low self-directedness (tci), mood, schizotypy and hypnotic susceptibility

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Personality and Individual Differences 39 (2005) 469–480

Low self-directedness (TCI), mood, schizotypy andhypnotic susceptibility

Tannis M. Laidlaw *, Prabudha Dwivedi, Akira Naito, John H. Gruzelier

Division of Neuroscience & Psychological Medicine, Imperial College London, St. Dunstan’s Road,

London W6 8RF, England

Received 27 January 2004; received in revised form 11 August 2004; accepted 31 January 2005

Available online 27 April 2005

Abstract

Relationships between personality and mood variables in a non-clinical sample were investigated using

80 medical students divided into two groups according to their Self-directedness (SD) scores from Clonin-

ger�s Temperament and Character Inventory (TCI). Those with low SD proved to have significantly raised

scores on hypnotisability, absorption, Self-transcendence and significantly lower scores on Co-operative-

ness. Both the schizotypal variables of Cognitive Activation and Withdrawal were raised. Further, the com-bination of low SD, low Co-operativeness and high Self-transcendence points also towards a schizotypal

personality style. These results corroborate a previously established link between schizotypy and hypnotic

susceptibility. Low scorers on SD also had significantly higher mood distress, anxiety and perceived stress.

Low SD, with its history of identifying personality disorders, in this data set appeared to be identifying

those medical students who were distressed in all measured aspects of mood as well as having indications

of higher levels of absorption, hypnotic susceptibility and aspects of schizotypy. The generality of distress

shown by these students raises important questions about their eventual competency in communication

skills and, indeed, decision making when they graduate as doctors involved in the treatment of patients.� 2005 Elsevier Ltd. All rights reserved.

Keywords: Hypnosis; Medical students; Personality; Self-directedness; Mood; Schizotypy

0191-8869/$ - see front matter � 2005 Elsevier Ltd. All rights reserved.

doi:10.1016/j.paid.2005.01.025

* Corresponding author. Tel.: +44 20 8979 7085; fax: +44 20 8846 1670.

E-mail address: [email protected] (T.M. Laidlaw).

mailto:[email protected]

470 T.M. Laidlaw et al. / Personality and Individual Differences 39 (2005) 469–480

1. Introduction

Associations between personality and functional disorders are wide ranging, but are usuallyrestricted to people with diagnosable DSM disorders where their Axis-I disorders are correlatedwith Axis-II. Looking for links in normal individuals lacks research. In this paper, we will discussthe personality and mood findings of 80 medical students who completed a variety of personalityand mood assessments including Cloninger�s Temperament and Character Inventory (Cloninger,Svrakic, & Przybeck, 1993), Gruzelier�s Personality Syndrome Questionnaire (Gruzelier, Jamie-son, Croft, Kaiser, & Burgess, in press), The Harvard Group Scale of Hypnotic Susceptibility:A (Shor & Orne, 1962) and various mood scales.

Cloninger and his colleagues have been researching methods of measuring personality in thecontext of a psychobiological model during the past two decades, first using the three-factorsof Reward Dependence, Novelty Seeking and Harm Avoidance measured with the TPQ (theThree Dimensional Personality Questionnaire), (Cloninger, 1987) and latterly with a seven-factormodel, the TCI (Temperament and Character Inventory) which adds another temperamentdimension, Persistence, and three character dimensions, Self-directedness, Self-transcendenceand Co-operativeness (Cloninger et al., 1993). In their investigations of the efficacy of the TCIin psychobiological research, it has been found that the low end of the character dimensionSelf-directedness (occasionally Self-directiveness) has been associated in an ubiquitous way withpersonality disorders (Joyce et al., 2003; Svrakic, Whitehead, Przybeck, & Cloninger, 1993),mostly along with another of the character dimensions, low Co-operativeness (Bayon, Hill,Svrakic, Przybeck, & Cloninger, 1996). Svrakic et al. (1993) suggested that a general factor com-mon to all personality disorders can be identified by scores that are low in these two Characterdimensions of the TCI, Self-directedness and Co-operativeness. They go on to suggest that per-sonality disorders can then be differentiated one from another by various unique configurationsof the TCI temperament factors of Reward Dependence, Harm Avoidance and Novelty Seeking.

Self-directedness is a combination of genetic influences and developmental processes that ma-tures with life experience. Low Self-directedness is associated with an inability to accept respon-sibility for actions or decisions and a tendency to ascribe blame onto others. Low scorers can driftthrough a goalless life, are decidedly less skilful in problem solving and lack confidence in theirown efficacy. Yet they can be unrealistic about their capabilities and, with their low self-esteem,tend to strive for impractical goals and wish to be best at everything, always. Often they display anunderlying paranoia (Cloninger et al., 1993).

Low Self-directedness has been associated with having problems in life in several studies e.g.,(Agosti & McGrath, 2002; Joyce et al., 2003; van Heeringen et al., 2003; Verschuur, Eurelings-Bontekoe, Spinhoven, & Duijsens, 2003). It correlates highly with personality disorder scales,and is the most important predictor of all personality disorders (Svrakic et al., 1993) suggestingit could be used as a universal diagnostic for personality disorders (Bayon et al., 1996).

Lower Self-directedness is associated with higher scores for distressed mood, especially depres-sion (Agosti & McGrath, 2002; Cloninger, Bayon, & Svrakic, 1998; Marijnissen, Tuinier, Sijben,& Verhoeven, 2002; Peirson & Heuchert, 2001; Richter, Polak, & Eisenmann, 2003). In the AgostiandMcGrath study (2002), the non-responders to medication (the antidepressants imipramine andfluoxetine) had significantly lower scores on Self-directedness than responders both before andafter treatment, while the responders had a normalised Self-directiveness score by the end of

T.M. Laidlaw et al. / Personality and Individual Differences 39 (2005) 469–480 471

the trial. This intriguing result was replicated in the Joyce et al. (2003) and Hirano et al. (2002)studies where improvement in Self-directedness scores occurred after treatment, although not rep-licated in the Marijnissen et al. study (Hirano et al., 2002; Marijnissen et al., 2002).

Schizotypy can be described as a dimensional set of characteristics ranging from a proneness topsychosis through to normal variants of the same characteristics and can no longer be associatedsolely with schizotypy, the personality disorder (Gruzelier, Burgess, Stygall, Irving, & Raine,1995; Gruzelier et al., in press). Roughly the personality characteristics parallel Liddle�s three-factor model of schizophrenia (Liddle, 1987): in schizophrenia Disorganisational with thought dis-orders corresponds to Gruzelier et al.�s Activated personality in schizotypy with odd beliefs andeccentricity; Psychomotor Poverty with its antisocial and withdrawn aspects of schizophrenia cor-responds with the Withdrawn syndrome in schizotypy that is characterised as being somewhatantisocial and having negative affect, and finally the Unreality syndrome in schizotypy corre-sponds to Reality Distortion in schizophrenia. Correlations had previously been found betweenhypnotic susceptibility and aspects of �positive� dimensions of schizotypy consisting of cognitiveactivation and the experience of unreality (Jamieson & Gruzelier, 2001).

In planning the present study, we were primarily interested in how Self-directedness, with itsinteresting relationships with personality disorders, relates both to other personality measures,in particular schizotypy and hypnotisability, and to mood in a non-clinical sample.

2. Methodology

2.1. Subjects

A voluntary sample of 80 students, recruited by word-of-mouth and posters, mostly completingtheir third year of Medicine, were tested with the TCI to identify those with low Self-directedness.They were subdivided into those who are at least one standard deviation below the mean in Self-directedness from the rest who are within one standard deviation of the mean or above. All weregiven detailed information sheets and informed consent was obtained. The age range was 18–37years, (mean = 21.7). There were 38 males and 42 females. Participants were paid £20–30.

2.2. Psychological Measures

The psychological testing used the following standardised tests:Personality Syndrome Questionnaire (PSQ): A personality questionnaire evolved from a mea-

surement of schizotypy (Gruzelier et al., in press).Temperament and Character Inventory (TCI): A seven-factor personality questionnaire (Clon-

inger et al., 1993).Profile of Mood States (POMS): A well-used mood inventory comprising 65 statements rated

on a Likert 5-point scale (McNair, Lorr, & Droppleman, 1971).State Trait Anxiety Inventory (STAI): the most commonly used anxiety questionnaire compris-

ing 20 anxiety-based questions on each of how the participant has been feeling generally over thepast week (trait) and how they are feeling right now (state) (Spielberger, Gorsuch, & Lushene,1970).


Perceived Stress Scale (PSS): designed to measure appraisal of stress (Cohen, Kamarck, & Mer-melstein, 1983).

Harvard Group Scale of Hypnotic Susceptibility (HGSHS:A): (Shor & Orne, 1962): the mostfrequently used group assessment tool for hypnotic susceptibility (Laidlaw & Large, 1997).

Tellegen�s Absorption Scale (TAS): the Jamieson version (Jamieson, 1987) which changes theoriginal True/False format into a 4-point Likert scale and has 5 sub-scales (Tellegen & Atkinson,1974). There has long been an association between hypnotic susceptibility and the concept ofabsorption e.g., (Crawford, 1982; Destun & Kuiper, 1996; Kihlstrom et al., 1989) with Pearsoncorrelations between measures of the two concepts of about 0.3 e.g., [(Jamieson & Sheehan,2002), where the correlation was r = .32, p < 0.05] so absorption was included to add furtherdepth to our understanding of hypnotic susceptibility.

2.3. Procedure

Testing for the POMS, STAI, PSS and the HGSHS:A were in the context of the several studiesin which the students participated (Laidlaw et al., 2003; Laidlaw et al., in press) and the persona-lity tests (TCI, PSQ and TAS) were completed later. Data was entered into SPSS (v 11) andexplored by ANOVA and Pearson correlational analyses.

3. Results

Those participants who scored one standard deviation below the mean or less on the TCI Char-acter variable, Self-directedness (�lows�), were compared with higher scoring participants (�others�which included both average and high scoring subjects). The data set was composed of 17 �lows�(range: 7–12) and 63 �others� (range: 13–25). The 17 �lows� were composed of 12 males and 5 fe-males, with a mean age that did not differ from �others�. Means and standard deviations of vari-ables of interest are to be found in Table 1.

There were no significant differences between males and females either in the entire group orin �lows� in any of the variables. The following results were analysed both with and withoutgender as a covariate. As there was little difference in the results, the simpler ANOVAs arereported.

3.1. Mood

The Total Distress Score of the POMS showed that �lows� were significantly more distressedthan �others� (m = 211.2 vs 262.7; F = 21.6, p < 0.000). Depression was significantly higher(Depression: F = 17.1, p < 0.000), and indeed all the various POMS sub-scales were higherfor �lows�: Tension (F = 13.31, p < 0.000), Anger (F = 11.74, p = 0.001), Fatigue (F = 5.5,p = 0.022), Confusion (F = 15.83, p < 0.000), and with less Vigour (F = 5.2, p = 0.025). SeeFig. 1.

Anxiety on the STAI overall score was higher for �lows� (m = 73.58 vs 85.94, F = 9.32,p = 0.003) primarily due to the high scores for Trait Anxiety (F = 22.46, p < 0.000).

Perceived stress was also rated higher by �lows� (m = 28.04 vs 23.61; F = 8.20, p = 0.005).

Table 1

Means and standard deviations of psychological variables: those with low levels of Self-directedness (n = 17) and the

others with average or high levels (n = 63)

Low Self-directedness Av or hi Self-directedness

Mean SD Mean SD

TCI Self-directedness 9.29 1.53 19.65 3.29

POMS total distress score 262.65 49.64 211.19 37.66

POMS tension 59.94 9.8 51.15 8.54

POMS anger 69.76 13.13 59.58 10.18

POMS vigour 58.12 8.76 63.82 9.21

POMS depression 66.53 11.3 56.29 8.31

POMS confusion 62.18 10.48 51.37 9.77

POMS fatigue 62.35 10.54 56.19 9.35

PSS 32.00 7.43 25.68 7.94

TCI co-operativeness 19.12 3.35 21.60 2.84

TCI harm avoidance 10.53 4.19 7.59 4.73

TCI reward dependence 9.00 3.10 10.25 2.95

TCI Self-transcendence 7.65 3.26 4.87 3.74

STAI state 38.29 8.81 35.40 9.78

STAI trait 47.65 7.59 38.18 7.22

PSQ withdrawal 12.06 4.66 9.57 4.42

PSQ cognitive activation 11.88 3.26 7.77 3.46

HGSHS: A 6.07 2.34 4.24 2.47

HGSHS: challenge 2.86 1.61 1.70 1.89

HGSHS: cognitive 0.50 0.94 0.18 0.39

TAS altered states of awareness 5.41 4.11 3.51 3.51

TAS imaginative involvement 20.47 6.04 17.62 5.93


3.2. Personality

Those with low Self-directedness were compared to �others� in the Character domain: �lows�were significantly lower in Co-operativeness (F = 20.20, p < 0.000). In the Temperament area,scores on Harm Avoidance (F = 4.2, p = 0.043) were significantly higher for �lows� compared tothe �others� and Reward Dependence was marginally lower (F = 3.0, p = 0.07). There were no sig-nificant differences on Novelty Seeking and Persistence scores.

The PSQ subscale Withdrawal differentiated the groups: �lows� were significantly more with-drawn (m = 9.57 vs 12.06; F = 4.15, p = 0.045). Withdrawal is associated with a deficiency in inter-personal mechanisms and is an integral aspect of one variety of schizotypal functioning.

Using the whole sample of 80 subjects, correlational analyses were conducted between Self-directedness and those variables where there were significant differences between those with lowand Self-directedness �others�. Many produced significant correlations see (Table 2). The two otherTCI character variables, Self-transcendence and Co-operativeness, were correlated with Self-directedness (r�s of �.38 and .53, p�s both <0.000), as were the mood variables (r�s of �.43 to�.47, p�s < 0.000) see (Table 3). Those variables were further entered into a stepwise regressionanalysis which showed that 60% of the variance of Self-directedness was predicted by a model thatincluded Co-operativeness (t = 5.04, p < 0.000), Self-transcendence (t = 2.49, p = 0.016), PSS

40

45

50

55

60

65

70

75

Tensio

nAng

er

Vigour

Depres

sion

Confus

ion

Fatigu

e

Low SD

Others

Fig. 1. Those with low Self-directedness (n = 17) had significantly more distress in all sub-scales of POMS: tension,

anger, depression, confusion, fatigue and less vigour than the others (n = 63).

Table 2

Variables correlated with Self-directedness

Variable Pearson�s r Significance

HGSHS:A �.324 0.009

HGSHS:A challenge �.215 0.087

HGSHS:A cognitive �.284 0.023

PSQ cognitive activation �.445 0.000

TAS altered states �.208 0.064

TAS imaginative involve �.230 0.040

TCI Self-transcendence �.384 <0.000

TCI co-operativeness .525 <0.000

PSS �.426 <0.000

Trait anxiety �.474 <0.000

POMS �.458 <0.000


(t = 2.42, p = 0.019), PSQ Cognitive Activation (t = 2.71, p = 0.009) and HGSHS:A (t = 2.08,p = 0.043).

3.3. Hypnotic susceptibility and factors related to dissociation

�Lows� (HGSHS:A m = 6.07) were significantly higher on the HGSHS:A than �others�(m = 4.24) (F = 6.15, p = 0.016). The groups were differentiated on the Challenge subscale items(F = 4.36, p = 0.041) and marginally on the Cognitive items (F = 3.68, p = 0.060) but not on theIdeo-motor items.

Table 3

Correlations of TCI Self-transcendence and dissociation-linked personality variables

Variable Pearson�s r Significance

PSQ activation .110 ns

PSQ withdrawal �.121 ns

PSQ unreality .216 0.055

PSQ cognitive activation .403 0.000

TAS total .637 0.000

TAS synesthesia .424 0.000

TAS altered states of consciousness .635 0.000

TAS aesthetic involvement .457 0.000

TAS imaginative involvement .541 0.000

TAS ESP .450 0.000

HGSHS:A total .227 0.071

HGSHS:A ideo-motor .038 ns

HGSHS:A challenge .226 0.073

HGSHS:A cognitive .197 ns


The Jamieson version of the TAS has 5 sub-scales, 2 of which marginally show that �lows�scored higher. Altered States of Consciousness [ASC] was higher in �lows� (m = 5.41) comparedto �others� (m = 3.51; F = 3.67, p = 0.059) and Imaginative Involvement [II]: was also higher(m = 20.5) than �others� (m = 17.6; F = 3.07, p = 0.084).

The Self-transcendence subscale of the TCI was significantly higher in �lows� (m = 7.7 vs 4.9;F = 10.5, p = 0.002) as was Cognitive Activation from the PSQ (m = 6.90 vs 10.21; F = 19.25,p < 0.000). PSQ Unreality did not differentiate the groups. When Self-transcendence was corre-lated with the other personality scales and sub-scales, it was clearly identified with absorption(TAS total: r = .64, p = 0.000) and all TAS subscales see (Table 3). It was also correlated withPSQ Cognitive Activation (r = .40, p = 0.000) and marginally with hypnotisability (r = .23,p = 0.071).

3.4. Personality styles

Cloninger and colleagues describe several personality styles using the character factors that in-clude low Self-directedness as a pre-requisite (Cloninger et al., 1998). Accordingly, of the 17 in ourgroup who scored lower than 1 SD below the mean, 11 met these criteria and could be identifiedwith specific personality styles. Of particular interest is the �schizotypal� style, which is the com-bination of low Co-operativeness, high Self-transcendence and low Self-directedness. This picturereflects the generalised description of those identified as low Self-directedness here.

4. Discussion

Those with low Self-directedness produced not only higher scores on hypnotic susceptibilityand mood distress scales than their colleagues but higher scores on related measures such asthe TCI Self-transcendence, some of the absorption subscales, PSQ Cognitive Activation and


PSQWithdrawal, and lower scores than their colleagues on Co-operativeness. Cloninger identifiesthe combination of low Self-directedness, low Co-operativeness and high Self-transcendence as a�schizotypal� personality pattern. Further, the PSQ is a measure of schizotypy. Recent PSQ inves-tigations from our laboratory identified aspects of schizotypy that were associated with higherhypnotic susceptibility (Jamieson & Gruzelier, 2001). The commonality of the association ofschizotypal characteristics and hypnotisability in both studies is intriguing and worthy of furtherexploration.

4.1. Mood

Several studies found that depressed people with low Self-directedness who responded to treat-ment not only improved mood, but also normalised their Self-directedness scores, and for some,their Cooperativeness scores (Agosti & McGrath, 2002; Hirano et al., 2002; Joyce et al., 2003).The results of our convenience sample of medical students begs the question of whether studentsshould or could be offered some sort of skill-enhancing intervention such as cognitive-behaviouraltherapy not only to rid themselves of distress, but also to contribute towards their effectiveness asdoctors. Certainly, the type of personality style found in this group appears to be antithetical tothe successful practice of medicine.

There appear to be definite associations with the extremes of the character factors and specifictypes of psychopathology (Cloninger et al., 1998) so perhaps it is not surprising that our studentshad degrees of distress, if not psychopathology, with their low Self-directedness scores. Cloningersuggests that these people may have subsyndromal pathology or they show a predisposition orvulnerability towards psychopathology. Mulder�s group examined low Self-directedness scoreswith personality disorders diagnosed with the SCID-II and found that personality disorders werethree times more likely in those with low Self-directedness than in those with high Self-directed-ness scores, and the relationship appeared to be a linear one (Mulder, Joyce, Sullivan, Bulik, &Carter, 1999). Selection for medical school with its emphasis on academic achievement doesnot preclude selecting those with low Self-directedness, of course. In fact, results from previouswork have shown that personality problems can be occasionally identified not only in post-grad-uate trainees, but also in senior consultants/specialists (Kluger, Laidlaw, Kruger, & Harrison,1999).

4.2. Personality

In the mature individual with high Self-directiveness, a high Self-transcendence leads to maturecreativity. However, when those with low Self-directiveness or low Co-operativeness possess thesesame characteristics of openness to experience and creative and inventive thought processes, theywere also open to odd aspects of unusual or divergent thinking and behaviours associated withschizotypy, and indeed, could be prone to psychosis (Bayon et al., 1996).

Gruzelier et al. describe a combination of related findings concerning brain lateralisation to-wards the left-hemisphere, which includes positive affect, approach behaviour, immune up-regu-lation and a cognitively activated personality (Gruzelier, Smith, Nagy, & Henderson, 2001).However, Gruzelier has unpublished work that identifies a small proportion of subjects whohad high cognitive activity but suffered distress. There is a possibility that too much cognitive


activity means a greater openness to ideas to the point of confusion, which possibly can lead ontoa negative state of withdrawal. Perhaps our low Self-directedness medical students, who showhigh cognitive activity, negative affect and withdrawal, fit here.

4.3. Hypnotisability

Hypnotic susceptibility scores appear to fluctuate independently of personality variables otherthan variables that relate to absorption, such as openness to experience (Glisky, Tataryn, Tobias,Kihlstrom, & McConkey, 1991). Hypnotisability does not appear to have previously been for-mally compared to TCI Self-transcendence other than a theoretical reference by Cloningeret al. (Cloninger et al., 1993). Self-transcendence is a personality variable that has characteristicsthat encompass the concept of absorption (Cloninger et al., 1993). However, on examination ofindividual questions in Self-transcendence, items that correspond to some in the Unreality sub-scale of the PSQ can also be found. Bayon et al. discovered that Self-transcendence, which ad-dresses imaginative, creative, inventive and spontaneous aspects of personality, had a dark side(Bayon et al., 1996). In a group of psychiatric patients, high Self-transcendence was correlatedwith histrionic, narcissistic, borderline and paranoid personality styles as well as bipolar disorder,thought disorder and delusional disorder as measured by the Millon Clinical Multiaxial Inven-tory, MCMI (Millon, 1987). Paranormal beliefs, as found in absorption and Self-transcendence,also have an association with depression (Thalbourne & French, 1995).

The association of high hypnotisability, good absorption abilities, openness to unusual ideasand emotional distress leads onto the related concept of dissociation, a concept not measureddirectly in this dataset yet one related to hypnotisability. Dissociation is associated with dysphoricmood (APA, 1994) including depression, somatoform disorders, and importantly, BorderlinePersonality Disorder (BPD) with its dissociative connotations such as high pain thresholds (Bohuset al., 2000; Russ et al., 1996). Absorption and dissociation are related paradigms that share par-ticular aspects of experience (Wolfradt & Meyer, 1998), that are again similar to those experiencedin an hypnotic experience. Yet, there appears to be no obvious reason why those with low Self-directedness and concomitant mood distress should be associated with higher dissociative behav-iours. But such associations have been found previously: Wolfradt found an intriguing mix ofassociations between beliefs in the paranormal, trait anxiety and absorption/dissociation a profilewhich fits that found in the present study (Wolfradt, 1997).

An association has been found between high absorption and more negative emotionality (Mc-Clure & Lilienfeld, 2002). Dissociation is considered to be an ineffective coping mechanism(Watson & Hubbard, 1996) and is linked with neuroticism (de Silva & Ward, 1993). Otherresearchers have found the association between the tendency to dissociate and feelings of negativ-ity, being overwhelmed and unable to cope (Dorahy & Schumaker, 1997; Kwapil, Wrobel, &Pope, 2002). As increased dissociation has been noted to occur during stressful periods, our find-ings of significantly increased amounts of perceived stress in this group is also consistent (Wolf-radt & Meyer, 1998).

Using the stress-vulnerability model, problems in basic personality constitute a vulnerabilitysuch that stress could hypothetically lead to psychopathology. Such a complex reaction would in-clude rigidity of response patterns and having a limited or inappropriate range of coping tech-niques. Millon hypothesises that in such cases stresses can get past the usual personality


defences to cause distress (Millon, 1996). Chronic stress can occur at deeper levels if defences areweak, which can then result in symptoms. There are implications for health and cognitive compe-tency when distress is measurable and chronic. This led Cloninger et al. to observe, in a commu-nity sample, that low scores on Self-directedness and Co-operativeness not only are associatedwith personality disorders but also could be a subsyndromal form of a mood disorder or a pre-cursor thereof (Cloninger et al., 1998). Our finding of low scores of co-operativeness in the groupappears to be consistent with previous findings using the 5-factor model of personality (Goldberg,1999; Ruiz, Pincus, & Ray, 1999) where those high on dissociation were low on a factor similar toCo-operativeness called �Agreeableness�.

The surprising finding of significantly higher levels of hypnotisability in our low Self-directed-ness group when compared to the others becomes less surprising when the link between hypnot-isability and dissociation is considered. Although hypnotisability has never, to our knowledge,been correlated with psychological distress, when those with high hypnotisability are restrictedto those with the characteristics found in low Self-directedness, the association becomes moreplausible. Severe dissociation, of course, is a maladaptive coping strategy with a well-researchedassociation with psychopathology.

In conclusion, the students who scored 1 SD or below in TCI Self-directedness also displayednegative aspects of schizotypy. The previous association between schizotypy using the PSQ andhypnotic susceptibility (Jamieson & Gruzelier, 2001) has been corroborated using the TCI vari-ables of low Self-directedness, low Co-operativeness and high Self-transcendence. The generalityof distress shown by these students raises important questions about their eventual competency incommunication skills and, indeed, decision making when they begin practice as doctors.

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