Personality and Health PDF

PS338: Personality Disorders, Mental and Physical Health Dr Jenny Groarke QWICKLY: 5834 University University ofGalway.ie ofGalway.ie People Are Different Personality psychology a...

PS338: Personality Disorders, Mental and Physical Health Dr Jenny Groarke QWICKLY: 5834 University University ofGalway.ie ofGalway.ie People Are Different Personality psychology addresses how and why people are different. Difference is good, Individual differences have consequences for mental and physical health University ofGalway.ie Personality Disorders Configurations of traits that are socially undesirable and taken to the extremes There is not an exact point that differentiates between normal and disordered personality. Create severe problems Prevalence: about 15 percent of American adults University ofGalway.ie Personality Disorders: The DSM The Diagnostic and Statistical Manual (DSM) First edition: 1952 Controversy Current edition: DSM-5 in 2013 Two systems for personality disorders Purposes Make diagnosis more objective Insurance billing University ofGalway.ie Defining Personality Disorders 1. Unusually extreme*** personality attributes In terms of cultural context Denial of reality 2. Problematic*** For the person: anxiety, depression, confusion For others University ofGalway.ie Defining Personality Disorders 3. Affect social relationships and interactions 4. Stable over time Can begin in adolescence or childhood Difficult to change with therapy or other means 5. Ego-syntonic Symptoms are seen as normal and valued aspects of personality by the person with the disorder They think others are the ones with a problem. University ofGalway.ie The Major Personality Disorders Old system 10 major disorders in three clusters Cluster A: odd and eccentric patterns of thinking Cluster B: impulsive and erratic patterns of behavior Cluster C: anxious and avoidant emotional styles University ofGalway.ie The Major Personality Disorders More useful to think in terms of basic beliefs Goal of cognitive-behavioral therapy is to change beliefs New system Six major disorders (four deleted); no clusters University ofGalway.ie ACTIVITY: Listen to 2 case studies Take note of symptoms and characteristics Discuss in pairs/groups and identify the personality disorder being described 1. Schizotypal 2. Narcissistic 3. Antisocial 4. Borderline 5. Avoidant 6. OCPD University ofGalway.ie Schizotypal Personality Disorder Extremely odd thoughts, strange ideas, unconventional behavior, superstitious beliefs, difficulty in close relationships Slightly more common in men Prevalence: 0.6 – 4.6% University ofGalway.ie Narcissistic Personality Disorder (NPD) Belief that one is superior Expects and needs recognition from others Expects special treatment and feels entitled Lack of empathy Difficult or impossible to treat Prevalence: up to 6.2% University ofGalway.ie University ofGalway.ie Antisocial Personality Disorder Illegal activities Impulsive and risky behaviors Irritable, aggressive, and irresponsible Problems caused to others do not bother them Associated with low economic status and urban settings Much more common in men Prevalence: 0.2 -- 3.3% University ofGalway.ie Borderline Personality Disorder (BPD) Most severe personality disorder Hallmark symptom: emotional instability, emotional emptiness Suicide attempts are common, Self-mutilation and self-harm Identity disturbance Interpersonal relationships are confusing, chaotic, noisy, unpredictable, and unstable. Partly due to splitting Possible origins – genetic + early environment Treatment: dialectical behavioral therapy Much more common in women Prevalence: 2% University ofGalway.ie Avoidant Personality Disorder Expect the absolute worst from others Need constant reassurance of uncritical acceptance Active inhibition of emotional expression Deep cravings for affection and social acceptance Similar prevalence in men and women Prevalence: 2.4% University ofGalway.ie Obsessive-Compulsive Personality Disorder (OCPD) Bound by rituals and rules Severely judgmental of others Lacks a sense of proportion Workaholism Inability to throw things away Can be ego-syntonic Not the same as obsessive-compulsive disorder Prevalence: 2.1-7.9% University ofGalway.ie ACTIVITY: Listen to 2 case studies Take note of symptoms and characteristics Discuss in pairs/groups and identify the personality disorder being described 1. Schizotypal 2. Narcissistic 3. Antisocial 4. Borderline 5. Avoidant 6. OCPD University ofGalway.ie Organizing and Diagnosing Disorders with the DSM-5 New way of organization The “Bad Five” 1. Negative affectivity 2. Detachment 3. Antagonism 4. Disinhibition 5. Psychoticism University ofGalway.ie Organizing and Diagnosing Disorders with the DSM-5 Diagnosis Follow three steps 1. Assess whether personality functioning is seriously impaired and rate degree of dysfunction. 2. Assess whether at least one of the defined types of personality disorder is present. 3. Assess degree of the five maladaptive personality traits. No sorting into a single diagnostic bin University ofGalway.ie Personality and Disorder: Pathologizing Do all ‘bad’ people have personality disorders? Should we refrain from punishing socially undesirable, illegal, or immoral behavior because people suffer from antisocial personality disorder? Describing behavior as the result of mental illness is problematic University ofGalway.ie Personality and Disorder: Mental Health Pathologizing tells us almost nothing about the nature of mental health Positive psychology aims to promote meaningful and happy living The health person can be defined in terms of the Big Five traits Improving mental health requires an understanding of normal personality University ofGalway.ie Personality and Disorder: Labeling Misleading Can limit understanding Not an explanation Can be useful and are necessary University ofGalway.ie Personality and Disorder: Normal and Abnormal There is not a sharp dividing line. Having a mild degree of a few characteristics does not imply having a disorder. Disorders may be thought of as exaggerated versions of traits that are advantageous when in the normal range. Unusual, original, and creative: schizotypal Self-confident and proud: narcissistic University ofGalway.ie The Healthy Personality: Mental Health Complex, fully elaborated, and well-integrated psychological world Mostly positive, volitional, and adaptive self-concept Rich, broad, and appropriately regulated emotional life Productive member of society Reciprocal and fulfilling relationships University ofGalway.ie The Healthy Personality: Physical Health Ability to do things one wants to do Feel good Supportive social relationships Productivity Good memory and ability to make decisions Stay alive (Friedman and Kern, 2014) University ofGalway.ie Physical Health Connections between personality and health Health is often assessed with self-report. Some items on personality tests and health assessments overlap. L data: medical records, death certificates I-data Challenge: explaining the connections Two possible pathways: biological and behavioral University ofGalway.ie Changes in leading causes of mortality (UK) Smoking, Diet, Alcohol, Exercise, Screening Smoking, Diet, Exercise Smoking, Vaccination Smoking, Diet, Exercise, Alcohol N = 25k (40-79 years), 11 yrs. Conclusions 4 health behaviours predict a 4-fold difference in total mortality estimated impact equivalent to 14 yrs in Figure 1. Survival Function According to Number of Health Behaviours in Men and Women Aged 45–79 Years without Known Cardiovascular Disease or Cancer, chronological age Adjusted for Age, Sex, Body Mass Index and Social Class, EPIC-Norfolk 1993–2006 Personality and Health Hippocrates, Galen: Temperament and health arise from bodily humours (bodily fluids that impact how a person functions) apathetic people have an excess of phlegm and are at risk of rheumatism. An excess of melancholy led to sadness, depression, degenerative diseases and cancer The sanguine person was healthy, with an optimistic personality.  Personality and Health Psychoanalytic perspective: diseases (e.g., ulcers, asthma) arise from unconscious Type D -> Illness psychological conflict. Middle 20th Century Early 20th Century Early 21st century Type A, B, C Personality -> Illness Type ‘A’, ‘B’ and ‘C’ personalities 01 02 03 Type A: Type B: Type C: Uptight, driven, highly Easygoing, lower stress ‘cancer-prone’ – strung – linked to cardiac levels introverted, compliant, episodes (Friedman and – opposite of Type A eager to please – again Rosenman, 1950s) – no conclusive evidence never demonstrated conclusively  Interaction of negative affectivity and social inhibition Latest research: Type D personality predict health status [e.g., PTSD in military personnel (Mommersteeg et al, 2011); physiological responses to stress (Habra et al, 2003); increased morbidity and mortality in CHD patients (Pedersen & Denollet, 2003) Personality and Health Review of hundreds of studies suggest it is not personality type linked to specific diseases, but rather: general set of characteristics (hostility, aggression, depression) that increases risk for multiple diseases: > ‘disease-prone personality’ (Friedman & Booth-Kewley, 1987). Friedman (1991) suggested the 'self-healing personality' = optimism, extraversion, sociability and hardiness (resilience). ‘Big Five’: Health Associations Personality is as good as common mortality risk factors (e.g., socio-economic status, obesity, and alcohol consumption), in predicting mortality and in some cases is better than (Ferguson, 2013)  Some variables (e.g., neuroticism) strongly linked to health outcomes, e.g., Lahey (2009): ‘Big Five’: ‘...there is growing evidence that Health neuroticism is a psychological trait of profound public health significance. Associations Neuroticism is a robust correlate and predictor of many different mental and physical disorders, comorbidity among them, and the frequency of mental and general health service use.’  Protective effect for openness based on meta-analysis studies examining openness and mortality (Ferguson & Bibby, 2012) Openness lowers odds of diagnosis of multiple cardiovascular health associations ‘Big Five’: such that one-unit increase in openness decreases onset of: Health Stroke by 31% Associations High blood pressure by 29% Angina, congestive heart failure, coronary heart disease, heart attack & other heart problems by 17% (Weston et al., 2014) Combinations of Big 5 High E & N, low C & A - risky sexual behaviours (Miller et al., 2004) High E, low C - more alcohol consumption (Grazo et al., 2004) High E, low N,- happiness (Stewart et al., 2005) Personality is the greatest predictor of happiness (Diener et al., 1999) Physical Health: Emotionality Negative and positive Related to extraversion and neuroticism Negative emotionality is associated with poor physical health. The connection is likely not direct. Unclear direction of the relationship Behavior and stress University ofGalway.ie Physical Health: Emotionality Cont’d Neuroticism can be beneficial to health. Positive emotions and optimism The relationship is complicated. University ofGalway.ie Physical Health: Conscientiousness Clear, positive relationship Related to quality and length of life Better able to handle stress Related to behaviors that make good health more likely Related to employment University ofGalway.ie  live longer (Friedman et al., 1995), engage in safe sex (Trobst Conscientiousnes et al., 2002), greater use of task-focused coping (Deary et al., 1996). Personality and Health Does childhood personality predict longevity? (Friedman et al., 1993) THEORY: From a biopsychosocial perspective health is multidimensional. There are individual differences in how processes of breakdown and repair unfold across the lifespan: impacted by who we are, what we experience and what we do Personality and Health Does childhood personality predict longevity? (Friedman et al., 1993) RESEARCH METHOD: Longitudinal study using archival data from the Terman Life Cycle Study (California, US) A study of 1528 children with high IQ (> 135). Baseline 1920-21, average age 11 years Questionnaires by parents, teachers and children (demographics, intellect, achievements, health, interests, psychosocial functioning) Every 10 years (+ relationships, occupation, health behaviour, etc.) Personality and Health Does childhood personality predict longevity? (Friedman et al., 1993) RESEARCH METHOD: Friedman collected death certificates -> longevity and cause of death. Identified variables in questionnaires related to personality variables: 6 personality variables = conscientiousness/social dependability, motivation/self-esteem, cheerfulness/humour, sociability, energy, and stability of mood. Personality and Health Does childhood personality predict longevity? (Friedman et al., 1993) RESEARCH METHOD: Outcome (DV) = 1. survival analysis (estimates the probability of dying at any given age) 2. Factors predictive of being alive (or not) at age 70 Personality and Health Does childhood personality predict longevity? (Friedman et al., 1993) RESULTS: Controlling for age and gender, 2 significant child personality factors = conscientiousness and cheerfulness. Over 70 years, a person rated in the highest quartile on conscientiousness had a significantly lower risk of dying at any given age than a person rated in the lowest quartile. Personality and Health Does childhood personality predict longevity? (Friedman et al., 1993) RESULTS: In contrast, cheerfulness predicted greater mortality risk. (not expected). Why? 1. Cheerful people may underestimate risk and fail to follow medical advice. Martin (2002) followed this up finding that cheerful children in the Terman sample were more likely to smoke, drink and engage in risky hobbies – but this did not explain the cheerful-mortality link. 2. Distinction between cheerful temperament and the tendency for optimistic people to engage in positive behaviours and use more adaptive coping (Carver, Scheier & Segerstrom, 2010).  Does childhood personality predict longevity? (Friedman et al., 1993) Personality and Health CRITQUE: The Terman study sample are unique: Highly intelligent (top 2.5% of the population in terms of IQ) Mostly Caucasian, middle and upper class. Cohort effects of The Great Depression, WW2, Cold war, the 60s, Tech revolution etc. YET, individual lives varied significantly.  Does childhood personality predict longevity? (Friedman et al., 1993) Personality CRITQUE: and Health Measurement issues – single item (did not have the valid and reliable measures we use today). Chance findings? The study was built on theory, but the analyses are exploratory. Type 2 vs Type 1 error e.g., findings re: cheerfulness conflict with other studies (Howell, Kern, & Lyubomirsky, 2007) – could be due to unreliable measures, selective sample, or capitalising on chance.  Does childhood personality predict longevity? (Friedman et al., 1993) Personality CRITQUE: and Health Findings re: conscientiousness could also be due to unreliable measures, selective sample, or capitalising on chance. BUT, others built upon this study, and replicated this finding using different samples, measures, time periods, and designs – supporting the original finding. Lifespan Approaches to Personality and Health Why are personality and longevity linked? MECHANISMS & MODERATORS 1. Smoking is the greatest risk factor for poor health outcomes (WHO, 2009). Conscientious people are more likely to engage in health behaviours (not smoking, healthy diet, moderate exercise, no/moderate alcohol intake (Lodi-Smith et al., 2010). 2. Positive social relationships are NB for health (Taylor, 2011). Across 94 studies high agreeableness, emotional stability, and conscientiousness related to greater investment in work, family, religion, and volunteering social roles, which support better social relationships (Lodi-Smith & Roberts, 2007). Lifespan Approaches to Personality and Health Why are personality and longevity linked? MECHANISMS & MODERATORS 3. Personality influences situations that a person selects or is drawn to. A conscientious person is more likely to obtain a good job and success professionally, leading to occupational advancement, income stability and associated health benefits. 4. Personality impacts experiences with and perceptions of stress. For instance, neuroticism is associated with experiencing a greater number of stressful events and using maladaptive approaches to dealing with stress, whereas conscientiousness is linked to adaptive coping styles (Carver & Connor-Smith, 2010). Stress increases risk of infections, illness, disease and breakdown (Kemeny, 2007). Lifespan Approaches to Personality and Health Why are personality and longevity linked? MECHANISMS & MODERATORS 5. Personality and health are most likely linked through a variety of connections – factors that impact BOTH personality and health. Personality is influenced by a number of genetic and environmental factors some of which also impact health. Lifespan Approaches to Personality and Health – health outcomes are hard to predict Lifespan Approaches to Personality and Health Even within this complexity, the Friedman et al studies show that personality matters Focus of earlier studies of personality and health was on negative emotional variables, Friedman et al., 1993 turned to positive variables, for the first time suggesting the protective effect of conscientiousness. Lifespan Approaches to Personality and Health Links between personality and health are not consistent or straightforward. For Example: some studies have found associations between higher neuroticism and increased mortality (Shipley, Weiss, Der, Taylor, & Deary, 2007; Weiss, Gale, Batty, & Deary, 2009), others have found no link (Almada et al., 1991; Costa, Weiss, Duberstein, Friedman, & Siegler, 2014; Iwasa et al., 2008; Jokela et al., 2013). In fact, a few studies have found that neuroticism might protect against mortality (Korten et al., 1999; Ploubidis & Grundy, 2009; Weiss & Costa, 2005; Weiss, Gale, Batty, & Deary, 2013). Longitudinal studies grounded in theory are needed to understand the trajectory over time. Physical Health: Prospects for Improving Health Some possibility of changing personality More direct routes are likely to be better. University ofGalway.ie Interventions to improve health Costa and McCrae – personality is ‘set in stone’ by age 30, but other research suggests that personality does change over time. People become more agreeable and conscientious, and less extraverted in older adulthood. Yet, there is evidence of Rank-order stability (the most extraverted at age 20 are still the most extraverted at age 70 – even if average extraversion has declined) Interventions to improve health Mills Longitudinal Study of women: marriage, work and marijuana consumption related to changes in social responsibility (facet of conscientiousness) In healthy adults, One high-dose Psilocybin session increased openness to experience, and was maintained 12 months later (MacLean, Johnson, & Griffiths, 2011) In 20 adults with treatment-resistant depression, psilocybin therapy significantly decreased neuroticism, and increased openness, extraversion and conscientiousness 3 months later (Erritzoe, Roseman, Nour, MacLean, Kaelen, Nutt, Carhart-Harris, 2018). - Purposeful personality change is possible. Interventions to improve health Developing conscientiousness in individuals and communities may benefit public health. However, it is unclear whether it is beneficial or even possible to change conscientiousness itself, or rather specific facets, behaviours and pathways that it predicts. Interventions to improve health interventions that develop health promoting traits, behaviours and cognitions in children and adolescents more likely to have ongoing and cumulative benefits. Most work in this area has focused on facets of conscientiousness, such as self-regulation. Is associated with healthy behaviours, high achievement, higher income, better physical and mental health and less criminal behaviour (Duckworth & Seligman, 2017).  Interventions could target the pathways between conscientiousness and health, such as health behaviour. Increasing health behaviours, and teaching Interventions (non-conscientious) people to be responsible to improve workers and good citizens can result in health benefits regardless of whether personality health traits change (Chapman et al., 2014). Interventions to improve health Personality and health studies can also inform approaches to treatment: Adding a brief measure of personality to health records might point to patients at increased risk, and may help doctors to more quickly understand their patients helping to inform personalised care, (Chapman et al., 2014).