Journal of Affective Disorders 107 (2008) 63–75www.elsevier.com/locate/jad

Research report

TEMPS-A (Rome): Psychometric validation of affectivetemperaments in clinically well subjects in mid- and south Italy

Maurizio Pompili a,b,⁎, Paolo Girardi a, Roberto Tatarelli a, Paolo Iliceto a,Eleonora De Pisa a, Leonardo Tondo b,c, Kareen K. Akiskal d, Hagop S. Akiskal d,e

a Department of Psychiatry, Sant'Andrea Hospital, University of Rome “La Sapienza”, Rome, Italyb Department of Psychiatry, Harvard Medical School and International Consortium for Bipolar Disorder Research,

McLean Division of Massachusetts General Hospital, Belmont, MA 02478-1906 USAc Department of Psychology, University of Cagliari, Centro Lucio Bini Mood Disorders Research Center, Cagliari, Sardinia, Italy

d International Mood Center, La Jolla, CA, USAe San Diego Veterans Administration Medical Center, USA

Received 5 April 2007; accepted 31 July 2007Available online 19 September 2007

Abstract

Background: Our aim was to study the psychometrics and factor structure replicability of the Temperament Evaluation ofMemphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A) in its Italian (Rome) Version. The questionnaire is a self-report110-item measure that postulates five affective temperaments—the depressive, cyclothymic, irritable, hyperthymic, and anxious—which embody both strengths and liabilities along affective reactivity. In Italian, the TEMPS has previously been validated in itsoriginal 32-item version, the TEMPS-I (Pisa), one which did not yet include an anxious subscale.Methods: The present sample consisted of 948 nonclinical subjects (27.39 years±8.22 S.D.). There were 476men (50.2%: 28.56 years±8.63 S.D.) and 472 women (49.8%: 26.21 years±7.61 S.D.). Reliability and validity were assessed by standard psychometric tests.Results: Principal Components Analysis with Varimax rotation resulted in a 3-factor solution: the first with highest explainedvariance (8.84%) represents Dysthymic, Cyclothymic and Anxious (Dys–Cyc–Anx) temperaments combined; the secondidentifies Irritable temperament (5.65% of variance); and the third Hyperthymic temperament (5.16% of variance). Cronbach Alphacoefficients for the three subscales were respectively .89, .77 and .74. The rates for the Dys–Cyc–Anx were 2.7%, and for theIrritable 3.1%. Despite the low rate of the Hyperthymic temperament (.2%), nonetheless 16% were between 1st and 2nd SD.Exploratory factor analysis revealed a positive loading combining Dys–Cyc–Anx with the Irritable; the Hyperthymic loadednegatively on this factor. In terms of dominant temperaments, based on z-scores, 2.7% were dysthymic, 1.7% cyclothymic, .7%hyperthymic, 3.5% irritable and 3% anxious.Limitation: Although developed for self-rated use, the Italian authors nonetheless administered the TEMPS-A in an interviewformat. It is uncertain in what ways this procedure could have influenced our results, if any. Another limitation is that we did notassess test–retest reliability.Conclusions: These data identify at least 3-factors, Dys–Cyc–Anx and Irritable (which are correlated), and Hyperthymic, which isuncorrelated with the others. Though our data are reminiscent of the neuroticism–extraversion distinction, importantly traits areoperationalized in affective terms. Beyond the well-known relationship between the Dysthymic and Cyclothymic subscales andthat between the Dysthymic and Anxious, the present data reveal a strong relationship between the Cyclothymic and Anxious as

⁎ Corresponding author. Department of Psychiatry, Sant'Andrea Hospital, Via di Grottarossa 1035, Rome 00189, Italy. Tel.: +39 0633775675;fax: +39 0633775342.

E-mail address: maurizio.pompili@uniroma1.it (M. Pompili).

0165-0327/$ - see front matter © 2007 Elsevier B.V. All rights reserved.doi:10.1016/j.jad.2007.07.031

64 M. Pompili et al. / Journal of Affective Disorders 107 (2008) 63–75

well, which is of great relevance for bipolar II. It is also provocative that much of hyperthymia (16%) in the +SD is between the1st and 2nd SD, thereby “normalizing” this temperament in Italy, as previously reported by TEMPS-I (Pisa) from Northern Italy(and TEMPS-A from Lebanon and Argentina).© 2007 Elsevier B.V. All rights reserved.

Keywords: Temperament; Psychometrics: TEMPS-A; TEMPS-I; Italy

1. Introduction

1.1. History

In Greco-Roman medicine temperaments were pro-posed as constitutional emotional reactivity patternsfashioned by the humoral theory (Akiskal et al., 2002;Akiskal, 1996). Kraepelin (1921 tr.) posited four basicaffective dispositions—depressive, manic, irritable andcyclothymic—which he believed to be subclinical formsof affective psychoses and to have their roots inadolescence. In line with these classic formulations,and concordant with Kretschmer's (1936) views,research by the senior author and his co-workers(Akiskal et al., 1979; Akiskal and Mallya, 1987; Akiskaland Akiskal, 1992) formulated criteria for temperamentswhich are relevant for mood disorders conceived in anaffective continuum, ranging from subthreshold affec-tive traits at one end to severe affective psychosis at theother end (Akiskal and Akiskal, 1992; Akiskal, 1996;Akiskal and Pinto, 2000).

In the framework just outlined, five temperaments areproposed (Akiskal and Akiskal, 2005): Depressive,Hyperthymic (borrowing this term from Schneider(1958) to replace the ‘manic’ type of Kraepelin),Cyclothymic, Irritable and generalized Anxious; the latterrepresents an addition beyond the classic Germanconcepts (Akiskal, 1998).However, it remains unresolvedwhether Irritable temperament is merely a subtype of theCyclothymic or whether it stands on its own (Akiskal,1992; Akiskal et al., 1998); furthermore, the place ofanxious subscale within the classical temperamentsremains to be determined by empirical data.

According to the bipolar spectrum perspective, mooddisorders are part of a continuum (Akiskal, 1983),differences in symptomatology reflecting but quantita-tive variations in genetic predisposition or in gender- anddevelopmental factors (Akiskal, 1996, 2003; Kelsoe,2003). This spectrum extends from the mildest, subclin-ical presentations ofmood disorder, the temperaments, tobipolar disorder type I and would also encompassrecurrent major and minor depression, bipolar disordertype II and, potentially, other mood disorders not yetofficially accepted, such as bipolar disorder types III and

IV (Akiskal et al., 1977, 2003; Akiskal and Pinto, 2000).Temperaments, however, are more than just formesfrustes of major affective disorders. Akiskal (1995),building upon the Kraepelinian position (1921), postu-lates that temperamental dysregulation is the fundamen-tal pathology of mood disorders and its presence inindividuals reflects an increased predisposition fordeveloping affective disorders. Even among individualswith mood disorders, temperamental dysregulationappears to be associated with increased risk of relapse(Cassano et al., 1989), and decreased response toantidepressant medication (Koukopoulos et al., 1983).

1.2. Current research

The original operationalization of the five tempera-ments derived from theoretical considerations andclinical observation (Akiskal et al., 1979; Akiskal andMallya, 1987; Akiskal and Akiskal, 1992; 2005). Thisformulation ultimately led to the development of aninstrument: the Temperament Evaluation of Memphis,Pisa, Paris and San Diego (TEMPS). One is semistruc-tured TEMPS, administered in interview format, whichhas only been tested in Italy: TEMPS-I (Pisa) (Akiskalet al., 1998; Placidi et al., 1998b). A parallel approach toassessment of temperament is the self-rating autoquestionnaire, the TEMPS-A (Akiskal et al., 2005b)with 109 (for men) or 110 (for women) items.

Previous well-known instruments (see for instancethe NEO-FFI, Costa and McCrae, 1989) for theassessment of personality have been derived fromstatistical analyses of ‘normal’ personality; they there-fore have no a priori specific relation to affectivity oraffective disorders. This is why the TEMPS-A wasconstructed in self-rated version to facilitate theassessment of clinically relevant aspects of temperamentrelated to affective disorders.

The first version of TEMPS-A contained 84 items,assessing Dysthymic (items 1–22), Cyclothymic (items23–42), Hyperthymic (items 43–63) and Irritable (items64–84) temperaments. Later, clinical and theoreticalconsiderations led to the elaboration of 26 new itemsdescribing the Anxious temperament, resulting in the110-item full-length version of the TEMPS-A.

Table 1Demographic characteristics of Italian sample

Variables Female Male

(N=472) (N=476)

Gender, % 49.8 50.2Age, years 26.21±7.61 a 28.56±8.63 a

College students, % 55.5 45.5Employed, % 36.8 63.2a Values shown as mean±SD.

65M. Pompili et al. / Journal of Affective Disorders 107 (2008) 63–75

The current autoquestionnaire version (TEMPS-A) hasbeen evolving over the past 10 years (see Akiskal andAkiskal, 2005; Akiskal et al., 2005a,b).While the TEMPS-I has beenwidely used in the Italian population (e.g., Perugiet al., 1990, 1997, 2001, 2003, 2006; Cassano et al., 1992;Placidi et al., 1998b; Akiskal et al., 1998; Maremmaniet al., 2005), the TEMPS-A to date has not been validatedin Italy. The aim of this study is to examine thepsychometric properties of this instrument in a nonclinicalItalian population. In particular we were interested toexamine the place of the irritable and anxious subscales inthe overall factorial structure of the TEMPS-A.

2. Materials and methods

2.1. Study setting

The psychiatric environment at the Sant'AndreaHospital (directed by RT) is a comprehensive structureincluding inpatient and outpatient clinic as well as a dayhospital. In this environment research activity is focused onearly recognition of suicide risk and other areas such asmood and psychotic disorders, eating disorders andviolence at the workplace. Research activity is also focusedon nonclinical populations such as university students.

2.2. Instrument

The autoquestionnaire version of the TemperamentEvaluationMemphis, Pisa, Paris and SanDiego (TEMPS-A) is a self-report instrument developed by the seniorauthors (K.K.A. and H.S.A.) of this article (Akiskal andAkiskal, 2005). To recapitulate, it consists of 110 itemsthat measure affective temperamental traits, present in thesubject's whole life, represented in five dimensionalscales: Depressive, Cyclothymic, Hyperthymic, Irritableand Anxious. Despite the autoquestionnaire format of theTEMPS-A, it was nonetheless administered via interviewin the present study. The Italian authors felt that suchadministration will make its results comparable with theinterview-administered TEMPS-I (32 items). Such con-cordance has been reported with the French studies oftemperament, showing in particular (Hantouche et al.,1998) excellent correlation for the cyclothymic temper-ament (r=.73).

The Italian version of the TEMPS-Awas prepared bytranslating the scale into Italian, back-translating it intoEnglish and adjusting the final Italian version as needed.This process was performed, supervised and directed byone of the authors (M.P.). Further supervision wasprovided by L.T., H.S.A. and K.K.A. as well as by aprofessional official public translator. After appropriate

adjustment for nuance, the final version (TEMPS-ARome) was administered to the subjects of this study.

All the procedures were conducted in conformitywith the Italian laws about research on human subjects.

2.3. Participants

The sample of this study consisted of 948 subjects(27.39 years±8.22 S.D.). There were 476 men (50.2%):(28.56 years±8.63 S.D.) and 472 women (49.8%):(26.21 years±7.61 S.D.); 69.6% were college studentsand 30.4% employed. All subjects were administeredTEMPS-A during the first half of 2005 and they allcame from the middle and south of Italy. None of thesubjects had a current major psychiatric disorder.Demographic characteristics are presented in Table 1.

2.4. Statistical analyses

Principal Components Analysis with Varimax rotationwas used to extract subscales using scree test to determinethe number of factors. The Cronbach Alpha wascalculated for each subscale to estimate internal consis-tency. Two-tailed Student t-tests were used to comparemales and females scores. Pearson's bivariate correlationswere calculated among the subscales. Statistical analyseswere conducted with SPSS for Windows release 11.0.

3. Results

3.1. Factorial structure

Weused Principal ComponentsAnalysiswithVarimaxrotation, and deleted 10 psychometrically weak items (17,18, 20, 21, 41, 42, 56, 60, 71, 76) with loadings≤ .10 atfirst pass. This procedure extracted a 3-factor solution(Table 2). The first, the most important with highestexplained variance (8.84%), represents Dysthymic,Cyclothymic and Anxious temperaments (Dys–Cyc–Anx) together with an eigenvalue of 12.28; the secondidentifies Irritable temperament (5.65% of variance) withan eigenvalue of 4.51; and the third, with an eigenvalue of

Table 2Principal Components Analysis

Temperament traits Dys–Cyc–Anx Irritable Hyperthymic

1 Sono una persona scontenta e triste .27 .23 − .29I am a sad, unhappy person

2 La gente mi dice che non sono in grado di apprezzare il lato positivo delle cose .15 .20 − .18People tell me I am unable to see the lighter side of things

3 Ho sofferto molto nella mia vita .26 .11 − .02I have suffered a lot in life

4 Penso che spesso le cose si rivelano negative .39 .14 − .22I think things often turn out for the worst

5 Mi arrendo facilmente .24 .11 − .36I give up easily

6 Per quanto mi posso ricordare, sono sempre stato un fallimento .18 .26 − .29As long as I can remember, I have felt like a failure

7 Mi sono sempre incolpato di cose che gli altri considerano di poco conto .37 .12 − .07I have always blamed myself for what others might consider no big deal

8 Non penso di avere tanta energia come gli altri .29 .06 − .39I do not seem to have as much energy as other people

9 Sono il tipo di persona che non ama i cambiamenti .20 − .01 − .26I am the kind of person who does not like change very much

10 In un gruppo, preferisco ascoltare gli altri che parlano .18 − .21 − .22In a group, I would rather hear others talk

11 Spesso cedo nei confronti degli altri .34 − .09 − .22I often give into others

12 Mi sento a disagio nell'incontrare gli altri .31 .12 − .30I feel very uneasy meeting new people

13 I miei sentimenti sono spesso feriti da critiche e rifiuti .36 .14 − .19My feelings are easily hurt by criticism or rejection

14 Sono il tipo di persona sulla quale si può fare affidamento .12 − .30 .16I am the kind of person you can always depend on

15 I bisogni degli altri vengono prima dei miei .29 − .08 .15I put the needs of others above my own

16 Sono una persona dedita al lavoro .11 − .24 .30I am a hard working person

17 a Preferirei lavorare per qualcun altro invece che per il mio capo .02 .03 .04I would rather work for someone else than be the boss

18 a Per me è naturale essere ordinato ed organizzato .01 − .00 .01It is natural for me to be neat and organized

19 Sono il tipo di persona che dubita di ogni cosa .19 .25 − .19I am the kind of person who doubts everything

20 a Il mio istinto sessuale è stato sempre scarso .03 .00 .01My sex drive has always been low

21 a Normalmente ho bisogno di più di nove ore di sonno .05 − .01 − .02I normally need more than 9 hours of sleep

22 Spesso mi sento stanco per nessun motivo .36 .25 − .12I often feel tired for no reason

23 Ho improvvisi cambiamenti di umore .37 .40 − .12I get sudden shifts in mood and energy

24 Il mio umore ed energia o sono alti o bassi, raramente una cosa intermedia .31 .40 − .08My moods and energy are either high or low, rarely in between

25 La mia abilità di pensare passa dalla nitidezza all'intorpidimento per nessuna ragione .24 .45 − .14My ability to think varies greatly from sharp to dull for no apparent reason

26 Può piacermi qualcuno molto e poi perdere completamente l'interesse .21 .26 .08I can really like someone a lot, and then completely lose interest in them

27 Spesso ho scatti di ira verso gli altri e poi mi sento in colpa .30 .45 − .01I often blow up at people and then feel guilty about it

28 Spesso inizio delle attività e poi perdo l'interesse prima di finirle .20 .38 − .08I often start things and then lose interest before finishing them

29 Il mio umore spesso cambia per nessun motivo .38 .40 − .09My mood often changes for no reason

66 M. Pompili et al. / Journal of Affective Disorders 107 (2008) 63–75

Table 2 (continued )

Temperament traits Dys–Cyc–Anx Irritable Hyperthymic

30 Costantemente passo dall'essere gioioso all'essere stanco .46 .36 − .13I constantly switch between being lively and sluggish

31 Spesso vado a letto triste, ma mi alzo al mattino sentendomi eccezionale .24 .23 .11I sometimes go to bed feeling down, but wake up in the morning feeling terrific

32 Spesso vado a letto sentendomi bene, ma mi alzo e sento che non vale la pena di vivere .23 .34 − .22I sometime go to bed feeling great, and wake up in the morning feeling life is not worth living

33 Spesso mi dicono che divento pessimista e mi dimentico dei momenti precedenti felici .39 .29 − .23I am told that I often get pessimistic about thing and forget previous happy times

34 Passo da sentimenti di grande autostima a sentimenti di insicurezza .44 .14 − .12I go back and forth between feeling overconfident and feeling unsure of myself

35 Passo da momenti di estroversione a momenti di introversione .31 .21 − .17I go back and forth between being outgoing and being withdrawn from others

36 Sento tutte le emozioni intensamente .13 − .06 .27I feel all emotions intensely

37 Il mio bisogno di sonno varia molto, da sole poche ore a più di nove ore .14 .25 .00My need for sleep varies a lot from just a few hours to more than 9 hours

38 Il modo in cui vedo le cose è a volte vivido, ma altre volte è privo di vita .37 .30 − .14The way I see things is sometimes vivid, but at other times lifeless

39 Sono il tipo di persona che può essere triste e felice allo stesso tempo .36 .21 .02I am the kind of person who can be sad and happy at the same time

40 Sogno molto ad occhi aperti su cose che gli altri considerano impossibili da raggiungere .26 .21 .19I daydream a great deal about things that other people consider impossible to achieve

41 a Spesso sento un bisogno irrefrenabile di fare cose oltraggiose .06 .02 .03I often have a strong urge to do outrageous things

42 a Sono il tipo di persona che si innamora e si “disinnamora” facilmente .02 .01 .01I am the kind of person who falls in and out of love easily

43 Sono di solito su di giri e di umore gioioso − .01 .11 .47I am usually in an upbeat or cheerful mood

44 La vita è una festa che io mi godo nella sua interezza − .14 − .04 .52Life is a feast which I enjoy to the fullest

45 Mi piace raccontare barzellette e la gente mi dice che sono divertente − .10 .14 .35I like telling jokes, people tell me I am humorous

46 Sono il tipo di persona che pensa che ogni cosa si risolverà per il meglio − .17 − .23 .50I am the kind of person who believes everything will eventually turn out all right

47 Ho una grande fiducia in me stesso − .30 .02 .51I have great confidence in myself

48 Ho spesso molte idee geniali .01 .02 .52I often get many great ideas

49 Sono sempre sul punto di partire .06 .00 .43I am always on the go

50 Riesco ad eseguire molti compiti senza stancarmi .01 − .15 .41I can accomplish many tasks without even getting tired

51 Ho la dote del parlare, convincere ed ispirare gli altri − .01 .06 .47I have a gift for speech, convincing and inspiring to others

52 Mi piace affrontare nuovi progetti anche se pericolosi − .12 .14 .42I love to tackle new projects, even if risky

53 Una volta che ho deciso di raggiungere qualcosa, niente mi può fermare − .07 − .01 .47Once I decide to accomplish something, nothing can stop me

54 Sono completamente a mio agio anche con persone che conosco appena − .16 .06 .47I am totally comfortable even with people I hardly know

55 Mi piace stare con molte persone − .11 − .02 .45I love to be with a lot of people

56 a La gente mi dice che mi intrometto negli affari altrui − .01 − .01 .03People tell me that I often get my nose into others business

57 Sono conosciuto per la mia generosità e spendo molti soldi per gli altri .21 − .05 .28I am generous, and spend a lot of money on other people

58 Ho competenza ed esperienza nel mio campo .00 − .08 .36I have abilities and expertise in many areas

(continued on next page)

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Table 2 (continued )

Temperament traits Dys–Cyc–Anx Irritable Hyperthymic

59 Ritengo di avere il diritto e il privilegio di fare quello che voglio .12 .17 .18I feel I have the right and privilege to do as I please

60 a Sono il tipo di persona a cui piace comandare .01 .02 .03I am the kind of person who likes to be the boss

61 Quando non sono d'accordo con qualcuno, mi infervoro nella discussione .04 .26 .20When I disagree with someone, I can get into a heated argument

62 Il mio desiderio sessuale è sempre alto − .06 .19 .32My sex drive is always high

63 Normalmente riesco ad andare avanti con meno di 6 ore di sonno .01 .11 .24Normally I can get by with less than 6 hours of sleep

64 Sono una persona irritabile .15 .49 − .02I am a grouchy (irritable) person

65 Sono per natura una persona insoddisfatta .26 .34 − .30I am by nature a dissatisfied person

66 Mi lamento molto .26 .39 − .16I complain a lot

67 Sono molto critico verso gli altri .10 .33 .06I am highly critical of others

68 Spesso mi sento in allarme .43 .24 − .08I often feel on edge

69 Spesso mi sento avvolto in me stesso .47 .25 − .10I often feel wound up

70 Sono governato da una irrequietezza spiacevole che non comprendo .37 .40 − .05I am driven by an unpleasant restlessness that I do not understand

71 a Spesso sono così furibondo che getterei via tutto .04 .05 − .01I often get so mad that I will just trash everything

72 Quando sono provocato, potrei finire in una rissa .04 .48 .11When crossed, I could get into a fight

73 La gente mi dice che perdo la pazienza per niente .16 .51 .03People tell me I blow up out of nowhere

74 Quando sono arrabbiato, scatto nervosamente con la gente .18 .43 .03When angry, I snap at people

75 Mi piace provocare la gente, anche se la conosco appena .08 .47 .14I like to tease people, even those I hardly know

76 a Il mio sarcasmo mi ha messo nei guai .04 .03 − .01My biting humour has gotten me into trouble

77 Posso essere così furioso che potrei far del male a qualcuno .01 .44 .02I can get so furious I could hurt someone

78 Sono così geloso del mio partner, che ne sono tormentato .25 .26 − .03I am so jealous of my spouse (or lover), that I cannot stand it

79 Sono conosciuto come colui che dice molte parolacce .04 .29 .00I am known to swear a lot

80 Mi è stato detto che divento violento anche solo dopo pochi drinks alcolici − .03 .27 − .06I have been told that I become violent with just a few drinks

81 Sono una persona molto scettica .11 .33 − .15I am a very skeptical person

82 Potrei essere un rivoluzionario .00 .37 .17I could be a revolutionary

83 Il mio istinto sessuale è spesso così intenso da diventare spiacevole .02 .29 .00My sex drive is often so intense that it is truly unpleasant

84 (sole donne) Ho attacchi di rabbia incontrollabile prima del periodo mestruale .17 .06 − .02(Women only): I have attacks of uncontrollable rage right before my periods

85 Sono stato una persona che ha sempre dato preoccupazioni .13 .34 .05I have been a worrier for as long as I can remember

86 Mi preoccupo sempre per qualcosa .58 .03 .00I am always worrying about one thing or another

87 Mi preoccupo di questioni quotidiane che gli altri considerano di pocaimportanza

.53 .09 .04

I keep on worrying about daily matters that others consider minor

68 M. Pompili et al. / Journal of Affective Disorders 107 (2008) 63–75

Table 2 (continued )

Temperament traits Dys–Cyc–Anx Irritable Hyperthymic

88 Non posso fare a meno di preoccuparmi .56 .15 − .01I cannot help worrying

89 Molte persone mi hanno detto di non preoccuparmi così tanto .59 .08 − .01Many people have told me not to worry so much

90 Quando sono stressato, la mia mente è spesso vuota .35 .21 .00When stressed, my mind often goes blank

91 Non riesco a rilassarmi .48 .16 − .13I am unable to relax

92 Spesso mi sento agitato internamente .58 .19 − .09I often feel jittery inside

93 Quando sono stressato, le mie mani tremano .36 .12 − .02When stressed, my hands often tremble

94 Spesso ho lo stomaco sottosopra .49 .14 .03I often have an upset stomach

95 Quando sono nervoso, mi capita di avere la diarrea .29 .01 − .10When I am nervous, I may have diarrhea

96 Quando sono nervoso, mi capita di avere la nausea .41 − .01 − .04When I am nervous, I often feel nauseous

97 Quando sono nervoso, devo andare in bagno più spesso .32 − .06 − .06When I am nervous, I have to go to the bathroom more often

98 Quando qualcuno ritarda a rientrare in casa, temo che possa aver avuto un incidente .42 − .04 − .02When someone is late coming home, I fear they may have had an accident

99 Spesso temo che qualcuno nella mia famiglia abbia una grave malattia .48 .11 − .01I am often fearful of someone in my family coming down with a serious disease

100 Temo sempre che qualcuno possa comunicarmi cattive notizie su qualcuno della mia famiglia .52 .09 .00I am always thinking someone might break bad news to me about a family member

101 Il mio sonno non è riposante .32 .10 − .08My sleep is not restful

102 Ho spesso difficoltà ad addormentarmi .36 .09 − .03I frequently have difficulty falling asleep

103 Sono per natura una persona molto cauta .13 − .27 − .07I am, by nature, a very cautious person

104 Spesso mi sveglio nella notte impaurito dal fatto che possano esserci dei ladri in casa .32 .10 − .06I often wake up at night afraid that burglars are in the house

105 Ho facilmente mal di testa quando sono stressato .35 .00 .03I easily get headaches when stressed

106 Quando sono stressato, ho una sensazione spiacevole nel mio torace .35 .11 − .12When stressed, I get an uncomfortable feeling in my chest

107 Sono una persona insicura .47 .00 − .46I am an insecure person

108 Anche piccoli cambiamenti nella routine mi stressano molto .41 .12 − .20Even minor changes in routine stress me highly

109 Quando guido, anche se non ho fatto nulla di sbagliato, temo che la polizia mi possa fermare .21 .08 − .12While driving, even when I have not done anything wrong I fear that police may stop me

110 Rumori improvvisi mi fanno sobbalzare facilmente .48 .00 .01Sudden noises startle me easily

Eigenvalue 12.28 4.51 2.86PCT VAR 8.84 5.65 5.16

Bold emphasis factor loading >.10.a Item discarded from TEMPS-A (Rome).

69M. Pompili et al. / Journal of Affective Disorders 107 (2008) 63–75

2.86, identifies the Hyperthymic temperament (5.16% ofvariance).

Reliability of TEMPS-A was assessed by CronbachAlpha coefficients for the components and theywere quitehigh; the Alpha computed for the first subscale, with thelargest number of items, was .89, for the Irritable .77, andfor the Hyperthymic .74.

Even though some factor loadings were less than .30,at this stage we felt they could contribute to account forsome of the variance for each of the subscales; wetherefore calculated total scores for any of these subscales.

The strong positive association between Dys/Cyc/Anxand Irritable temperaments shows the higher coefficient(r=.594; p=.000); we found also a negative correlation

Table 3Frequencies and percentage of subjects

Inside the distribution +1 SD +2 SD

Dys/Cyc/Anx 779 (82.2%) 143 (15.1%) 26 (2.7%)Irritable 786 (82.9%) 133 (14.0%) 29 (3.1%)Hyperthymic 792 (83.5%) 154 (16.2%) 2 (.2%)

70 M. Pompili et al. / Journal of Affective Disorders 107 (2008) 63–75

between Dys/Cyc/Anx and the Hyperthymic tempera-ment (r=− .232; p= .000). No correlation emergedbetween Irritable and Hyperthymic temperament.

Applying Principal Components Analysis to the threesubscales of the test, we extracted a superfactorialstructure explaining 55.17% of the variance; Dys/Cyc/Anx factor loading=.896, Irritable= .841, and Hyperthy-mic=− .380.

3.2. Gender and prevalence

Two-tailed Student t-test evidenced differences be-tween genders; females showed higher scores inDys/Cyc/Anx component (t=2.72; p= .007), whereas malespresented higher scores in Hyperthymic temperament(t=5.97; p=.000). In Irritable temperament there was nostatistically significant difference between the sexes.

We considered cut-off scores higher than 2 SD. Theprevalence of the dominant temperaments are listed inTable 3: 2.7% for Dys/Cyc/Anx, 3.1% for Irritable and .2for Hyperthymic. With respect to dominant tempera-ments based on z-scores, 2.7% were dysthymic, 1.7%cyclothymic, .7% hyperthymic, 3.5% irritable, and 3%for the anxious (Table 4).

4. Discussion

4.1. Substantive findings

We found a 3-factor structure of TEMPS-A,with a firstfactor comprising Dysthymic, Cyclothymic and Anxious

Table 4TEMPS-A (Rome)

SD Dysthymic Cyclothymic

N (%) N (%)

−3 SD 2 (.2)−2 SD 86 (9.1) 182 (19.2)−1 SD 412 (43.5) 308 (32.5)+1 SD 306 (32.3) 260 (27.4)+2 SD 109 (11.5) 182 (19.2)+3 SD 26 (2.7) 16 (1.7)+4 SD 7 (.7)

Distribution of frequencies on the basis of z-scores.

temperaments combined (Dys–Cyc–Anx), accountingfor the largest variance. The Irritable andHyperthymic arerespectively the second and the third factors. Dys/Cyc/Anx and Irritable temperaments have a positive associ-ation, whereas Irritable and Hyperthymic temperamentwere orthogonal.

Exploratory factor analysis showed a superfactorialstructure with highest positive factor loading on Dys/Cyc/Anx component and Irritable temperament, and anegative loading on Hyperthymic temperament.

Gender differences showed females with higherscores on Dys/Cyc/Anx scale andmales on Hyperthymicscale. We found a very low rate of prevalence (+2 SD)for Hyperthymia (.2%), whereas the prevalence is 2.7%for the Dys/Cyc/Anx, and 3.1% for Irritable. In all threesubscales, there were high rates of prevalence, about15%, between +1 SD and +2 SD.

4.2. Interpretation

Our findings are generally consistent with those ofTEMPS-A studies form different countries (Akiskal andAkiskal, 2005).

It will be instructive to compare them first with thoseof TEMPS-I form Italy (Placidi et al., 1998b). Thisversion did not have an anxious temperament, otherwisethe superstructure which combined Dysthymic andCyclothymic and contrasted them with hyperthymic issimilar to the present data. An interesting refinement isthat the irritable temperament in the present study has nocorrelation with the Hyperthymic, instead it is part of theDys–Cyc–Anx superstructure.

That the anxious temperament correlates stronglywith the Dysthymic and Cyclothymic and aggregatesinto a superfactor is reminiscent of the superfactor ofneuroticism in the Eysenck Personality Inventory(Eysenck and Eysenck, 1969). In terms of more modernconcepts tuned with familial-genetic trends, the strong

Hyperthymic Irritable Anxious

N (%) N (%) N (%)

26 (2.7)99 (10.4) 188 (19.8) 176 (18.6)317 (33.4) 317 (33.4) 317 (33.4)328 (34.6) 290 (30.6) 323 (34.1)172 (18.2) 118 (12.4) 100 (10.5)6 (.7) 33 (3.5) 28 (3.0)

2 (.3) 4 (.4)

71M. Pompili et al. / Journal of Affective Disorders 107 (2008) 63–75

correlation of cyclothymic and anxious reactivity isquite meaningful as a substrate for bipolar II disorder(Akiskal et al., 2006).

The very low rate of the Hyperthymic is consistentwith the TEMPS-I from Pisa (Placidi et al., 1998b),TEMPS-A from Lebanon (Karam et al., 2005), andTEMPS-A from Argentina (Vázquez et al., 2007). Itis even more provocative that 15% of Hyperthymiafalls within the 1st and 2nd standard deviation, justlike the TEMPS-I (Italy) and TEMPS-A (Lebanon)and TEMPS-A (Buenos Aires). We tentatively suggestthat in some cultures the Hyperthymic is more of the“norm”.

4.3. Limitation

That test–retest reliability was not undertaken isnot a serious limitation given that such data exist forTEMPS-A from other cultures (e.g. Vahip et al., 2005;Vázquez et al., 2007), and most importantly from Italywith the TEMPS-I (Placidi et al., 1998a). SinceTEMPS-A is for self-administration, in future studiesit would be relevant to see if the findings of the presentstudy hold up. Given the overall concordance with otherTEMPS-A studies, we feel that TEMPS-A adminis-tered in interview or self-evaluated format will cor-relate highly.

Appendix A

TEMPS-A (Rome)

Proposed traits for the tripartite structure of TEMPS-A (Rome)

Temperament traits

4 Penso che spesso le cose si rivelano negativeI think things often turn out for the worst

5 Mi arrendo facilmenteI give up easily

7 Mi sono sempre incolpato di cose che gli altri considerano di poco coI have always blamed myself for what others might consider no big d

8 Non penso di avere tanta energia come gli altriI do not seem to have as much energy as other people

10 In un gruppo, preferisco ascoltare gli altri che parlanoIn a group, I would rather hear others talk

11 Spesso cedo nei confronti degli altriI often give into others

12 Mi sento a disagio nell'incontrare gli altriI feel very uneasy meeting new people

13 I miei sentimenti sono spesso feriti da critiche e rifiutiMy feelings are easily hurt by criticism or rejection

15 I bisogni degli altri vengono prima dei mieiI put the needs of others above my own

22 Spesso mi sento stanco per nessun motivoI often feel tired for no reason

Appendix A

5. Concluding remarks

TEMPS-A (Rome) complements previous findingsfrom Italy (Placidi et al., 1998b; Akiskal et al., 1998) andthe world (Akiskal and Akiskal, 2005) in fascinating ways.The Anxious appears to be clearly part of a broaderconstruct which subsumes the Dysthymic and Cyclothy-mic. The Irritable emerges as distinct from the Hyperthy-mic. The Hyperthymic is “normal” in southern Italy, as it isin Northern Italy; in this respect Italians appear to be likethe Lebanese and Argentineans, but distinct from mostother nationalities investigated thus far. As most Argenti-neans came from Spain (and many others from Italy andFrance), the high prevalence of the hyperthymic in Italy,Lebanon and Argentina may point to a commonMediterranean legacy.

Given that we permitted at first pass the inclusion ofmany items≥ .10 and ≤3.0, we have used clinicaljudgment to retain some of these, but not others, tofacilitate the clinical and investigational use of TEMPS-A (Rome), resulting in a 74-trait version (Appendix A).

Role of the funding source

Nothing declared.

Conflict of interest

No conflict declared.

Dys–Cyc–Anx Irritable Hyperthymic

.39 .14 − .22

.24 .11 − .36

nto .37 .12 − .07eal

.29 .06 − .39

.18 − .21 − .22

.34 − .09 − .22

.31 .12 − .30

.36 .14 − .19

.29 − .08 .15

.36 .25 − .12

(continued on next page)

Appendix A (continued )

Proposed traits for the tripartite structure of TEMPS-A (Rome)

23 Ho improvvisi cambiamenti di umore .37 .40 − .12I get sudden shifts in mood and energy

24 Il mio umore ed energia o sono alti o bassi, raramente una cosa intermedia .31 .40 − .08My moods and energy are either high or low, rarely in between

29 Il mio umore spesso cambia per nessun motivo .38 .40 − .09My mood often changes for no reason

30 Costantemente passo dall'essere gioioso all'essere stanco .46 .36 − .13I constantly switch between being lively and sluggish

33 Spesso mi dicono che divento pessimista e mi dimentico dei momenti precedenti felici .39 .29 − .23I am told that I often get pessimistic about thing and forget previous happy times

34 Passo da sentimenti di grande autostima a sentimenti di insicurezza .44 .14 − .12I go back and forth between feeling overconfident and feeling unsure of myself

35 Passo da momenti di estroversione a momenti di introversione .31 .21 − .17I go back and forth between being outgoing and being withdrawn from others

38 Il modo in cui vedo le cose è a volte vivido, ma altre volte è privo di vita .37 .30 − .14The way I see things is sometimes vivid, but at other times lifeless

39 Sono il tipo di persona che può essere triste e felice allo stesso tempo .36 .21 .02I am the kind of person who can be sad and happy at the same time

40 Sogno molto ad occhi aperti su cose che gli altri considerano impossibili da raggiungere .26 .21 .19I daydream a great deal about things that other people consider impossible to achieve

43 Sono di solito su di giri e di umore gioioso − .01 .11 .47I am usually in an upbeat or cheerful mood

44 La vita è una festa che io mi godo nella sua interezza − .14 − .04 .52Life is a feast which I enjoy to the fullest

45 Mi piace raccontare barzellette e la gente mi dice che sono divertente − .10 .14 .35I like telling jokes, people tell me I am humorous

46 Sono il tipo di persona che pensa che ogni cosa si risolverà per il meglio − .17 − .23 .50I am the kind of person who believes everything will eventually turn out all right

47 Ho una grande fiducia in me stesso − .30 .02 .51I have great confidence in myself

48 Ho spesso molte idee geniali .01 .02 .52I often get many great ideas

49 Sono sempre sul punto di partire .06 .00 .43I am always on the go

50 Riesco ad eseguire molti compiti senza stancarmi .01 − .15 .41I can accomplish many tasks without even getting tired

51 Ho la dote del parlare, convincere ed ispirare gli altri − .01 .06 .47I have a gift for speech, convincing and inspiring to others

52 Mi piace affrontare nuovi progetti anche se pericolosi − .12 .14 .42I love to tackle new projects, even if risky

53 Una volta che ho deciso di raggiungere qualcosa, niente mi può fermare − .07 − .01 .47Once I decide to accomplish something, nothing can stop me

54 Sono completamente a mio agio anche con persone che conosco appena − .16 .06 .47I am totally comfortable even with people I hardly know

55 Mi piace stare con molte persone − .11 − .02 .45I love to be with a lot of people

58 Ho competenza ed esperienza nel mio campo .00 − .08 .36I have abilities and expertise in many areas

62 Il mio desiderio sessuale è sempre alto − .06 .19 .32My sex drive is always high

63 Normalmente riesco ad andare avanti con meno di 6 ore di sonno .01 .11 .24Normally I can get by with less than 6 hours of sleep

64 Sono una persona irritabile .15 .49 − .02I am a grouchy (irritable) person

66 Mi lamento molto .26 .39 − .16I complain a lot

67 Sono molto critico verso gli altri .10 .33 .06I am highly critical of others

72 M. Pompili et al. / Journal of Affective Disorders 107 (2008) 63–75

Appendix A (continued )

Proposed traits for the tripartite structure of TEMPS-A (Rome)

72 Quando sono provocato, potrei finire in una rissa .04 .48 .11When crossed, I could get into a fight

73 La gente mi dice che perdo la pazienza per niente .16 .51 .03People tell me I blow up out of nowhere

74 Quando sono arrabbiato, scatto nervosamente con la gente .18 .43 .03When angry, I snap at people

75 Mi piace provocare la gente, anche se la conosco appena .08 .47 .14I like to tease people, even those I hardly know

77 Posso essere così furioso che potrei far del male a qualcuno .01 .44 .02I can get so furious I could hurt someone

79 Sono conosciuto come colui che dice molte parolacce .04 .29 .00I am known to swear a lot

80 Mi è stato detto che divento violento anche solo dopo pochi drinks alcolici − .03 .27 − .06I have been told that I become violent with just a few drinks

81 Sono una persona molto scettica .11 .33 − .15I am a very skeptical person

82 Potrei essere un rivoluzionario .00 .37 .17I could be a revolutionary

83 Il mio istinto sessuale è spesso così intenso da diventare spiacevole .02 .29 .00My sex drive is often so intense that it is truly unpleasant

86 Mi preoccupo sempre per qualcosa .58 .03 .00I am always worrying about one thing or another

87 Mi preoccupo di questioni quotidiane che gli altri considerano di poca importanza .53 .09 .04I keep on worrying about daily matters that others consider minor

88 Non posso fare a meno di preoccuparmi .56 .15 − .01I cannot help worrying

89 Molte persone mi hanno detto di non preoccuparmi così tanto .59 .08 − .01Many people have told me not to worry so much

90 Quando sono stressato, la mia mente è spesso vuota .35 .21 .00When stressed, my mind often goes blank

91 Non riesco a rilassarmi .48 .16 − .13I am unable to relax

92 Spesso mi sento agitato internamente .58 .19 − .09I often feel jittery inside

93 Quando sono stressato, le mie mani tremano .36 .12 − .02When stressed, my hands often tremble

94 Spesso ho lo stomaco sottosopra .49 .14 .03I often have an upset stomach

95 Quando sono nervoso, mi capita di avere la diarrea .29 .01 − .10When I am nervous, I may have diarrhea

96 Quando sono nervoso, mi capita di avere la nausea .41 − .01 − .04When I am nervous, I often feel nauseous

97 Quando sono nervoso, devo andare in bagno più spesso .32 − .06 − .06When I am nervous, I have to go to the bathroom more often

98 Quando qualcuno ritarda a rientrare in casa, temo che possa aver avuto un incidente .42 − .04 − .02When someone is late coming home, I fear they may have had an accident

99 Spesso temo che qualcuno nella mia famiglia abbia una grave malattia .48 .11 − .01I am often fearful of someone in my family coming down with a serious disease

100 Temo sempre che qualcuno possa comunicarmi cattive notizie su qualcuno della mia famiglia .52 .09 .00I am always thinking someone might break bad news to me about a family member

101 Il mio sonno non è riposante .32 .10 − .08My sleep is not restful

102 Ho spesso difficoltà ad addormentarmi .36 .09 − .03I frequently have difficulty falling asleep

104 Spesso mi sveglio nella notte impaurito dal fatto che possano esserci dei ladri in casa .32 .10 − .06I often wake up at night afraid that burglars are in the house

105 Ho facilmente mal di testa quando sono stressato .35 .00 .03I easily get headaches when stressed

(continued on next page)

73M. Pompili et al. / Journal of Affective Disorders 107 (2008) 63–75

Appendix A (continued )

Proposed traits for the tripartite structure of TEMPS-A (Rome)

106 Quando sono stressato, ho una sensazione spiacevole nel mio torace .35 .11 − .12When stressed, I get an uncomfortable feeling in my chest

107 Sono una persona insicura .47 .00 − .46I am an insecure person

108 Anche piccoli cambiamenti nella routine mi stressano molto .41 .12 − .20Even minor changes in routine stress me highly

109 Quando guido, anche se non ho fatto nulla di sbagliato, temo che la polizia mi possa fermare .21 .08 − .12While driving, even when I have not done anything wrong I fear that police may stop me

110 Rumori improvvisi mi fanno sobbalzare facilmente .48 .00 .01Sudden noises startle me easily

74 M. Pompili et al. / Journal of Affective Disorders 107 (2008) 63–75

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