DISC Personality Traits and Well-Being Among Medical Students in Saudi Arabia: A Cross-Cultural Pilot: Cross-Sectional Study

Abstract

This cross-sectional pilot study examined associations between DISC personality traits (Dominance, Influence, Steadiness, Conscientiousness) and psychological well-being among 62 medical students from 10 countries at a private university in Saudi Arabia. Well-being was measured with the WHO-5 well-being index (mean=14.08, SD=4.99) using simplified self-categorization for DISC assessment. Steadiness (69.4%) and Conscientiousness (66.1%) were the most frequently endorsed traits, consistent with patterns observed in other medical trainee populations. No significant associations were found between any DISC trait and WHO-5 well-being scores. Effect sizes were small (Steadiness g=0.43, 95% CI −0.06 to 1.00; Influence g=0.34, 95% CI −0.17 to 0.89), and multivariable regression explained minimal variance (R²=0.074). Conscientiousness prevalence differed across countries (P=0.001), although subgroup sizes were small. These null findings suggest no association between DISC traits and well-being in this pilot sample, contrasting with recent studies reporting DISC associations with perceived stress. This divergence highlights important distinctions between stress reactivity and baseline well-being as outcomes. Broader contextual factors including academic workload, institutional support, and cultural context may be more relevant to well-being than behavioral style alone. DISC may be more appropriately applied to communication training and team development rather than well-being prediction. Future research should employ validated DISC instruments, larger culturally balanced samples, and examine both stress and well-being outcomes to clarify the differential predictive utility of personality profiles across psychological constructs.

Introduction

Personality and behavioral tendencies have been examined in relation to academic performance and well-being among medical students.^1–3 Most work has focused on trait-based models, while less is known about behavioral style frameworks such as DISC, which is frequently used in educational and clinical training settings.^4,5 DISC, developed by Marston,⁶ describes outward behavioral preferences as Dominance, Influence, Steadiness, and Conscientiousness, and may illuminate interpersonal communication patterns and teamwork dynamics within multicultural learning environments. Recently, DISC has been applied to leadership development training for internal medicine residents, demonstrating utility as a framework for enhancing self-awareness and interpersonal communication.⁷

Despite widespread use of DISC in medical education and clinical training settings, research on DISC and psychological outcomes in medical students remains limited and inconclusive. While one recent study found significant differences in perceived stress across DISC personality types among Indonesian medical students,⁸ the relationship between DISC profiles and broader well-being outcomes has not been systematically examined, particularly in multicultural settings. This gap is particularly relevant because DISC frameworks are frequently applied to team-based learning, interprofessional communication training, and clinical skills development in medical education, yet their relevance to student psychological well-being remains unclear. Additionally, the high-stress medical education environment characterized by intense academic workload, clinical exposure, and performance pressure may differentially affect students with varying behavioral tendencies. Furthermore, cross-cultural variation in behavioral style expression remains under-explored in multicultural medical cohorts, where cultural background may shape both how students express behavioral preferences and how they experience and report well-being. Understanding these relationships could inform whether student support programs should consider behavioral style factors alongside traditional academic and environmental interventions, and whether DISC-based communication training might indirectly benefit student well-being.

Several studies in health-profession and dental education have explored DISC or similar frameworks in relation to communication, academic performance, and perceived stress.⁸ These studies demonstrate that DISC profiles are distributed across student populations and may relate to educational outcomes, though findings have been inconsistent across settings. Separately, personality profiles have been associated with well-being and resilience in medical students,⁹ and psychological well-being among medical students has been linked to academic demands, learning environment quality, and institutional support factors.¹⁰ In Saudi Arabian medical schools specifically, stress levels and their sources have been well-documented,¹¹ though the relationship between DISC behavioral styles and well-being outcomes remains largely unexamined, particularly in multicultural medical education contexts where cultural norms may influence both behavioral expression and well-being.

Given this gap and the need for preliminary data to guide future research, the current pilot study aimed to describe DISC behavioral style distribution in a culturally diverse medical student cohort and examine whether DISC styles were associated with WHO-5 well-being scores.

Materials and Methods

Study Design and Ethics

A cross-sectional observational design was used. Ethical approval was obtained from the Alfaisal University Institutional Review Board (IRB20308, dated 3rd June 2024). All participants provided written informed consent in accordance with the Declaration of Helsinki prior to survey completion.

Participants and Sampling

Participants were recruited through convenience sampling via student Email listservs and course announcements between May and June 2024. Students from all academic years at Alfaisal University College of Medicine were eligible to participate regardless of nationality or country of origin. Alfaisal University enrolls both Saudi and international medical students from diverse countries; the multicultural composition of the sample reflects the university’s international student body. The sampling approach aimed to capture diverse cultural backgrounds; however, this method may introduce selection bias as participation was voluntary and students who self-selected may differ systematically from non-responders in personality traits or well-being levels. Cultural representation was not balanced by design, limiting generalizability of cross-cultural comparisons. No stratification by country, academic year, or demographic characteristics was performed.

Procedures

Deidentified survey data were collected through an online questionnaire administered via Google Forms. The survey took approximately 10–15 minutes to complete. After providing informed consent, participants completed demographic questions (age, sex, academic year, country of origin), the Well-being index, and DISC self-categorization items. No identifying information was collected to ensure participant confidentiality.

Measures

WHO-5 Well-Being Index

The WHO-5 Well-being index is a brief 5-item self-report measure assessing psychological well-being over the previous two weeks.¹² Items are rated on a 6-point Likert scale (0 = at no time, 5 = all the time), yielding a total raw score range of 0–25, with higher scores indicating better well-being.

DISC Behavioral Style

DISC style was assessed using simplified self-categorization. Participants were presented with brief descriptive statements for each of the four DISC behavioral styles (Dominance: direct, results-oriented, decisive; Influence: enthusiastic, optimistic, collaborative; Steadiness: patient, supportive, consistent; Conscientiousness: analytical, detail-oriented, systematic) and asked to select all traits that described their typical behavioral tendencies. Participants could endorse multiple styles. This simplified self-identification approach has lower psychometric validity compared to validated DISC instruments such as the DISC Classic Profile or DISC Workplace Assessment. Similar simplified or freely available DISC assessment tools have been used in previous medical education research;^13,14 though psychometric properties of these instruments remain largely unestablished.

Statistical Analyses

The analyses were conducted using Python 3.11 (Python Software Foundation, Wilmington, DE, USA). Descriptive statistics (means, standard deviations, frequencies, percentages) characterized the sample and variable distributions. Univariate comparisons of WHO-5 scores by DISC trait presence/absence were conducted using independent samples t-tests, with Hedges’ g effect sizes and 95% confidence intervals reported. Multivariable linear regression examined the simultaneous association of all four DISC traits with continuous WHO-5 scores. Multivariable logistic regression examined associations with dichotomized well-being (WHO-5 ≥15 vs <15). Chi-square tests examined differences in DISC trait prevalence across countries with ≥5 participants. The statistical significance level was established at α = 0.05.

As a pilot study, formal power calculations were not performed a priori. Post-hoc power analysis indicated that with n=62 and observed effect sizes (g=0.34–0.43), statistical power ranged from 15–25% to detect significant differences at α=0.05, confirming this study was underpowered for inferential testing. Accordingly, results are interpreted descriptively with emphasis on effect size estimates and confidence intervals rather than statistical significance testing.

Results

The sample included 62 students from 10 countries. Sample characteristics are presented in Table 1. The mean WHO-5 WELL-BEING INDEX score was 14.08 (SD=4.99). Steadiness (69.4%) and Conscientiousness (66.1%) were the most frequently endorsed DISC traits; participants could select multiple traits.

Table 1.

Sample Characteristics and DISC Trait Prevalence

Characteristic	Value
Sample size (total)	62
Valid WELL-BEING INDEX scores	62
WHO-5 well-being scores mean (SD)	14.08 (4.99)
WELL-BEING INDEX median (IQR)	14 (10–18)
DISC Trait Prevalence
Dominance	32 (51.6%)
Influence	30 (48.4%)
Steadiness	43 (69.4%)
Conscientiousness	41 (66.1%)

Notes: WHO-5 well-being scores (0–25; higher scores indicate better well-being). Participants could endorse multiple DISC traits.

Univariate analyses (Table 2) showed small, non-significant differences in WHO-5 well-being scores across traits. Steadiness had the largest effect size (g=0.43), and Influence had a similarly modest estimate (g=0.34). Dominance and Conscientiousness showed minimal or slightly negative differences. All confidence intervals included zero. Figure 1 displays WHO-5 well-being scores distributions by trait presence/absence for each DISC dimension.

Table 2.

DISC Trait Comparisons: Well-Being Index Score Differences

DISC Trait	Mean Difference	Hedges g	95% CI	P-value
Dominance	−0.30	−0.06	[−0.55, 0.46]	0.700
Influence	1.72	0.34	[−0.17, 0.89]	0.200
Steadiness	2.17	0.43	[−0.06, 1.00]	0.200
Conscientiousness	−0.96	−0.19	[−0.74, 0.32]	0.500

Notes: Mean differences represent Well-being index score difference between trait-present versus trait-absent groups. All confidence intervals include zero, indicating non-significant associations.

Abbreviation: CI, confidence interval.

Figure 1.

WHO-5 Well-being scores by DISC Personality Trait. Box plots comparing WHO-5 well-being scores for participants with each DISC trait present (green) versus absent (pink). Each box plot shows the distribution of well-being scores: the box represents where the middle 50% of scores fall, with a line marking the median (middle value), and the vertical lines (whiskers) showing the range of most data points. Overlapping boxes and similar medians indicate no meaningful difference between groups. For example, students with Steadiness present have similar well-being score distributions to those without Steadiness. WHO-5 scores range from 0–25, with higher scores indicating better well-being. N = 62 participants from 10 countries. Traits coded as present (1) or absent (0).

Abbreviations: DISC, Dominance, Influence, Steadiness, Conscientiousness.

Multivariable linear regression (R²=0.074) and logistic regression yielded non-significant coefficients for all DISC traits. Steadiness and Influence displayed the largest numerical coefficients, but with wide confidence intervals. See Table 3.

Table 3.

Multivariable Regression Results

A. Linear Regression (R2=0.074)
Predictor	Coefficient (β)	95% CI
Dominance	−0.09	[−2.58, 2.40]
Influence	1.46	[−1.17, 4.10]
Steadiness	2.22	[−0.48, 4.93]
Conscientiousness	−0.69	[−3.49, 2.10]
B. Logistic Regression (Outcome: Well-being index ≥15)
Predictor	Odds Ratio	95% CI
Dominance	0.78	[0.29, 2.11]
Influence	1.67	[0.61, 4.57]
Steadiness	2.49	[0.80, 7.77]
Conscientiousness	0.71	[0.25, 2.04]

Notes: All confidence intervals include the null value (0 for linear regression, 1 for logistic regression), indicating non-significant associations.

WHO-5 well-being scores were similar across Saudi Arabia (M=14.2, SD=4.8, n=20), India (M=13.9, SD=5.3, n=15), and Pakistan (M=14.5, SD=4.7, n=12). Conscientiousness prevalence differed significantly by country (P=0.001), largely due to higher endorsement in Pakistan and India. Other DISC traits showed no consistent pattern. These findings warrant careful interpretation considering both the study’s design and the broader medical education context.

Discussion

This pilot study did not identify statistically significant associations between DISC behavioral styles and WHO-5 well-being scores. Although Steadiness and Influence displayed slightly higher mean well-being scores, the confidence intervals were wide and included zero, supporting a descriptive rather than inferential approach.

DISC Distribution Among Medical Students

The prominence of Steadiness and Conscientiousness in this cohort is remarkably consistent across multiple studies of medical trainees using DISC assessment. A recent study of internal medicine residents in the United States found that 46% identified primarily as Steadiness and 35% as Conscientiousness,⁷ while a study of Indonesian medical students reported nearly identical distributions (Steadiness: 39.44%, Conscientiousness: 40.84%).⁸ These convergent findings across different countries and training levels strongly support the notion that S and C behavioral styles may be more prevalent among individuals pursuing medical careers. The even higher prevalence observed in our study (69.4% Steadiness, 66.1% Conscientiousness) likely reflects our methodological approach of allowing multiple trait endorsement, whereas other studies typically assign a single dominant personality type.^7,13,15 This consistent pattern across cultures suggests that medical education may attract or select individuals with behavioral tendencies toward patience, consistency, analytical thinking, and attention to detail characteristics central to S and C profiles. Such variation in reported prevalence may also reflect institutional cultures, cultural contexts, or differences in how individuals from various backgrounds perceive and report their behavioral tendencies. The cross-cultural nature of our sample adds additional complexity, as cultural norms around self-description and behavioral expression may influence DISC self-categorization. Because DISC was measured using simplified self-categorization rather than validated instruments,¹⁶ these findings should be considered preliminary and interpreted with appropriate caution.

Null Findings: Stress versus Well-Being as Distinct Constructs

The null findings in our study warrant careful interpretation in light of recent evidence linking DISC profiles to perceived stress in medical students. Angriyani and Angelika⁸ found significant differences in perceived stress levels across DISC types, with Influence (I) personality types reporting lower stress compared to Dominance (D) and Steadiness-Compliance (SC) types. This contrasts with our finding of no significant associations between DISC traits and WHO-5 well-being scores. Several factors may explain this divergence.

First, perceived stress and psychological well-being, while related, represent distinct constructs. Stress, as conceptualized in transactional stress theory,¹⁷ reflects the appraisal of demands as exceeding resources, whereas well-being encompasses broader positive psychological functioning including life satisfaction, positive affect, and sense of purpose. DISC behavioral styles may differentially affect reactivity to acute stressors (captured by stress measures) without substantially influencing baseline well-being states. The Perceived Stress Scale¹⁷ used by Angriyani and Angelika⁸ specifically assesses feelings of being overwhelmed and lacking control over the past month, whereas the WHO-5 well being index measures general positive well-being over two weeks, these temporal and conceptual differences may yield different sensitivity to personality effects.

Second, cross-cultural factors may moderate the personality-outcome relationship. Indonesian and Saudi students face different cultural expectations, educational systems, and social support structures that could amplify or attenuate personality effects. In collectivist cultures where interpersonal harmony and group cohesion are emphasized, behavioral style preferences may interact differently with environmental stressors compared to more individualistic cultural contexts. Research in Saudi Arabian medical schools has documented specific stressors related to academic workload, examination pressures, and cultural expectations,¹⁴ which may interact with personality in complex ways.

Third, sample size differences (n=71 vs n=62) and statistical power limitations in both pilot studies suggest that larger, adequately powered investigations are needed to definitively characterize these relationships. The effect sizes observed in our study (g=0.06 to 0.43) suggest small-to-moderate associations that would require substantially larger samples to detect reliably.

These discrepancies highlight the importance of distinguishing between the absence of stress (measured negatively) and the presence of well-being (measured positively) when examining personality correlates in medical education.¹⁸ Future research should examine both constructs simultaneously to clarify whether DISC profiles predict stress reactivity, well-being promotion, or both through distinct mechanisms.

Reasons for Null Findings

Several factors may explain the absence of significant associations in this pilot. First, the simplified self-categorization method for DISC assessment lacks the psychometric rigor of validated instruments,¹⁹ potentially introducing measurement error that attenuates true associations. Second, the small sample size (n=62) provided limited statistical power (15–25%) to detect small-to-moderate effects. Third, well-being is multifactorial; in medical education contexts, academic workload, clinical exposure, financial stress, social support, and institutional culture may exert stronger influences than stable behavioral preferences. Fourth, cross-cultural variation in how students interpret and report both personality traits and well-being may introduce noise that obscures relationships. Finally, the restricted range of well-being scores (mean=14.08, SD=4.99 on a 0–25 scale) suggests relatively moderate well-being across the sample, which may limit variance available to explain.

Appropriate Applications of DISC in Medical Education

These null findings have important implications for understanding appropriate applications of DISC in medical education. Recent educational interventions have successfully applied DISC frameworks to leadership training and interpersonal communication development in medical residency programs, where the goal is to enhance self-awareness and facilitate discussion of communication preferences rather than predict psychological outcomes.⁷ Our findings suggest that while DISC may have utility as a descriptive and educational tool for understanding behavioral tendencies in team settings, it should not be assumed to predict individual well-being outcomes.²⁰ This distinction is critical: DISC may be valuable for facilitating conversations about communication styles, team dynamics, and leadership development without necessarily serving as a predictor of psychological states. The factors that shape well-being in medical education—including workload, institutional support, financial stress, social relationships, and learning climate may operate largely independently of stable behavioral style preferences measured by DISC.

Environmental and Cultural Determinants of Well-Being

The null findings align with broader medical education literature^7,8,11,14 and leadership development frameworks. These suggest that environmental and situational factors including curriculum intensity, assessment burden, clinical stressors, peer relationships, and work-life balance are primary determinants of medical student well-being.^3,4,10 Even when DISC profiles show associations with perceived stress,⁸ the effect sizes suggest that situational and environmental factors likely exert stronger influences than stable behavioral preferences. The limited variance explained by the regression models (R²=0.074) reinforces that DISC behavioral styles alone accounted for minimal variation in well-being in this cohort. This suggests DISC may be more applicable for communication training and teamwork development than for understanding or predicting psychological well-being outcomes.

Cultural factors may also play important roles that warrant further investigation.²¹ Students from collectivist versus individualist backgrounds may experience and report well-being differently, and cultural norms around help-seeking, emotional expression, and work ethic may moderate relationships between personality and well-being. Personal challenges such as financial strain, family expectations, language barriers (for international students), and adaptation to a new country may overwhelm the influence of stable behavioral tendencies. Future research should incorporate these multilevel factors spanning individual characteristics, interpersonal dynamics, and institutional contexts, to better understand the complex determinants of medical student well-being.

Overall, this study provides descriptive data on DISC styles in a multicultural cohort and offers initial effect size estimates that may help inform sample size calculations and methodological approaches for future investigations.

Limitations

This study has several limitations. Convenience sampling from a single institution limits generalizability. The simplified DISC self-identification method may introduce misclassification compared with validated psychometric assessments.¹⁹ The overall sample size was modest, and cross-cultural subgroup sizes were small and unbalanced, reducing precision in comparisons. All measures were self-reported, introducing potential response bias, and the cross-sectional design does not allow temporal or causal inference. Additionally, our use of simplified self-categorization rather than validated DISC instruments limits psychometric rigor. While cost-free assessment approaches have been used in previous medical education research,^7,8 the validity and reliability of such measures remain uncertain compared to commercially available, validated instruments. Furthermore, the use of well-being as the outcome measure, rather than perceived stress or distress, may have influenced our ability to detect personality associations. Recent research suggests DISC profiles may relate more strongly to stress reactivity than to baseline well-being states,⁸ indicating that future studies should examine multiple psychological outcomes to fully characterize the personality-mental health relationship in medical students. These factors underscore that findings should be considered preliminary and hypothesis-generating rather than conclusive.

Conclusion

In this cross-sectional pilot study, DISC behavioral styles showed no significant associations with WHO-5 psychological well-being scores among a multicultural medical student cohort. While Steadiness and Conscientiousness were most frequently endorsed, effect sizes for all traits were small and confidence intervals included zero.

From a practical standpoint, these findings suggest that DISC assessments may be more appropriately applied to communication training, team development, and understanding interpersonal dynamics rather than as predictors of psychological well-being or screening tools for students at risk of distress. Student support programs should prioritize addressing modifiable environmental stressors such as academic workload, learning climate, mentorship quality, and institutional support structures, over personality-based interventions.

Future research should employ validated DISC instruments with established psychometric properties, recruit larger and culturally balanced samples, incorporate longitudinal designs to examine temporal relationships, and integrate multilevel factors (individual, interpersonal, and institutional) to provide comprehensive understanding of medical student well-being. Comparative studies examining both positive well-being and negative stress outcomes are particularly needed to clarify whether DISC profiles differentially predict various dimensions of psychological functioning. Intervention studies examining whether DISC-informed team-building or communication training indirectly benefits well-being through improved peer relationships or reduced interpersonal stress would also be valuable.

Funding Statement

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The APC was covered by Alfaisal University.

Data Sharing Statement

The authors declare that all data supporting the findings of this study are available within the article. The datasets generated and analyzed during the current study are available from the corresponding authors upon reasonable request.

Ethics Approval and Consent to Participate

This study was conducted in accordance with the principles of the Declaration of Helsinki and received ethical approval from the Alfaisal University Institutional Review Board (IRB approval number: IRB20308, dated 3rd June 2024). All participants were provided with detailed information about the study purpose, procedures, potential risks and benefits, and their right to withdraw at any time without consequences. Written informed consent was obtained from all participants prior to enrollment in the study. Participants were informed that their participation was voluntary and that all data would be collected anonymously and treated confidentially. No identifying information was collected, and all data were deidentified before analysis to ensure participant privacy and confidentiality.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.