Individual differences in mental health

Mental health

A state of well-being in which the individual realises his/ her abilities can cope with the normal stresses of life (WHO, 2004).

Health

A state of complete physical, mental and social well-being and not merely the absence of disease of infirmity (Official Records of the World Health Organisation).

Suls & Rittenhouse (1990) and Smith & Williams (1992)

Suggested four possible ways in which personality and illness may be linked.

Personality and illness link 1

It was thought that individuals with certain personality characteristics were more at risk of developing psychosomatic conditions. These are conditions where psychological factors are considered to play a major role in the development of a disorder.

Personality and illness link 2

Mathew et al. (2003) claimed that an individual with a genetic susceptibility to develop heart disease and this same gene also results in a predisposition towards being a hostile person.

Personality and illness link 3

Having certain personality traits may lead individuals to engage in particular behaviours that influence their health and/ or increase the risk of illness.

Personality and illness link 4

Being physically ill and having to undergo treatment in hospital may have a significant psychological impact on individuals. Heckhausen and Schulz (1995) concluded that the effects of acute health crises and becoming chronically ill long-term can cause significant changes in some individuals.

Large prospective population

Taking personality and health measures from a large, health population, and then following this up some years later in hope that sufficient numbers of the population become ill so that you can compare their scores with their baseline scores.

Type A

Determined, competitive, hostile to competitors, drive for recognition, advancement and power.

Type B

Very relaxed and unhurried in their approach, less interested in competition, achievement and more likely to take life as it comes.

Western Collaborative Study Group (Friedman & Rosenman)

In this study, 3,524 men (39-59 years) were assessed in 1960. The sample was followed up 8.5 years later and Type A men were found to have twice as much CVD than Type B men.

Type D

Having a tendency towards negative affectivity. This personality is also described as being socially inhibited and have difficulty expressing their feelings,

Denollet (2000)

Developed a 14-item questionnaire, which measures negative affectivity and social inhibition constituents of type D. He found that individuals with CHD were classified as being Type D; they suffered from higher levels of emotional stress, anger and tension, and low well-being.

Framingham Study (Haynes et al., 1978)

Between 1965 and 1967, 5,127 men and women were assessed. In 1978, they followed up and found the incidence of CVD to be significantly higher in Type As than Type Bs. Type A behaviour increased the risk of CVD in men aged 55-64 years but only if they were white-collar workers.

The transactional model of stress

Describes four components to the stress response and together determine how the individual actually deals with the situation.

1. emotional experience

2. physiological response

3. behavioural response

4. cognitive response

Stevens et al. (1995)

Reviewed the literature on co-occurence of physical disease and depression, and reported that depression is a common reaction to diagnosis and treatment of serious physical conditions.

Hypochondria

Individuals with this worry excessively about their health; they attend to every little change in their body’s state, believing that they are ill despite what the medical profession tell them.

Subjective well-being (SWB)

The extent to which people think and feel that their lives are going well.

Three components of SWB

• cognitive component - an individual’s judgement that their life is going well

• affective component 1 - frequent positive affect

• affective component 2 - infrequent negative affect

Factors influencing SWB

• basic needs

• psychological needs

• personality

• demographics

Positive and Negative Affect Scheduele (Watson and Tellegen, 1985)

Identifies feelings of positive and negative affect at the present moment, is a well used as a measure of the emotional component to SWB.

Satisfaction with Life Scale (Diener et al., 1985)

This scale consists of five items which ask respondants to indicate how they feel at the present moment where their life is.

Diener & Tay (2015)

Investigated annual household income, and discovered large differences in life satisfaction between countries with a similar income.

Psychological well-being

Individual development through engagement with the challenges within life, concentrating on issues of meaning and self-reflection.

Six aspects to psychological well-being (Keyes et al., 2002)

1. autonomy

2. environmental mastery

3. personal growth

4. purpose in life

5. positive relations with others

6. self-acceptance

Mental disorder

A clinically significant disturbance in an individual’s cognition, emotional regulation, or behaviour

Six criteria for personality disorders

1. enduring, maladaptive patterns of behaviours and cognitions that deviate markedly from what is expected

2. the enduring pattern is inflexible

3. it leads to significant distress or impairment

4. the pattern is stable and can be traced back to adolescence or early childhood

5. exclusion of other mental disorders

6. exclusion of alternative causes

General criteria for personality disorders: DSM-5, APA (2013)

There needs to be a deviation from what is expected in two of the factors described in Criterion A, plus the conditions described in Criteria B to E.

Criterion A

1. cognitions of the person

2. emotions of the individual

3. interpersonal functioning

4. impulse control

Criterion B

The pattern of thought, emotion and behaviour must be enduring, inflexible and must be applied consistently across a broad range of personal and social situations.

Criterion C

Clinically significant impairment or distress is caused by the pattern of thought, emotion and behaviour to the individual’s life in some way.

Criterion D

The pattern of thought, emotion and behaviour must be stable over time and must be present over a long duration.

Criterion E

The patterns of thought, emotion and behaviour cannot be explained as part of another mental disorder.

Cluster A

Disorders are defined by cognitive disturbances, which then impact on social and personal relationships. These include paranoid personality disorder, schizoid personality disorder and schizotypal personality disorder.

Cluster B

Disorders defined by lack of impulse control, disturbed or inappropriate affect and cognition. These include antisocial personality disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder.

Cluster C

Contains anxious, overly dependent or fearful disorders. These include avoidant personality disorder, dependent personality disorder and obsessive-compulsive disorder.

Heritability and personality disorders

Torgersen and colleagues calculated the highest heritability estimate was for Cluster C disorders (0.62). The results lend support to the suggestion that personality disorders have a substantial genetic component.

Environmental influences on personality disorders

Zanarini and Frankenburg (1997) found that individuals with borderline personality disorder also report a history of abuse and neglect in childhood.

Biological & neuropsychological factors on personality disorders

Davis (1991) provided a model that suggested personality disorders are associated in four aspects of psychological functioning and behaviour.

Cognitive/ perceptual

Based on the brain systems related to attention and response. Dopamine is control to the parts of the brain that control our movements and is commonly associated with pleasure aspects of the brain.

Impulsivity/ aggression

Based on those brain systems that are associated with the capacity to inhibit behaviour. Serotonin is known to modulate and regulate mood, emotion and sleep, and is involved in the control of numerous behavioural and psychological functions.

Anxiety/ inhibition

Reduced dopamine activity and increased serotonin activity that are related to Cluster C personality disorders.

Affect regulation

Based on those brain systems related to the stability of mood. Norepinephrine is a stress hormone that affects parts of the human brain where attention and impulsivity are controlled.

Diathesis-stress model

Posits that mental disorders result from an interaction between inherent vulnerability and environmental stressors.

Risk and protective factors (Aragna et al., 2018)

• genetic

• biological

• family-related

• society

Cognitive epidemiology

The study of the links between intellectual abilities and health & disease.

Low intelligence in early adulthood

• higher risk of hospitalisation for mental disorders

• higher illness severity

Low childhood intelligence increases risk for

• schizophrenia

• depression

• alzheimer’s disease

Scar-complication model

Mental disorders may lead to changes in premorbid personality

Vulnerability-risk model

Specific personality traits put an individual at risk of developing a particular mental disorder.

Pathoplasty model

Personality traits modify the presentation, course, and severity of mental disorders.

Spectrum model

Personality and mental disorders are part of the same continuum.

Criticisms of personality disorder diagnosis’

• The simultaneous presence of personality disorders and with other mental disorders.

• Extremity is not sufficient to define dysfunction

Emotional intensity

Individuals with antisocial personality disorder often feel indifferent even when they have mistreated, stolen from, or hurt another person.

• May exhibit a lack of remorse

Emotion frequency

Individuals with dysthymia/ persistent depressive disorder may experience a depressed mood for more days than not and for a period of 2 years or longer.

Emotion duration

Specific phobia is defined as a persistent, excessive, and unreasonable fear when anticipating, or in the presence of a feared object or situation.

Emotion type

Individuals with schizophrenia may show emotional disturbances, which means they display odd or inappropriate emotions, so they may display anger in a situation which sadness might be expected.

Emotion regulation as a risk factor (Aldao et al., 2010)

• ER strategies associated with various mental disorders

• Maladaptive strategies were associated with more and adaptive strategies with less psychopathology