Medical Psychology 24.03.2011

The role of personality in changes of health status

Is there a ConnectionIs there a ConnectionBetween Personality and Between Personality and

DiseaseDisease??

► Workaholics have heart Workaholics have heart attacks?attacks?

► Worriers get ulcers?Worriers get ulcers?

► Uptight people get asthma?Uptight people get asthma?

Stress and Heart Disease: Clinical Evidences

► Highly stressed workers were 2x as likely to die from heart problems (Kivimaki et al 2002)

► Stress-prone individuals with heart problems 3x more likely to die from heart attack (Sheps et al 2002)

► Stress-prone individuals: higher LDL ‘bad’ blood cholesterol (Steptoe et al 2005)

Stress & Heart Disease: The „Type-A” Study

(Friedman & Rosenman 1974)

► 3200 healthy American men

► Characteristics of stress-prone individuals (Type A-s):– Anger & hostility– Competitiveness– Time-urgency

Follow-Up Study (Friedman & Rosenman, 1982)

After 8½ years, participants were reassessed

► 257 had developed CHD► Of these, 70% were Type As

Association remained when smoking and other lifestyle factors were accounted for

Type A & Heart Disease

(Miller, et al., 1991)

Characteristics of the Type A Personality

• Strenuous work • Poor sleep pattern• Compulsive tendencies • Aggressive• Depressive and neurotic

tendencies • Angry, impatient • Low on introspection• Anxious • Hard driving• Little time for relaxation • Conscientious

Type A Type B

Type A-s and Type B-s

Type A Type B

Personality Characteristics

Time Urgency

Easily aroused hostility

Competitiveness

Not constantly in a hurry

Can relax without feeling guilty

Not easily hostile

Not overly competitive

Heart Attack Frequency

Twice that of Type B

Half that of Type A

Type A Behavior Patterns in Stress and Illness

► respond more quickly, rapidly to stressors, seeing them as threats.

► greater physiological reactivity► tend to seek out demanding

situations which leads to stress.

► ignore early signs of heart attacks► often fail to adhere to medical

regimens

Physical (Facial) Signs of Type A Behaviour

► Facial tension (tight lips, clenched jaw, etc.)

► Tongue clicking or teeth grinding

► Dark circles under eyes

► Facial sweating (on forehead or upper lip)

The key factor in the type A personality that makes a person more susceptible to heart disease is:

1. Competition

2. Ambition

3. Hostility 4. Fast pace

5. Upset easily

Hostility is a form of

angry internal rejection or denial

in psychology (George Kelly, 1957).

In everyday speech it is more commonly used as a synonym for anger and aggression.

Hostility and Coronary Heart Disease

Hostility is predictor of CHD and mortality, especially when it is expressed outward and involves cynicism. (Matthews et al. 1998)

200 females over 10 years, high initial hostility -> more likely symptoms of CHD 10 years later (Niaura et al., 2002)

– older males with coronary artery blockage: 8% L hostility, 18% H hostility

Higher resting blood pressure poorer heart pumping efficiency, and higher heart rate

Personality factors may influence health behaviour

People high in neuroticism, hostility and Type-A behaviors are more likely

to:

► smoke and abuse alcohol

► eat less healthy foods

► avoid exercise

► sleep less

► use more caffeine

► more traffic risk taking behaviors

Personality factors, physiological reactions to stress, and cardiovascular response

Hostility: higher heart rates and blood pressure – extreme cardiac response to stress (Raikkonen et al., 1999)

Hostile persons mistrust others and are on guard – higher physiological arousal and more ware and tear on heart

Type D Personality (Denollet et al 1996)

► Gloomy, socially inactive

►‘Distressed personality’ – associated with depression and social alienation

Greater risk of heart attack!► FOLLOW-UP STUDY: 300 male and

female heart attack sufferers. 10 years later Type D-s 4x more likely to have another heart attack (Denollet et al 1996)

Type C (Cancer-Prone) Personality (Temoshok, 1987)

Lydia Temoshok

Characteristics of Type C-s

► Suppress emotions – especially negative ones

► Unassertive

► Likeable – non-argumentative, want to please others

► Generally helpful to others

Effects of Type-C Personality

Cope with stress in a way that ignores their own needs (even physical ones).

Stresses suppressed.

More susceptible to cancer because more chronic stressors affect the immune system and increase risk of cancer.

Pessimistic explanatory style and low perceived control correlate with weaker immune responses - poorer DNA repair

Controversies in Cancer and Personality Connections

• Population-based cohort study 59,548 Swedish (1974–1999) and Finnish (1976–2004) participants

association of personality traits extraversion and neuroticism with risk of

cancer

• 4,631 cancer cases for a maximum 30 years of follow-up

• Extraversion and neuroticism were not significantly associated with risk of cancers at all sites

(Nakaya et al, 2010)

► Some personality characteristics make us more vulnerable to the negative effects of stress, while others makes us more resilient.

Is there a Disease-Prone Personality?

Evidences and DilemmasEvidences and Dilemmas

► It It is is proved proved that there is athat there is ann “immune- “immune-prone” personalityprone” personality, a personality that is , a personality that is “hardy” to the effects of stress.“hardy” to the effects of stress.

► It is It is provedproved that that emotions play a key emotions play a key role role in the outcome (recovery rate) of illness in the outcome (recovery rate) of illness but but not in causing not in causing illnessillness..

►It is still a It is still a question question whetherwhether there is there is anyany personality that predicts illness.personality that predicts illness.

Research has so far proved Research has so far proved

only only that that

personality personality

probably probably plays an important roleplays an important role

in determining our health status.in determining our health status.