Ann. rheum. Dis. (1964), 23, 145.

PERSONALITY CORRELATES OF THE RAPIDITY OFPROGRESSION OF RHEUMATOID ARTHRITIS

BY

RUDOLF H. MOOS AND GEORGE F. SOLOMON*From the Department ofPsychiatry, Stanford University School ofMedicine, Palo Alto, California

Several recent papers (Moos and Solomon, 1963a,b, 1964) have shown some agreement concerning theparticular personality factors possibly related to theonset or course ofrheumatoid arthritis. The presentpaper reports an attempt to discover whether thereare relationships between personality variables andthe rapidity of progression ofrheumatoid arthritis.

There have been, to the authors' knowledge, littleor no previous investigations in this field. Threerecent comprehensive reviews covering, respectively,the treatment of rheumatoid arthritis (Wright, 1963),the epidemiology of rheumatoid arthritis withparticular attention to social and personality factors(Scotch and Geiger, 1962), and the associationbetween rheumatoid arthritis and personality charac-teristics (Moos, 1964), all failed to report a singlestudy attempting to relate the rapidity of progressionof illness to personal or social factors.

Patients with rheumatoid arthritis have beenconsistently found to show more compliance-sub-servience, nervousness-restlessness, depression,conservatism-security, and sensitivity (to anger) thanvarious control subjects. They are also apparently

* Formerly consultants to the Rheumatic Disease Group, Depart-ment of Medicine, University of California Medical Center, SanFrancisco, Calif.

strongly prone to deny their hostility, and to beself-sacrificing and masochistic, as well as shy,inhibited, perfectionistic, rigid, and moralistic (Moos,1964; Moos and Solomon, 1963a, b, 1964).The hypothesis was made that some of these

personality factors might differentiate betweenpatients whose disease had progressed relativelyrapidly and patients whose disease had progressedrelatively slowly. King (1955) had earlier hypothe-sized a possible relationship between the strictness ofego-control or inhibition of feelings and the severityof arthritis, and King and Cobb (1959) had foundsome differences between mild and severe arthriticpatients.

SubjectsThis study, which was done as a special part of a

larger longitudinal family study of rheumatoid arth-ritis, deals with 49 female arthritic patients; in 32 thedisease was classified as "definite" by virtue of ful-filling five or six of the criteria of active rheumatoidarthritis, and in seventeen as "classical" by virtue offulfilling seven or eight of the criteria established bythe American Rheumatism Association (1959).

Table I summarizes the duration of disease, stageof severity of disease, the grade or functional capacity

BLE I

SEVERITY AND DURATION OF DISEASE, FUNCTIONAL CAPACITY, AND RESULTS OFFH TEST IN ALL PATIENTS

Severity of Disease Functional Capacity Duration of Disease FII Test

Stage No. of Cases Grade No. of Cases Years No. of Cases* Result No. of Cases*

13 1 9 1-5 11 Negative 6

2 23 2 27 6-10 15 Positive 1:224 to 1:448 5

3 19 3 10 11-15 74 2I4 1 16-20 5

Positive 1:896 to 1:3,584 114 2 4 1 16-20 5

>20 10 Positive > 1:7,000 17

Total 47 47 48 39

* The number of cases does not total 49 because of missing data on a few patients.145

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ANNALS OF THE RHEUMATIC DISEASESmanifested by the patient, and the results of the FIltest (an agglutination test for the presence of rheu-matoid factor in the serum).Two groups of patients were selected from this

larger sample for further study. In one group therate of progression of the disease had been relativelyrapid and in the other relatively slow. Thosepatients who had had the disease for the longest timebut who were still classified in Stages 1 or 2 were inthe slow progression group, and those who had hadthe disease for the shortest time but were alreadyclassified in Stages 3 or 4 were in the rapid pro-gression group. The categories of Steinbrocker,Traeger, and Batterman (1949) were used tocharacterize the stages of disease (early, moderate,severe, and terminal). The eleven patients whosedisease had progressed most rapidly were thencompared with the eleven whose disease had pro-gressed most slowly. Table II shows the durationand stage of severity of disease for these two groups.

TABLE It

DURATION AND STAGE OF SEVERITY OF DISEASEIN PATIENTS SHOWING FAST AND SLOW PROGRESSION

Duration of Disease Severity of DiseaseRate of

Progression Years No. of Stage No. ofCases Cases

1-6 4 1 07-12 5 2 0

Fast 13-18 2 3 10>19 0 4 1

Mean 8'5 1 1 11

1-6 0 1 17-12 5 2 10

Slow 13-18 4 3 0>19 2 4 0

Mean 14- 3 1 1 1 1

The grade of functional capacity was, of course,different. Those in the rapid progression groupmanifested a greater absolute degree of incapacity

than those in the slow progression group; however,the degree of incapacity relative to the objectiveprogression of the disease was the same in bothgroups.

All patients had completed a questionnaire relatingto such variables as age, parents' occupational status,and education. This information made it possibleto match the two groups utilized in this study on anumber of background variables. It was importantto match the two groups by these factors since theyhave been repeatedly shown to affect responses on

psychological tests. Table III shows the closematching achieved between the two groups.

MethodsA Minnesota Multiphasic Personality Inventory

(MMPI) was administered to each patient in the slowand the fast progression groups. The MMPI is aself-administered objectively-scored 566-item ques-tionnaire which has been extensively used in clinicaland experimental research (Hathaway and McKinley,1951; Welsh and Dahlstrom, 1956). Over 200different scales measuring variables ranging fromsocial and emotional alienation to somatizationreaction, denial of symptoms, anxiety reaction, egostrength, ethnocentrism, intellectual efficiency, socialintroversion, and rigidity, have been empiricallyderived from these items.Those scales which had already been shown to

differentiate significantly between patients withrheumatoid arthritis and the healthy members oftheir families (Moos and Solomon, 1964) and thosewhich had been shown to differentiate significantlybetween patients with a high or low degree offunctional capacity relative to the stage of severityof their disease (Moos and Solomon, 1963c) were

chosen for comparison. These scales reflected (1)physical symptoms; (2) depression, apathy, lack ofmotivation; (3) general neurotic symptoms, includingalienation from self and others, anxiety, hostility;

TABLE III

BACKGROUND VARIABLES OF PATIENTS SHOWING FAST AND SLOW PROGRESSION

Rate of A verage Average Marital Status No. of Parents'Progression Age (yrs) Education (yrs) Children Occupational Class*

Single 2 0-1 6 1 0Fast 43*4 11 8 Married 5 2-3 3 lI 3

(11 cases) Widowed, divorced, >3 2 III 6separated, and/or IV 2remarried 4 V 0

Single 1 0-1 4 I 0Slow 47-9 11 2 Married 4 2-3 6 It 3

(11 cases) Widowed, divorced, >3 1 III 7separated, and/or IV Iremarried 6 V 0

* Classifications were made according to a modification of the Warner, Meeker, and Eells (1949) seven-grade grouping.

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PERSONALITY AND PROGRESSION OF ARTHRITIS

(4) psychological rigidity; (5) problems of control ofimpulses; (6) simnilarity to other "psychosomatic"diseases.

Rationally-derived MMPI scales constructed tomeasure personality trait dimensions, which, accord-ing to previous findings, were particularly prevalentin rheumatoid arthritis, were also scored. All 566items of the MMPI had been sorted independentlyby two sorters, who each decided whether an itemwas relevant to a particular personality trait dimen-sion, and, if relevant, how it should be scored toreflect that dimension. Eleven personality traitscales, including only items on which the two ratersagreed, were constructed in this manner.The detailed procedure by which the personality

trait dimensions had been identified from researchfindings in the literature has been described in aprevious paper (Moos and Solomon, 1963a). Thedimensions are listed in Table IV.

TABLE IV

PERSONALITY TRAIT SCALES DERIVED FROM MMPI

1. Dependency v. Denial of dependency, hyperindependence2. Physical activity v. Motor inhibition3. Duty conscientiousness v. Lackadaisicalness4. Compulsivity, perfectionism v. Disorderliness, slovenliness5. Compliance-subservience v. Defiance6. Masochism, self-sacrifice, denial of hostility v. Sadism7. Conservatism, security v. Boldness, willingness to take risks8. Overconcern about looks, impression v. Unconcern about

appearance9. Sensitivity (especially to others' anger) v. Insensitivity

10. Busyness v. Idleness11. Emotional lability v. Emotional stability

The following are typical examples:Item 235: "I have been quite independent and free

from family rule", was scored false on thedependent-independent dimension.

Item 138: "Criticism or scolding hurts me terribly",was scored true on the sensitivity-callous-ness dimension.

Item 493: "I prefer work which requires closeattention to work which allows me to becareless", was scored true on the compul-sive, perfectionistic dimension.

Item 408: "I am apt to hide my feelings in somethings to the point that people may hurtme without their knowing it", was scoredtrue on the masochism-self-sacrificedimension.

ResultsThe comparisons which reached statistical signifi-

cance (P <-05) are listed in Table V.The patients whose disease had progressed rela-

tively slowly scored higher on scales reflectingcompliance-subservience, perfectionism, denial ofhostility, capacity for status, social responsibility,

and social status; whereas those whose disease hadprogressed relatively rapidly scored higher on scalesreflecting physical malfunctioning, general mal-adjustment, judged anxiety, judged manifest hostility,and imperturbability.

TABLE V

GROUPS OF SCALES SHOWING SIGNIFICANTDIFFERENCES BETWEEN PATIENTS SHOWING SLOW

AND FAST PROGRESSION

Group Observations

I Physical symptomsPhysical Malfunctioning

II Depression, apathy, lack ofmotivationThere were no significantly differentiating scales

III General "neurotic" symptomsGeneral maladjustmentJudged anxietyImperturbabilityJudged manifest hostility* Capacity for status* Social responsibility* Social status* Compulsivity, perfectionism

IV Psychological rigidity-None

V Problems ofcontrol ofimpulsesPsychopathic deviate* Compliance, subservience v. defiance* Masochism, self-sacrifice, denial of hostility

VI Similarity to other "psychosomatic"conditions* Ulcer personality

* The slow progression group scored higher on this scale.

Typical items which also differentiated signifi-cantly (P< .05) between the two groups on thesescales include the following:

(1) "During the past few years I have been well mostof the time." This item was scored false on thephysical malfunctioning scale and was answeredfalse significantly more often by the rapidprogression group.

(2) "I feel anxiety almost all the time" and "It makesme nervous to have to wait", were both scoredtrue on the judged anxiety scale and were bothanswered true significantly more often by therapid progression group.

(3) "I think most people would lie to get ahead",and "It's all right to get around the law if youdon't actually break it", were both scored trueon the judged manifest hostility scale and wereboth answered true significantly more often bythe rapid progression group.

(4) "I am apt to pass up something I want to dowhen others feel that it isn't worth doing", wasscored true on the compliance-subservience scaleand was answered true significantly less often bythe rapid progression group.

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ANNALS OF THE RHEUMATIC DISEASESOther typical items differentiating between the

two groups include:

(1) "I am apt to hide my feelings in some things tothe point that people may hurt me without theirknowing it" (scored true on the masochism-self-sacrifice scale and answered true significantlyless often by the rapid progression group).

(2) "My parents have often objected to the kind ofpeople I went around with" (scored true on thepsychopathic deviate scale and answered truesignificantly more often by the rapid progressiongroup).

(3) "It wouldn't make me nervous if any membersof my family got into trouble with the law"(scored true on the imperturability scale, whichreflects, in general, a denial of sensitivity and aproclamation of independence from the opinionsof other people, and answered true significantlymore often by the rapid progression group).

The ulcer personality scale items, on which theslow progression group scored higher, tend to reflectcompliance, shyness, conscientiousness, religiosity,and moralism. Relevant items include:

"I like to go to parties and other affairs where thereis lots ofloud fun" (scored false);"I feel like giving up quickly when things go wrong"(scored false);"Everything is turning out just like the prophets ofthe Bible said it would";"I believe in the second coming ofChrist";"I prefer work which requires close attention towork which allows me to be careless."

There were several additional scales on which therapid progression patients scored higher than theslow progression patients, but not quite to a statisti-cally significant degree. These scales reflecteddepression, lassitude-malaise, denial ofsocial anxiety,familial discord, authority problems, delinquency,and predjudice.

DiscussionIt is clear that there were differences between the

two groups in their responses to the MMPI. Theparticular differentiating scales strongly suggest thatthose whose disease progressed more rapidly werebeginning to experience vague feelings of ego dis-organization and breakdown. Rheumatoid arthriticpatients, at least initially, tend to adjust to theirdisease with stoicism and optimism (Johnson, Shapiro,and Alexander, 1947), and tend to show the particularpersonality traits of compliance-subservience,masochism, self-sacrifice, perfectionism, rigidity, and

moralism. Those whose disease had progressedmore rapidly could be differentiated from the otherson some of these personality traits. The patientswith rapidly progressing disease obtained higherscores on scales reflecting anxiety and manifesthostility, but lower scores on scales reflectingcompliance-subservience, compulsivity-perfection-ism, masochism-self-sacrifice, social status, and socialresponsibility. These group differences suggest thatthe patients with rapidly progressive disease wereexperiencing an inability to use previously successfulcoping mechanisms; they were more anxious anddepressed, and they were not as well able to utilizethe adaptive defences of compliance, compulsivity,and suppression of anger as were those in the slowprogression group.The patients with rapidly progressive disease

appeared to be making a strong but relativelyunsuccessful attempt to keep their impulses undercontrol. On the one hand they attempted to denytheir anxiety in social situations and affirm theirindependence from other people (imperturbability)and on the other hand they obtained higher scoreson the judged anxiety scale and lower scores on thesocial status and responsibility scales. It is probablethat these patients felt more isolated, and lonely, andalienated from others, that they received less socialsupport in attempting to cope with their disease;that they were experiencing feelings of ego dis-organization, with a concomitant increase in anxietyand depression and a decrease in the ability tocontinue their former modes of adaptation andcoping; that they were still strongly attempting toregain ego control through increased defensivenessand partial denial of anxiety. The breakdown ofprior adaptive modes appears to manifest itself moststrongly around additional problems with the controlof impulses.The relationship of personality factors to the

rapidity of progression of disease has been studiedin other disease states, including multiple sclerosisand cancer.

Personality characteristics of passive dependency,submission, compliance, absence of awareness ofinner tension, excessive cordiality and friendliness,immaturity, and depression have been linked topatients suffering from multiple sclerosis. Manyinvestigators have hypothesizedrelationships betweenexacerbations and relapses and emotional shock orstress, precipitated by severe mental conflict, financialworries, increased responsibilities, an unhappy homelife, or loss of an important sustaining relationship.Two investigators attempted to correlate personaland social factors with the progression of the disease.Baldwin (1952) found that depression, which was

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PERSONALITY AND PROGRESSION OF ARTHRITIS

the predominant pattern in almost all cases ofmultiple sclerosis, was directly related to the lengthand degree of progression of the disease process.Wullstein (1957), in a study of over 4,800 cases ofmultiple sclerosis, concluded that the course of thedisease was influenced, at least to a limited degree,by occupation, social position, military service, orprevious illness or accidents.

Interest in these questions in cases of cancer,judging from the number of publications, has beeneven more intense (Le Shan and Worthington, 1956a,b). Patients with cancer have been characterized asbeing subject to sudden stresses such as the loss of animportant sustaining relationship, as showing evi-dence of despair, as being unable to discharge theirfeelings directly and thus showing high levels ofanxiety, as being victims of prolonged frustrationand/or lack of satisfaction, and as showing paranoidtendencies and various other personality problems.There have been several attempts to relate the severityof these and other personality characteristics to therapidity of progression of malignant growth(Gengerelli and Kirkner, 1954). Blumberg and hiscollaborators suggested that rapidly progressingcancer cases were characterized by a high degree ofdefensiveness, a high amount of anxiety anddepression, and an abnormal lack of ability to de-crease anxiety through some outward correctiveaction (Blumberg, West, and Ellis, 1954). Perrinand Pierce (1959) have criticized these studies, butappear to take seriously the possibility that patientswith fast-growing cancers are more defensive, moreinhibited, and more anxious than patients withslow-growing cancers. Klopfer (1957) has suggestedthat:

If a good deal of the vital energy that the patient hasat his disposal is used up in the defence of an insecureego, then the organism seems not to have the vitalenergy at his disposal to fight the cancer off. If,however, a minimum of vital energy is consumed inego defensiveness, then the cancer has a hard timemaking headway.

Using this and other criteria Klopfer was able todifferentiate significantly between patients with fastand slow-growing tumours on the basis of theirRorschach protocols. Renneker, Cutler, Hora,Bacon, Bradley, Kearney, and Cutler (1963) suggestthat depressive reactions may decrease host resis-tance, and Shrifte (1962) that cancer patients with apoorer prognosis tend to put more into the outsideworld than they take from it.

Our results are basically, although not totally,consistent with those relating rapidity of progression

of malignant growth to personality factors in cancer.Patients with rapidly-progressing rheumatoid arth-ritis and patients with rapidly-progressing malignantgrowth tended to invest a high amount of energy inego-defensiveness and to show evidence of defencefailure as indicated by increasing degrees of anxietyand depression. The rapidly-progressing arthriticpatients were, on the other hand, less inhibited thanthose with slowly-progressing disease, a findingseemingly in direct contradiction to that in cancer.It is likely that this difference is related to therelationship between the stage of progression of adisease and the time of psychological evaluation.The cancer patients were, in general, evaluated earlyin the disease process, and, at that stage, their egodefensive mechanisms were still successful enough toward off problems or control of impulses. It ispossible, had they been evaluated later, that theirdefensive mechanisms would have been less suc-cessful and that they would therefore have mani-fested difficulties with impulsivity, as did ourrapidly-progressing arthritic patients, who weregenerally evaluated quite late in the disease process.Our results were also comparable to those of

Baldwin (1952), who found a positive relationshipbetween depression and the length and degree ofprogression of multiple sclerosis. The patients withrapidly-progressing rheumatoid arthritis had higherscores (although not quite to a statistically significantdegree) on the depression and lassitude-malaise scalesthan those whose disease had progressedmore slowly.

It is not clear to what extent the particularpersonality factors mentioned as related to rapidityof progression of disease are related to this factorrather than to the degree of incapacity which thepatient shows. Similar personality factors differ-entiated between one group of patients who showeda relatively high degree of functional capacity andanother group who showed a relatively low degreeof functional capacity (Moos and Solomon, 1963c).Unfortunately, however, because of the relativelysmall total number of cases available, it was notpossible completely to match rapidity of progressionin the two groups of our earlier study or grade ofcapacity in the two groups used in this study.Grade of capacity relative to the progression of thedisease state had been matched; however, the patientswith rapidly progressing disease were, on an absolutelevel, functioning more poorly than the patientswhose disease had progressed more slowly.

These factors suggest that the results must beinterpreted with caution. Answers to questionsregarding the reliability of these findings, and theextent to which relevent personality factors arerelated to the rapidity of progression of disease and

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ANNALS OF THE RHEUMATIC DISEASESto the degree of functional capacity of the patient,or to both, must await further research.

It is of course undetermined to what extent thedifferences in these two groups reflect differences inreaction to the fact of having a chronic disease andto what extent they reflect personality differencespresent before the onset of illness. The slow pro-gression group, for whatever reasons, were still ableto maintain, in the face of the stress of chronicallycrippling illness, quite adequate adaptation, butthose in the rapid progression group were beginningto find the stress potentially highly disruptive andthreatening.The findings may reflect the fact that it is psycho-

logically easier to adapt successfully to a moreslowly progressing disease, partly because the patienthas longer to mobilize his defensive and adaptive egoresources. One may also see the process as a"vicious circle" in which the high degree of energy(pre-disease) involved in ego defensiveness againstanxiety or depression and the rapid progression ofthe disease mutually enhance and reinforce eachother.The stress of disease may stimulate adaptations

which seem, on the surface at least, partially success-ful. In some patients these defences consume agood deal of the available vital energy, and it seemsto be in these patients that the disease progressesmore rapidly. This may lead to greater stress, andthis may, in turn, lead to a greater expense of energyon defensive mechanisms, and this again to increasedrapidity ofprogression ofdisease. In this connexion,it is possible that the physiological concomitants ofincreased anxiety and depression (e.g. high levels ofcorticosteroids which probably depress lymphocytesand thus antibody formation) may be related toresistance to disease. These and other possiblemechanisms will be discussed in a later paper.

SummaryIt has been suggested that particular personality

factors may differentiate between rheumatoid arth-ritic patients whose disease progresses relativelyrapidly and those whose disease progresses relativelyslowly. Those patients whose disease had pro-gressed most rapidly (shortest duration and greatestseverity) and those whose disease had progressedmost slowly (longest duration and least severity)were selected from a larger sample and compared onan objective psychological inventory.The patients with relatively slow disease pro-

gression scoredhigheron scalesreflectingcompliance-subservience, perfectionism, denial of hostility,capacity for status, social responsibility and social

status; whereas those with relatively rapid diseaseprogression scored higher on scales reflecting physicalmalfunctioning, general maladjustment, judgedanxiety, judged manifest hostility and imperturb-ability.

It is suggested that the patients whose disease wasprogressing most rapidly were experiencing feelingsof ego disorganization with concomitant increase inanxiety and depression and decrease in the ability tocontinue former modes of psychological adaptationand coping. Data relating progression of diseaseto personality factors in multiple sclerosis and cancerare reviewed and it is suggested that the process maybe regarded as a "vicious circle" in which the highdegree of energy involved in ego defensiveness andthe rapid progression of the disease mutuallyenhance and reinforce each other.

Part of this research was conducted during the seniorauthor's tenure at a postdoctoral fellowship in theInterdisciplinary Program for Research in the BasicSciences Related to Mental Health, and thejunior author'stenure as a USPHS career teacher in psychiatry, both atthe University of California School of Medicine, SanFrancisco.The research was supported in part by funds made

available from USPHS Grants 2M-7082 and 2M-7552,and by a grant from the Northern California Chapter ofthe Arthritis and Rheumatism Foundation.

Particular appreciation is due to Dr. Ephraim P. Engle-man and the Rheumatic Disease Group, Department ofMedicine, University of California Medical Center, SanFrancisco, for making the patients available for theinvestigation, to Dr. Curtis Hardyck and Bernice S. Moosfor their exceedingly helpful consultation on computeranalysis of the data, and to Eleanor Vaughn and Dr.Hector Boffi for valuable help in various phases of theinvestigation.

REFERENCES

American Rheumatism Association (1959). "Primer onthe Rheumatic Diseases." The Arthritis andRheumatism Foundation, New York.

Baldwin, M. V. (1952). J. nerv. ment. Dis., 115, 299.Blumberg, E. M., West, P. M., and Ellis, F. W. (1954).

Psychosom. Med., 16,277.Gengerelli, J. A., and Kirkner, F. J. (eds.), (1954). "The

Psychological Variables in Human Cancer".University of California Press, Los Angeles.

Hathaway, S. R., and McKinley, J. C. (1951). "Minne-sota Multiphasic Personality Inventory Manual",rev. ed. Psychological Corporation, New York.

Johnson, A., Shapiro, L. B., and Alexander, F. (1947).Psychosom. Med., 9,295.

King, S. H. (1955). J. chron. Dis., 2,287.- and Cobb, S. (1959). Arthr. and Aheum., 2,322.Klopfer, B. (1957). J.proj. Tech., 21,331.

150

group.bmj.com on November 18, 2013 - Published by ard.bmj.comDownloaded from

PERSONALITY AND PROGRESSION OF ARTHRITISLeShan, L., and Worthington, R. E. (1956a). Brit. J.

med. Psychol., 29,49.(1956b). J. nerv. ment. Dis., 124,460.

Moos, R. H. (1964). J. chron. Dis., 17,41.and Solomon, G. F. (1963a, b, c). Unpublishedstudies.

(1964). J. psychosom. Res. (in press).Perrin, G. M., and Pierce, I. R. (1959). Psychosom.

Med., 21,397.Renneker, R. E., Cutler, R., Hora, J., Bacon, C., Bradley,

G., Kearney, J., and Cutler, M. (1963). Ibid., 25,106.

Scotch, N. A., and Geiger, H. J. (1962). J. chron. Dis.,15, 1037.

Shrifte, M. L. (1962). Psychosom. Med., 24, 390.Steinbrocker, O., Traeger, C. H., and Batterman, R. C.

(1949). J. Amer. med. Ass., 140,659.Warner, W. L., Meeker, M., and Eells, K. (1949).

"Social Class in America: A Manual of Procedurefor the Measurement of Social Status." ScienceResearch Associates, Chicago.

Welsh, G. S., and Dahlstrom, W. G. (eds) (1956)."Basic Readings on the MMPI in Psychology andMedicine." University of Minnesota Press,Minneapolis.

Wright, V. (1963). J. chron. Dis., 16,83.Wullstein, 0. (1957). Excerpt. med., Sect. 8, 10, 30.

"VI int. Congr. Neurol., Brussels, 1957."

La personalit6 en fonction de la vitesse d'evolutionde l'arthrite rhumatismale

RtSUMEI1 a ete postule que des facteurs particuliers de person-

alite peuvent differentier entre des patients atteintsd'arthrite rhumatismale a 6volution relativement rapideet ceux dont la maladie evolue relativement lentement.Des patients dont la maladie avait 6volue le plus rapide-ment (la plus courte dur&e, la plus grande severit6) etceux dont la maladie avait evolue le plus lentement (laplus longue duree et la moindre severit6) ont et6 choisisd'entre un grand nombre de malades et compares al'aide d'une echelle psychologique objective.Les malades atteints d'arthrite a evolution relativement

lente ont marque plus de points quand il s'agissait de:conformit6-asservissement, perfectionisme, deni d'hosti-lit6, capacite pour status, responsabilit6 sociale et rangsocial; par contre, les malades atteints d'arthrite a

evolution relativement rapide ont marque plus de pointsquand il s'agissait de: desordre de la fonction physique,mauvais ajustement general, anxiete jugee, hostilitMmanifestejugee et imperturbabilite.On pense que les patients dont la maladie evoluait

tres rapidement eprouvaient la sensation de desorganisa-tion de l'ego avec augmentation concomitante del'anxiete et de la depression et avec diminution de lacapacite de maintenir leur modes d'adaptation psycho-logique et de faire face aux difficultes. On passe enrevue les faits concernant l'evolution morbide par rapportaux facteurs de personalite dans la sclerose en plaques etdans le cancer et on pense qu'il peut s'agir ici d'un "cerclevicieux", oii beaucoup d'energie appliquee a l'actiondefensive de l'ego et l'evolution rapide de la maladies'augmentent et se renforcent mutuellement.

La personalidad en funci6n de la rapidez de evolucionde la artritis reumatoide

SUMARIOSe ha sugerido que factores particulares de personali-

dad pueden diferenciar entre pacientes con artritisreumatoide cuya enfermedad sigue un curso relativa-mente rApido y aquellos cuya enfermedad sigue un cursorelativamente lento. Pacientes cuya enfermedad habiaprogresado mas rApidamente (menor duraci6n y mayorseveridad) y los cuya enfermedad habia adelantado masdepacio (mayor duraci6n y menor severidad) fueronelegidos de un mayor grupo de enfermos y comparadoscon la ayuda de una escala psicologica objetiva.Los enfermos con artritis de evolucion relativamente

lente marcaron mAs puntos al tratarse de: conformidad-sumision, perfeccionismo, denegaci6n de hostilidad,capacidad de mantener su posicion social (status),responsabilidad social y nivel social; en cambio, los conartritis de evolucion relativamente rapida marcaron mAspuntos al tratarse de: trastomo de la funci6n fisica, malajustamiento general, ansiedad juzgada, hostilidadmanifiestajuzgada e imperturbabilidad.

Se sugiere que los pacientes cuya enfermedad adelan-taba muy rapidamente percibian la sensaci6n dedesorganizacion del ego con aumento concomitante deansiedad y de depresi6n y con disminucion de la capacidadde mantener sus modos de adaptaci6on psicol6gica y dehacer frente a las dificultades. Se repasan los datosrespecto a la relacion entre la evolucion de la enfermedady los factores de personalidad en la esclerosis diseminaday en el cancer y se sugiere que se trata aqui de un "circulovicioso", en que mucha energia aplicada a la acciondefensiva del ego y la evoluci6n rApida de la enfermedadse aumentan y reforzan mutualmente.

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doi: 10.1136/ard.23.2.145 1964 23: 145-151Ann Rheum Dis

 Rudolf H. Moos and George F. Solomon Rheumatoid ArthritisRapidity of Progression of Personality Correlates of the

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