Personality is of central concern to understand health: towards a theoretical model for health psychology

Figures & data

Figure 1.  Illness process: personality and mechanisms.

Table 1. Summary of the evidence linking personality to health.

	Organizational	Group	Individual
Empathy	Selection of medical students^29	Charitable giving & helping behaviour,^27 doctor–patient interaction^28	High: Pain,^23, [longevity, well-being (via helping)],^24 empathic distress,^25 depression^26 Low: Psychopathy, anti-social behaviour
Health anxiety	Doctor-shopping,^34 health care utilization,^33 medical student syndrome^35	Doctor–patient interaction^36	Symptom reporting,^30 steeper diurnal cortisol,^31 SC,^32 S&C,^33 SBS^52
Type D			MI,^37 immune function,^38 HB,^39 S&C,^40 SC^41
Alexithymia	Health care utilisation^44	Doctor–patient interaction^61	PI,^42 ACM,^43 Symp,^43, immune function,^45 HB^46
Neuroticism	Negative attitudes to RCTs,^58 Increased burnout^59	Doctor–patient interaction,^36,55,56 not giving blood,^48 not phase 1,^50 partner's personality is detrimental^57	PI,^1 ACM,^2,4 HB,^6 SC,^9,10,12 S&C,^13,16,53 C&C,^14 Symp,^17,18 Assoc,^20 SBS^51
Extraversion		Not giving blood,^48 phase 1,^50 doctor–patient interaction^55	PI,^1 ACM,^4 HB,^6,8 SC,^9,10 S&C,^13,16,53 C&C,^14 Cyt,^15 Infect,^19 DP^54
Openness		Phase 1,^50 doctor–patient interaction^55,56	PI,^1 ACM,^5 HB,^6 SC,^10 S&C,^16,53 Symp,^17 DP^54
Agreeableness		Giving blood,^47 helpline volunteer,^49 not phase 1^50	PI,^1 ACM,^2,4 HB,^6 SC,^9,10 S&C^16,53
Conscientiousness	Selection of medical students,^21 transition to work^60	Compensatory health factors,^22 giving blood,^48 doctor–patient interaction^55,56	PI,^1 ACM,^4 Longevity,^3 HB,^6–8 SC,^10,11 S&C,^16,53 DP^54
Note: PI, physical illness; SC, social cognitions; S&C, stress and coping processes; MI, myocardial infarction; HB, health behaviours; CHD, coronary heart disease; FSS, functional somatic syndromes; ACM, all cause mortality; C&C, cortisol/cholesterol; Cyt, cytokines; Symp, symptom reporting; infect, susceptibility to infection; Assoc, associative mechanisms in health; SBS, sensitivity to bodily sensations; DP, disease progression; Phase 1, phase 1 studies.
^1Goodwin and Friedman (2006); ^2Chapman et al. (2010); ^3Kern and Friedman (2008); ^4Roberts et al. (2007); ^5Taylor et al. (2009); ^6Booth-Kewley and Vickers (1994); ^7O'Connor et al. (2009); ^8Raynor and Levine (2009); ^9Gerend et al. (2004); ^10Vollrath et al. (1999); ^11Chatzisarantis and Hagger (2008); and Conner and Abraham (2001); and Conner, Grogan, Fry, Gough, and Higgins (2009); ^12de Bruijn et al. (2009); ^13Ferguson (2001); ^14LeBlanc and Ducharme (2005); ^15Chapman et al. (2009); ^16DeLongis and Holtzman (2005) and David and Suls (1999); ^17Feldman et al. (1999); ^18Watson and Pennebaker (1989); ^19Totman et al. (1980); ^20Devriese et al. (2000); ^21Ferguson et al. 2000a, 2002, 2003; ^22Roberts et al. 2009; ^23Schieman and van Gundy (2000); ^24Brown et al. (2003); ^25Schaller and Cialdini (1988); ^26Kim et al. (2007); ^27Ferguson et al. (2008); ^28Kim et al. (2004); ^29Ferguson et al. (2002); ^30Noyes et al. (2005); ^31Ferguson (2008); ^32Barsky et al. (1993); ^33Noyes et al. (1999); ^34Kasteler et al. (1976); ^35Moss-Morris and Petrie (2001); ^36Ferguson (2000); ^37Denollet et al. (1996); ^38Denollet et al. (2003); ^39Williams et al. (2008); ^40Williams et al. (2009); ^41Mols and Denollet (2010); ^42Grabe et al. (2010); ^43Tolmunen et al. (2010); ^44Lumley et al. (2007); ^45Dewaraja et al. (1997); ^46Helmers and Mente (1996); ^47Bekkers (2006); ^48Ferguson (2004a); ^49Paterson et al. (2009); ^50Almeida et al. (2008); ^51Pud et al. (2004); ^52Gramling et al. (1996); ^53Carver and Connor-Smith (2010) and Connor-Smith and Flachsbart (2007); ^54Ironson et al. (2008); ^55Eaton and Tinsley (1999); ^56Chapman et al. (2008); ^57Ruiz et al. (2006); ^58McCulloch et al. (2005); ^59Deary et al. (1996); ^60Cave et al. (2009); ^61Rastling et al. (2005).

Figure 2.  The proposed personality hierarchy.

Table 2. Evolutionary cost-benefit analysis for health-related traits.

	Costs	Benefits	Hypotheses
Emotional empathy	Empathic distress, exploitable	Helping others, reciprocity, kin selection, parental–child social bonds, group cohesion	Mediation model for pooper health: Empathic distress mediates the link between EE and poor health behaviours
Cognitive empathy	Empathic distress	Exploit, deceive, greater social understanding, reciprocity, cheater detection	Alexithymia moderated model: Poorer health behaviour observed only for a combination of high CE and high alexithymia
Health anxiety	Obsessive behaviours, lack of trust	Help seeking, health vigilance, ‘reduced mortality’, steeper diurnal cortisol slope	Reduced infection exposure and incidence of infection; reduced risk of cancer and other major illness
Type D	Poor health, negative health behaviours, poor social interaction	Vigilance	Reduced infection exposure and incidence of infection
Alexithymia	Poor social interactions, poor health behaviours, poor health, pathological gambling, autistic spectrum, reduced empathy	Risk taking, less exploitable	Increased status, reduced infection exposure

Figure 3.  A theoretical model of personality and social cognition.

Taylor , M.D. , Whiteman , M.C. , Fowkes , G.R. , Lee , A.J. , Allerhand , M. and Deary , I.J. 2009 . Five factor model of personality traits and all-cause mortality in the Edinburgh Artery study cohort . Psychosomatic Medicine , 71 : 631 – 641 .

 PubMed Web of Science ®Google Scholar

Booth-Kewley , S. and Vickers , R.R. 1994 . Associations between major domains of personality and health behaviour . Journal of Personality , 62 : 281 – 298 .

 PubMed Web of Science ®Google Scholar

Conner , M. , Grogan , S. , Fry , G. , Gough , B. and Higgins , A.R. 2009 . Direct, mediated and moderated impacts of personality variables on smoking initiation in adolescents . Psychology and Health , 24 : 1085 – 1104 .

 PubMed Web of Science ®Google Scholar

Watson , D. and Pennebaker , J.W. 1989 . Health complaints, stress and distress: Exploring the central role of negative affectivity . Psychological Bulletin , 96 : 234 – 254 .

 Google Scholar

Ferguson , E. , James , D. and Madelely , L. 2002 . Factors associated with success in medical school: Systematic review of the literature . British Medical Journal , 324 : 952 – 957 .

 PubMed Web of Science ®Google Scholar

Schieman , S. and van Gundy , K. 2000 . The personal and social links between age and self-reported empathy . Social Psychology Quarterly , 63 : 152 – 174 .

 Web of Science ®Google Scholar

Brown , S.L. , Nesse , R.M. , Vinokur , A.D. and Smith , D.M. 2003 . Providing social support is more beneficial than receiving it . Psychological Science , 14 : 320 – 327 .

 PubMed Web of Science ®Google Scholar

Schaller , M. and Cialdini , R.B. 1988 . The economics of empathic helping: Support for a mood management motive . Journal of Experimental Social Psychology , 24 : 163 – 181 .

 Web of Science ®Google Scholar

Kim , Y. , Schulz , R. and Carver , C.S. 2007 . Benefit finding in the cancer caregiving experience . Psychosomatic Medicine , 69 : 283 – 291 .

 PubMed Web of Science ®Google Scholar

Ferguson , E. , Farrell , K. and Lawrence , C. 2008 . Blood donation is an act of benevolence rather than altruism . Health Psychology , 27 : 327 – 336 .

 PubMed Web of Science ®Google Scholar

Noyes , R. , Watson , D.B. , Letuchy , E.M. , Longley , S.L. , Black , D.W. , Carney , C.P. and Doeddeling , B.N. 2005 . Relationship between hypochondriacal concerns and personality dimensions and traits in a military population . Journal of Nervous and Mental Disease , 193 : 110 – 118 .

 PubMed Web of Science ®Google Scholar

Ferguson , E. 2008 . Health anxiety moderates the day-time cortisol slope . Journal of Psychosomatic Research , 64 : 487 – 494 .

 PubMed Web of Science ®Google Scholar

Barsky , A.R. , Coeytaux , R.R. , Sarnie , M.K. and Clearly , P.D. 1993 . Hypochondriacal patient's beliefs about good health . American Journal of Psychiatry , 150 : 1085 – 1089 .

 PubMed Web of Science ®Google Scholar

Noyes , R. , Happel , R.L. and Yagla , S.J. 1999 . Correlates of hypochondriasis in a nonclinical population . Psychosomatics , 40 : 461 – 469 .

 PubMed Web of Science ®Google Scholar

Kasteler , J. , Kane , R.L. , Olsen , D.M. and Thetford , C. 1976 . Issues underlying prevalence of ‘doctor shopping’ behaviour . Journal of Health and Social Behavior , 17 : 328 – 339 .

 Web of Science ®Google Scholar

Moss-Morris , R. and Petrie , K.J. 2001 . Redefining medical students’ disease to reduce morbidity . Medical Education , 35 : 724 – 728 .

 PubMed Web of Science ®Google Scholar

Denollet , J. , Sys , S.U. , Stroobant , N. , Rombouts , H. , Gillebert , T,C. , & Brutsaert , D.L. 1996 . Personality as independent predictor of long-term mortality in patients with coronary heart disease . Lancet , 347 , 417 – 421 .

 PubMed Web of Science ®Google Scholar

Denollet , J. , Conraads , V.M. , Brutsaert , D.L. , De Clerck , L.S. , Stevens , W.J. and Vrints , C.J. 2003 . Cytokines and immune activation in systolic heart failure: The role of type D personality . Brain Behavior and Immunity , 17 : 305 – 309 .

 Web of Science ®Google Scholar

Williams , L. , O'Connor , R.C. , Howard , S. , Hughes , B.M. , Johnston , D.W. , Hay , J.L. and O'Carroll , R.E. 2008 . Type D personality mechanisms of effect: The role of health-related behaviour and social support . Journal of Psychosomatic Research , 64 : 63 – 69 .

 PubMed Web of Science ®Google Scholar

Williams , L. , O'Carroll , R.E. and O'Connor , R.C. 2009 . Type D and cardiac output in response to stress . Psychology and Health , 24 : 489 – 500 .

 PubMed Web of Science ®Google Scholar

Mols , R. , & Denollet , J. 2010 . Type D personality in the general population: A systematic review of health status, mechanisms of disease and work-related problems . Health and Quality of Life Outcomes , 8 ( 9 ). Retrieved from http://www.hqlo.com/content/8/1/9

 PubMed Web of Science ®Google Scholar

Grabe , H.J. , Schwahn , C. , Barnow , S. , Spitzer , C. , John , U. , Freyberger , H.J. and Völzke , H. 2010 . Alexithymia, hypertension and subclinical atherosclerosis in the general population . Journal of Psychosomatic Research , 68 : 139 – 147 .

 PubMed Web of Science ®Google Scholar

Tolmunen , T. , Lehto , S.M. , Heliste , H. , Kurl , S. and Kauhanen , J. 2010 . Alexithymia is associated with increased cardiovascular morality in middle-aged Finnish men . Psychosomatic Medicine , 72 : 187 – 191 .

 PubMed Web of Science ®Google Scholar

Dewaraja , R. , Tanigawa , T. , Araki , S. , Kawamura , N. , Ago , Y. and Sasaki , Y. 1997 . Decreased cytotoxic lymphocyte counts in alexithymia . Psychotherapy and Psychosomatics , 66 : 83 – 86 .

 PubMed Web of Science ®Google Scholar

Helmers , K.F. and Mente , A. 1996 . Alexithymia and health behaviors in healthy male volunteers . Journal of Psychosomatic Research , 47 : 635 – 645 .

 Web of Science ®Google Scholar

Gramling , S.E. , Clawson , E.P. and McDonald , M.K. 1996 . Perceptual and cognitive abnormality model of hypochondriasis: Amplification and physiological reactivity in women . Psychosomatic Medicine , 58 : 423 – 431 .

 PubMed Web of Science ®Google Scholar

Connor-Smith , J.K. , & Flachsbart , C. 2007 . Relations between personality and coping: a meta-analysis . Journal of Personality and Social Psychology , 93 , 1086 – 1107

 Web of Science ®Google Scholar

Eaton , L.G. and Tinsley , B.J. 1999 . Maternal personality and health communication in the pediatric context . Health Communication , 11 : 75 – 96 .

 PubMed Web of Science ®Google Scholar

McCulloch , P. , Kaul , A. , Wagstaff , G.F. and Wheatcroft , J. 2005 . Tolerance of uncertainty, extroversion, neuroticism and attitudes to randomized controlled trials among surgeons and physicians . British Journal of Surgery , 92 : 1293 – 1297 .

 PubMed Web of Science ®Google Scholar

Deary , I.J. , Blenkin , H. , Agius , R.M. , Endler , N.S. and Zeally , H. 1996 . Models of job-related stress and personal achievement among consultant doctors . British Journal of Psychology , 87 : 3 – 29 .

 PubMed Web of Science ®Google Scholar

Cave , J. , Woolf , K. , Jones , A. and Dacre , J. 2009 . Easing the transition from student to doctor: How medical schools help prepare their graduates for starting work? . Medical Teacher , 31 : 403 – 408 .

 PubMed Web of Science ®Google Scholar

Rastling , M. , Brosig , B. and Beutel , M.E. 2005 . Alexithymic characteristics and patient-therapist interaction: A video analysis of facial affect display . Psychopathology , 38 : 105 – 111 .

 PubMed Web of Science ®Google Scholar