Temperament and Character Profile in Patients with Noncardiac Chest Pain

Noncardiac or unexplained chest pain can be defined as recurrent angina-like or substernal chest pain thought to be unrelated to the heart after a reasonable cardiac evaluation. We examined the personality profiles of patients complaining of noncardiac chest pain (NCCP) and healthy control subjects using the Temperament and Character Inventory (TCI), and determined whether the data acquired were related to the depressive status of the patients. We assessed 70 patients (ages 18-65 years) referred to a cardiology practice with NCCP. Eighty control subjects, matched for age, gender, and education level, were included in the study. Each subject was evaluated with TCI, Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). The TCI assesses four dimensions of temperament, namely, novelty seeking, harm avoidance, reward dependence and persistence and three dimensions of character, being self-directedness, cooperativeness and self-transcendence. We found higher harm avoidance scores and lower self-directedness and cooperativeness scores in patients group than those in healthy control subjects. High harm avoidance scores were associated with high depression level. However, all the character subdimensions were associated with an elevated level of depression. In the stepwise regression model, the presence of NCCP was determined by harm avoidance and self-directedness levels. These findings suggest state and trait dependence of harm avoidance, and strong state dependence of self-directedness scores in NCCP patients. When interpreting data regarding personality measured by the TCI in NCCP patients, the effects of depressive symptomatology should be taken into account.