Personality and ealth

Personality in illness process

Distal predictors: Personality + behavior + cognition →

symptom reporting and check-ups →

interactions with health care, diagnosis, disease progression, treatment choices, compliance, mortality ← health behaviors, social cognition, health beliefs

Roberts’ mechanisms of personality influence on health

Pathogenenesis: individual differences in physiological reactivity, vulnerability, responses to environmental influences

health behaviors: smoking, exercise, preventive behaviors, diet

coping: individual differences in appraisal and management of stress and illness +

social cognition: intentions, expectations, health and illness beliefs,

communication (with health professionals)

Influence of health and illness on personality

Illness, brain/neurological changes, medical treatments, persistent changes in life circumstances may alter personality

Medical illness types and effects on personality

• Direct bio/neuro effects: medical condition directly altering personality functioning

• Chronic illness: alters personality traits: lower E, C, O, and emotional stability

Explanations of illness-related personality change

Illness-related distressed, physiological and functional changes, burden of illness, limits to functioning, reduced opportunities for activities and experience

Multilevel illness process

1. Individual: personal health outcomes, health processes and behaviors

2. Group: small group interactions (doctor-patient, family)

3. Organisational: structure and function of HC system, delivery of HC

Components of conscientiousness

• Impulse Control: cautiousness, deliberation, self-control

• Reliability: responsibility, socialisation

• Conventionality: traditionalism, rule consciousness

• Industriousness: competence, purposefulness, self-discipline

• Orderliness: order, perfectionism, organisation

Personality hierarchy

1. General factor of personality (GFP)

2. FFM: OCEAN

3. Health-specific traits: empathy, health anxiety (HA), type D, alexithymia

Health-specific traits

Empathy, Health Anxiety, Type D, Alexithymia

Empathy components

• Affective/emotional empathy: capacity to experience and share emotions with others

• Cognitive empathy: understand the emotional state of others without feeling the same

• Empathetic distress: negative emotion felt by empathises due to sharing

• Motor empathy:individual’s ability to mirror emotional responses of others

Empathy on Level 1

High: longevity, well-being, pain, distress, depression; Low: psychopathy and anti-social

Empathy on Level 2

• Charities, helping behaviors, positive doctor-patient interactions

• Physician’s empathy → compliance and satisfaction, but, empathetic distress → burnout

Empathy on Level 3

Selection of medical students

Health anxiety definition

Disease phobia/conviction, bodily preoccupation

Health Anxiety on level 1

Non-specific symptom report, cortisol, social cognition, poor stress coping, sensitivity to bodily sensations, medically unexplained symptoms, unrealistic health beliefs, focus on health goals, altered physiological responses, low pain threshold

Health Anxiety on level 2

Unsatisfactory doctor-patient interactions, poor trust

Health Anxiety on level 3

Doctor shopping, HC utilisation, medical student syndrome

Type D trait definition

Tendency for negative affect and self-expression inhibition

Type D on Level 1

Negative perception of health, poor health behaviors and coping, cytokine levels, CVDs, immune diseases

Type D on Level 2

Negative doctor-patient interactions

Type D on Level 3

HC utilisation

Alexithymia definition

Difficulty identifying feelings, externally-oriented thinking

Alexithymia on Level 1

• Negative health behaviors, high mortality, psychosomatic symptoms, risk taking, low immune function

• Poor physical health outcomes: type 1 diabetes, cancer, Parkinson’s, Lupus

Alexithymia on Level 2 and 3

Poor doctor-patient interactions; high HC utilisation

Cost-benefits of health-specific traits

• Empathy: empathetic distress mediates the relationship between EmEm and poor health behaviors

• HA: low infection exposure and incidence, low risk for cancer

• Type D: low infection exposure and incidence

• Alexithymia: high status, low infection exposure

FFM: mortality

• High risk: high N & low A

• Low risk: E & C

• Protective factor: O

• Symptom report: NCO

FFM: Pathogenesis

• High OCE: high cortisol, susceptibility to infections; low inflammation and disease progression

• High N: low cellular immune activity, high inflammation

FFM: Health behaviors

• C: good health behaviors, low SUD

• N: SUD

• E: sexual risky behaviors

FFM: Coping

• EO: overall engagement in problem-focused coping strategies

• N: disengagement strategies

FFM: Social cognition

• EAC: low perceived disease susceptibility

• N: high disease susceptibility

• C moderates effect of intentions

FFM: Communication (Levels 2 and 3)

• 2: N: low reassuring doctor-patient interactions, spouse’s depression; C: spouse’s positive health outcomes

• 3: N: physician’s burnout; C: successful in medical training

Synergistic trait effects

High N + High C = low health limitations, high health vigilance

Compensatory health behaviors: FFM

• C+N = both good and bad health behaviors, good reported but poor actual health status

Neuroscience of FFM

• O: working memory and attention

• C: impulse control

• E: sensitivity to rewards

• A: altruism

• N: sensitivity to punishment

Socio-cognitive model of personality and health

Motivation to act (N+E; HA + Empathy) →

Selection of action (O) →

Action (C+A) →

Evaluation of consequences (Alexithymia)

Peterson: pessimistic explanatory style

• Originated from Learned Helplessness

• 3 dimensions: stable/unstable, global/specific, internal/external

Rosenbaum: Learned resourcefulness

A repertoire of skills and cognitive strategies supporting self-regulation, which helps maintain goal-directed behavior in difficult situations

Rosenbaum: Self-Control Schedule

Cognitive self-instructions, application of problem-solving, ability to delay gratification, strong belief in effective self-regulation

Learned resourcefulness → adherence

Past adherence + Learned Resourcefulness → Perceived success in past adherence + Attributing past adherence to effort → Self-efficacy expectations → Future adherence

Personality in symptom perception

Personality influences perception and attention to sensations, labelling as illness, HC utilisation and symptom report

Personality pathology in health care

• Difficulties in emotion regulation, interpersonal conflicts, dependency, impulsivity, distrust →

• Ambivalence about change

• Problematic boundaries with clinicians

• Poorer adherence

• Help-rejecting behaviors

• Idealisation-devaluation