PERSONALITY Bhavana Nair SOCIAL EPIDEMIOLOGY MASTERS PROGRAM November

PERSONALITY Bhavana Nair SOCIAL EPIDEMIOLOGY MASTER’S PROGRAM November 1, 2004

Personality Who we are – our uniqueness Has a bearing on our behavior, thoughts, moods, attitudes, emotions, even our unconscious feelings Is reflected in our interactions with other people and the environment around us Can predict how we would act or react under different situations

Why should we know more about our personality ? Links between personality, emotion, health and illness have long been described The link gained credibility as present day research between stress and illness grew Our personality can be molded in different ways Nature vs Nurture - genes (biological factors ) - environmental factors (including childhood experiences, socio-cultural influences, interpersonal relationships, situational circumstances, life events) All these have a strong bearing on our health and functioning

Models of Personality and Increased Illness Risk The Personality Induced Hyperreactivity Model The Constitutional Predisposition Model The Personality As Precipitator Of Dangerous Behavior Model

The Personality Induced Hyper. Reactivity Model Stress appraisal Personality Physiological Hyper-reactivity Health Risk

The Constitutional Predisposition Model Personality trait Physiological status Health Risk

The Personality As A Precipitator of Dangerous Behavior Model RISK Personality (DANGEROUS BEHAVIOURS) Physiological status

Ecological Perspective Model Socio-cultural context Interpersonal context Personality, Health & Disease Temporal context Situational context

Types of Personality Main types – Type A, B, C TYPE A PERSONALITY - impatient & hyperactive - highly competitive & ambitious - always in a hurry - easily annoyed or upset - sense of being under constant time pressure - never satisfied - try to do multiple things at a time - constant apprehension of future disasters - very independent - prone to outbursts of rage or temper tantrums - prone to hostile episodes - actively try to control the situation at hand – born leaders - achievement–oriented – successful in their professions - prone to high risk for CHD – this is a very strong link

Types of Personality TYPE B PERSONALITY - relaxed - not prone to outbursts of rage or anger - non-competitive & less driven - easy-going - patient - optimistic - have a sense of humor - at peace with their environment and themselves - able to express their emotions appropriately - pleasant demeanor - temporary fearlessness in face of trauma - hence able to cope with stress effectively - less susceptible to disease - though not driven over-achievers, they are often successful in their professions

Types of Personality TYPE C PERSONALITY - the cancer prone personality type - present a calm front externally, but often have pent-up emotions, usually negative emotions like anger, depression, - non competitive & submissive - have difficulty expressing their emotions and feelings - often overwhelmed with feelings of hopelessness & helplessness - meticulous, serious and neat people - have an increased susceptibility to oncogenic viruses and cancer (decreased immunological function as a result of their altered neuroendocrine responses) - have poor coping skills to stressful situations - show self-blame at the time of diagnosis of terminal illnesses especially cancer

Theories of Personality Different personality theories have been put forward by many different famous researchers and sociologists : - Sigmund Freud – The id, ego, superego theory - Hans Eysenck – hereditary factors and environment - Raymond Catell – 2 tiered personality structure with 15 primary factors and 5 secondary factors - Albert Bandura – Suggested that forces of memory and feelings worked in conjunction with environmental influences - B. F. Skinner - Suggested that human personality was developed through external stimuli - Gordon Allport – Delineates 3 kinds of traits with varying degrees of intensity : cardinal traits, central traits and secondary traits - Lewis Goldberg – Proposed a 5 dimension personality model – called the “Big Five” – Extroversion, Agreeableness, Conscientiousness, Emotional stability and Intellect - Abraham Maslow, Carl Rogers – who emphasized the basic goodness of people - Carl Jung

Theories of Personality Sigmund Freud’s Personality Theory - Freud’s psychoanalytical theory most influential theory still to date - He discovered the method of free association – and through recalling dreams and childhood memories – there were signs of unconscious wishes and fears

Theories of Personality Sigmund Freud’s Personality Theory - ID : The oldest system of the personality from which the ego & super ego develop. Already present from birth and only knows the inner world of opinions and feelings. Operates by the pleasure- pain principle (attempts to obtain pleasure and avoid pain), regardless of external circumstances and deals with primary desires – eat, drink, eliminate wastes, etc - EGO : Represents reasonable and sensible thinking. Tries to make the connection with reality. Understands what and when actions are appropriate. Operates by the reality principle. - SUPEREGO : Represents moral standards. Sets a sense of right and wrong behavior and thus a moral code on our behaviors

Personality Testing Types of Personality Testing - Self – report inventories - Projective Testing Self – Report Inventories - Include personality testing questionnaires - Different popular personality tests – Eysenck’s questionnaires, Myer-Briggs Personality Indicator, Enneagram tests, Big Five personality tests - The Minnesota Multiphasic Personality Inventory

Personality Testing Projective Testing - Very abstract manner of testing to eliminate problems with the person tending to give socially acceptable answers - 2 widely used are the Rorschach Test & the Thematic Apperception Test

Personality Disorders Personality Type Basic desire / Pleasure Basic fear / Distress Personality Disorder Conscientious ness Control Lack of control Obsessive Compulsive Solitary Solitude Intimacy Schizoid Sensitive Acceptance Rejection Avoidant Vigilant Autonomy Subordination Paranoid Dramatic Attention Being ignored Histrionic Aggressive Dominance Submission Sadistic Idiosyncratic Non-conformity Conformity Schizotypal Inventive Recognition Obscurity Compensatory Narcissistic

Personality Disorders Personality Type Basic desire / Pleasure Basic Fear / Distress Personality Disorder Leisurely Freedom to do as one pleases Compulsory activity Passive – Aggressive Serious Duties and responsibilities Not having duties/respons. Depressive Self - sacrificing Being needed Being unappreciated Masochistic Devoted Being taken care of Having to act Independently Dependent Self-confident Admiration Scorn Narcissistic Adventurous Adventure Routine Antisocial Mercurial Relationship Being alone Borderline Artistic Creativity Being unable to Cyclothymic

Personality Disorders Diagnostic and Statistical Manual of Mental Disorders (DSM – IV) - Personality Disorders in 3 main clusters or groups - Cluster A (the Odd Eccentric Group – Psychotics) paranoid, schizoid & schizotypal personality disorders - Cluster B (Dramatic, Erratic Group – Extraverts) antisocial, borderline, histrionic & narcissistic personality disorders - Cluster C (Anxious, Fearful Group – Neurotics) avoidant, dependent and obsessive-compulsive personality disorders

Personality Disorders Cluster A Paranoid Personality Disorder : SUSPECT (4 criteria) S : Spouse fidelity suspected U : Unforgiving (bears grudges) S : Suspicious of others P : Perceives attacks (and reacts quickly) E : “Enemy or friend” (suspects associates, friends) C : Confiding in others feared T : Threats perceived in benign events

Personality Disorders Schizoid Personality Disorder : DISTANT (4 criteria) D : Detached (or flattened affect) I : Indifferent to criticism or praise S : Sexual experiences of little interest T : Tasks (activities ) done solitarily A : Absence of close friends N : Neither desires nor enjoys close relations T : Takes pleasure in a few activities

Personality Disorders Schizotypal Disorder : ME PECULIAR (5 criteria) M : Magical thinking or odd beliefs E : Experiences unusual perceptions P : Paranoid ideation E : Eccentric appearance or behavior C : Constricted (or inappropriate) affect U : Unusual (odd) thinking and speech L : Lacks close friends I : Ideas of reference A : Anxiety in social situations R : Rule out psychotic disorders & pervasive development disorder

Personality Disorders Cluster B Antisocial personality disorder : CORRUPT (3 criteria) C : Conformity to law lacking O : Obligations ignored R : Reckless disregard for safety of self and others R : Remorse lacking U : Underhanded (deceitful, lies, cons others) P : Planning insufficient (impulsive) T : Temper (irritable and aggressive )

Personality Disorders Borderline Personality Disorder : AM SUICIDE (5 criteria) A : Abandonment M : Mood instability (marked reactivity of mood) S : Suicidal or self mutilating behavior U : Unstable and intense relationships I : Impulsivity C : Control of anger I : Identity disturbance D : Dissociative (or paranoid) symptoms that are transient & stress –related E : Emptiness (chronic feelings of)

Personality Disorders Histrionic Personality disorder : PRAISE ME (5 criteria) P : Provocative (or sexually seductive) behavior R : Relationships (considered more intimate than they are) A : Attention (uncomfortable when not in center of attention) I : Influenced easily S : Style of speech (impressionistic, lacks detail) E : Emotions (rapidly shifting and hollow) M : Made up (physical appearance used to draw attention to self) E : Emotions exaggerated (theatrical)

Personality Disorders Narcissistic Personality Disorder : SPECIAL (5 criteria) S : Special (believes he/she is special and unique) P : Preoccupied with fantasies (of unlimited success, power, brilliance, beauty, or ideal love) E : Entitlement C : Conceited (grandiose sense of self-importance) I : Interpersonal exploitation A : Arrogant (haughty) L : Lacks empathy

Personality Disorders Cluster C Avoidant Personality Disorder : CRINGES (4 criteria) C : Certainty (of being liked required before willing to get involved in others) R : Rejection (or criticism) preoccupies one’s thoughts in social occasions I : Intimate relationships (restraint in intimate relationships due to fear of being shamed) N : New interpersonal relationships (is inhibited in) G : Gets around occupational activity (involving interpersonal contact) E : Embarrassment (potential) prevents new activity or taking personal risks S : Self-viewed as unappealing, inept or inferior

Personality Disorders Dependent Personality Disorder : RELIANCE (5 criteria) R : Reassurance required for decisions E : Expressing disagreement difficult (due to fear of loss of support or approval) L : Life responsibilities (needs to have these assumed by others) I : Initiating projects difficult (due to lack of self-confidence) A : Alone (feels helpless and discomfort when alone) N : Nurturance (goes to excessive lengths to obtain nurturance and support) C : Companionship (another relationship) sought urgently when close relationship ends E : Exaggerated fears of being left to care for self

Personality Disorders Obsessive-Compulsive Personality Disorder : LAW FIRMS (4 criteria) L : Loses point of activity (due to preoccupation with detail) A : Ability to complete tasks (compromised by perfection) W : Worthless objects (unable to discard) F : Friendships (and leisure activities) excluded due to preoccupation with work I : Inflexible, scrupulous, over-conscientious (on ethics, values, morality, not accounted for by religion or culture) R : Reluctant to delegate (unless others submit to exact guidelines) M : Miserly (towards self and others) S : Stubbornness (and rigidity)

Personality Disorders TREATMENT OF PERSONALITY DISORDERS - Individual Level Medical care : Psychodynamic psychotherapy, Cognitive therapy , Interpersonal therapy, Group therapy Medications – Antidepressants, Anticonvulsants, Antipsychotics - Community Level

Implications for Society INTERVENTIONS To the extent that some personality characteristics can be modified via psychological intervention, people can be helped through such therapies such as stress management & anger control – any therapy that will reduce stress, anger, cynicism and other negative emotions DIRECTIONS FOR FUTURE Besides personality, we need to look at social factors, genetic factors and health risk behaviors, undertake more research in these areas and apply them to effective policy interventions at both the individual & community level