TEMPERAMENT AS A RISK FACTOR OF SOMATIC DISEASES

TEMPERAMENT AS A RISK FACTOR OF SOMATIC DISEASES

The idea that personality is the cause of somatic illnesses such as coronary heart disease (CHD) or cancer for many researchers seems to be humorous. Among the determinants of the diseases, which may be interpreted as consequences of interactions between a variety of factors such as immune system regulation, neuroendocrine and biochemical factors, genetically determined vulnerability and environmental risk factors, an important role was found for temperament and other personality dimensions. Three independent prospective studies were
conducted over a ten-year period. Subjects in all three samples were diagnosed by means
of inventories into four different personality types:
• Type I (equivalent to Type C)—cancer-prone, over-cooperative, unassertive,
unexpressive of negative emotions, avoiding conflicts, over-patient and defensive in
response to stress
• Type II (equivalent to Type A)—CHD-prone, chronically irritated and angry, failing to
establish stable emotional relations, showing aggression and hostility responses
• Type III—hysterical, oscillating between inadequacy and anger
• Type IV (equivalent to Type B)—mentally healthy.
At the end of the ten-year period, mortality and cause of death were recorded. The results
disclosed that in all three samples cancer mortality was highest in Type I and CHD mortality in Type II. It was also shown that a group of subjects diagnosed by relatives and friends as being permanently stressed showed significantly higher mortality rates (cancer and CHD) as compared with the non-selected (normal) group. The individuals representing Type IV reported significantly less heart disease as compared with Types I and II. There were, however, no significant differences between the three types as regards cancer. The relationship between heart disease and personality type was blurred by such variables as age, smoking, diet and exercising. Types I and II were older and smoked more, and Type IV persons had a healthier diet and exercised more. The literature also reports plenty of research in which CHD has been related to the Eysenckian temperament dimensions. Findings from several studies .The high neuroticism and high psychoticism (in terms of hostility and aggressiveness) interact with stressors to raise the risk of developing CHD. In a review comprising over 40 years of studies, Whiteman, Deary and Fowkes (2000) when searching for personality cardiovascular disease relationships found that Type A and hostility-related traits account for approximately 2 per cent of the variance in this disease. A five-year follow-up study was conducted by Whiteman and coworkers (2000) in which two categories of incident CHD—angina and myocardial infarction—were related to submissiveness and hostility. It turned out that submissiveness is protective against myocardial infarction but not angina. Increased dominance, the opposite pole to submissiveness, considered as a component of Type A behaviour was associated with higher risk of coronary disease. Curiously enough, hostility was not related to any of the two categories of CHD. In this study a variety of demographic and SES variables were under control.
The meta-analytic studies suggest that certain personality traits seem to be a common risk factor for both CHD and cancer, but some of them may be illness specific. We hypothesized thatdepression (depressiveness) is a general risk factor for many different illnesses (including lung cancer and myocardial infarction). Hostility may be treated as a myocardial infarction risk factor, but submissiveness as a risk of lung cancer. Regarding the temperamental traits, it was expected that emotional reactivity may be considered a common risk factor, strongly related to depressiveness. In turn, activity is illness specific: high activity is related to hostility and myocardial infarction; low activity is related to submissiveness and lung cancer. Additionally, temperamental traits are regarded rather as an indirect risk factor of both illnesses with direct effects of personality factors (and direct relationships between temperament and other personality traits). It was assumed also that smoking is influenced by temperament.

significance of temperament

significance of temperament
It was already the ancient Greek typology of temperament that developed, as a result of observations, that inappropriate activity combined with the amount and mixture of the four hormones constituting the physiological basis of temperament, leads to different kinds of illnesses. Thus Hippocrates and his follower, Galen, were the first to show that temperament plays an important role in human functioning. The significance of temperament as a factor that accelerates, or is conducive to, psychiatric disorders has been strongly emphasized by constitutionally oriented researchers, was probably one of the first to show that temperamental traits, when in interaction with an adverse environment, result in behaviour disorders. His experiments conducted on dogs demonstrated the functional significance of temperamental traits, especially the strength of the central nervous system (CNS), in the individual’s adaptationto environmental demands, such as strong stimulation, deprivation, and radical changes in the surroundings.
Independently of age-specific activity and situations, many researchers agree that the functional significance of temperamental traits comes to the fore when individuals are confronted with difficult situations, extreme stressors or demands that exceed their capacities to cope. Based on this point of view, different approaches have been developed, depending on whether these situations and demands refer to children or to adults. In research on children, specific concepts, such as ‘difficult temperament’ and ‘goodness of fit’ have been constructed, whereas in studies on adults concepts referring to different aspects of stress have gained widest popularity. This distinction, however, is not exclusive since both approaches can be found in studies on children and adults. In several temperament theories the assumption that temperament plays an important role in moderating stress is incorporated as one of the most important postulates. For example, Kagan (1983, 1994) considered the two types of temperament distinguished by him—inhibited and uninhibited temperaments—as representing different vulnerability to experience stress under situations of unexpected or unpredictable events. According to Nebylitsyn (1972) and Strelau (1983) the functional significance of temperament is evident when individuals are confronted with extreme situations or demands. In arousal-oriented theories of temperament, which refer to the concepts of optimal level of arousal or stimulation, temperamental characteristics are regarded as moderators in experiencing the state of stress under extreme levels of stimulation, as exemplified in the domain of extraversion
The question arises as to why temperamental traits should be considered as important variables moderating stress phenomena. Temperamental traits have a moderator status, by which we mean, after Folkman and Lazarus (1988), that they constitute antecedent conditions that influence other conditions. The individual has a given temperament since birth and it is present before stressors and states of stress occur.From the point of view of the studies the following three are of special importance:
• the impact of temperament in determining the intensity of stressors
• the role of temperament as a co-determinant of the state of stress
• the contribution of temperamental traits to the psychophysiological and/ or psychological costs of the state of stress.
Psychological stress is understood here in a different way. It is characterized by strong negative emotions, such as fear, anxiety, anger, hostility, or other emotional states evoking distress, accompanied by physiological and biochemicalchanges that evidently exceed the baseline level of arousal (see Strelau, 1995). Such an understanding of the state of stress, encountered among many researchers in the domain of stress (see Strelau, 1995), underlines the importance of both emotions and arousal as inseparable components of the state of stress. Both emotions and arousal are regarded as core concepts in temperament research, and thus constitute a good rationale for searching for links between the phenomena being studied here—temperament and stress. Excessive stress, resulting from demands with which the individual is unable to cope, consists of extremely strong negative affects accompanied by unusually high elevation of the level of arousal. As consequence changes in the organism occur, which may result in variations in psychological functioning such as an increased level of anxiety and depression, or in physiological or biochemical disturbances expressed in psychosomatic diseases or other health problems. Stress should be regarded as one of the many risk factors (external and internal) contributing to maladaptive functioning and disorders. When the state of stress interacts with other factors that decrease or dampen the consequences of stress, maladjustment or behavioural disturbances may not occur. Temperament determines individual arousability and constitutes the domain of personality that more than any other increases or decreases the probability of developing the state of stress, and as a consequence the psychologicalor psychophysiological costs of stress. This justifies the introduction of the concept of temperament risk factor (TRF), by which we mean any temperamental trait or configuration of traits that by itself and most probably in interaction with other factors acting excessively, persistently or recurrently, increases the risk of developing behaviour disorders or pathology, or that favours the shaping of a maladjusted personality .Our own studies aimed at testifying the functional significance of temperamental traits are based on the Regulative Theory of Temperament (RTT; see Strelau, 1998). In short, RTT can be described by ten postulates. The following four served as a starting point for formulating hypotheses:
1 Temperament reveals itself in formal characteristics of behaviour, it can be described in terms of energy and time.
2 Temperament characteristics are in their primary (inborn) form a product of biological
evolution and there must exist some genetic bases as well as physiological mechanisms regulating the individual-specific level of arousal that co-determine individual differences in temperament.
3 Temperament plays a regulatory function consisting in modifying (moderating) the stimulative and temporal characteristics of situations and behaviour adequately to the individual’s temperamental traits.
4 The role of temperament in regulating the relationships between persons and their environment becomes evident in difficult situations and maladaptive behaviour.

Two temperamental traits were selected—emotional reactivity and activity— regarded according to RTT as moderators taking part in regulating the energetic aspects of situations and/or behaviours. The structure of temperament as postulated by RTT comprises six traits that refer to the formal characteristics of behaviour and includes, in addition to the two mentioned above, briskness, perseveration(both refer to the temporal characteristics of behaviour), sensory sensitivity and endurance.
• emotional reactivity (ER): tendency to react intensively to emotion-eliciting stimuli, expressed in high emotional sensitivity and in low emotional endurance;
• activity (AC): tendency to undertake behaviour of high stimulative value or to supply by means of behaviour strong stimulation from the surroundings.
Considering these traits as dimensions, the definitions refer to one of the two poles characterizing high intensity of both emotional reactivity and activity.