Models of the Personality Illness Connection

Researchers have proposed several ways of thinking about how personality can relate to health. These models can take the form of diagrams of key variables, with the causal relations among those variables depicted by arrows. Models are useful to researchers in guiding their thinking about specific variables, and especially in thinking about ho those variables influence one another ( iebe & Smith, 1997). In most of the models we will discuss, one variable—stress—will be important. Stress is the subjective feeling produced by events that are uncontrollable or threatening. It is important to realize that stress is a response to the perceived demands in some situation. Stress is not in the situation; stress refers to how people respond to a particular situation.

An early model of the personality health relationship, called the interactional model, is depicted in Figure 18.1(a). This model suggests that objective events happen to people, but personality factors determine the impact of those events by influ encing people's ability to cope. In this model, personality has its ef fects on coping responses—that is, on how people respond to the event. It is called the interactional model because personality is assumed to moderate (influence) the relationshi between stress and illness. In other words, events such as exposure to microbes or chronic stress cause illness, but personality factors make a person more or less vulnerable to those events. Personality influences how the person copes with stressfu events. For example, if a person were infected with a cold virus but had a hard-driving, competitive personality, such that the person would not rest, would not take time off from work, and would not do other behaviors necessary to quickly recover from a cold, this person could become very ill, perhaps with the cold turning into pneumonia, because the person' s personality influenced how well he or she coped with th viral infection. How a person copes can influence the degree, duration, and frequenc of a stressful event.

Although the interactional model was useful in early research, health psychologists soon found its limitations. One problem was that researchers were unable to identify stable coping responses that were consistently adaptive or maladaptive (Lazarus, 1991). Subsequently , the interactional model was developed into a more complex and perhaps a more realistic model—the transactional model, depicted in Figure 18.1(b). In this model, personality has three potential ef fects: (1) it can influ ence coping, as in the interactional model; (2) it can influence how the perso appraises or interprets the events; and (3) it can influence the events themselves. These last two processes deserve special attention.

In the transactional model, it is not the event itself that causes stress but, rather , how the event is appraised, or interpreted, by the person. You will recall from Chapter 12 that interpretation is important in determining behavior . An event, such as getting stuck in traf fic on the way to a job intervie , can happen to two people, yet the two people can interpret the event dif ferently and, thus, experience it dif ferently. One person might interpret getting stuck as a major frustration and, hence, might respond with a great deal of worry, stress, and anxiety. The other might interpret getting stuck in traffic as an opportunity to relax, enjoy some music on the radio, and do som planning on how to reschedule the job interview . This person does not experience the same level of stress.

The third point on the transactional model at which personality can have an impact consists of the events themselves. That is, people don't just respond to situations; they also create situations through their choices and actions, as we discussed

Illness

Physiological arousal

Objective events capable of producing stress

Appraisal of events as threatening and/ or uncontrollable

Coping responses

Personality

Personality

Health behaviors

1

1

Objective events capable of producing stress

Appraisal of events as threatening

Coping responses

Illness

I

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Physiological arousal

Figure 18.1

Three models specifying the role of personality in moderating the effects of stress on illness: (a) the interactional model, which specifies that personality influences how people cope; (b) the transaction model, which specifies that personality influences how people cope, as well as how they appraise a influence situations; and (c) the health behavior model, which specifies that personality influences people cope, appraise, and influence situations, along with influencing the likely health behaviors th people practice.

in Chapter 4. People select to be in certain kinds of situations; they evoke certain responses from those situations, especially from the persons in the situations; and they manipulate the people in those situations, all in ways that may reflect their per sonalities. For example, a high-neuroticism person, someone who complains all the time, may create situations in which others frequently avoid him or her . Or a disagreeable person may create interpersonal situations in which he or she gets into a lot of arguments.

These two parts of the transactional model—appraisal and the person' s influ ence on events—are why the model is called transactional. These two elements of the model imply that stressful events don' t just influence persons; persons also are under stood to influence events. And this influence comes about through the appraisal o events, as well as the selection and modification of events. This reciprocal influenc of persons and events makes this a more complicated, though perhaps more realistic, model of how the process actually works.

The interactional and transactional models of personality and health are similar and were developed early on in research in this area. They are similar in that both posit a causal role for personality in coping with stress. However , the transactional model adds two additional roles for personality in influencing whether a stres response is evoked: first, personality influences the kinds of situations one encounte in life, and second, personality influences how one interprets the situations on encounters. In both these models, personality is thought to directly influence the rela tionship between stressful events and illness.

A third model, the health behavior model, adds another factor to the trans-actional model. It is important to realize that, so far , the three models are simply extensions of the theme that personality influences the stress-illness link. In thi model, which is depicted in Figure 18.1(c), personality does not directly influenc the relationship between stress and illness. Instead, in this model, personality af fects health indirectly, through health-promoting or health-degrading behaviors. Everyone knows that poor health behaviors, such as eating too much fat, smoking, and practicing unsafe sex, increase the risk of developing certain illnesses. This model suggests that personality influences the degree to which a person engages in variou health-promoting or health-degrading behaviors. Health behaviors are increasingly being acknowledged as important contributors to the personality-health link (W iebe & Smith, 1997). For example, extraversion is associated with a tendency to smoke (Eysenck, 1989). And smoking is, of course, associated with a number of health problems, including lung cancer , high blood pressure, and heart disease.

A fourth model of the link between personality and health, the predisposition model, is shown in Figure 18.2(a). The previous three models were all variations on the same theme that personality influences the relationship between stress and illnes either directly (interactional and transactional models) or indirectly (health behavior model). The fourth model is completely dif ferent and holds that personality and illness are both expressions of an underlying predisposition. This model is a very simple conception, suggesting that associations exist between personality and illness because of a third variable, which is causing them both. For example, enhanced sympathetic nervous system reactivity may be the cause of subsequent illnesses, as well as the cause of the behaviors and emotions that lead a person to be called neurotic. That is, an association can be found between disease and personality because of a predisposition that underlies both. The predisposition model has not been the topic of much systematic study, though it seems likely that this model will guide investigators interested in the genetic basis of illnesses. It may well turn out that some genetic

Normal physiological sensations

Heightened perception of and attention to sensations

Labeling of —► sensations as illness

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Personality

Reports of symptoms

Health behaviors, such as going to the doctor

Figure 18.2

Additional models of the relationship between personality and health: (a) the predisposition model, which holds that personality and health are related due to a common predisposition; and (b) the illness behavior model, which specifies how personality might influence whether or not a person would seek medic attention or report illness symptoms.

predispositions are expressed both in terms of a stable individual dif ference and in terms of susceptibility to specific illnesses (Bouchard et al., 1990). For example, som researchers speculate that there is a genetic cause of novelty seeking (a trait like sensation seeking) and that this genetic sequence also causes, or makes a person more likely to develop an addiction to drugs (Cloninger , 1999). Consequently, the correlation between the novelty-seeking personality trait and addiction to drugs such as cocaine, meth, or heroin may be due to the fact that these two variables are both independently caused by a third variable—genes. This simple model may be useful as the human genome project (see Chapter 6) progresses from mapping the genome to understanding what specific genes control

The final model for our consideration—called the illness behavior model—is not a model of illness per se but, rather , a model of illness behavior. Illness itself is define as the presence of an objectively measurable abnormal physiological process, such as fever, high blood pressure, or a tumor . Illness behavior, on the other hand, is the action that people take when they think they have an illness, such as complaining to others about their symptoms, going to a doctor , taking the day of f from school or work, or taking medication. Illness behaviors are related to actual illnesses, but not perfectly .

Some individuals may tough out an illness, stoically refusing to engage in illness behaviors (e.g., refusing to take the day of f from work when ill). Alternatively, other people engage in all sorts of illness behaviors even in the absence of actual illness.

Figure 18.2(b) portrays the illness behavior model. It suggests that personality influences the degree to which a person perceives and pays attention to bodily sen sations and the degree to which the person interprets and labels those sensations as an illness. The way in which a person perceives and labels those sensations, then, influences the person s illness behaviors, such as reporting the symptoms and going to a doctor. As discussed in Chapter 13, the personality trait of neuroticism is associated with a tendency to complain about physical symptoms. Self-reports of physical symptoms and illness behaviors may be influenced by factors other than actua illness, however, and these reports and behaviors are determined by how the person perceives and labels bodily sensations.

Most of the models of personality and illness contain one important variable— the concept of stress. Stress is an important but also a very much misunderstood phenomenon.

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Responses

  • Aila
    What is healthbehavior andillnes behavior?
    3 years ago

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