Carver and Miller, 2006, Relations of Serotonin Function To Personality - Current Views and A Key Methodological Issue

Psychiatry Research 144 (2006) 1 15
www.elsevier.com/locate/psychres
Review article
Relations of serotonin function to personality: Current views
and a key methodological issue
Charles S. Carver , Christopher J. Miller
Department of Psychology, University of Miami, Coral Gables, FL 33124-0751, United States
Received 18 October 2005; received in revised form 1 February 2006; accepted 1 March 2006
Abstract
Studies of biological underpinnings of personality suggest that serotonergic functioning relates to certain personality traits.
However, how to interpret the findings depends partly on assumptions about how personality is organized. These assumptions are
reflected in the assessment devices used and also in how the data are examined. Review of evidence to date appears to link
serotonin function to impulsivity and, to some extent, to hostility. The relation of serotonin function to anxiety proneness is far
more questionable. Indeed, when such a relation occurs, it often takes a form opposite to the direction argued by theory. It is
recommended that research use measures that discriminate adequately among personality qualities reflecting incentive sensitivity,
threat sensitivity, and impulsiveness. Indeed, it is highly desirable to examine facets of each of these qualities separately.
2006 Elsevier Ireland Ltd. All rights reserved.
Keywords: Serotonin; Personality; Temperament; Anxiety; Impulsivity; Harm avoidance
Contents
1. Conceptualizing and measuring personality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

1.1. Impulse and constraint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2. Serotonin functioning and personality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
2.1. Serotonin manipulation in nonclinical samples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
2.2. Cross-sectional studies of clinical samples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
2.2.1. Impulsive aggression. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
2.2.2. Borderline personality disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
2.2.3. High serotonin function in obsessivecompulsive disorder . . . . . . . . . . . . . . . . . . . . . . . 7
2.3. Cross-sectional studies of normal samples on measures of aggression-hostility . . . . . . . . . . . . . . . . . 7
2.4. Cross-sectional studies of normal samples using omnibus measures . . . . . . . . . . . . . . . . . . . . . . . 7
2.5. Role of anxiety-proneness. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
3. Genotype research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
4. Conclusions and recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
4.1. What traits should be measured? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Corresponding author. Tel.: +1 305 284 2817; fax: +1 305 284 3402.
E-mail address: [email protected] (C.S. Carver).
0165-1781/$ - see front matter 2006 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.psychres.2006.03.013
2 C.S. Carver, C.J. Miller / Psychiatry Research 144 (2006) 115
5. Serotonin function and emotion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
The idea that specific neurotransmitters are differen- substrates of personality is the Revised NEO Personality
tially involved in particular aspects of human behavior is Inventory (NEO-PI-RI; Costa and McCrae, 1992). Most
receiving steadily increasing research attention. For studies using measures from the five-factor approach focus
some researchers, that work is an effort to link specific on the supertraits, but many measures (including the NEO-
disorders to specific neurotransmitters, in the hope of PI-R) have facet scales within each global trait for more
clarifying the nature of the disorder. There is also subtle and differentiated assessment.
growing interest in the idea that neurotransmitter Two three-factor models that are similar in some
functions relate to normal variations in personality ways to the five-factor model are also in wide use.
(Depue and Collins, 1999; Zuckerman, 2005). Evidence Eysenck (1970, 1992) posited neuroticism and extra-
of such associations would represent a bridge across version, plus a third trait called psychoticism. These
disciplines, helping to clarify the nature of personality. traits are typically assessed by the Eysenck Personality
This article focuses on the effort to relate serotonin Inventory (EPI; Eysenck and Eysenck, 1964) or the
function to personality (and more briefly addresses Eysenck Personality Questionnaire (EPQ; Eysenck and
another literature on links from personality to genetic Eysenck, 1975). Tellegen (1985) recast neuroticism
markers of serotonin function). To study this relationship slightly as negative emotionality and extraversion as
requires assessing both serotonin function and personal- positive emotionality, and added a third factor called
ity. In many studies on this topic, serotonin functioning is constraint. These traits are assessed by the Multidimen-
assessed by responses to a drug challenge; in other sional Personality Questionnaire (MPQ; Tellegen,
studies, serotonin function is experimentally manipulated. 1985). To some extent, psychoticism in Eysenck's
In assessing personality, methods have been more diverse. model and constraint in Tellegen's model represent
Indeed, the methods differ enough to create potentially blends of agreeableness and conscientiousness.
serious problems in interpreting research outcomes (see Zuckerman et al. (1993) have proposed an alterna-
also Sen et al., 2004a; Munaf et al., 2005). tive 5, in which sociability is generally equivalent to
extraversion, aggression-hostility is similar to agree-
1. Conceptualizing and measuring personality ableness (inversely), impulsive sensation seeking is
similar to conscientiousness (inversely), and neuroti-
There are many ways to conceptualize personality cism-anxiety is generally the same as neuroticism
(Carver and Scheier, 2004), but most research on the (Zuckerman, 1995, 2005). These five factors are
biological substrate of personality adopts some version assessed by the ZuckermanKuhlman Personality
of a trait approach. Some studies examine one trait at a Questionnaire (ZKPQ; Zuckerman et al., 1993). An
time, but researchers sometimes employ broad invento- important difference between this model and the others
ries of traits. Many people regard such inventories as is that Zuckerman et al. place hostility in a factor
interchangeable, but they differ in very important ways. separate from neuroticism. There are independent
These differences can make it difficult to compare reasons to believe that that placement is the more
measures to each other, and thus to compare results from appropriate one (see Jang et al., 2002; Carver, 2004).
studies using different measures. There is an emerging consensus among those who
Perhaps the most influential approach to personality adopt the five-factor models and these three-factor
assessment at present is the five-factor model (e.g., McCrae models that extraversion (positive emotionality) reflects
and John, 1992; Goldberg, 1993; Wiggins, 1996; McCrae a system that regulates approach of incentives and
and Costa, 1997). This approach, based in factor-analytic neuroticism (negative emotionality) reflects a system
work, holds that much of the variability in personality can that regulates avoidance of threats (Tellegen, 1985;
be captured by five broad dimensions. The first two Fowles, 1993; Gray, 1994a; Depue, 1995; Harmon-
dimensionsneuroticism and extraversionalso appear Jones and Allen, 1997; Depue and Collins, 1999;
in most other trait models. The other dimensions are best Watson et al., 1999; Carver et al., 2000; Davidson et al.,
known as agreeableness, conscientiousness, and openness 2000; Lucas et al., 2000). Such a construal serves to link
(or intellect). Several measures of these five traits are in two bio-behavioral-functional properties to what other-
wide use; the one most often seen in studies of biological wise are only descriptive dimensions.
C.S. Carver, C.J. Miller / Psychiatry Research 144 (2006) 115 3
Another view of personality often adopted in studies of theories, and how it is operationalized in the various
biological substrates is that of Cloninger (1987; Cloninger measures.
et al., 1993). Cloninger (1987) began with three The simplest dynamic behind impulse versus re-
dimensions: novelty seeking (the tendency to seek straint is one in which impulsiveness and anxiety are at
excitement); harm avoidance (the tendency to inhibit opposite ends of a dimension. Specifically, impulsive-
behavior to avoid punishment); and reward dependence ness occurs when anxiety is low; on the other side, high
(the intensity of responses to social approval), measured levels of anxiety inhibit impulses (Gray, 1982, 1994a,b).
by the Tridimensional Personality Questionnaire (TPQ). It is increasingly recognized, however, that at least
The TPQ also has facet scales. Cloninger (1987) proposed two different dynamics underlie displays of impulse
that each trait relates to the functioning of a specific versus restraint (Derryberry and Rothbart, 1997; Nigg,
neurotransmitter, linking serotonin to harm avoidance. 2000; Eisenberg, 2002; Carver, 2005). One dynamic
The theory was later elaborated (Cloninger et al., 1993) to derives from anxiety about an impending threat (versus
add a fourth dimension (persistence) to what was now the impulse to approach an incentive). A separate
called temperament, plus three new dimensions referred dynamic concerns the choice between having a small
to as character. The latter are self-directedness (self- desired outcome now versus a larger desired outcome
determination, purposefulness, or willpower), coopera- later: the phenomenon of delay of gratification (Mischel,
tiveness (empathy with and acceptance of other people), 1974) or the problem of intertemporal choice (Manuck
and self-transcendence (spirituality and absorption). With et al., 2003). Some theorists see these two dynamics as
elaboration of the theory came a new measure, the underlying distinct classes of restraint phenomena.
Temperament and Character Inventory (TCI). Restraint in response to threat is considered relatively
This last theoretical view obviously shares some involuntary, whereas planned restraint is considered
themes with the others previously outlined. There effortful (Derryberry and Rothbart, 1997; Rothbart and
appears at first glance to be considerable similarity Bates, 1998; Rothbart et al., 2000, 2004; see also Nigg,
between novelty seeking and extraversion, and between 2000; Kochanska and Knaack, 2003). Involuntary
harm avoidance and neuroticism. However, there are restraint involves reflexive avoidance of harm. Effortful
also important differences. Novelty seeking incorpo- restraint reflects attempts to optimize outcomes by
rates a thrill-seeking, impulsive quality that is not part of selecting the best choice of available actions.
extraversion. Indeed, some view this trait as closer to Eisenberg (2002) characterized cases of involuntary
psychoticism or impulsive sensation seeking than to restraint (which she terms reactive inhibition) as being
extraversion (Zuckerman, 1995). There are also differ- largely under the control of subcortical areas, and cases
ences pertaining to harm avoidance. Although being of effortful inhibition as depending more on executive
high in harm avoidance yields the inhibited apprehen- cortical function. The sense of this characterization can
sion that one would expect from high neuroticism, low also be found in statements by Cloninger et al. (1993)
levels of harm avoidance are said to yield sociability, that qualities of temperament (including harm avoid-
which in other models relates to extraversion rather than ance) depend on procedural memory and habits,
low neuroticism. Low harm avoidance also manifests as whereas qualities of character depend on propositional
openness to risk taking and proneness to harmful memory and more effortful processing.
impulsive behavior such as aggression and suicide. The idea that there are two distinct sources of impulse
Thus, impulsiveness is strongly implicated in both and restraint also resonates with ideas and evidence
novelty seeking and harm avoidance. linking brain function with impulsive versus restrained
behavior (see Lieberman et al., 2002; Strack and Deutsch,
1.1. Impulse and constraint 2004; Bechara, 2005; Carver, 2005). Some of the
conceptual models relating to this work suggest there
In considering evidence on how serotonin function are two modes of processing, one of which (subcortical) is
relates to personality, the quality of impulsiveness quick and associative, the other (with more cortical
versus constraint emerges repeatedly as important; involvement) is slower, more deliberative, and symbolic
indeed, as will be seen, there is a very good basis for (see also Epstein, 1973, 1994; Smolensky, 1988; Shastri
arguing that this quality of behavior is the core of the and Ajjanagadde, 1993; Sloman, 1996; Metcalfe and
relation of serotonin to personality (see also Soubri, Mischel, 1999; Smith and DeCoster, 2000). Evidence
1986; Depue, 1995; Depue and Collins, 1999; Manuck consistent with this view is reviewed elsewhere (Lieber-
et al., 2003). For that reason, it is important to examine man et al., 2002; Strack and Deutsch, 2004; Carver,
more closely how this quality is viewed in various 2005).
The five-factor and three-factor trait models other seeking and inversely with dutifulness and deliberation.
than Cloninger's all incorporate one or more dimensions Although harm avoidance is typically interpreted in terms
bearing specifically on impulse and restraint. In of anxiety proneness, it also correlates substantially with
Eysenck's theory, this factor is psychoticism; in Tel- extraversion (Zuckerman, 1995; De Fruyt et al., 2000).
legen's theory, it is constraint; in the alternative five, it is Indeed, Zelenski and Larsen (1999) found that harm
impulsive sensation seeking; the dominant five-factor avoidance loaded almost equivalently on three factors:
models have two factors that are relevant, conscien- incentive sensitivity, threat sensitivity, and impulsivity
tiousness and agreeableness. Measures of each of these (see also Carver and White, 1994).
personality qualities have been linked to diverse The TPQ and TCI have also been criticized more
behaviors that reflect impulsiveness versus restraint generally on psychometric grounds, both with regard to
and sometimes antisociality (for review, see Carver, failures to find the theoretical factor structure and with
2005). What is particularly important at present is that regard to the blending of conceptually distinct qualities
the dimensions just listed are empirically distinct from within scales (Waller et al., 1991; Earleywine et al.,
the dimensions bearing on incentive sensitivity and 1992; Cannon et al., 1993; Herbst et al., 2000; see also
threat sensitivity (Watson et al., 1994; Clark and Cloninger et al., 1991). For example, Herbst et al.
Watson, 1999; Zelenski and Larsen, 1999). (2000) factor-analyzed facet scales as data points in a
Some versions of the five-factor model suggest another sample of 946 normal participants. One emerging factor
source of at least some kinds of impulse, in the trait of had positive loadings for all facets of harm avoidance
neuroticism. Indeed, in the NEO-PI-R (Costa and McCrae, plus inverse loadings for exploratory excitability (from
1992), one neuroticism facet scale is named Impulsiveness. novelty seeking), three facets of self-directedness
Inclusion of impulsiveness in neuroticism in this measure (purposefulness, resourcefulness, and congruent second
appears to reflect the fact that some impulsive acts (e.g., nature), and social acceptance (from cooperativeness).
overindulgence, which is well represented in that facet This pattern appears to suggest a key role for impulse
scale) are prompted by negative feelings, which themselves versus constraint in the emerging factor, which is
are a hallmark of neuroticism. In a factor analysis of defined partly around harm avoidance.
measures of diverse aspects of impulsiveness, Whiteside In another study, Cannon et al. (1993) conducted an
and Lynam (2001) found the NEO-PI-R's Impulsiveness item-level analysis of TPQ data among 303 male
facet scale loaded on the same factor as the Urgency alcoholics. They found that harm-avoidance items split
subscale of their new impulsiveness measure. Two-thirds of into a distress factor and a relaxed confidence factor
the items of the Urgency subscale refer specifically to (indeed, no TPQ dimension was unidimensional in that
actions that are responses to negative feelings. study). Of considerable interest, the relaxed confidence
Although the NEO-PI-R does have a role for neuro- factor related to a variety of measures of antisocial
ticism in impulsiveness, it is important to be very clear behavior, whereas the overall harm-avoidance scale
about what that role is. The way in which impulsive related to none of them. Indeed, the relaxed confidence
action is linked to neuroticism in this case is antithetical factor made unique contributions to the antisocial
to the idea that restraint follows from elevated anxiety measures, even when entered along with a disinhibition
and impulse follows from absence of anxiety. Rather, factor deriving from novelty seeking.
impulsive action in this case stems from the same core Thus, measures from the different theories have very
quality of personality as underlies anxiety proneness. different ways of assessing impulse versus restraint. This is
That is, the people who report often being distressed and an important difference among measures. Disregarding this
anxious are the ones who also report overindulging and difference can lead to confusion in interpreting results.
doing things on impulse that they later regret.
In contrast to measures derived from those three- and 2. Serotonin functioning and personality
five-factor models, measures from Cloninger's approach
incorporate qualities of impulse in multiple traits. As With these issues in mind, we turn to a consideration
noted above, novelty seeking (which some equate with of evidence linking serotonin function to personality.
extraversion) has a thrill-seeking quality that is not part of Our coverage here is relatively selective. We focus on
extraversion. Indeed, Zuckerman (1995) reported that three groups of studies: some examined effects of
novelty seeking relates primarily to impulsive sensation experimental manipulations of serotonin function in
seeking from his inventory. Similarly, De Fruyt et al. nonclinical samples; some examined how serotonin
(2000) found that novelty seeking correlated positively function relates to certain kinds of disturbances in
with NEO-PI-R facets of impulsiveness and excitement behavior; and some examined relations of naturally
occurring differences in serotonin function to personal- tendencies became more aggressive, hostile, and
ity in nonclinical samples. quarrelsome after tryptophan depletion, and less so
after tryptophan enhancement, with no effect among
2.1. Serotonin manipulation in nonclinical samples those low in aggressive tendencies. This pattern
suggests that variations in serotonin function are less
Many studies have manipulated serotonin function by about aggression per se and more about the restraint (or
selective serotonin reuptake inhibitors (SSRIs) and looked lack of restraint) of habitual tendencies to be aggressive.
for impact on personality qualities or behavior. The vast A subsequent study (Bjork et al., 2000) found a
majority of these studies, however, used patient samples similar pattern: tryptophan depletion led to a greater
under treatment. In such cases, an important question aggressive response to provocation among men high in
arises as to whether any change observed relates to the aggressiveness, but effects were opposite among those
change in serotonin function or relates instead to other low in aggressiveness. Evidence of a similar pattern was
changes that follow from improved psychiatric status. subsequently found among a subset of women:
Given such issues, studies examining effects of SSRIs in increased aggression after tryptophan depletion, and
nonclinical samples are of particular value. Several such decreased aggression after tryptophan enhancement
studies have now been published. (Marsh et al., 2002).
Knutson et al. (1998) found that 4 weeks of an SSRI Moskowitz et al. (2001) administered tryptophan and
(paroxetine) among 26 nonclinical participants (com- placebo to 98 healthy subjects in a crossover design,
pared with a control group of 25) led to lower self- measuring self-reports concerning social interactions
reports of assaultiveness and irritability scores on the during the day. Elevated tryptophan reduced self-reports
BussDurkee Hostility Inventory (BDHI; Buss and of quarrelsome behavior, but only when tryptophan
Durkee, 1957) and less overall negative affect (as an followed placebo. Elevated tryptophan also increased
index from the Positive and Negative Affect Scales, reports of dominant behavior (regardless of order). In
PANAS; Watson et al., 1988). There was no change in another study (Wingrove et al., 1999), tryptophan
positive affect, and no tests were reported for specific depletion led to more aggressiveness in evaluative
affects. Participants on paroxetine also displayed more messages sent to partners on a cooperative task, but only
cooperative behavior in a group task than did controls. among persons who were high on a measure of
Another small study of nonclinical participants motivational drive in incentive situations. Another
(n = 11 vs 9) examined effects of an SSRI (citalopram) study found that tryptophan depletion led to a more
on personality self-reports (Tse and Bond, 2001). The impulsive response style on a laboratory task (Walder-
outcome measure was an abbreviated version of the haug et al., 2002).
TCI. SSRI administration produced an increase on self- To summarize, these data appear to be relatively
direction (reflecting such qualities as responsibility consistent in suggesting that experimentally elevated
versus blaming, purposefulness, and resourcefulness) serotonin function caused three kinds of changes.
but no other difference. Another study by the same Elevations caused decreases in aggression and increases
researchers (Tse and Bond, 2002) assessed personality in cooperativeness; there also were increases in what
by roommate ratings, and measured several qualities of might be thought of as social potency. Reduction in
behavior during a mixed-motive game with another serotonin function caused increases in expression of
person. Participants receiving an SSRI (citalopram, aggression and deterioration in cooperativeness, though
n = 10) were rated by roommates as being less these effects sometimes occurred only among persons
submissive compared with controls (n = 10). Similarly, who were relatively high in aggressive tendencies by
those receiving SSRI showed more dominant eye- disposition.
contact behavior during the game than controls, but they
also displayed more cooperative, affiliative behavior. 2.2. Cross-sectional studies of clinical samples
The latter result replicates the finding of Knutson et al.
(1998). Another source of information linking serotonin
There have also been studies in which the effect of function to personality is cross-sectional assessment of
serotonin function on personality-related behavior was some quality or qualities of personality and serotonin
examined in normal subjects by manipulation of function. Many of these studies have focused on patient
tryptophan, a precursor to serotonin. Cleare and Bond samples, typically comparing patients with controls. In
(1995) examined samples of participants assessed as some cases the personality qualities were related to
high and low in aggression. Those high in aggressive serotonin function within the patient sample. Two
popular groups for study in this way have been persons serotonin challenge. Regions of interest were estab-
displaying impulsive aggression and persons with lished in the orbitofrontal cortex (OFC) and anterior
borderline personality disorder. cingulate gyrus (ACG), and participants were scanned
both under serotonin challenge and under placebo.
2.2.1. Impulsive aggression Scans revealed several differences between groups in
A number of studies have related lower serotonin response to challenge (relative to placebo): patients
function to a history of fighting and assault (Coccaro et showed deactivation of the ACG, whereas controls
al., 1997), domestic violence (George et al., 2001), and showed activation; patients showed activation in
impulsive aggression more generally, particularly posterior cingulate, whereas controls showed deactiva-
among men (Cleare and Bond, 1997). There is also tion. Finally, in left medial posterior OFC, patients
evidence of low serotonin function in a subset of showed lower activation than controls. New et al. (2002)
depressed patients who had anger attacks, compared interpreted the findings as indicating that impulsive
with other depressed patients (Fava et al., 2000). Indeed, aggression by these patients reflects lack of activity in
low serotonin function also has long been implicated in the OFC, because those areas are involved in planning
suicidal behaviors (e.g., gren, 1980). One recent study and long-term regulation. Consistent with these find-
found that low serotonin related (independently) to ings, the OFC has also been implicated in the control of
lifetime aggression and to high-lethality suicide aggressive impulses in other research (Dutton, 2002).
attempts (i.e., resulting in greater medical damage), Another PET scan study (Frankle et al., 2005) exam-
but not to low-lethality suicide attempts (Placidi et al., ined 10 patients with impulsive aggression and 10
2001). controls, but it did not incorporate a cortisol challenge.
Several recent studies make similar, but somewhat A difference between groups emerged in one region of
more differentiated points with regard to impulsive interest. Lower serotonin availability was displayed in
aggression. Dolan et al. have reported a series of studies the ACG among patients than controls. This difference
of correlates of serotonin function in male aggressive is in the same direction as the pattern of change
offenders (and the psychopathic subset of that group). observed by New et al. (2002) when a serotonin
Dolan et al. (2001) assessed aggressive qualities by challenge was introduced.
BDHI and the interview-derived Lifetime History of
Aggression (LHA, Brown et al., 1979). Impulsivity was 2.2.2. Borderline personality disorder
assessed by Eysenck and Eysenck's (1978) Impulsive- Another group of relatively frequent study in this
ness-Venturesome-Empathy (IVE) and the Barratt context is persons with borderline personality disorder
Impulsivity Scale (Barratt, 1985). Low serotonin (BPD, e.g., Siever and Davis, 1991). Paris et al. (2004)
function related to elevations in both impulsivity and determined that female borderline patients who were
aggression. Importantly, impulsivity and aggression also high on impulsivity by Barratt scores (n = 14)
both related to higher, rather than lower, anxiety. showed lower serotonin function than patients low in
Dolan et al., 2001 pointed out specifically that the impulsivity (n = 13). Within the BPD subsample, low
association of anxiety with measures of impulsivity serotonin function related to high indirect hostility as
argues against a simple model of impulsive aggression assessed by the BDHI, which tends to reflect impulsive
being attributable to low fear. acts such as angry outbursts and tantrums. However,
Dolan and Anderson (2004) reported that low effects of impulsivity were more robust than those of
serotonin function related to high scores on the hostility.
impulsive-antisocial factor from the Psychopathy In a related study, Soloff et al. (2003) found that
Checklist Screening Version. Dolan et al. (2002) found males with BPD (n = 20) had lower serotonin response
that impulsivity and aggressiveness both related to than controls (n = 36), and that this response was also
poorer executive (frontal lobe) function. They argued predicted by impulsivity (by Barratt) and history of
that the aggressiveness observed in their sample was aggression (by LHA). When impulsivity was controlled
likely attributable to frontal deficits rather than a low for, the effect of BPD on serotonin was eliminated. In
serotonin functioning per se. The possibility remains, of this study, unlike that of Paris et al. (2004), there were
course, that the frontal deficits and the low serotonin no effects among females. Verkes et al. (1998) found
functioning are two sides of the same coin. that lower serotonin function related to greater impul-
A particularly interesting study by New et al. (2002) siveness as reflected in the sensation-seeking subscale
examined 13 persons with a history of impulsive ag- of the EASI-III (Buss and Plomin, 1975) and in an index
gression and 13 controls by PET scan while undergoing of harmful impulsive behaviors from a questionnaire
used to diagnose borderline personality disorder The Depue (1995) article went beyond showing this
(n = 144). Fitting this general picture, current discus- relationship, in several ways. Depue found associations
sions of treatment for BPD sometimes suggest the value of low serotonin function with the control-impulsivity
of mindfulness training to diminish impulsive reactions facet scale of the MPQ's Constraint factor, the
(Ryan, 2005). aggression facet of the MPQ's Negative emotionality
factor (but not to other facets), to two sensation seeking
2.2.3. High serotonin function in obsessivecompulsive subscales (social disinhibition and boredom suscepti-
disorder bility), and to several indices of impulsiveness,
It is also of interest that high serotonin function, including Barratt scores and psychoticism, but not risk
rather than low, has been implicated in another type of taking or venturesomeness. Depue also reported a
disorder. Specifically, Insel et al. (1985) linked higher greater differentiation among components of BDHI
serotonin function to obsessivecompulsive disorder. hostility, with the strongest relations of low serotonin
Similar associations have since been reported by function being to subscales pertaining to impulsive,
Fineberg et al. (1997) and Swedo et al. (1992). This action-oriented aggression, rather than to more passive,
pattern has been interpreted as suggesting a particularly cognitive forms.
low level of impulsivity among patients with this A more recent study (Hennig et al., 2005) yielded
disorder. results consistent with the latter finding. Hennig et al.
To summarize, as a group, the findings reviewed in related serotonin function assessed by drug challenge to
this section appear to be consistent with the idea that aspects of aggression-hostility (by BDHI) in 48 normal
serotonin influences a behavioral dimension that has males. Two aspects of hostility emerged from factor
inhibition and overcontrol at one end (obsessive analysis, a neurotic hostility component (composed of
compulsive disorder) and impulsivity (and possibly irritability, resentment, verbal hostility, and guilt) and a
aggressiveness) at the other end (impulsive aggression, component that was labeled aggressive hostility (com-
borderline personality disorder). This pattern is consis- posed of assaultiveness, negativism, and low guilt).
tent with the view that serotonergic pathways are Only the latter factor related to serotonin function (recall
differentially involved in impulse control (Depue and that Knutson et al., 1998, found SSRI treatment reduced
Spoont, 1986; Soubri, 1986; Depue, 1995; Depue and self-reports of assaultiveness). The authors also noted
Collins, 1999; Manuck et al., 2003; Zuckerman, 2005). that the aggressive hostility index did not relate to an
Further, it appears to be consistent with a view in which independent measure of neuroticism, except for the
restraint (when it does occur) is effortful, rather than an neuroticism facet bearing on aggression. They conclud-
involuntary reaction to anxiety. Although there is a good ed that the aggressive hostility factor probably reflects a
deal of evidence linking low serotonin function to quality similar to Eysenck's factor of psychoticism (an
hostility and aggressiveness, most of the researchers impulsive, socially unconnected quality), rather than
involved appear to believe that the link is more directly neuroticism.
to impulsiveness or volatility in behavior than to There have also been several other demonstrations of
hostility per se. links between serotonin function and aspects of
sensation seeking. Netter et al. (1996) related low
2.3. Cross-sectional studies of normal samples on serotonin function (by drug challenge) to the disinhibi-
measures of aggression-hostility tion and experience-seeking subscales. They also found
that the drug challenge in combination with experimen-
Several studies have also been conducted correlating tal provocation produced elevated aggression only
personality qualities and serotonin function among among participants high on disinhibition.
nonclinical samples. Two relatively early studies
(Depue, 1995; Cleare and Bond, 1997) fit well with the 2.4. Cross-sectional studies of normal samples using
literature reviewed in the previous section, both in the omnibus measures
measure used and in the results obtained. Specifically,
both found a relation between low serotonin function and The research reviewed thus far focused mostly on
elevated aggression-hostility, as measured by the BDHI, impulsiveness and aggression. Other research on
similar to associations found with aggressive samples. personality and serotonin function in normal samples,
Similarly, Netter et al. (1999) found a relation between however, has had a broader focus. At least seven such
low serotonin function and aggressiveness as measured studies have been conducted using omnibus measures of
by the Freiburg Personality Inventory. personality, sometimes along with other measures.
One study by Manuck et al. (1998), in a community tiveness) related to higher Ca; persistence (from reward
sample (N = 59 men, 60 women), used the NEO-PI-R, dependence) and purposeful (from self-directedness)
plus additional measures. All effects that emerged did so related to lower Ca. The latter appear consistent with the
among men only. Low serotonin function related to link of high serotonin function to conscientiousness
greater life history of aggression (by LGA) and (Manuck et al., 1998).
impulsiveness (by Barratt), consistent with previous Moresco et al. (2002) conducted PET scans to assess
results. Low serotonin function also related to higher the binding of cortical serotonin receptors in 11 normal
neuroticism (from the NEO-PI-R), and the neuroticism participants, and related those results to TPQ scores.
facet scale angry hostility (other facets were not tested). Harm avoidance had a substantial inverse relationship to
High serotonin response related to higher conscien- receptor binding, particularly in the frontal and left
tiousness (from the NEO-PI-R). The relation of parietal areas. The authors noted, however, that the
neuroticism to low serotonin function was later biological meaning of the association is uncertain: it
replicated in a larger sample by the same research may indicate higher or lower levels of serotonin activity
group (Flory et al., 2004), but they did not report a test relate to high harm avoidance.
for any facet scale, nor a test for conscientiousness. Thus, two of four studies of normal samples using the
At least four studies have related serotonin response TPQ found an association between greater harm
to the TPQ in normal samples. Hansenne and Ansseau avoidance and higher serotonin function, with one
(1999) found a significant relation between low levels of study being ambiguous about the direction of the
TPQ harm avoidance and low serotonin response to association. Two studies using the TCI appear to have
drug challenge in 23 normal subjects. Gerra et al. (2000) had conflicting results, with one relating greater harm
found a similar relation in 22 normal males. Hennig et avoidance to greater receptor sensitivity and the other to
al. (2000) found the opposite in a sample of 16 males. lower receptor sensitivity. The latter two studies also
Evans et al. (2000) selected extremes on Eysenck and found partial support for the idea that high serotonin
Eysenck's (1964) index of impulsivity, and found response relates to qualities reflecting focused concen-
evidence of a lower serotonin response among the tration and deliberation.
more impulsive (n = 14) than the less impulsive (n = 14)
subjects, but no association of serotonin response with 2.5. Role of anxiety-proneness
any TPQ scale.
At least two studies have also related the TCI in An early view of serotonin related it to the experience
normal samples to serotonin receptor sensitivity, rather of anxiety (Handley, 1995). It is clear from the evidence
than response to drug challenge. Peirson et al. (1999) reviewed above that the majority of findings in humans
found that greater harm avoidance related to greater relate serotonin function to impulsiveness rather than
receptor sensitivity in a sample of 49. This finding anxiety. Nonetheless, it remains quite common to refer
appears to be opposite to those described in the previous to anxiety-related traits in discussing this literature (e.g.,
paragraph (greater receptor sensitivity implies lower Lesch and Mssner, 1998; Mazzanti et al., 1998;
serotonin function), though Peirson et al. (1999) Katsuragi et al., 1999; Hennig et al., 2000; George et
interpreted it as being consistent with Cloninger's al., 2001; Murphy et al., 2001; Schinka et al., 2004;
theory. This study also found associations with lower Munaf et al., 2005; Schinka, 2005). To some degree,
receptor sensitivity for TCI self-directedness and the this appears to reflect associations of serotonin function
self-directedness facets of responsibility and resource- with harm avoidance from the TPQ and TCI, and the
fulness. These links seem consistent with links between further assumption that the harm-avoidance scale
high serotonin function and conscientiousness (Manuck measures anxiety proneness. There is good reason to
et al., 1998). suggest, however, that what is relevant to serotonin
Kusumi et al. (2002) also tested serotonin receptor function about the harm-avoidance scale is not its
sensitivity in 133 normal participants. They found a assessment of anxiety proneness, but rather its assess-
tendency (P b 0.07) toward an association of greater ment of impulsiveness.
receptor sensitivity (reflected in greater Ca levels to a A slightly different but related issue can be raised
uniform serotonin dose) with lower harm avoidance, about studies examining the broad factor of neuroticism
consistent with the picture of lower harm avoidance as the operationalization of anxiety proneness. The view
relating to lower serotonin function. Four facets scales that anxiety proneness is the core of neuroticism may
significantly related to Ca: shyness (from harm well be correct. However, broad-scope measures of
avoidance) and pure-hearted principles (from coopera- neuroticism such as the NEO-PI incorporate other
qualities as well. When the facets are examined however, themselves raise important issues that have
separately, which is not commonly done, the weight of generally been disregarded.
the effect appears to be carried by angry hostility (e.g., Sen et al. (2004a) conducted a meta-analysis of
Manuck et al., 1998). studies relating 5-HTTLPR genotype with neuroticism.
Finally, it should also be noted that associations of They reported that when all studies were combined,
low serotonin function with high anxiety proneness, there was not a significant association. When the studies
rather than low, completely contradict the idea that the were separated by personality measure, however, there
absence of anxiety is what results in the impulsive was an association of genotype with NEO-PI-R, but not
behavior. Support for the latter idea is almost wholly with TCI/TPQ harm avoidance. Schinka et al. (2004)
lacking in this literature. reached a similar conclusion from their meta-analysis.
Munaf et al. (2005) found exactly the opposite: a
3. Genotype research significant relation of genotype with TPQ/TCI harm
avoidance, but no relation of NEO-PI neuroticism.
We should also consider the literature that links One more meta-analysis is worth noting, because it
serotonin genotype to personality, though we will do examined three broad aspects of personality rather than
so more briefly. This literature began with several just one (Munaf et al., 2003). The authors concluded
large-scale studies in which the data were examined that serotonin genotype related to avoidance traits
quite thoroughly. Lesch et al. (1996) related variations (broadly defined) and also aggressive traits (broadly
in the 5-HTTLPR gene to personality in a sample of defined). There was no test of the moderating role of the
505 normal participants, mostly male. They found a measure of avoidance traits, however, and the oper-
relation between neuroticism and the genotype that ationalization of aggressive traits across the meta-
relates to low serotonin function. Of particular interest, analysis was quite diverse. Given that diversity, those
however, analysis of facet scales revealed that the results are difficult to evaluate.
strongest associations were with angry hostility, Unfortunately, all of these meta-analyses but the last
depression, and impulsiveness, with anxiety being one disregarded traits other than neuroticism. Thus,
barely significant and vulnerability nonsignificant. there was no test of a potential link from genotype to
There was also an association with low scores on the agreeableness, as the earlier large-scale studies had
trait of agreeableness. found (Lesch et al., 1996; Greenberg et al., 2000).
Greenberg et al. (2000) conducted a similar analysis Similarly, in no case did the meta-analysis examine
of 397 participants, mostly female. Again, there was an facets of neuroticism. Because facet analyses had been
association of genotype with both neuroticism and very informative in the earlier large-scale studies, this
agreeableness. Again analysis of facets of neuroticism appears a very important omission. We would argue that
revealed that the strongest relations were with angry these meta-analyses serve more to muddy the waters
hostility and depression. Anxiety, impulsiveness, and than to clarify them. Indeed, by ignoring facet scales and
vulnerability were all nonsignificant in this study. emphasizing overall neuroticism (which they often label
A third large-scale study was reported by Sen et al. trait anxiety, e.g., Schinka, 2005), the authors of those
(2004b). This sample of 419 participants in a blood articles may unwittingly be misleading the field.
pressure study yielded an association of genotype with
NEO-PI neuroticism and a weaker, though significant 4. Conclusions and recommendations
association with agreeableness. As in the previous
studies, the strongest facet scale association was The evidence reviewed here leads us to a conclusion
depression. Anxiety and self-consciousness were sig- about the role of serotonin in personality that is not so
nificant in this sample, hostility only marginal different from the one that was reached earlier by
(P = .052), and impulsiveness and vulnerability not Soubri (1986), Depue (1995), and Zuckerman (2005),
significant. though the evidence leading us to this conclusion differs
A relatively large number of smaller-scale studies somewhat from what was reviewed by those authors.
have been conducted on this topic, including failures to We should be explicit in pointing out, as did those
find an association (e.g., Willis-Owen et al., 2005) and authors, that an attempt to link any given neurotrans-
the occasional reverse finding (e.g., Brummett et al., mitter to the operation of a single behavioral system may
2003). By this point in the evolution of this literature, be a great oversimplification. There is a good basis for
there have now been several meta-analyses to assess the arguing that some of the effects attributable to one
strength of the relationship. These meta-analyses neurotransmitter may depend on the person's level of
another neurotransmitter (Depue, 1995; Zuckerman, scores, particularly in the frontal and left parietal
2005). Despite these cautions, however, some consis- areas. This general line of inquiry certainly deserves
tency does seem to emerge from the findings. further scrutiny.
Serotonin function appears to relate far more reliably
to impulsiveness, volatility, and aggressiveness than to 4.1. What traits should be measured?
anxiety proneness. To the extent that serotonin function
does relate to anxiety proneness, the direction of the We believe it is important for researchers who take up
relation contradicts the assumption that anxiety traits this topic to avoid the automatic mental link between
and impulsive traits oppose each other. When relations serotonin and anxiety-related traits. This link remains
do emerge in the data, they tend to link high anxiety very much alive in many minds, despite an announce-
proneness to low serotonin function, the very pattern ment of its burial 20 years ago (Panksepp and Cox,
that relates to high impulsiveness. 1986). This automatic association leads researchers to
What is the meaning of the link between low be far more limited in their approach to trait assessment
serotonin function and volatility in behavior? If the than they should be. Studies should examine associa-
impulsiveness is not a reflection of low anxiety, what tions for a broader range of traits whenever they are
does it reflect? Following the lead of others (Derry- availablefor example, in cases in which the full NEO-
berry and Rothbart, 1997; Rothbart and Bates, 1998; PI is used. Only in that way can a pattern of associations
Nigg, 2000; Rothbart et al., 2000, 2003; Eisenberg, with traits other than anxiety-proneness become visible.
2002; Kochanska and Knaack, 2003), we argued Although we are discussing this issue with respect to
earlier in the article that there are two potential routes serotonin function, it obviously applies as well to
to behavioral constraint (see also McClure et al., research linking personality to other neurotransmitters,
2004). In one route, a threat response opposes and or to genetic polymorphism.
inhibits an incentive response. That route is not We believe that studies relating serotonin function to
supported in the data on serotonin. In the other route, personality should use a measure of personality that
constraint reflects greater deliberative planning and isolates separate traits pertaining to approach, avoid-
executive control. A relative deficit in this path to ance, and constraint. Unless the qualities are assessed
constraint strongly resembles an aspect of Depue's separately, one cannot know which quality or qualities
(1995) characterization of low serotonin effects: that relate to serotonin function. It is important to keep in
low serotonin function creates enhanced responsive- mind that what a scale is assessing is not always clear
ness to current reward stimuli rather than to cues of from its label. The scales in the TPQ and TCI, which
longer-term outcomes (thus an inability to delay have been used in a good deal of research in this area,
gratification). We also sketched earlier in the article a blend together qualities that other measures differentiate
depiction, deriving from theory and evidence from (see, e.g., Waller et al., 1991). If the tendencies are not
other sources, suggesting an important role for frontal differentiated, their separate roles cannot be determined
cortical involvement in that quality of planfulness (see (Clark and Watson, 1999). For this reason, we
also Clarke et al., 2004). recommend against the use of these two measures.
In light of that picture, it may be noteworthy that With measures such as the NEO-PI, the MPQ, the
some of the studies reviewed here raised the ZKPQ, or the BIS/BAS scales of Carver and White
tantalizing possibility that the volatility linked to low (1994), the two routes to constraint can be examined
serotonin function may represent a deficit in frontal separately. The anxiety-proneness versus reward-seek-
cortical control over behavior. Dolan et al. (2002) ing route can be examined by looking separately (or
found that impulsivity and aggressiveness both related jointly) at involvement of incentive sensitivity and
to poorer frontal lobe function. New et al. (2002) threat sensitivity. If the hypothesis concerns a highly
found that persons with a history of impulsive reactive incentive system, that sensitivity can be
aggression had PET scan patterns under serotonin assessed by scales for extraversion or positive emotion-
challenge indicating a deactivation of the ACG and the ality or two of the BAS scales. If the hypothesis
left medial posterior OFC. Frankle et al. (2005) found concerns a highly reactive threat system, that sensitivity
that patients with impulsive aggression had lower can be assessed by scales for neuroticism or negative
serotonin availability in the ACG than controls, emotionality or the BIS scale; if the hypothesis is that
without a drug challenge. Moresco et al. (2002) the balance between these two is crucial, that balance
found greater binding of cortical serotonin receptors in can be computed. The second source of impulse can and
normal participants with elevated harm-avoidance should be assessed separately, by measures organized
explicitly around the construct of deliberative restraint: this article awaits in that research as well. Specifically,
measures of constraint (Tellegen, 1985; Watson and just as less than complete consensus exists about how to
Clark, 1993), psychoticism (Eysenck, 1970), impulsive parse personality, there is less than complete consensus
sensation seeking (Zuckerman, 1995), impulsiveness on how to parse affect. One widely known approach
(Barratt, 1985; Whiteside and Lynam, 2001), or fun groups affects by valence, into those that are positive
seeking (Carver and White, 1994). and those that are negative (e.g., Watson and Tellegen,
We should also emphasize, however, that each of these 1985; Lang et al., 1998; Cacioppo et al., 1999; Watson
broad constructs can be manifested in diverse ways. For et al., 1999). Many who adopt this view would argue
example, many people would consider it reasonable to use that it is more effective to aggregate into these positive
neuroticism as the equivalent of anxiety proneness. As and negative affect groups than to make fine distinc-
noted earlier, anxiety proneness may well be the core of tions within each group. Because this argument has
neuroticism. However, broad-scope measures of neurot- many adherents, a good deal of research does not
icism (such as the NEO-PI) incorporate other qualities as distinguish, for example, among anger, depression, and
well. When the facets are examined separately as anxiety, but rather blends them into overall negative
correlates of serotonin function, which is not commonly affect.
done, the weight of the effect often appears to be carried Whether this is a good strategy is highly question-
by facets other than anxiety proneness. Accordingly, we able. Although these negative feelings do correlate,
very strongly recommend systematically examining facet there is also evidence that they relate to the actions of
scales separately. Indeed, we are not alone in this different biological systems. In particular, although
preference: Hennig (2004) has gone so far as to advocate there is consensus that anxiety relates to the functioning
examining individual items separately. of a threat-avoidance system, there is evidence that
The same issue exists for the other traits under anger and at least some cases of sadness relate to the
discussion. Impulsiveness is represented in a very wide functioning of an incentive-approach system (for
range of ways, which are not that closely related to each review, see Carver, 2004).
other. Impulsiveness can be cognitive or behavioral This appears to constitute an important basis for
(White et al., 1994). It can reflect variations in arguing that different affects should be examined
attentional management (Stanford and Barratt, 1992); separately, even if they share a common valence, at
it can reflect an inability to persevere, or distractibility, least at this relatively early stage of investigation. If
or the lack of planning and forethought (Whiteside and serotonin function were to prove over replications to
Lynam, 2001). These qualities need to be examined relate more robustly to anger than to anxiety, that would
separately from each other, to assess which among them be an important finding with implications for many areas
relate to serotonin function. The evidence thus far of theory. If serotonin function proved to relate
appears to suggest that planning and foresight are key, equivalently to a wide range of affects, it would similarly
but the evidence at this point is quite sketchy. have important implications. This question cannot be
The empirical strategy we recommend is very much asked, however, unless the affects are examined
that of the splitter rather than the lumper. By separately. We recommend that this be done as a matter
splitting broad constructs into their constituent facets, of course.
researchers can evaluate the generality of effects across
the facets. They can thereby create the potential of Acknowledgments
realizing that there are patterns of facet associations that
do not fit the overall picture they had expected. Indeed, Preparation of this article was facilitated by NCI
that strategy can lead to conceptual advances, by grants CA64710 and CA78995. We thank Sheri L.
allowing researchers to use emergent patterns of facets Johnson and the journal's anonymous reviewers for
to create recombinant constructs that better reflect the comments on earlier drafts.
nature of the patterns.
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Psychiatry Research 144 (2006) 1 15

Keywords: Serotonin; Personality; Temperament; Anxiety; Impulsivity; Harm avoidance

1. Conceptualizing and measuring personality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

5. Serotonin function and emotion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

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