Balkan Military Medical Review
Jan - Mar 2013; 16(1): 10-20
Original Article
Diagnosing Personality Disorders in Temperament and Character
Inventory (TCI), Cloninger’s Questionnaire
LT Milena DIMITROVA, PhD; COL Toni Donchev, Assoc. Prof., MD, PhD*
Affiliation of authors:
Clinic of Psychiatry – Military Medical Academy, Sofia, Bulgaria
Corresponding Author:
LT Milena DIMITROVA, PhD, Psychologist
Clinic of Psychiatry – Military Medical Academy, Sofia, Bulgaria
e-mail: [email protected]
Abstract
Personality disorders are very impor
tant and quite often remain occult
during the first psychological selection
for military personnel. Personality
disorders are difficult in their diagnosis
even when the person has already
demonstrated emotional and behavioral
symptoms of disadaptation. We present
our experience in diagnosing personality
disorders with the adaptation of a
psychological test for the Bulgarian
population: Temperament and Chara
cter Inventory (TCI), Cloninger’s. It is a
new psychological test of good proven
effectiveness, extremely useful when
Dimitrova M. et al: Diagnosing Personality Disorders in Temperament and Character Inventory
making the first psychological selection
for entry in the military service,
participation in military missions and
training abroad and for objectification
of military medical expertise.
The
study,
conducted
on
534
servicemen, suggests that determining
the type of temperament allows the
prediction of the occurrence of certain
types of personality disorder. The
features which invariably recur and are
especially important for the formation
of almost all types of abnormal
personality peculiarities are: Coopera
tiveness (C), Self-transcendence (ST)
and Harm avoidance (HA). A chara
cteristic with less importance is Selfdirectedness (S).
Keywords: temperament, character,
personality disorders, depression
Introduction
As authors of this paper and leading
specialists in the care for the mental health
of the Bulgarian Army, we are constantly
looking for new methods that would be
useful in the prognosis and early diagnosis
of mental illness and in particular
personality disorders [4, 5], depressive
symptoms and more. Personality disorders
are particularly important for us because
they often go undetected during the
original psychological selection for
acceptance in military service and remain
difficult in diagnosing later, when the
person falls into a state of disadaptation [3,
11].
It is crucial to have a qualitative
methodology in making the selection for
participation in military missions and
training outside the country as well as
joining the armed forces at all. On the
11
other hand we need to objectify Military
psychiatric-psychological expertise.
The conditions of employment in
the military are unique, oftentimes being
responsible for unlocking the mental
disorders: it is the fulfillment of orders or
issues such observance of discipline, work
with explosives and weapons, acting in
specific weather conditions and in
dangerous areas, wearing guard gear,
interior detail, drilling and other habits.
During peacekeeping missions abroad the
environment gets particularly stressful,
associated with the existing continuous
threat to life and health of military
personnel. Often there is no predictability
of upcoming events. All this, along with
individual personality characteristics,
genetic predisposition and family history
could adversely affect the mental health of
soldiers and result in behavioral
disturbances, depressive reactions, etc. [6,
7].
Temperament
and
Character
Inventory (TCI) is a psychological
questionnaire
which
identifies
temperament
and
character
traits,
personality disorders, depression, and
interactions between them.
Views in the clinical aspect of the
Cloninger model can serve as a useful tool
for diagnosis and for prediction of
personality disorders. Each group of
personality disorders appears to be
associated with a unique set of points in
temperament and character scales and
questionnaires [8].
Purpose, objectives, methods
The aim of this study is to
demonstrate the effectiveness of the -new
for the Bulgarian army- psychological
questionnaire TCI, when used as a reliable
method of psychometric personality
disorders.
12
Assumptions/Hypotheses
1. There is a statistically significant
difference in mean values of the used tests
in different groups of subjects.
2. The type of temperament test TCI has
no connection/dependence/type of abnor
mal personality in screening for
personality disorders IPDE.
3. No correlation between the values in
Depression scale and screening to detect
personality disorders IPDE.
4. Correlation exists between the
dimensions of temperament and character
of the TCI with dimensions of abnormal
personality types of screening for
personality disorders IPDE.
Tasks
1. Disclosure effectiveness of specific
psychological instrument (TCI test) with
which to diagnose personality disorders;
2. Finding specific peculiarities of
temperament and character which are
indicative for predicting personality
disorders and depressive reactions.
Methods and Tools
Several psychological test methods
were utilised:
1. Cloninger’s Temperament and
Character Inventory (TCI). The author was
based at Washington University in St.
Louis, USA and the Bulgarian version of
the questionnaire was adapted during
2003-2004. TCI consists of 240
dichotomous items, completed indepen
dently and is displayed as a result of
Cloninger’s bio-social model.
Temperament
and
Character
Inventory (TCI) of Cloninger consists of
four temperament dimensions. They are:
Novelty seeking (NS), Harm avoidance
(HA), Reward dependence (RD) and
Persistence (P). Subsequently it was
expanded to include three new dimensions
Balkan Military Medical Review
Vol. 16, No 1, Jan-Mar 2013
that describe the character. The three
personality
dimensions
are:
Selfdirectedness (S), Cooperativeness (C) and
Self-transcendence (ST).
The result is a developed
Temperament and Character Inventory
(TCI) with measurements obtained via
seven-dimensional
model.
Unlike
temperament, aspects of character are
influenced by social learning in a
significantly great extent and may change
during the life of person [9].
Considering the clinical aspect of
the Cloninger model, it can be a useful tool
for diagnosis and prediction of personality
disorders. Each group with a personality
disorder are associated with a unique set of
points in TCI scales. From character traits
depends on whether the person is abnormal
at all, while temperament depends on the
type of abnormality and vulnerability to
affective disorders [9].
2. Screening for personality
disorders IPDE (International Personality
Disorders Examination); developed by
WHO
(A.Loranger,
A.Janca
and
N.Sartorius) in collaboration with an
international team in 1985. IPDE is a
structural interview, diagnostic tool
compatible with ICD-10 and DSM IV. It
contains 157 questions into six sections:
work, personality, interpersonal relations,
affects, reality testing, impulse control.
The interview items were assessed with the
ball, from which diagnostic value have the
highest ratings. This model allows
assessment of personality as the sum of all
scores - dimensional evaluation. Covering
a number of criteria allows the diagnosis of
a personality disorder. Screening IPDE is a
short questionnaire containing 59 questions
with possible answers dichotomous
/right/wrong. It aims to "shift" strongly
negative cases, according to the authors is
constructed so that all "suspicious" cases
give positive results. The Bulgarian
version of the semi-structured interview
Dimitrova M. et al: Diagnosing Personality Disorders in Temperament and Character Inventory
and screening IPDE were probated in
Bulgaria in 2005 [1].
3. Depression Scale of Back. There
are tests that measure depressive state. The
depressive scale used in this study was A.
Back’s, constructed in 1961. This version
consists of 21 symptoms, each of which is
given in four versions, with total complex
form of depression; thus, avoiding the
alternative formulation of the answers
‘yes/no’ or ‘true/not true’ which are typical
for most questionnaires. These are the
experiences, feelings, thoughts and
behaviors - referring to sadness, courage,
failure, pleasure, guilt, punishment,
frustration, crying, irritability, ability to
take decisions, etc. The calculation results
are based on simple collection points, the
level of each item and scale for reporting
results is a 5-speed transition from normal
to depressive symptoms [13].
Sample Description: our study
included 534 military personnel from
various divisions of the Bulgarian Army.
They had concluded secondary education,
the majority being enlisted men aged 19 to
35 years. The survey was conducted
voluntarily, independently and anony
mously. One part of the survey included
229 men - healthy individuals who had
completed the appropriate selection for the
adoption in military service and were in
the first trimester of their military service.
(For brevity, they will be listed as the ‘first
group’).
Another
group
were
159
respondents who had completed at least
one year of their military service (for
brevity, they will be listed as the ‘second
group’ of military personnel). These two
groups of soldiers consist of healthy people
at different stages in their military life
(which carries specific conditions and
obligations in the workplace), which
suggests different stages of adaptation
respectively - a state of impaired
adaptation.
13
The third important target group of
146 military personnel in the territory of
the Military Medical Academy psychiatric clinic, were informed and
agreed to participate voluntarily in the
study. These were personnel referred by
their commander after reporting subjective
complaints following a psychological crisis
characterized by the inability of the
individual to continue to perform as
required by their duties. (‘third group’).
Organization and conducting empirical
research
The empirical research was
conducted in three divisions of the
Bulgarian Army. The study was conducted
at different intervals appropriate to the
specific activity of the respondents, as
suggested by their military commanders,
within a 10-15 hour timeframe, in the halls
of the subdivision. Respondents worked
the questionnaires anonymously.
Methods of statistical analysis
- Narrative /descriptive/ statistics;
- ANOVA;
- Regression analysis;
- Linear discriminant analysis;
- Cross-tabulation
- Calculation of quartile values;
Results
Descriptive statistics were used,
necessary because of information on the
mean and variance for each feature tested
in terms of all the tests for the three groups
of subjects; ANOVA was also utilized
because of the three sample groups and the
need for data comparison between them.
Linear discriminant analysis of the
relationship of the groups of individuals
from the scales of a questionnaire for
Depression and IPDE to personality
disorders.
14
This analysis allows us to build a
model out of the type of subjects based on
four characteristics. The classification
features of the model are: G1, G2, G3, as
X1 – Depression
X2 - impulsive personality type
X3 - hysteria personality type
X4 - anxious personality type
G1 = A/-0, 04295./X1/depression/
+A/0.46506 / .X2/impulsive/ +A/0.75914.
/X3/hysteria +_A/01305.X4/ anxious
G2
=
A/-0,
02061/.X1/depression
+A/0.23240/ .X2/impulsive/ +A/0.61005/
.X3/hysteria +A/0.08200 / .X4/anxious
G3 = A/0.1530/ .X1/depression/ + A/-0,
1347/.X2/impulsive/+A/0.4821/
.X3/hysteria +A/0.3880/ .X4/anxious
As a result, we can say that the
probability of correctly distinguishing
clinical case / third group of subjects/ is
above 75%. The results show that those
respondents who have symptoms of
depression are especially anxious, hysteria
and impulsive personality type.
These results are illustrated in
Table 1 and Figure 1.
Table 1 presents the results of the
three groups experienced. G3 is a third
group military man in which we had the
highest number of correctly identified
cases of depression.
Figure 1 depicts the variance of the
three groups of subjects in the coordinate
system of linear discriminant analysis. In
green are military personnel (patients)
where scattering is greatest.
Balkan Military Medical Review
Vol. 16, No 1, Jan-Mar 2013
Table 1
Figure 1
Results of Cross-tabulation
To make this analysis we took
criteria A /relevant performance test for
IPDE personality disorders/ and standard B
/relevant performance test for TCI/.
We assume that criteria A and B
are independent; an alternative to that
hypothesis is that A and B are dependent
on each other.
We trust p <0.05 and the result is
that the alternative A and B are dependent
on correct.
Cross-tabulations that there is a
correlation between:
Dimitrova M. et al: Diagnosing Personality Disorders in Temperament and Character Inventory
Paranoid personality type of the
IPDE screening and passive-aggressive
/cautious/ type of temperament TCI / p =
0.065462 /;
Dissocial personality type of the
IPDE screening and withdrawn /adventure,
antisocial/ by TCI, at p = 0.00024648;
Dissocial personality type of
screening for personality disorders and
hysteria from TCI, p <0.045385;
Borderline personality type and
passive-aggressive /cautious/ from TCI in
p <0.039944;
Borderline personality type and
irritable /explosive border/ type of
temperament TCI, p <0.0016508;
Borderline personality type of
screening for personality disorders and
affective /narcissistic/ type of temperament
TCI in p <0.012807;
Anxious personality type and manic
/obsessive/ type of temperament TCI, p
<0.027571.
Results of descriptive statistics
Descriptive
statistics
has
information about the mean and variance
for each single-feature on all tests used by
us for the three groups of subjects.
Regarding the verification of the
hypotheses we work with the consent α = 0.05, which is standard in sociology. In
value method ANOVA, p-value is
important for verifying the hypothesis, as it
shows the error probability, assuming that
the hypothesis is correct (in this research
p-value <α).
In terms of test IPDE - screening
for personality disorders, it appears that
there
are
statistically
significant
differences between groups of subjects in
terms of individual scales. It turns out that
the group of patients with higher values
statistically distinguishable in terms of the
scale of measurement: schizoid, anankast
dependent, anxious and borderline
personality type. While the second group
15
of patients have significantly lower values
than the other groups in all scales. In the
first group respondents (military personnel
at the beginning of their military service)
there is statistically significant difference
with the other groups, as regards the
hysterical personality type.
Results of regression analysis
If there is a connection between
two quantitative traits, the task of statistics
is to determine the form and evaluate the
strength of that relationship. In a study of
statistical dependence, the form of the
relationship can be characterized by the
regression function and the overall analysis
is called regression analysis. Most
available for determining the unknown
regression coefficients are linear models.
This analysis was used in this
study to detect a correlation between
different dimensions of the used tests, all
results with low values of the coefficient of
determination R2 of around 0.2. Despite
the statistical significance of some of the
predictors, it means that the regression
could be used to predict the value of the
response.
Using regression analysis, we
check which of the personality and
temperament dimensions (test TCI) affect
the dimensions of the screening of
personality disorders IPDE.
We note that for the third group of
subjects (patients) barely used analysis
found significant relationships between the
dimensions of the two tests.
The results for all groups of
respondents indicate that the formation of
anankast
personality
influenced
persistence, self-transcendence, cooperati
veness and novelty seeking.
Regarding the first group of
subjects, there are important dimensions of
the test TCI: self-transcendence is high,
with low novelty seeking as well as a
16
second group of subjects: persistence, selftranscendence and low cooperativeness.
Regarding the formation of
impulsive personality, it is mostly
influenced by low cooperativeness.
The
formation
of
anxious
personality is influenced by lower values
in novelty seeking, cooperativeness and
self-directedness and positive values of
harm avoidance and self-transcendence.
The formation of dependent
personality type is influenced by low selfdirectedness and greater self-transcendence
and harm avoidance, whereas in the second
group of respondents only selftranscendence and harm avoidance.
Hysteria personality is mostly
influenced by positive self-transcendence
and low cooperativeness (second group)
whereas in the first group of subjects it is
influenced only by self-transcendence.
In terms of schizoid personality
type most influenced dimensions reward
dependence and self-transcendence. The
second group of subjects influenced by low
reward dependence and high scores of selftranscendence. For the third group of
subjects it is influenced only by lower
reward dependence. The first group is
influenced by low values of selfdirectedness, cooperativeness, reward
dependence and high value of selftranscendence.
On paranoid personality type most
are influenced by negative cooperativeness
and novelty seeking, and positive sign –
harm avoidance. The second group of
subjects are influenced by higher selftranscendence.
Regarding dissocial personality
type, most are influenced by low
cooperativeness and reward dependence
and high novelty seeking.
Balkan Military Medical Review
Vol. 16, No 1, Jan-Mar 2013
Border
on
personality
type
influenced by low self-directedness and
greater self-transcendence and harm
avoidance.
For the interpretation of individual
values and description of where the
individual results stand, there is a need to
determine quartile points. It is that value of
the frequency distribution of the random
variable that is greater than or equal to a
percentage of the measurements.
In accordance with the model of
personality (Cloninger’s) these statistics
can be used to obtain a typology of
temperament for the Bulgarian population.
As points of division are used
corresponding median values such as 17,
16, 14, etc. According to Cloninger, there
is a high risk of immaturity of character,
and, hence, personality disorders if the
results on the scores for self directedness
and cooperativeness are low. As immature,
can be considered those who have a total
score in both scales below the 25th
percentile, less than 49 (or, S + C <49).
Calculation of quartile values shows
that the most immature character are the
third group of subjects (patients), in whom
the sum between self-directedness and
cooperativeness is far less than 49 (S + C =
39).
Second in the "immaturity" of
character are the first group of subjects, in
which S + C = 43. The second group has
the least ‘immature’ character among its
representatives: S + C = 44.5.
Results from the testing of hypotheses
Hypothesis 1 was tested using
ANOVA and confirmed; there are
statistically significant differences between
the groups of subjects in terms of the
whole of the questionnaire.
Dimitrova M. et al: Diagnosing Personality Disorders in Temperament and Character Inventory
17
Table 2
groups of
respondents
all groups
of
respondents
together
First group
of
respondents
Second
group of
respondents
third group
of subjects,
patients
Dimensions of TCI
%
Of
base
=534
Persistence
(Р)
Selfdirectedness
(S)
Cooperativeness
(С)
Selftranscendence
(ST)
Novelty
seeking
(NS)
Harm
avoidance
(НА)
Reward
dependence
(RD)
0
25
50
75
100
0
4
5
6
12
6
21
25
30
41
3
21
25
30
38
2
12
16
20
31
5
16
19
23
35
1
11
15
19
30
0
12
13
15
22
0
25
50
75
100
0
4
5
6
12
7
22
26
30
41
9
21
25
29
37
4
13
16
21
31
9
16
19
23
35
3
11
15
18
30
5
12
14
15
22
0
25
50
75
100
1
4
5
7
8
11
23,25
28
31,75
40
7
21,25
26
31
38
4
11
14
18
29
9
17
20
24
33
1
8
13
16
29
5
12
14
15
22
0
25
50
75
100
0
3
5
6
8
6
20
23
28
34
3
19
23
29
37
2
12
17
21
29
5
13
18
22
31
3
15
20
25
30
0
11
12
16
21
Regarding the questionnaire TCI –
the third group (patients) have the lowest
values in the temperament scales
‘persistence’ and ‘novelty seeking’ and the
highest values in ‘harm avoidance’,
making them the least adaptable and prone
to non-adaptive events. In terms of
character scales they had the lowest values
in ‘cooperativeness’ and ‘self-directed
ness’ as evidenced by the presence of the
highest
percentage of ‘immature characters’. Patients are the most depressed
among other respondents.
The second group of respondents
had lower values than the other groups in
all scales of screening for personality
disorders. They show the highest values in
the character scales ‘self-directedness’ and
‘cooperativeness’, thereby having the
fewest ‘immature characters’ in their group. They have the highest values in the
temperament scales ‘persistence’ and
‘novelty seeking’, which is a sign of
adaptability.
Hypothesis 2 is also confirmed. The
analysis showed a high correlation
between most of the characteristics of the
questionnaire IPDE and TCI and low
margin of error between:
a/ paranoid personality type of the
screening IPDE screening and passiveaggressive (harm avoidance) type of
temperament TCI;
b/ dissocial antisocial personality type and
/adventurous, asocial/ temperament type;
18
c/ dissocial personality type and hysteria
temperament type;
d/ borderline personality type and passiveaggressive /harm avoidance/ temperament
type;
e/ borderline personality type and irritable
/explosive, border/ temperament type;
f/ borderline personality type and affective
/narcissistic/ temperament type;
g/ anxious personality type and manic
/obsessive/ temperament type;
To make it more clear it can be said
that the study of the relationships between
the characteristics of the IPDE screening
and TCI - three personality disorders
clusters in DSM IV coincide. No sufficient
evidence of schizoid and dependent
personality disorders was found.
Hypothesis 3 is rejected. The linear
discriminant analysis found correlation
between the two tests (test for depression
and screening for personality disorders),
the probability of correctly distinguishing a
clinical case is over 75%. The results are
statistically significant mostly in the third
group: this shows that people who have
symptoms of depression are especially
anxious, with hysteria and impulsive
personality type.
Hypothesis 4 was confirmed using
regression analysis to verify and establish
which of the TCI dimensions affect the
dimensions of the screening IPDE.
Findings for the first two groups of
subjects (i.e., in healthy military personnel)
show that the formation of each type of
abnormal personality is influenced by
certain traits and temperament, which are
detailed above.
The additional linear discriminant
analysis allows us to conclude that some
features are consistently repeated and are
particularly important in the formation of
almost all types of abnormal personality these are: self-transcendence, cooperative
ness and harm avoidance. Although
slightly less, the following are also
important: reward dependence, novelty
Balkan Military Medical Review
Vol. 16, No 1, Jan-Mar 2013
seeking and harm avoidance. The least
important is a personality feature – selfdirectedness. In the third group of subjects
we found significant features only in the
schizoid personality type and hysteria with
lower values in reward dependence and
self-directedness, respectively.
According to Cloninger there is a
high risk of immaturity of character and
personality disorders if the sum of the
scales of Self-directedness (S) and
cooperativeness (C) is low. Calculation of
quartile values shows that most immature
characters exist in the third group of
subjects. The first group of respondents are
next on ‘immaturity’. The second group
have the fewest ‘immature’ characters
among its representatives.
Discussion - Conclusions
In general, we feel that the goals
and objectives of this study have been
achieved. We examined the temperament
and character inventory in our sample
population as a predictor of poor
adaptation causing depression and
personality disorders. Our working
hypotheses have been statistically proven
or discarded [12].
The TCI questionnaire provides a
high degree of reliability and validity in
the diagnosis and prognosis of personality
disorders. The same questionnaire was able
to determine the maturity of character and
personality sustainability, which can
significantly simplify and shorten the
procedure
regarding
psychological
selection of military personnel, to predict
predisposition to developing mental
disorders and objectify military medical
expertise.
The following conclusions were
derived:
1. The personality (character)
scales Cooperativeness (C) and selfdirectedness (S) are signs of ‘maturity of character’ of the military personnel. High
Dimitrova M. et al: Diagnosing Personality Disorders in Temperament and Character Inventory
values are indicative of strong self-esteem,
ability to work in teams and independently
for realistic decision making. The presence
of an ‘immature character’ increases the
risk of disadaptation events and may detect
abnormal personality and personality
disorders.
2. The majority of people who are
anxious or have hysteria and/or impulsive
personality type (or personality disorder)
suffer of depression and poor adaptation.
3. Determination of the type of
temperament allows for prediction of the
occurrence of personality disorders. These
features are repeated and are particularly
important in the formation of almost all
types of abnormal personality are
personality characteristics: Cooperative
ness (C), Self-transcendence (ST) and
Harm avoidance (HA). Least important is
Self-directedness (S).
The authors this study recommend
to
include
new
personality
test
methodology /questionnaire TCI /, which
is able to simultaneously determine the
maturity of character, persistence and
personality predisposition to personality
abnormality. This would considerably
facilitate prevention, selection of military
and military medical expertise objectified.
[10]
It should be noted that the study
was conducted in a limited number of
specific military units. Secondly, it only
included enlisted personnel without
representation of the officers’ corps.
Despite the above limitations,
however, the results can and should be
seen as distinct and proven trends and
conclusions resulting from the analysis are
valid and can be used for practice in the
Army. We feel that more detailed and
focused studies on this issue, both from our
country and from other authors should be
conducted in the future.
19
References
1. Casey PR, Tyrer PJ: Personality,
functioning
and
symptomatology
Journal of Psychiatric Research, 20:
363-374, 1986
2. Cloninger CR, Svrakic DM, Przybeck
TR: A psychobiological model of
temperament and character. Archives of
General Psychiatry 50: 975-990, 1993
3. Cloninger CR, Przybeck TR, Svrakic
DM, et al: The Temperament and
Character Inventory (TCI): A guide to
its development and use. St. Louis, MO:
Center
for
Psychobiology
and
Personality, 1994
4. Donchev, T., Personality disorders in
the Military, Sofia, 2006 (dissertation)
[in Bulgarian]
5. Jones, Franklin D.: Disorders of
Frustration and loneliness, War
Psychiatry, Armed Forces institute of
Pathology, Washington D.C., (1995),
pp. 63-83
6. Kalinov K., Milanov C., Zhablenski A:
Validity and factor structure of the
Temperament and character Inventory
(TCI) in Bulgarian population,
Psychological Investigations, book 2,
(2005), pp. 57-70 [in Bulgarian]
7. Livesley, WJ: The DSM-4 personality
disorders. New York, NY: Guilford
Press, (1995)
8. Manning, F.: Morale, Cohesion and
Esprit de Corps, Military Psychology;
edit Gal, R.; Mangeisdorff, D. (1991)
9. Nikolkova S., Marinov P.: Psychiatry,
psychology
and
psychotherapy
Medical University Publishing House,
Sofia, 582, (2002) 236-245 [in
Bulgarian]
10. Onchev, G.: Medical aspects of
personality
disorders.
Modern
Medicine
47:61-64,
1996
[in
Bulgarian]
11. Onchev, G.: Personality abnormality
in clinical practice, Sofia, 2001 [in
Bulgarian]
20
12. Ross, C.E., Mirovski, J.: Explaining
the social patterns of depression:
control and problem solving or
support and talking. Journal of Health
and Social Behavior 30: 206-219,
1989
13. Tenth revision of the International
Classification of Diseases, Chapter V,
categories F40-F48, F50, F63. WHO
Geneva. Sofia, 2003, Bulgarian
Psychiatric Association [in Bulgarian]
Balkan Military Medical Review
Vol. 16, No 1, Jan-Mar 2013