A number of studies have reported that patients with MDD report higher levels of harm avoidance and lower levels of self-directedness than do healthy controls (e.g., Celikel et al. 2009). Most of the traits in Cloninger’s system are influenced by the respondent’s mood state (e.g., Farmer et al. 2003); however, abnormal levels of harm avoidance and self-directedness are present even after remission (e.g., Smith et al. 2005). Increased harm avoidance and lower self-directedness are also characteristic of most anxiety disorders, indicating that these effects are not specific to MDD (Öngür et al. 2005).
