Blok G&M 1ste Ba Medische Psychologie Hoofdstuk 3 Persoonlijkheid.pdf

# Introduction to personality Personality is understood as the stable aspects of individual behavior that differentiate people and influence their reactions to situations, especially in the context of illness or health messages. This area of study aims to explore why individuals behave differently even when faced with identical circumstances [2](#page=2). ## 1. Introduction to personality Personality refers to the stable aspects of an individual's behavior. These stable aspects allow individuals to be distinguished from others. Understanding these stable characteristics enables predictions about a person's behavior, which is often considered in interactions with patients [3](#page=3). ### 1.1 Key concepts: State versus Trait Within personality theory, a distinction is made between "state" and "trait" [4](#page=4). #### 1.1.1 Trait A trait is defined as a stable characteristic of an individual, such as being aggressive, social, or introverted. Traits remain consistent across different situations and over time. They influence an individual's behavior, thoughts, and feelings [4](#page=4). #### 1.1.2 State A state, in contrast, is a temporary condition, such as feeling delighted, embarrassed, or furious. States are not consistent across situations and time [4](#page=4). > **Tip:** Remember that "traits" are enduring qualities, while "states" are transient feelings or conditions. This distinction is crucial for understanding individual differences in responses. --- # Historical and modern approaches to personality This topic explores the evolution of personality theory, contrasting early, simplistic typological models with contemporary, scientifically grounded psychobiological frameworks [5](#page=5). ### 2.1 Older approaches to personality: Typologies Older personality theories often adopted a typological approach, categorizing individuals into distinct, mutually exclusive types. This approach assumed that all individuals within a given category were essentially the same [5](#page=5). #### 2.1.1 Hippocrates' humoral theory One of the earliest typological approaches was proposed by Hippocrates (460 BC-370 BC), who linked psychological typologies to the four bodily humors: phlegm, blood, yellow bile, and black bile. Health was believed to depend on the balance of these humors, with imbalances leading to illness. Different temperaments were associated with an excess of a particular humor [6](#page=6): * **Phlegmatic (calm):** Associated with excess phlegm. Characteristics include being quiet, calm, not letting many people in, being dreamy, and needing a lot of time [6](#page=6) [7](#page=7). * **Sanguine (optimistic, passionate):** Associated with excess blood. Characteristics include being cheerful, happy, superficial, easily distracted, having many interests, and always being short on time [6](#page=6) [7](#page=7). * **Choleric (irritable, hot-tempered):** Associated with excess yellow bile. Characteristics include being busy, hot-tempered, persistent, active, having a clear goal, taking the lead, and being future-focused [6](#page=6) [7](#page=7). * **Melancholic (depressed):** Associated with excess black bile. Characteristics include being gloomy, somber, serious, worried, liking an overview, remembering well, and thinking a lot [6](#page=6) [7](#page=7). #### 2.1.2 Sheldon's somatotypes William Sheldon (1898-1977) linked psychological typologies to body types (somatotypes). He proposed three temperaments associated with specific body builds [8](#page=8): * **Viscerotonic temperament:** Characterized by a relaxed, comfortable, and enjoying lifestyle (eating, drinking, sleeping). This was linked to an **endomorphi** body build, with a dominant digestive system and weak muscles and bones [8](#page=8). * **Somatotonic temperament:** Characterized by an energetic, aggressive, and active lifestyle, being loud, living in the present, and fearing aging. This was linked to a **mesomorph** body build, described as triangular, with strong muscles and bones, and an athletic physique [8](#page=8). * **Cerebrotonic temperament:** Characterized by a withdrawn, inhibited, and mentally intense lifestyle, having difficulty waking up, being at their best in the evening, and thinking and dreaming a lot. This was linked to an **ectomorph** body build, with underdeveloped digestive organs, bones, and muscles, long extremities, and a flat chest [8](#page=8). #### 2.1.3 Type A, B, C, and D personalities Cardiologists Friedman and Rosenman developed a typological approach in the 1980s, categorizing individuals into Type A, B, C, and D personalities [9](#page=9). * **Type A personality:** Marked by high competitiveness, great work drive, preoccupation with schedules and deadlines, chronic hurriedness, and demanding behavior [9](#page=9). * **Type B personality:** Characterized by a more relaxed and less hurried behavioral pattern, more enjoyment, calmness, and often a good mood [9](#page=9). * **Type C personality:** Involves difficulty expressing emotions, a rationalizing attitude, conformity, and a tendency to react to stress with helplessness [9](#page=9). * **Type D personality:** A combination of negative affectivity (worrying, gloominess, irritability) and social inhibition (reservedness and lack of self-confidence) [9](#page=9). > **Tip:** Typological approaches are largely considered oversimplified today because human behavior is too complex to be reduced to a few distinct categories [5](#page=5). ### 2.2 Modern psychobiological personality model (Cloninger) The contemporary and scientifically supported approach to personality is represented by psychobiological models, such as Cloninger's. This model distinguishes between temperament and character, which together constitute personality [10](#page=10) [11](#page=11) . #### 2.2.1 Temperament Temperament refers to aspects of personality that are largely heritable, automatic, and influence unconscious learning processes. It involves genetic differences in how brains respond to stimuli and individual differences in automatic emotional reactions. Temperamental traits can be observed early in childhood and remain stable throughout life [10](#page=10). Cloninger's model identifies four dimensions of temperament: * **Novelty seeking (Prikkelzoekend):** The degree of impulsivity, curiosity, enthusiasm, hot-headedness, and boredom [12](#page=12). * **Harm avoidance (Leedvermijdend):** The degree of caution, attentiveness, and anxiety [12](#page=12). * **Reward dependence (Sociaalgericht):** The degree of sensitivity, lovingness, and sociability [12](#page=12). * **Persistence (Volhardend):** The degree of perseverance, achievement drive, and perfectionism [12](#page=12). #### 2.2.2 Character Character refers to individual differences in goals and values based on insights and beliefs about oneself and others. It develops through learning in one's environment and making personal choices. Character progressively develops throughout life under the influence of socio-cultural learning experiences and reaches full development in adulthood, influencing personal and social effectiveness [11](#page=11). Cloninger's model identifies three dimensions of character: * **Self-directedness (Zelfsturend):** The degree of maturity, responsibility, reliability, goal orientation, and self-acceptance [13](#page=13). * **Cooperativeness (Coöperatief):** The degree of identifying and accepting others, empathy, supportiveness, and honesty [13](#page=13). * **Self-transcendence (Zelftranscendent):** The degree of creativity, altruism, spirituality, and lack of pretension [13](#page=13). > **Tip:** Everyone possesses different gradations (from low to high) on these seven dimensions [13](#page=13). #### 2.2.3 Personality as temperament and character In Cloninger's model, personality is the sum of a person's temperament and character. Temperament represents the more automatic, unconscious, and genetically influenced aspects of reacting to stimuli, while character represents the conscious, planned, and volitional aspects involving cognitions, perceptions, interpretations, and behavior [11](#page=11) [14](#page=14). * **Temperament components:** Novelty seeking, harm avoidance, reward dependence, persistence [14](#page=14). * **Character components:** Self-directedness, cooperativeness, self-transcendence [14](#page=14). These components interact to shape an individual's cognitions, perceptions, interpretations, and behavior, influencing both unconscious, automated responses and conscious, planned actions [14](#page=14). --- # Personality differences in response to illness and treatment This section explores how individual personality traits influence various aspects of a patient's experience with illness and treatment, including symptom perception, coping mechanisms, and attitudes towards treatment, as well as the placebo effect [15](#page=15). ### 5.1. Perception of symptoms Perception of symptoms refers to how individuals interpret their bodily signals. There are significant variations in pain perception, partly influenced by situational and cultural factors, such as stress increasing physical tension and thus amplifying the perception of bodily signals. However, personality also plays a role, with introverted individuals reporting a lower pain threshold and feeling pain more readily. Differences in symptom perception and the intensity of subjective pain experiences can influence whether an individual seeks medical help [16](#page=16). ### 5.2. Reaction to symptoms Reactions to perceived symptoms vary, leading to different decisions about seeking medical help, such as the distinction between high and low consumers of medical services. This tendency is not necessarily correlated with the severity of symptoms. Explanations for these differences encompass situational factors, like prior similar experiences with doctors, as well as underlying individual differences, such as an anxious personality [17](#page=17). ### 5.3. Specificity of illness The specificity hypothesis proposed a link between certain personality types and somatic disorders, particularly in the early days of psychosomatic medicine. For example, Type A personality was historically associated with coronary heart disease, and Type C personality with cancer. However, current scientific evidence does not support these direct correlations. There is scientific evidence, however, for correlations between Cloninger's temperament and character traits and an increased risk of certain psychological disorders. For instance, depression is linked to high harm avoidance and low self-directedness and eating disorders are also associated with high harm avoidance and low self-directedness [18](#page=18). ### 5.4. Coping with illness Illness typically necessitates adaptation to reduced social, psychological, or physical capabilities, and the way individuals cope with this differs significantly from person to person. Personality traits can make these coping styles more predictable. Coping styles can range from over-reacting or exhibiting aggressive and hostile attitudes, potentially to foster dependence on others, to denying the severity or discomfort of the illness. Understanding these different reaction styles is crucial in patient interactions, as they also influence how patients respond to treatment [19](#page=19). ### 5.5. Attitudes towards treatment Individuals differ in their responses to both the specific aspects of treatment, such as the efficacy of medication, and non-specific aspects, like the attention received from a doctor. The placebo effect is any therapeutic outcome not directly attributable to the specific properties of a treatment or medication. This effect varies from person to person and from situation to situation. Therefore, personality influences treatment responses, but situational factors, such as the behavior of the physician or caregiver, also play a significant role [20](#page=20). > **Tip:** Recognize that while personality traits are important predictors of how a patient might react to illness and treatment, situational and contextual factors are also highly influential. Therefore, a comprehensive understanding requires considering both individual predispositions and the immediate environment. --- # Personality disorders: types and development Personality disorders are complex psychiatric conditions defined by maladaptive patterns of inner experience and behavior that deviate significantly from societal expectations, impacting multiple areas of life and originating from early maladaptive schemas related to basic needs [22](#page=22) [29](#page=29). ### 4.1 Definition and diagnostic criteria A personality disorder is characterized by a pervasive and enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture, evident in at least two of the following areas [24](#page=24): * Cognitions (i.e., ways of perceiving and interpreting oneself, other people, and events) [24](#page=24). * Affectivity (i.e., the range, intensity, lability, and appropriateness of emotional response) [24](#page=24). * Interpersonal functioning [24](#page=24). * Impulse control [24](#page=24). This enduring pattern must also: * Be inflexible and pervasive across a wide range of personal and social situations [24](#page=24). * Lead to clinically significant distress or impairment in social, occupational, or other important areas of functioning [24](#page=24). * Be stable and of long duration, with an onset typically evident in adolescence or early adulthood [24](#page=24). * Not be better explained as a manifestation or consequence of another mental disorder or a physiological consequence of substance use or another medical condition [24](#page=24). > **Tip:** It is crucial to be cautious with rapid diagnoses of personality disorders. Certain traits must be highly pronounced, long-lasting, and persistently present, significantly impacting relationships, work, and life to warrant such a diagnosis. Complaints should manifest across multiple life domains and not solely as a reaction to a specific life event [23](#page=23). ### 4.2 Types of personality disorders Personality disorders are typically categorized into three clusters based on shared characteristics: Cluster A (odd or eccentric), Cluster B (dramatic, emotional, or erratic), and Cluster C (anxious or fearful) [25](#page=25). #### 4.2.1 Cluster A: Odd or eccentric * **Paranoid personality disorder (PS):** Characterized by a pervasive pattern of distrust and suspiciousness of others, interpreting their motives as malevolent [26](#page=26). * **Schizoid personality disorder (PS):** Marked by detachment from social relationships and a restricted range of emotional expression in interpersonal settings [26](#page=26). * **Schizotypical personality disorder (PS):** Involves social and interpersonal deficits, marked discomfort with and reduced capacity for close relationships, as well as cognitive or perceptual distortions and eccentricities of behavior [26](#page=26). #### 4.2.2 Cluster B: Dramatic, emotional, or erratic * **Borderline personality disorder (PS):** Defined by a pervasive pattern of instability in interpersonal relationships, self-image, and affects, and marked impulsivity [27](#page=27). * **Histrionic personality disorder (PS):** Characterized by a pervasive pattern of excessive emotionality and attention-seeking behavior [27](#page=27). * **Antisocial personality disorder (PS):** Involves a pervasive pattern of disregard for and violation of the rights of others [27](#page=27). * **Narcissistic personality disorder (PS):** Marked by a pervasive pattern of grandiosity, need for admiration, and lack of empathy [27](#page=27). #### 4.2.3 Cluster C: Anxious or fearful * **Avoidant personality disorder (PS):** Characterized by a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation [28](#page=28). * **Dependent personality disorder (PS):** Involves a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation [28](#page=28). * **Obsessive-compulsive personality disorder (PS):** Defined by a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency [28](#page=28). ### 4.3 Development of personality disorders Personality disorders are associated with early maladaptive schemas that relate to fundamental unmet basic needs [29](#page=29). #### 4.3.1 Basic needs The core basic needs that, when unmet, can contribute to the development of maladaptive schemas include: * **Attachment:** The need for secure attachment, connection, and the ability to have and feel contact with others [30](#page=30). * **Autonomy:** The need for a sense of self, independence, and the freedom to form desired relationships [30](#page=30). * **Giving:** The need to learn how to give to others [30](#page=30). * **Attractiveness:** The need to be found attractive, contributing to self-worth [30](#page=30). * **Self-realization:** The ability to communicate one's desires and feelings to others [30](#page=30). #### 4.3.2 Schemas Schemas are mental structures or organized bodies of information that represent our understanding of ourselves, others, and the world. They are formed over a lifetime based on early experiences and can encompass knowledge in various forms, including language, visual information, actions, rhythm, and bodily sensations, much of which may be unconscious or inexpressible in words. Without schemas, memory would consist of disconnected recollections and thoughts. Schemas play a crucial role in [31](#page=31): * Determining what is perceived [32](#page=32). * Influencing information processing and interpretation [32](#page=32). * Activating specific feelings and behaviors in response to events [32](#page=32). #### 4.3.3 Early maladaptive schemas (EMS) Early maladaptive schemas, as described by Young are the result of a combination of temperament and dysfunctional childhood experiences (nature $\times$ nurture). When activated by events, they provoke intense arousal characterized by feelings of anxiety, sadness, shame, guilt, or anger, leading to an overwhelming emotional state. These schemas are self-perpetuating due to biases in information processing and drive rigid behavioral patterns [33](#page=33). ##### 4.3.3.1 EMS related to attachment: Disconnection and rejection These schemas manifest as beliefs such as: * "Someone will abandon me." [34](#page=34). * "Someone will mistreat or exploit me." [34](#page=34). * "My emotional needs will not be understood." [34](#page=34). * "I am unwanted or inferior." [34](#page=34). * "I am all alone in the world." [34](#page=34). ##### 4.3.3.2 EMS related to self-identity: Impaired autonomy These schemas reflect a diminished capacity for independence and include beliefs like: * "I can't do anything on my own." [35](#page=35). * "I am powerless against any event." [35](#page=35). * "I cease to exist without you." [35](#page=35). * "I am a failure." [35](#page=35). ##### 4.3.3.3 EMS related to giving: Impaired limits These schemas are characterized by beliefs of superiority or entitlement, such as: * "I am superior." [36](#page=36). * "I get whatever I want." [36](#page=36). ##### 4.3.3.4 EMS related to self-worth: Other-directedness These schemas involve a preoccupation with the needs and opinions of others, including: * "My feelings and needs are subordinate." [37](#page=37). * "I must always be available for others." [37](#page=37). * "I must do everything to avoid rejection." [37](#page=37). ##### 4.3.3.5 EMS related to self-realization: Overvigilance and inhibition These schemas are marked by excessive worry, self-criticism, and perfectionism, such as: * Constant worry about what could go wrong [38](#page=38). * Prohibition on feeling anger [38](#page=38). * Perfectionism [38](#page=38). * Being excessively critical of oneself and/or others [38](#page=38). --- # The overall impact of personality on health Personality profoundly influences how individuals perceive, cope with, and react to illness and medical conditions throughout their health journey. This impact spans from the initial perception of symptoms to adherence to treatment and even shapes the dynamics of the healthcare provider-patient relationship [39](#page=39). ### 5.1 Components of personality and their influence Personality is understood as a combination of temperament and character, and it significantly shapes a patient's cognitions, emotions, and behavior. These internal processes, in turn, affect how an individual experiences and responds to health events [39](#page=39). #### 5.1.1 The interplay of cognitions, emotions, and behavior The patient's journey with illness involves a complex interplay between events/sensations, cognitive/mental processes, emotions, and behavior [41](#page=41). * **Cognitive/Mental Processes:** This includes perception, attention, information processing, memory, and learning processes. Personality traits can bias how individuals attend to, interpret, and remember health-related information [41](#page=41). * **Emotions:** The emotional responses to illness are heavily influenced by personality. Certain personality types may be more prone to anxiety, depression, or anger when faced with health challenges [41](#page=41). * **Behavior:** Ultimately, personality impacts the behaviors exhibited by the patient. This can range from seeking medical help promptly, adhering to medication regimens, engaging in healthy lifestyle choices, or withdrawing from social support [41](#page=41). > **Tip:** Understanding the specific cognitive, emotional, and behavioral patterns linked to a patient's personality can provide healthcare providers with valuable insights for tailoring communication and treatment strategies. ### 5.2 The patient's experience of illness The way an individual processes an acute, life-threatening, or chronic illness is strongly associated with their personality. Temperament and character play a role in [39](#page=39): * **Perception of complaints:** Personality can influence the threshold at which symptoms are noticed and reported [39](#page=39). * **Following treatment:** Adherence to medical advice and treatment plans is often mediated by personality characteristics such as conscientiousness, optimism, or a tendency towards impulsivity [39](#page=39). * **Healthcare provider-patient contact:** The nature of the relationship between the patient and their healthcare provider is also affected by personality. For example, assertive or agreeable personalities might interact differently with medical professionals [39](#page=39). > **Example:** An individual with a highly conscientious personality might meticulously follow their doctor's instructions regarding medication and lifestyle changes, leading to potentially better health outcomes. Conversely, someone with a more impulsive personality might struggle with consistent adherence to long-term treatment plans. ### 5.3 Integrating personality into health understanding The model presented illustrates how personality, comprising temperament and character, acts as a foundational element influencing cognitions, emotions, and subsequently, behavior. These elements collectively determine how an individual navigates health events and medical conditions. The perception, attention, processing, memory, and learning associated with health are all filtered through the lens of personality [41](#page=41). --- ## Common mistakes to avoid - Review all topics thoroughly before exams - Pay attention to formulas and key definitions - Practice with examples provided in each section - Don't memorize without understanding the underlying concepts

| Term | Definition | |------|------------| | Personality | The stable aspects of individual behavior that distinguish a person from others, allowing for predictions about their behavior in various situations. | | Trait | Stable characteristics of an individual, such as being aggressive or social, that remain consistent across different situations and over time, influencing behavior, thoughts, and feelings. | | State | A temporary condition of an individual, such as feeling happy, ashamed, or furious, which is not consistent across different situations and over time. | | Typology-approach | An older approach to personality that categorizes individuals into distinct types, viewing all members within a category as similar, often using a small number of categories. | | Viscerotone temperament | A temperament associated with a relaxed, comfortable, and enjoyable life attitude, linked to an endomorphic body type characterized by a dominant digestive system. | | Somatotone temperament | An energetic, aggressive, and active life attitude linked to a mesomorphic body type, characterized by a triangular build, strong muscles, and bones. | | Cerebrotone temperament | A withdrawn, inhibited, and mentally intensive life attitude linked to an ectomorphic body type, characterized by underdeveloped digestive organs, bones, and muscles. | | Type A personality | A personality characterized by high competitiveness, strong work ethic, preoccupation with schedules and deadlines, chronic haste, and demanding behavior. | | Type B personality | A personality characterized by a more relaxed and less hurried behavioral pattern, with more enjoyment, calmness, and frequent good spirits. | | Type C personality | A personality characterized by difficulty in expressing emotions, a rationalizing attitude, conformity, and a tendency to respond to stress with helplessness. | | Type D personality | A personality combining negative affectivity (worrying, gloominess, irritability) with social inhibition (reserve and lack of self-confidence). | | Temperament | Aspects of personality that are largely hereditary, occur automatically, and influence unconscious learning processes, reflecting genetic differences in brain responses to stimuli. | | Character | Individual differences in goals and values based on insights and beliefs about oneself and others, learned through the environment and socio-cultural experiences. | | Novelty seeking | A temperament dimension reflecting the degree of impulsivity, curiosity, enthusiasm, and tendency to get bored. | | Harm avoidance | A temperament dimension reflecting the degree of caution, attentiveness, and anxiety. | | Reward dependence | A temperament dimension reflecting the degree of sensitivity, affection, and sociability. | | Persistence | A temperament dimension reflecting the degree of perseverance, drive for achievement, and perfectionism. | | Self-directedness | A character dimension reflecting the degree of maturity, responsibility, reliability, goal orientation, and self-acceptance. | | Cooperativeness | A character dimension reflecting the degree of identifying and accepting others, empathy, supportiveness, and honesty. | | Self-transcendence | A character dimension reflecting creativity, selflessness, spirituality, and lack of pretension. | | Personality disorder | A complex psychiatric disorder characterized by difficulties in adapting to the environment and others, rigid and negative traits, intense emotions, and problems maintaining social contacts. | | Early maladaptive schemas (EMS) | Cognitive structures formed in childhood due to temperament and dysfunctional experiences that are resistant to change and shape perception, information processing, and behavior. | | Schema | A mental memory structure containing stored information and knowledge about oneself, others, and the world, formed from early experiences. | | Attachment | A basic need related to secure connection, bonding, and feeling connected to others. | | Autonomy | A basic need related to having one's own identity, being self-reliant, and feeling free to form desired relationships. | | Self-worth | A basic need related to feeling attractive and valued by others. | | Self-realization | A basic need related to the ability to communicate one's wants and feelings. | | Placebo reaction | Any therapeutic outcome that is not a direct result of a specific treatment or medication, varying significantly between individuals and situations. |