signicant links between ST and PLEs in
adults, we chose to exclude the ST subscale from the present study
in children and adolescents.
1.2.4. Pubertal development
Sexual development was evaluated using the widely used
Tanner stages scale of pubertal development [30]. This scale is a
self-report measure that asks subjects to look at drawings
depicting bodies in various stages of pubertal development and

The relationships between CAPE subscale scores and the

demographic variables of age and sex were rst evaluated. Sex
differences in the CAPE and the JTCI subscales were assessed using
independent samples t-tests or MannWhitney U tests, as
appropriate, while age differences in CAPE and JTCI variables
were investigated using Pearson or Spearmans rho correlations, as
appropriate. Next, a stepwise regression was used to evaluate
which of the six JTCI domains would best predict CAPE psychotic
symptom summed scores. To assess the differential impact of
personality on positive versus negative symptoms, two follow-up
stepwise regressions were conducted on the CAPE positive and
negative psychotic symptom subscales.

2. Results
Although the CAPE psychotic symptoms summed score was
found to be normally distributed, the CAPE positive and negative
symptom subscales were not normally distributed in the present
study, which is consistent with our past work [20]. All subscales of
the JTCI were similarly not normally distributed with the exception
of novelty seeking. Thus, sex differences in the CAPE psychotic
symptoms summed score as well as the JTCI novelty seeking
subscale were assessed using t-tests, while the CAPE positive and
negative symptom subscales and the other JTCI subscales were
assessed using MannWhitney U tests. Age differences in the CAPE
psychotic symptoms summed score and the JTCI novelty seeking
subscale were assessed using Pearson correlations, while the CAPE
positive and negative experiences subscales and the other JTCI
subscales were assessed using Spearmans rho correlations.
No signicant sex differences were observed in the CAPE
psychotic symptoms summed score, the CAPE positive symptoms
subscale, or the CAPE negative symptoms subscales (t(2,123) = .70, U = 1853.5, U = 1842.5, all ps > 0.05). However, age was
signicantly correlated with the CAPE psychotic symptoms
summed score (r = 0.40, p < 0.001), the CAPE positive symptoms
subscale (r = 0.39, p < 0.001) and the CAPE negative symptoms
subscale (r = 0.38, p < 0.001). Sex differences were observed for
the JTCI variables of novelty seeking (t(2,123) = 3.45, p < 0.001),
harm avoidance (U = 1219, p < 0.001) and cooperativeness
(U = 1386, p  0.01) but not for reward dependence, persistence,
or self-directedness (U = 1518, U = 1656, U = 1879, all ps > 0.05).
Age was signicantly correlated with novelty seeking (r = 0.31,
p < 0.001), persistence (r = 0.20, p < 0.05), and cooperativeness
(r = 0.19, p < 0.001), but not harm avoidance, reward dependence,
or self-directedness (r = 0.11, r = 0.04, and r = 0.10, respectively, all ps > 0.05). Since signicant relationships were observed
between demographic variables and the variables of research
interest, age and sex were regressed out of all CAPE and JTCI
variables. For a full summary of intercorrelations between study
variables, see Table 1.
The stepwise multiple regression on the age- and sex-corrected
CAPE psychotic symptom summed score resulted in a signicantly
predictive model accounting for 39.4% of the variance in PLEs
(F(2,122) = 38.98, p < 0.001), where higher harm avoidance
(b = 0.03, p < 0.001) and lower self-directedness (b = 0.03,
p < 0.001) signicantly predicted higher endorsement of PLEs.
Two follow-up stepwise multiple regressions were next conducted
to assess the impact of TCI variables on positive and negative PLEs
separately. First, the stepwise multiple regression on the age- and

G.C. Nitzburg et al. / European Psychiatry 31 (2016) 6065

63

Table 1
Intercorrelations between study variables.
1
1. Age
2. Sex
3. Body structure
4. Pubic hair
5. CAPE positive
6. CAPE negative
7. CAPE psychosis summed
8. Novelty seeking
9. Harm avoidance
10. Reward dependence
11. Persistence
12. Self-directedness
13. Cooperativeness

3
0.12
1

4
0.70***
0.22*
1

0.68***
0.23*
0.70***
1

0.36***
0.05
0.23*
0.22*
1

0.36***
0.07
0.21*
0.24*
0.67***
1

0.40***
0.06
0.24*
0.26**
0.92***
0.91***
1

9
0.31***
0.30**
0.16
0.30**
0.17
0.07
0.132
1

10
0.08
0.31**
0.21*
0.28*
0.39***
0.51***
0.49***
0.12
1

0.04
0.19
0.01
0.03
0.31**
0.28**
0.32***
0.12
0.31***
1

11

12

0.18
0.15
0.07
0.12
0.15
0.32***
0.26***
0.34***
0.03
0.12
1

13

0.03
0.02
0.05
0.08
0.41***
0.45***
0.47***
0.17
0.47***
0.39***
0.31***
1

0.28**
0.22**
0.02
0.09
0.30**
0.27**
0.31***
0.32***
0.22*
0.39***
0.27**
0.37***
1

*p < .05; **p < .01; ***p < .001.

sex-corrected CAPE positive symptom score resulted in a

signicantly predictive model accounting for 27.2% of the variance
in PLEs (F(2,122) = 23.40, p < 0.001), where higher harm avoidance (b = 0.02, p  0.001) and lower self-directedness (b = 0.03,
p  0.001) signicantly predicted higher endorsement of positive
PLEs. Second, the stepwise multiple regression on the age- and
sex-corrected CAPE negative symptom score resulted in a
signicantly predictive model accounting for 41.3% of the variance
in PLEs (F(3,122) = 27.90, p < 0.001), where higher harm avoidance (b = 0.04, p < 0.001), lower self-directedness (b = 0.03,
p < 0.05), and lower persistence (b = 0.05, p < 0.001), signicantly predicted higher endorsement of negative PLEs. The
unstandardized residuals for both of these follow-up regression
models (i.e. for the CAPE positive and negative symptom subscales)
were found to be normally distributed (D = 1.235 and
D = 0.841 respectively, both ps > 0.05), which demonstrated the
statistical validity of our use of regression models with non-normal
data. For a full summary of these results, see Table 2.
Given that adolescence is a time of increased risk for both
subclinical and clinically signicant manifestations of psychotic
symptoms [10,11] as well as a time of personality changes [1], we
questioned whether our observed associations of PLEs and
personality with age may reect changes in pubertal status. Thus,
we ruled out any undue inuence from pubertal development
using a series of regression models. Specically, we evaluated the
effect of pubertal development on CAPE scores in a subset of
103 participants with Tanner Stages data [30]. None of regression
models with Tanner Stages measures of pubic hair nor body
structure predicting CAPE scores were statistically signicant,
including the CAPE psychotic symptom summed score as well as
the CAPE positive and negative symptom subscales
(F(2,103) = 0.99, 0.01, and 0.21, respectively, all ps > 0.05). In
addition, none of the regression models with JTCI domains
Table 2
Stepwise regression analyses of temperament and character dimensions predicting
psychotic-like experiences.
JTCI dimensions

Stepwise model for psychotic symptoms summed

HA
0.03
SD
0.03

<0.001
<0.001

Stepwise model for positive symptoms

HA
SD

0.02
0.03

<0.001
<0.001

Stepwise model for negative symptoms

HA
SD
P

0.04
0.03
0.05

<0.001
<0.05
<0.001

Note: R2psychotic symptoms summed = 0.394; R2positive symptoms = 0.272; R2negative symptoms = 0.413.

predicted by the Tanner Stages measures of pubic hair or body

structure were statistically signicant, including novelty seeking,
harm avoidance, reward dependence, persistence, self-directedness and cooperativeness (F(2,103) = 2.27, 1.68, 0.07, 0.33, 0.20,
and 1.53, respectively, all ps > 0.05).
In addition, given that some past studies have shown that
childhood personality traits do not fully crystallize until around
age 16 [1], a subsample of our participants with 1-year longitudinal
data (N = 47) were evaluated to conrm that our participants
temperament and character domains were sufciently static to
evaluate their relation to PLEs. Specically, the stability of JTCI
domains across a 1-year time span was assessed using a repeated
measures ANOVA, with results showing the JTCI to remain static
across a 1-year time span (F(5,47) = 1.00, p > 0.05). Thus, although
the JTCI dimensions under study might be susceptible to change up
until age 16, these dimensions were determined to be temporally
stable enough across a 1 year time span to investigate their
inuence on the manifestation of PLEs. For the full summary of
repeated measures ANOVA results, see Table 3.
3. Discussion
Our results indicate that the severity of PLEs in healthy children
and adolescents were associated with a temperament and
character pattern of higher harm avoidance and lower selfdirectedness. This personality prole was consistent with our past
work in healthy adults [20] and with the personality dimensions
showing the largest effect sizes in a recent meta-analysis of
schizophrenia patients [21]. These results were consistent with our
hypothesis and provide additional support for a fully dimensional
view of psychosis ranging from manifestations of psychotic-like
experiences in otherwise healthy individuals in the general
population to clinically signicant psychotic disorders.
However, contrary to our ndings in adults, the personality
proles associated with positive, negative, and overall PLE levels in
children and adolescents did not evidence any potential resilience
Table 3
Repeated measures analysis of variance in temperament and character across 1 year
controlling for sex and baseline age.
Variable

df

JTCI
JTCI  Age
JTCI  Sex
TIME
TIME  Age
TIME  Sex
JTCI  Time
JTCI  Time  Age
JTCI  Time  Sex

6.13
0.24
3.45
0.0003
0.004
1.00
1.00
1.58
1.05

5,
5,
5,
5,
5,
5,
5,
5,
5,

p
47
47
47
47
47
47
47
47
47

p < 0.001
ns
p = 0.019
ns
ns
ns
ns
ns
ns

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G.C. Nitzburg et al. / European Psychiatry 31 (2016) 6065

factors. Specically, higher harm avoidance and lower selfdirectedness were signicantly predictive of positive, negative,
and overall PLE levels, with only the one character trait of lower
persistence being identied as uniquely predictive of higher
negative PLE levels. These results run counter to our past work in
healthy adults uniquely linking higher persistence to positive PLEs
and higher cooperativeness to negative PLEs, which were
interpreted as possible resilience factors separating those with
PLEs from those with clinically signicant psychotic disorders
[20]. It is possible that these results reect the ndings of Gaweda
et al.s [13] study, which did not nd persistence to be associated
with PLEs in adults. However, another explanation for the current
ndings is that, unlike adults, children and adolescents have not
yet crystallized personality structures to help them cope with the
adversity associated with positive and negative symptoms. That is,
compared to adults, children and adolescents may be less able to
use their personality characteristics to cope with positive
symptoms by persisting through them. Further, they may be less
able to cope with negative symptoms by resisting the tendency to
socially withdraw and instead cooperate with and accept social
support from others. Thus, such characteristics may represent an
important new therapeutic treatment target in high risk populations, as clinicians may focus on teaching work-around strategies
to young adults lacking in protective personality factors such as
persistence and cooperativeness. Future studies are needed to
examine how the development of personality characteristics
across childhood, particularly persistence and cooperativeness,
may contribute to the severity and persistence of PLE occurrences
over time. In addition, past work has identied distinct trajectories
of increasing, decreasing, persistently low, and persistently high
levels of PLE occurrences across childhood and adolescence [34],
and future studies are needed to identify how the development of
personality traits may contribute to, or interact with, these
trajectories. Specically, future longitudinal studies across childhood and adolescence are needed to examine if and how the
crystallization of personality-based resilience factors, such as
persistence and cooperativeness (alongside other resilience
factors), may inuence the development of these PLE trajectories
into decreasing/persistently low trajectories versus increasing/
persistently high trajectories. In particular, these studies of
developmental trajectories across childhood should further elucidate the role of dysfunctional meta-cognitive beliefs, which were
recently shown to mediate the relationship between TCI domains
and PLE manifestations in adults [12,13]. Such future work may
also expand on such ndings by investigating how other
maladaptive cognitive beliefs and interpersonal patterns inuence
the relationship between personality structures and PLE manifestations across childhood and adolescence.
The present study was limited by the non-normal distribution
of the CAPE positive and negative symptom subscales. However, all
of our analyses adequately controlled for this non-normality.
Furthermore, the CAPE total score was normally distributed, and
the personality correlates of the CAPE subscales were largely
consistent with those of the CAPE total score, with the one
exception being the association between lower persistence and
CAPE negative symptoms. Our ndings may also be limited by a
lack of generalizability to individuals from rural and purely
suburban communities without access to a large major city, as our
community sample was drawn from a geographic region bridging
urban New York City with suburban Long Island. Future studies are
needed to conrm ndings in individuals from rural and suburban
communities without access to major cities. The present study was
also limited by the lack of a comparison group of early onset or
rst-episode psychosis patients, which limited our ability to draw
direct comparisons across the full range of psychotic symptom
manifestations. However, our results are consistent with the

comprehensive body of existing literature on the temperament

and character dimensions of PLE occurrences in healthy adults as
well as patients diagnosed with schizophrenia spectrum disorders.
It may also be argued that our analyses may have inuenced by
personality traits not fully crystallizing until around age 16. However, we conducted a post hoc, repeated measures ANOVA across a
1 year time span in a subset of the present sample who had 12month longitudinal data (N = 47). Results suggested that while
personality may indeed be susceptible to change across the entire
time span of childhood and adolescence, it is temporally stable
enough across a 1 year time span to investigate the inuence of
personality on the manifestation of PLEs. Our study was also
limited by small effect sizes. Although many of the associations
between the JTCI and the CAPE reached statistical signicance,
many of the beta weights were quite small and generally hovered
around zero. However, small beta weights were expected since the
CAPEs scoring procedures result in small values ranging from 0 to
3 after scores are weighted for non-response.
In conclusion, the present study identied a personality prole
associated with PLEs in otherwise healthy children and adolescents that is notably similar to both our prior work in healthy
adults and past studies of adult schizophrenia patients. Specically, higher harm avoidance and lower self-directedness was
associated with positive, negative, and overall levels of PLEs,
and lower persistence was uniquely associated with negative PLEs.
Although this personality prole was largely consistent with the
prole identied in past studies of PLEs in healthy adults, the
present results did not suggest the presence of putative resilience
factors found in past work, such as persistence and cooperativeness [20]. Although such ndings may merely reect a lack of
association with PLEs [13], these results may also suggest that
children and adolescents may not yet have crystallized personality
structures that help them cope with the adversity of PLE
manifestations. Future studies are needed to conrm the present
ndings in rural and purely suburban communities, as well as to
investigate how personality development across childhood may
inuence the development of PLEs and the possible mediating role
of maladaptive cognitive beliefs [12,13] in this developmental
process.
Disclosure of interest
The authors declare that they have no conicts of interest
concerning this article.
References
[1] Allik J, Laidra K, Realo A, Pullmann H. Personality development from 12 to
18 years of age: changes in mean levels and structure of traits. Eur J Pers
2014;18(6):44562.
[2] Brandstrom S, Richter J, Przybeck T. Distributions by age and sex of the
dimensions of Temperament and Character Inventory in a cross-cultural
perspective among Sweden, Germany, and the USA. Psychol Rep 2001;89:
74758.
[3] Branje SJ, Van Lieshout CF, Gerris JR. Big Five personality development in
adolescence and adulthood. Eur J Pers 2007;21(1):4562.
[4] Cloninger CR, Temperament personality. Curr Opin Neurobiol 1994;4(2):
266273.
[5] Cloninger CR, Przybeck TR, Svrakic DM. The tridimensional personality questionnaire: US normative data. Psychol Rep 1991;69(3):104757.
[6] Cloninger CR, Svrakic DM, Przybeck TR. A psychobiological model of temperament and character. Arch Gen Psychiatry 1993;50(12):97590.
[7] Cloninger CR, Przybeck TR, Svrakic DM. The Temperament and Character
Inventory (TCI): a guide to its development and use. St. Louis, MO: Center
for Psychobiology of Personality, Washington University; 1994.
[8] Duijsens IJ, Spinhoven P, Goekoop JG, Spermon T, Eurelings-Bontekoe EH. The
Dutch temperament and character inventory (TCI): dimensional structure,
reliability and validity in a normal and psychiatric outpatient sample. Pers
Indiv Differ 2000;28(3):48799.
[9] First M, Spitzer R, Williams J, Gibbon M. Structured clinical interview for DSMIVnon-patient edition, version 1.0. Washington, DC: American Psychiatric
Association; 1995.

G.C. Nitzburg et al. / European Psychiatry 31 (2016) 6065

[10] Fonseca-Pedrero E, Lemos-Giraldez S, Muniz J, Garca-Cueto E, CampilloAlvarez A. Schizotypy in adolescence: the role of gender and age. J Nerv Ment
Dis 2008;196(2):1615.
[11] Galdos P, van Os J. Gender, psychopathology, and development: from puberty
to early adulthood. Schizophr Res 1995;14(2):10512.
[12] Gaweda , Kokoszka A. A relationship between hallucination proneness and
character and temperament: a mediating role of meta-cognitive beliefs in a
non-clinical sample. Psychiatry Res 2013;208(2):1835.
[13] Gaweda , Prochwicz K, Cella M. Cognitive biases mediate the relationship
between temperament and character and psychotic-like experiences in healthy adults. Psychiatry Res 2015;225(1):507.
[14] Gillespie NA, Cloninger CR, Heath AC, Martin NG. The genetic and environmental relationship between Cloningers dimensions of temperament and
character. Pers Indiv Differ 2003;35(8):193146.
[15] Heiman N, Stallings MC, Hofer SM, Hewitt JK. Investigating age differences in
the genetic and environmental structure of the tridimensional personality
questionnaire in later adulthood. Behav Genet 2003;33(2):17180.
[16] Kaufman J, Birmaher B, Brent D, Rao U. Schedule for affective disorders and
schizophrenia for school-age children present and lifetime version (K-SADSPL): initial reliability and validity data. J Am Acad Child Psychiatry
1997;36:9808.
[17] Kelleher I, Connor D, Clarke MC, Devlin N, Harley M, Cannon M. Prevalence of
psychotic symptoms in childhood and adolescence: a systematic review and
meta-analysis of population-based studies. Psychol Med 2012;42(09):1857
63.
[18] Linscott RJ, Van Os J. An updated and conservative systematic review and
meta-analysis of epidemiological evidence on psychotic experiences in children and adults: on the pathway from proneness to persistence to dimensional
expression across mental disorders. Psychol Med 2013;43(06):113349.
[19] Luby JL, Svrakic DM, McCallum K, Przybeck TR, Cloninger CR. The junior
temperament and character inventory: preliminary validation of a child
self-report measure. Psychol Rep 1999;84(3c):112738.
[20] Nitzburg GC, Malhotra AK, DeRosse P. The relationship between temperament
and character and subclinical psychotic-like experiences in healthy adults. Eur
Psychiatry 2014;29(6):3527.
[21] Ohi K, Hashimoto R, Yasuda Y, Fukumoto M, Yamamori H, Iwase M, et al.
Personality traits and schizophrenia: evidence from a casecontrol study and
meta-analysis. Psychiatry Res 2012;198(1):711.
[22] Otter C, Huber J, Bonner A. Cloningers Tridimensional Personality Questionnaire: reliability in an English sample. Pers Indiv Differ 1995;18(4):47180.

65

[23] Poulton R, Caspi A, Moftt TE, Cannon M, Murray R, Harrington H. Childrens

self-reported psychotic symptoms and adult schizophreniform disorder: a 15year longitudinal study. Arch Gen Psychiatry 2000;57(11):10538.
[24] Roberts BW, DelVecchio WF. The rank-order consistency of personality traits
from childhood to old age: a quantitative review of longitudinal studies.
Psychol Bull 2000;126(1):3.
[25] Roberts BW, Walton KE, Viechtbauer W. Patterns of mean-level change in
personality traits across the life course: a meta-analysis of longitudinal
studies. Psychol Bull 2006;132(1):1.
[26] Schmeck K, Goth K, Poustka F, Cloninger RC. Reliability and validity of the
Junior Temperament and Character Inventory. Int J Method Psychiatr Res
2001;10(4):17282.
[27] Soto CJ, John OP, Gosling SD, Potter J. Age differences in personality traits from
10 to 65: Big Five domains and facets in a large cross-sectional sample. J Pers
Soc Psychol 2011;100(2):330.
[28] Stefanis NC, Hanssen M, Smirnis NK, Avramopoulos DA, Evdokimidis IK,
Stefanis CN, et al. Evidence that three dimensions of psychosis have a distribution in the general population. Psychol Med 2002;32(2):34758.
[29] Stukenberg KW, Dura JR, Kiecolt-Glaser JK. Depression screening scale validation in an elderly, community-dwelling population. Psychol Assess
1990;2:1348.
[30] Tanner JM. Growth at adolescence. Blackwell Scientic Publication; 1962.
[31] Trouillet R, Gana K. Age differences in temperament, character and depressive
mood: a cross-sectional study. Clin Psychol Psychother 2008;15(4):26675.
[32] Van Os J, Linscott RJ, Myin-Germeys I, Delespaul P, Krabbendam L. A systematic review and meta-analysis of the psychosis continuum: evidence for a
psychosis pronenesspersistenceimpairment model of psychotic disorder.
Psychol Med 2009;39(2):17995.
[33] Weyers P, Krebs H, Janke W. Reliability and construct validity of the German
version of Cloningers Tridimensional Personality Questionnaire. Pers Indiv
Differ 1995;19(6):85361.
[34] Wigman JTW, Van Winkel R, Raaijmakers QAW, Ormel J, Verhulst FC, Reijneveld SA, et al. Evidence for a persistent, environment-dependent and deteriorating subtype of subclinical psychotic experiences: a 6-year longitudinal
general population study. Psychol Med 2011;41(11):231729.
[35] Wiltink S, Nelson B, Velthorst E, Wigman JTW, Lin A, Baksheev G, et al. The
relationship between personality traits and psychotic like experiences in a
large non-clinical adolescent sample. Pers Indiv Differ 2015;73:927.
[36] Yu Y, Chamorro-Premuzic T, Honjo S. Personality and defense mechanisms in
late adulthood. J Aging Health 2008;20(5):52644.