Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-28T00:17:42.711Z Has data issue: false hasContentIssue false

Big Five personality traits and medically unexplained symptoms in later life

Published online by Cambridge University Press:  23 March 2020

S.D.M. van Dijk*
Affiliation:
University of Groningen, University Medical Center Groningen, Interdisciplinary Center for Psychopathology of Emotion regulation (ICPE), PO box 30.001RB Groningen9700, The Netherlands
D. Hanssen
Affiliation:
Radboud University Nijmegen Medical Center, Department of Psychiatry & Research Institute for Health Sciences, Nijmegen, The Netherlands
P. Naarding
Affiliation:
Radboud University Nijmegen Medical Center, Department of Psychiatry & Research Institute for Health Sciences, Nijmegen, The Netherlands Department of Old Age Psychiatry, GGNet, Apeldoorn, The Netherlands
P. Lucassen
Affiliation:
Radboud University Nijmegen Medical Center, Department of Primary and Community Care, Nijmegen, The Netherlands
H. Comijs
Affiliation:
GGZinGeest & Department Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
R. Oude Voshaar
Affiliation:
University of Groningen, University Medical Center Groningen, Interdisciplinary Center for Psychopathology of Emotion regulation (ICPE), PO box 30.001RB Groningen9700, The Netherlands
*
*Corresponding author. Tel.: +31 50 3611312. E-mail address:[email protected](S.D.M. van Dijk).
Get access

Abstract

Background

Personality dysfunction has been postulated as the most clinically salient problem of persons suffering from medically unexplained symptoms (MUS) but empirical studies are scarce. This study aims to compare the personality profile of older patients suffering from MUS with two comparison groups and a control group.

Methods

Ninety-six older patients with MUS were compared with 153 frequent attenders in primary care suffering from medically explained symptoms (MES), 255 patients with a past-month depressive disorder (DSM-IV-TR), and a control group of 125 older persons. The Big Five personality domains (NEO-Five-Factor Inventory) were compared between groups by multiple ANCOVAs adjusted for age, sex, education, partner status and cognitive functioning. Linear regression analyses were applied to examine the association between health anxiety (Whitley Index) and somatization (Brief Symptom Inventory).

Results

The four groups differed with respect to neuroticism (P < 0.001), extraversion (P < 0.001), and agreeableness (P = 0.045). Post hoc analyses, showed that MUS patients compared to controls scored higher on neuroticism and agreeableness, and compared to depressed patients lower on neuroticism and higher on extraversion as well agreeableness. Interestingly, MUS and MES patients had a similar personality profile. Health anxiety and somatization were associated with a higher level of neuroticism and a lower level of extraversion and conscientiousness, irrespective whether the physical symptom was explained or not.

Conclusions

Older patients with MUS have a specific personality profile, comparable to MES patients. Health anxiety and somatization may be better indicators of psychopathology than whether a physical symptom is medically explained or not.

Type
Original article
Copyright
Copyright © Elsevier Masson SAS 2016

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Olde Hartman, TCBlankenstein, AHMolenaar, AOBentz van den Berg, DVan der Horst, HEArnold, IAet al.NHG guideline on medically unexplained symptoms (MUS). Huisarts Wet. 2013;56(5): 222230Google Scholar
Barsky, AJOrav, EJBates, DWSomatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Arch Gen Psychiatry. 2005;62:903910CrossRefGoogle ScholarPubMed
Koch, Hvan Bokhoven, MAter Riet, Gvan der Weijden, TDinant, GJBindles, PJEDemographic characteristics and quality of life of patients with unexplained complaints: a descriptive study in general practice. Qual Life Res. 2007;16(9): 14831489CrossRefGoogle ScholarPubMed
Margalit, APEl-Ad, ACostly patients with unexplained medical symptoms: a high-risk population. Patient Educ Couns. 2008;70(2): 173178CrossRefGoogle ScholarPubMed
American Psychiatric Association, Diagnostic and statistical manual of mental disorders (DSM-5). 5th ed. 2013 American Psychiatric Press Washington, DCCrossRefGoogle Scholar
Bass, CMurphy, MSomatoform and personality disorders: syndromal comorbidity and overlapping developmental pathways. J Psychosom Res. 1995;39(4): 403427CrossRefGoogle ScholarPubMed
Fink, PSchröder, AOne single diagnosis, bodily distress syndrome, succeeded to capture 10 diagnostic categories of functional somatic syndromes and somatoform disorders. J Psychosom Res. 2010;68(5): 415426CrossRefGoogle ScholarPubMed
Rost, KMAkins, RNBrown, FWSmith, GRThe comorbidity of DSM-III-R personality disorders in somatization disorder. Gen Hosp Psychiatry. 1992;14:322326CrossRefGoogle ScholarPubMed
Garcia-Campayo, JAlda, MSobradiel, NOlivan, BPascual, APersonality disorders in somatization disorder patients: a controlled study in Spain. J Psychosom Res. 2007;62(6): 675680CrossRefGoogle ScholarPubMed
Stern, JMurphy, MBass, CPersonality disorders in patients with somatisation disorder. A controlled study. Br J Psychiatry. 1993;12(163): 785789CrossRefGoogle Scholar
Kuwabara, HOtsuka, MShindo, MOno, SShioiri, TSomeya, TDiagnostic classification and demographic features in 283 patients with somatoform disorder. Psychiatry Clin Neurosci. 2007;61(3): 283289CrossRefGoogle ScholarPubMed
Noyes, R Jr.Langbehn, DRHappel, RLStout, LRMuller, BALongley, SLPersonality dysfunction among somatizing patients. Psychosomatics. 2001;42(4): 320329CrossRefGoogle ScholarPubMed
Zunhammer M, Eberle H, Eichhammer P, Busch V. Somatic symptoms evoked by exam stress in university students: the role of alexithymia, neuroticism, anxiety and depression. PLoS One. doi:10.1371/Journal.pone.2013.08.491.CrossRefGoogle Scholar
Wongpakaran, TWongpakaran, NPersonality traits influencing somatization symptoms and social inhibition in the elderly. Clin Interv Aging. 2014;13(9): 157164CrossRefGoogle Scholar
Benraad, CEHilderink, PHvan Driel, DTDisselhorst, LGLubberink, Bvan Wolferen, Let al.Physical functioning in older persons with somatoform disorders: a pilot study. J Am Med Dir Assoc. 2013;14(1): 913CrossRefGoogle ScholarPubMed
Hilderink, PHBenraad, CEvan Driel, DBuitelaar, JKSpeckens, AEOlde Rikkert, MGet al.Medically unexplained physical symptoms in elderly people: a pilot study of psychiatric geriatric characteristics. Am J Geriatr Psychiatry. 2009;17(12): 10851088CrossRefGoogle ScholarPubMed
Hilderink, PHBurger, HDeeg, DJBeekman, ATOude Voshaar, RCThe temporal relation between pain and depression: results from the longitudinal aging study Amsterdam. Psychosom Med. 2012;74(9): 945951CrossRefGoogle ScholarPubMed
Kroenke, KPatients presenting with somatic complaints: epidemiology, psychiatric comorbidity and management. Int J Methods Psychiatr Res. 2003;12(1): 3443CrossRefGoogle ScholarPubMed
Hilderink, PHCollard, RRosmalen, JGMOude Voshaar, RCPrevalence of somatoform disorders and medically unexplained symptoms in old age populations in comparison with younger age groups: a systematic review. Ageing Res Rev. 2013;12:151156CrossRefGoogle ScholarPubMed
Dunlop, SPJenkins, DNeal, KRSpiller, RCRelative importance of enterochromaffin cell hyperplasia, anxiety and depression in post-infectious IBS. Gastroenterology. 2003;125(6): 16511659CrossRefGoogle Scholar
Van Eck Van der Sluijs, JTen Have, MRijnders, Cvan Marwijk, Hde Graaf, Rvan der Feltz-Cornelis, CMedically unexplained and explained physical symptoms in the general population: association with prevalent and incident mental disorders.. PLoS One. doi:10.1371/j.pone.0123274.CrossRefGoogle Scholar
Hegeman, JMde Waal, MWComijs, HCKok, RMvan der Mast, RCDepression in later life: a more somatic presentation?. J Affect Disord. 2015;1(170): 196202CrossRefGoogle Scholar
Steunenberg, BBraam, AWBeekman, ATDeeg, DJKerkhof, AJEvidence for an association of the Big Five personality factors with recurrence of depressive symptoms in later life. Int J Geriatr Psychiatry. 2009;24(12): 14701477CrossRefGoogle ScholarPubMed
Costa, PT Jr.Bagby, RMHerbst, JHMcCrae, RRPersonality self-reports are concurrently reliable and valid during acute depressive episodes. J Affect Disord. 2005;89(1–3):4555CrossRefGoogle ScholarPubMed
Wessely, SHotopf, MIs fibromyalgia a distinct clinical entity? Historical and epidemiological evidence. Baillieres Best Pract Res Clin Rheumatol. 1999;13(3): 427436CrossRefGoogle ScholarPubMed
Sheehan, DVLecrubier, YSheehan, KHAmorim, PJanavs, JWeiller, Eet al.The Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(20): 2233Google ScholarPubMed
Comijs, HCvan Marwijk, HWvan der Mast, RCNaarding, POude Voshaar, RCBeekman, ATet al.The Netherlands Study of Depression in Older persons (NESDO); design and methods. BMC Research Notes. 2011;4(1): 524CrossRefGoogle Scholar
Kessler, RCUstun, TBThe World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res. 2004;13(2): 93121CrossRefGoogle Scholar
Andrews, GPeters, LThe psychometric properties of the Composite International Diagnostic Interview. Soc Psychiatry Psychiatr Epidemiol. 1998;33:8088CrossRefGoogle ScholarPubMed
Costa, PT Jr.McCrae, RRDomains and facets: hierarchical personality assessment using the revised NEO personality inventory. J Pers Assess. 1995;64(1): 2150CrossRefGoogle ScholarPubMed
Chapman, BPBandwidth and fidelity on the NEO-Five-Factor Inventory: replicability and reliability of Saucier’s (1998) item cluster subcomponents. J Pers Assess. 2007;88(2): 220234CrossRefGoogle ScholarPubMed
Folstein, MFFolstein, SEMcHugh, PR“Mini mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3): 189198CrossRefGoogle ScholarPubMed
Rush, AJGiles, DESchlesser, MAFulton, CLWeissenburger, JBurns, CThe Inventory for Depressive Symptomatology (IDS): preliminary findings. Psychiatry Res. 1985;18:6587CrossRefGoogle Scholar
Speckens, AEvan Hemert, AMSpinhoven, PBolk, HJThe diagnostic and prognostic significance of the Whitely Index, the Illness Attitude Scale and the Somatosensory Amplification Scale. Psychol Med. 1996;26:10851090CrossRefGoogle ScholarPubMed
Speckens, AESpinhoven, PSloekers, PPBolk, JHvan Hemert, AMA validation study of the Whitely Index, the Illness Attitude Scale, and the Somatosensory Amplification Scale in general medical and general practice patients. J Psychosom Res. 1996;40:95104CrossRefGoogle ScholarPubMed
Derogatis, LRCleary, PAConfirmation of the dimensional structure of the SCL-90: a study in construct validation. J Clin Psychol. 1977;33(4): 9819893.0.CO;2-0>CrossRefGoogle Scholar
Arrindell, WAEttema, JHMSymptom checklist. Handleiding bij een multidimensionele psychopathologie indicator. Lisse: Swets & Zeitlinger; 2003Google Scholar
Croog, SHLevine, STesta, MABrown, BBulpitt, CJJenkins, CDet al.The effects of antihypertensive therapy on the quality of life. N Engl J Med. 1986;314(26): 16571664CrossRefGoogle ScholarPubMed
Aroian, KJPatsdaughter, CAMultiple-method, cross-cultural assessment of psychological distress. Image J Nurs Sch. 1989;21(2): 9093CrossRefGoogle ScholarPubMed
Derogatis, LRBrief symptom inventory (BSI): administration, scoring, and procedure manual. 4th ed. 1993 National Computer Systems Minneapolis, MNGoogle Scholar
Kroenke, KSpitzer, RLWilliams, JBLöwe, BThe Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. Gen Hosp Psychiatry. 2010;32(4): 345359CrossRefGoogle ScholarPubMed
IBM Corp, IBM SPSS Statistics for Windows, Version 22.0. Armonk, New York: IBM Corp; 2013Google Scholar
Steunenberg, BTwisk, JWBeekman, ATDeeg, DJKerkhof, AJStability and change of neuroticism in aging. J Gerontol B Psychol Sci Soc Sci. 2005;60(1): 2733CrossRefGoogle Scholar
Bogg, TRoberts, BWThe case for conscientiousness: evidence and implications for a personality trait marker of health and longevity. Ann Behav Med. 2013;45(3): 278288CrossRefGoogle ScholarPubMed
Smith, TWMacKenzie, JPersonality and risk of physical illness. Annu Rev Clin Psychol. 2006;2:435467CrossRefGoogle ScholarPubMed
Noftle, EEFleeson, WAge differences in Big Five behavior averages and variabilities across the adult life-span: moving beyond retrospective, global summary accounts of personality. Psychol Aging. 2010;25(1): 95107CrossRefGoogle ScholarPubMed
Kaye, ADBaluch, AScott, JTPain management in the elderly population: a review. Ochsner J. 2010;10(3): 179187Google ScholarPubMed
Sofaer, BMoore, APHolloway, ILamberty, JMThorp, TAO’Dwyer, JChronic pain as perceived by older people: a qualitative study. Age Ageing. 2005;34(5): 462466CrossRefGoogle ScholarPubMed
Goulia, PPapadimitriou, IMachado, MOMantas, CPappa, CTsianos, Eet al.Does psychological distress vary between younger and older adults in health and disease?. J Psychosom Res. 2012;72(2): 120128CrossRefGoogle ScholarPubMed
Goodwin, RDFriedman, HSHealth status and the five-factor personality traits in a nationally representative sample. J Health Psychol. 2006;11(5): 643654CrossRefGoogle Scholar
Kisely, SGoldberg, DSimon, GA comparison between somatic symptoms with and without clear organic cause: results of an international study. Psychol Med. 1997;27(5): 10111019CrossRefGoogle ScholarPubMed
Escobar, JICook, BChen, CNGara, MAAlegría, MInterian, Aet al.Whether medically unexplained or not, three or more concurrent somatic symptoms predict psychopathology and service use in community populations. J Psychosom Res. 2010;69(1): 18CrossRefGoogle ScholarPubMed
Joustra, MLJanssens, KABültmann, URosmalen, JGFunctional limitations in functional somatic syndromes and well-defined medical diseases. Results from the general population cohort LifeLines. J Psychosom Res. 2015;79(2): 9499CrossRefGoogle ScholarPubMed
Tomenson, BEssau, CJacobi, FLadwig, KHLeiknes, KALieb, Ret al.Total somatic symptom score as a predictor of health outcome in somatic symptom disorders. Br J Psychiatry. 2013;203(5): 373380CrossRefGoogle ScholarPubMed
Creed, FExploding myths about medically unexplained symptoms. J Psychosom Res. http://dx.doi.org/doi:10.1016/j.jpsychores.2016.02.007.CrossRefGoogle Scholar
Hyphantis, TGoulia, PCarvalho, AFPersonality traits, defense mechanisms and hostility features associated with somatic symptom severity in both health and disease. J Psychosom Res. 2013;75(4): 362369CrossRefGoogle ScholarPubMed
Ormel, JRosmalen, JGFarmer, ANeuroticism:, a non-informative marker of vulnerability to psychopathology. Soc Psychiatry Psychiatr Epidemiol. 2004;39(11): 906912CrossRefGoogle ScholarPubMed
Santor, DABagby, RMJoffe, RTJEvaluating stability and change in personality and depression. Pers Soc Psychol. 1997;73(6): 13541362CrossRefGoogle ScholarPubMed
Spinhoven, PPenelo, Ede Rooij, MPenninx, BWOrmel, JReciprocal effects of stable and temporary components of neuroticism and affective disorders: results of a longitudinal cohort study. Psychol Med. 2014;44(2): 337348CrossRefGoogle ScholarPubMed
Van Noorden, MSvan Fenema, EMvan der Wee, NJvan Rood, YRCarlier, IVZitman, FGet al.Predicting outcomes of mood, anxiety and somatoform disorders: the Leiden routine outcome monitoring study. J Affect Disord. 2012;142(1–3):122131 [15]CrossRefGoogle ScholarPubMed
Hilderink, PHCollard, RRosmalen, JGOude Voshaar, RCHow does ageing affect the impact of medically unexplained symptoms and medically explained symptoms on health-related quality of life?. Int J Geriatr Psychiatry. 2015;30(7): 734737CrossRefGoogle ScholarPubMed
Lucas, REDonnellan, MBPersonality development across the life-span: longitudinal analyses with a national sample from Germany. J Pers Soc Psychol. 2011;101(4): 847861CrossRefGoogle ScholarPubMed
Mooi, BComijs, HCBeekman, ATKerkhof, AJStability of personality in later life. Tijdschr Gerontol Geriatr. 2006;37(4): 136141CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.