Personality and health: Road to well-being

Personality has acquired the central position in the protective mechanism under stress. To explain why certain people are healthier than others, a wide variety of personality concepts and their relationships to health outcomes have been studied.[1,2] However, the studies examining personality-health relationship are constrained by several problems. Narrow bandwidth of personality traits was flawed by overlapping item content as a derivative of health related concepts.[3] In this context mental health parameters of personality were identified to be, optimism and self efficacy. Mental health literacy is a related concept which tries to identify parameters of mental health. The term “mental health literacy” was first coined by Jorm[4] meaning “knowledge and beliefs about mental disorders which aid their recognition, management, or prevention.”^] The term “mental health literacy” was first coined by Jorm[4] meaning “knowledge and beliefs about mental disorders which aid their recognition, management, or prevention.” Mental health literacy consists of several components, including the ability to recognize different types of psychological distress, knowledge, and beliefs about risk factors and causes and self-help interventions. In this context, knowledge about some of the personality parameters helpful in maintaining health would go a long way in the management of distress.

WHO has included mental well-being in the definition of health. WHO defines health as: A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.[5] In this background, it is worth examining the role of personality as a moderating variable of mental health. Mental health needs to be redefined from the point of view of positive mental health in different contexts and cultures. Strategies for mental health promotion are related to improving the quality of life and potential for health rather than amelioration of symptoms and deficits.[6]

PERSONALITY AS A MODERATING VARIABLE

Personality as a mediating variable in health-related domains and outcome has received attention since time immemorial. Among the earlier descriptions, constitutional basis of personality proposed by Hippocrates delineated temperament and health based on humors. Temperament theory has its roots in the ancient four humors theory. It was believed that certain human moods, emotions, and behaviors were caused by an excess or lack of body fluids (called “humors”): Blood, yellow bile, black bile, and phlegm.[7]

These four categories Galen named “sanguine,” “choleric,” “melancholic,” and “phlegmatic” after the bodily humors, respectively. Each was the result of an excess of one of the humors that produced, in turn, the imbalance in paired qualities.[8] Subjective well-being (SWB) reported as satisfaction with life has been commented upon by psychologists as one of the factors determining the positive sense of self. The moot question to be answered is as to what determines this sense of satisfaction and happiness. A review by Dienner et al.[9] found that genetic factors, e.g., inherited tendency to have pleasant, easygoing temperament contributes to positive mental health. Some of the personality factors like low on neuroticism and high in affiliation, perceived control feel positive and optimistic.[10]

Research findings have also revealed that people who are optimistic, extraverted, avoid undue worrying tend to be happier than those who are pessimistic, introverted, and prone to worry.[11]

Following the robust evidence available on Five Factor Model (FFM), the research evidence implied across the various domains of health started getting prominence. This model achieved wide popularity in health-related research. The acceptance of this model was qualified because of comprehensive understanding of a personality.[12]

Clinical model has elaborated the relationship of personality with psychopathology, however, mental health aspects and its relationship were not enumerated with equal emphasis and less is discussed about personality to health as a state of physical, mental, and social well-being. In recent decades, health-related researches and health care have focused on negative mental processes such as psychological distress and dysfunction, while positive mental processes such as psychological well-being have been much less studied.[13] Certain aspects of personality are modifiable hence understanding these factors helps in moderating distress.[14] In fact, the problems can be evidenced as early as toddler stage indicating an association of sleep problems with the vulnerability of temperament.[15]

Approaches of personality

Various approaches have been used in the measurement of personality. Factor analysis approach of understanding personality acquired significance after Cattell's work in the field.[16] In the meta-analysis conducted by Watson, to assemble a matrix of correlations among the 44 scales from 52 prior studies, found factors strongly resembling the domains of the FFM.[17] Among the factor approaches to personality, some of the well-researched are Eysenck's[18] three dimensions of neuroticism, extraversion, and psychoticism; Harkness and McNulty's five factors of positive emotionality/extraversion, aggressiveness, constraint (CN), negative emotionality/neuroticism, and psychoticism.[19] Tellegen's[20] personality model assessed with the Multidimensional Personality Questionnaire (MPQ), and the Big Five model, operationalized by Costa and McCrae's.[21] Joint factor analyses found that MPQ constructs could be well-organized under the Big Five model, and the NEO constructs could be well-organized under the Tellegen higher-order dimensions. Tellegen's higher-order dimensions relate to components of the Big Five hierarchically. Negative emotionality encompasses Big Five neuroticism and agreeableness, positive emotionality encompasses extraversion and the surgent aspect of conscientiousness, and CN encompasses the controlled aspect of conscientiousness and much of openness to experience. McCrae[22] five dimensions of sociability, activity, aggression hostility, impulsive sensation seeking, and neuroticism-anxiety also relate to these groups.

The five personality factors – Neuroticism, extraversion, openness, agreeableness, and conscientiousness – are the main focus of FFM. Neuroticism as a factor of personality is related to low self esteem, irrational perfectionistic beliefs, and pessimistic attitudes. Extraversion is related to varied interests and social dimension Openness to experience refers to need for variety, novelty, and change. Agreeableness is related to forgiving attitudes, belief in cooperation. Conscientiousness is related to organized support network, technical expertise. Among the five factors, neuroticism is shown to be related to psychopathology.[22]

SUBJECTIVE WELL-BEING AND HEALTH

Positive psychology has its own facets; some of them are intrinsic to health and behavior pattern. Subjective Well Being (SWB) was evaluated and correlated with personality factors; positive relationship was noted to be present between extraversion and SWB, and negative relationship between neuroticism and SWB. In respect to mental health and well-being, well-being variables such as gratitude are positively correlated with extraversion, agreeableness, openness, and conscientiousness, and negatively correlated with neuroticism.[2] Meta-analysis has found an association between neuroticism, extraversion, agreeableness, conscientiousness and all components of SWB, and quality of life.[23] There has been consistent evidence regarding neuroticism negatively correlated with positive affect and extraversion inversely related with negative affect.[24] There is a consistency in finding on one dimension of personality being assessed by Five Factor Model ie Neuroticism. Neuroticism was most consistently related to worse subjective health outcomes, while out of 3 health related personality constructs, negative experience was related to worse and optimistic control to better subjective health outcomes.[25,26]

Seven Factor model of personality was devised by Cloninger. Temperament and character inventory (TCI) is based on synthesis of information from family studies, and data from various resources being genetic and environmental in nature. There are four temperaments (harm avoidance, novelty seeking, reward dependence, and persistence) and three character domains (self directedness, cooperativeness, and self transcendence). The interaction between these four temperament and three character domains gives very elaborate ptofile of an individual. TCI has been applied to measure mental health, psychopathology, personality and well being These traits have strong effects on the perception of well being.[27,28,29]

PERSONALITY AND ITS ASSOCIATION WITH PSYCHOPATHOLOGY

Association of personality traits as vulnerability to stress finds neuroticism as a robust predictor of future psychopathology along with mood changes, eating disorder, substance use, and anxiety predominantly in response to life stress. Neuroticism may contribute to both diathesis and stress, providing vulnerability through both reactive and evocative person environment interactions.[30] ependent personality traits have also been shown to have an important role in the etiology of depression. Multiple prospective, longitudinal studies have confirmed that dependent cognitions and behaviors result in increased feelings of depression in reaction to interpersonal loss or rejection. The dependent traits of neediness, clinging, preoccupation with fears of loss, and excessive reassurance seeking can also evoke a disengagement and rejection by others.[31] Research evidence pertaining to contention that people use alcohol to reduce stress, is complex and inconclusive. Individuals with susceptibility to stress show strongest correlation between stress and drinking. The most severe alcohol problems have been reported in individuals who are characterized by both high levels of negative affect, low levels of CN, and high sensation seeking.[31] A number of models in the area of addiction, however, place personality variables into the nexus of other etiological constructs. In these models, personality variables are viewed in the context of mediating and moderating relationships. Positive temperament is associated with “normalcy” from the high level of adaptation that characterizes those who are particularly psychologically healthy; that high levels of positive affectivity may distinguish those who are average versus particularly adept at dealing with life's slings and arrows.[32,33]

Five Factor Model has been widely studied and noted to be having impact on health outcomes. Studies carried ou on health related variables found certain personality constructs implied in positive health behaviors. Some of them to be worth mentioning are optimism, anger control and inhibition. On five factor model conscientiousness have been consistently associated with health behaviors. On the other hand higher scores on neuroticism or negative affect are associated with perceived poor health and reporting of more symptoms. It is worth mentioning that conscientiousness has also been associated with less tobacco use and alcohol consumption.[34,35]

Personality traits have occupied a prominent position in etiological theories of substance use disorders, predominantly traits of behavioral under control and negative emotionality being linked to substance disorders particularly alcoholism.[36] Personality indicators of behavioral under control and impulsivity had been shown to predict the onset of substance use disorders. Behavioral under-control denotes a broad range of interrelated behaviors that collectively reflect the difficulty in inhibiting behavioral impulses. Behavioral under-control is expressed through not only normal range variation in personality, such as impulsivity, low CN, or high risk taking, but also by more pathological conditions such as conduct disorder and antisocial personality disorder. Behavior problems including behavioral under-control (i.e. number of substances used, sexual intercourse, trouble with police), when exhibited prior to age 15, identifies a subset of youth who have a high and generalized risk for developing adult psychopathology.[37]

The psychological craving experienced by the alcoholics is also explained by personality factors. People of tense temperament resort to drinking as alcohol calms their inner anxiety and helps them to relax. A study done by Dudley et al.[38] has shown that alcoholics tend to be insecure, anxious oversensitive, and dissatisfied with themselves and their lives. Eysenck et al.[39] observed male alcoholics tend to have higher extraversion and neuroticism.

A number of models in the area of addiction, however, place personality variables into the nexus of other etiological constructs. In these models, personality variables are viewed in the context of mediating and moderating relationships. Even in risk-taking behavior, unstable extroverts are more likely than other personality types to engage in behavior that places them at risk for HIV infection. For them, immediacy of the reward of sex is more important, they are noted to be remarkably inattentive to the risk of acquiring an infection. They are more likely to experiment with different kinds of drugs and to use greater quantities. Unstable introverts are anxious, moody, and pessimistic. Similarly, nonadherence is more common among extroverted or unstable patients. The same personality characteristics that place them at risk for HIV also reduce their ability to adhere to demanding drug regimens. The mercurial emotions of unstable extroverted patients interfere with compliance to drugs.[40]

PERSONALITY AND COPING

There are differences in coping strategies used by people who are optimists and those who are pessimists. Optimism is considered to be instrumental in problem-focused coping strategies; optimists turn to adaptive emotion-focused coping strategies such as acceptance, use of humor, and positive reframing. Pessimists tend to cope through overt denial and by disengaging from the goals. A positive coping skill is an indicator of mental health.[41]

CONCLUSION

The assessment of personality has by and large attempted to focus on clinical psychopathology model. The positive mental health aspect of personality dimensions are less discussed. The facets of personality found to be implied in mental health are positive emotionality conscientiousness and behavioral control. Understanding of these dimensions will help in identification and modification of the personality, thereby enhancing mental health.