Private self-consciousness and the five-factor model of personality: distinguishing rumination from reflection

A distinction between ruminative and reflective types of private self-attentiveness is introduced and evaluated with respect to L. R. Goldberg's (1982) list of 1,710 English trait adjectives (Study 1), the five-factor model of personality (FFM) and A. Fenigstein, M. F. Scheier, and A. Buss's (1975) Self-Consciousness Scales (Study 2), and previously reported correlates and effects of private self-consciousness (PrSC; Studies 3 and 4). Results suggest that the PrSC scale confounds two unrelated, motivationally distinct dispositions--rumination and reflection--and that this confounding may account for the "self-absorption paradox" implicit in PrSC research findings: Higher PrSC scores are associated with more accurate and extensive self-knowledge yet higher levels of psychological distress. The potential of the FFM to provide a comprehensive framework for conceptualizing self-attentive dispositions, and to order and integrate research findings within this domain, is discussed.

Psychiatric illness in general practice. A detailed study using a new method of case identification

A self-administered questionary (the General Health Questionnaire) aimed at detecting current psychiatric disturbance was given to 553 consecutive attenders to a general practitioner's surgery. A sample of 200 of these patients was given an independent assessment of their mental state by a psychiatrist using a standardized psychiatric interview. Over 90% of the patients were correctly classified as "well" or "ill" by the questionary, and the correlation between questionary score and the clinical assessment of severity of disturbance was found to be +0.80.The "conspicuous psychiatric morbidity" of a suburban general practice assessed by a general practitioner who was himself a psychiatrist and validated against independent psychiatric assessment was found to be 20%. "Hidden psychiatric morbidity" was found to account for one-third of all disturbed patients. These patients were similar to patients with "conspicuous illnesses" in terms both of degree of disturbance and the course of their illnesses at six-month follow-up, but were distinguished by their attitude to their illness and by usually presenting a physical symptom to the general practitioner.When 87 patients who had been assessed as psychiatric cases at the index consultation were called back for follow-up six months later, two-thirds of them were functioning in the normal range. Frequency of attendance at the surgery in the six months following index consultation was found to have only a modest relationship to severity of psychiatric disturbance.It is argued that minor affective illnesses and physical complaints often accompany each other and usually have a good prognosis.

Mental disorders in primary health care: a study of their frequency and diagnosis in four developing countries

1624 patients who were attending primary health facilities in 4 developing countries were examined to determine how many were suffering from mental disorder. Using stringent criteria to establish the presence of psychiatric morbidity, 225 cases were found, indicating an overall frequency of 13.9%. The great majority of cases were suffering from neurotic illnesses and for most the presenting complaint was of a physical symptom, such as headache, abdominal pain, cough or weakness. The health workers following their normal procedure correctly detected one third of the psychiatric cases.

A computerized psychiatric diagnostic system and case nomenclature for elderly subjects: GMS and AGECAT

The Geriatric Mental State and a new computerized diagnostic system, AGECAT, are briefly described. A nomenclature for designating cases for epidemiological work is introduced. Concordance between AGECAT and psychiatrists' diagnoses for these studies, hospital and community based (total of 541 subjects), achieved overall kappa values of 0.84 for a psychiatric hospital sample and 0.74 for a community sample. The values for depression and organic illness specifically in these settings were psychiatric hospital 0.80/0.86, and community 0.80/0.88, respectively.

A short clinical diagnostic self-rating scale for psychoneurotic patients. The Middlesex Hospital Questionnaire (M.H.Q.)

In the practice of our department at the Middlesex Hospital, the need has been felt for a means of rapid quantification of common symptoms and traits relevant to the conventional diagnostic categories of psychoneurotic illness. Until now, none of the available British scales have fulfilled this requirement. The most widely used is the Maudsley Personality Inventory (Eysenck, 1959) with its subsequent modifications. This, however, although scientifically based, is limited to the assessment of broad categories such as “neuroticism” and “extraversion” which appear to go only a small way towards describing the wide variability of psychoneurotic disturbances. Foulds and his co-workers (Foulds, 1965) have for a number of years developed personality scales in which clinical sophistication and a rigorous methodology are combined. Their Symptom-Sign Inventory, however, consists of eighty questions which have to be presented orally. Furthermore, although the inventory covers psychotic disturbances, it is necessary to use an additional questionnaire, the Hysteroid-Obsessoid Questionnaire (Caine & Hawkins, 1963) to complete the spectrum of psychoneurotic illness. Moreover, the concept of psychiatric illness developed by these workers is individual rather than conventional in a number of respects. The Tavistock Self-Assessment Inventory (Sandler, 1954) is too long for the present purposes (876 items in six booklets). The Taylor Manifest Anxiety Scale (Taylor, 1953) is short and convenient, but it measures one dimension only. As many doctors, including psychiatrists, find it useful to think in terms of orthodox clinical categories for diagnostic, therapeutic, prognostic and research purposes, it was decided to design and attempt to validate a self-rating scale adapted to these categories, taking the patient 5–10 minutes to complete and capable of being rapidly scored by the doctor or an assistant.

The illusion of mental health

It is argued that researchers' reliance on "objective" mental health scales and disregard for clinical judgment has led to many mistaken conclusions. Specifically, standard mental health scales appear unable to distinguish between genuine mental health and the facade or illusion of mental health created by psychological defenses. Evidence is presented indicating that (a) many people who look healthy on standard mental health scales are not psychologically healthy, and (b) illusory mental health (based on defensive denial of distress) has physiological costs and may be a risk factor for medical illness. Clinical judges could distinguish genuine from illusory mental health, whereas "objective" mental health scales could not. The findings call into question the conclusions of many previous studies that rest on standard mental health scales. They suggest new ways of understanding how psychological factors may influence health. Finally, they suggest that clinical methods (which researchers often malign) may have an important role to play in meaningful mental health research.

Personality and disinhibitory psychopathology: alcoholism and antisocial personality disorder

We discuss the relation between personality factors and two adult forms of disinhibitory psychopathology--alcohol abuse or dependence and antisocial personality disorder. First, we briefly review various methodological issues relevant to research in this area. Next, we review empirical findings relating three broad-band personality trait dimensions neuroticism/emotionality, impulsivity/disinhibition, extraversion/sociability) to both alcohol abuse and dependence and antisocial personality disorder. Finally, theoretical models of the relationship between personality and each of these two disorders are presented. We conclude that although no single personality description is likely to be both a sensitive and specific indicator of either alcoholism or antisocial personality disorder, personality variables are important components of etiological models of these disorders.

A population-based twin study of the relationship between neuroticism and internalizing disorders

OBJECTIVE

The anxiety and depressive disorders exhibit high levels of lifetime comorbidity with one another. The authors examined how genetic and environmental factors shared by the personality trait neuroticism and seven internalizing disorders may help explain this comorbidity.

METHOD

Lifetime major depression, generalized anxiety disorder, panic disorder, agoraphobia, social phobia, animal phobia, situational phobia, and neuroticism were assessed in over 9,000 twins from male-male, female-female, and opposite-sex pairs through structured diagnostic interviews. Multivariate structural equation models were used to decompose the correlations between these phenotypes into genetic and environmental components, allowing for sex-specific factors.

RESULTS

Genetic factors shared with neuroticism accounted for between one-third and one-half of the genetic risk across the internalizing disorders. When nonsignificant gender differences were removed from the models, the genetic correlations between neuroticism and each disorder were high, while individual-specific environmental correlations were substantially lower. In addition, the authors could identify a neuroticism-independent genetic factor that significantly increased risk for major depression, generalized anxiety disorder, and panic disorder.

CONCLUSIONS

There is substantial, but not complete, overlap between the genetic factors that influence individual variation in neuroticism and those that increase liability across the internalizing disorders, helping to explain the high rates of comorbidity among the latter. This may have important implications for identifying the susceptibility genes for these conditions.

A motivational perspective on risky behaviors: the role of personality and affect regulatory processes

The present study tested a motivational model in which personality influences on risky behaviors were hypothesized to be primarily indirectly mediated, by shaping the nature and quality of emotional experience as well as characteristic styles of coping with these emotions. This model was tested in a representative community sample of 1,666 young adults, aged 18 to 25 years old. Results revealed strong support for the model, indicating that broad traits related to neuroticism and extraversion promote involvement in alcohol use and risky sex via distinct pathways. Neurotic individuals were prone to engage in risky behaviors as a way to cope with aversive mood states, whereas extraverted individuals were more likely to engage in risky behaviors as a way to enhance positive affective experience. In contrast, impulsivity directly predicted some forms of risk taking, and interacted with extraversion and neuroticism to predict motives for risky behaviors. The model provides a highly general though not complete account of risky behaviors.

A re-analysis of the reliability of psychiatric diagnosis

Classification systems such as diagnosis have two primary properties, reliability and validity. Reliability refers to the consistency with which subjects are classified; validity, to the utility of the system for its various purposes. In the case of psychiatric diagnosis, the purposes of the classification system are communication about clinical features, aetiology, course of illness and treatment. A necessary constraint on the validity of a system is its reliability. There is no guarantee that a reliable system is valid, but assuredly an unreliable system must be invalid.

Perfectionism and psychopathology: a review of research and treatment

Clinical experience suggests that perfectionism can impede the successful treatment of psychological disorders. This review examines the concept of perfectionism, critically evaluates its assessment, reviews the association between existing measures of perfectionism and psychopathology, and considers the impact of perfectionism on treatment. It is concluded that existing measures do not reflect the original construct of perfectionism and that, consequently, new measures are needed. The evidence reviewed indicates that high personal standards are specifically elevated in patients with eating disorders and beliefs about others' high standards for the self are associated with a broad range of psychopathology. The importance of examining mean scares across studies (as well as associations between variables within studies) is emphasized. There has been no systematic evaluation of the treatment of perfectionism despite existing cognitive-behavioral treatment protocols.

Range of mental illness among the elderly in the community. Prevalence in Liverpool using the GMS-AGECAT package

A sample of 1070 elderly persons aged over 65 living in the Liverpool community was interviewed using the community version of the Geriatric Mental State (GMS) and the findings processed to provide a computerised diagnosis by AGECAT. Levels of organic disorder, probably dementia, reached 5.2%, intermediate between those of London and New York derived from previous studies. Levels for depressive illness overall were below those of other studies at 11.3% while levels for neurotic disorder were much the same at 2.4%. The rise in the prevalence of dementia with age was further confirmed. The GMS AGECAT Package provides a method for standardising both the collection of data and the diagnostic process for comparative epidemiological studies and other research.

Reliability of a procedure for measuring and classifying "present psychiatric state"

It is generally agreed that psychiatric illnesses can fairly reliably be categorized into four broad groups—organic psychoses, functional psychoses, neuroses and personality disorders. Cases are assigned with greatest confidence to the first group and with least confidence to the fourth. The reliability of specific diagnoses within these classes is much less secure and decreases in the same order. The best recent reviews of the literature are by Kreitman (1961) and Foulds (1965).

The daily life of the garden-variety neurotic: reactivity, stressor exposure, mood spillover, and maladaptive coping

This article describes a series of studies using the daily process paradigm to describe and understand the affective dynamics of people who experience frequent and intense bouts of a wide range of negative emotions. In several studies, community residents reported on problem occurrence and affect several times a day or at the end of the day. We found reliable evidence that persons who scored high (vs. low) in Neuroticism reported more daily problems, tended to react with more severe emotions, experienced more mood spillover from prior occasions, and exhibited stronger reactions to recurring problems (the "neurotic cascade"). The susceptibility of neurotics to stress seems to extend to all types of problems while certain other dimensions of personality (e.g., Agreeableness) are associated with hyperreactivity to particular kinds of problems. The research demonstrates how daily process research can provide insight about classic problems in the field of individual differences.

Validity of the NIMH Diagnostic Interview Schedule for Children: a comparison between psychiatric and pediatric referrals

The NIMH Diagnostic Interview Schedule for Children (DISC) was used to evaluate 40 psychiatric referrals aged 7-11 and 40 pediatric referrals matched for age, sex, race, and socioeconomic status. Each parent and child was interviewed separately using parallel versions of the interview, DISC-P and DISC-C, and parents completed the Child Behavior Checklist (CBCL). The psychiatric referrals had more psychiatric diagnoses and higher symptom scores than the pediatric referrals. Parent reports discriminated better between the criterion groups than child reports. In both groups, mild oppositional behavior and fears were commonly reported by parents, whereas mild separation anxiety, fears, and dysthymia were commonly reported by children. Attention deficit disorder, conduct disorder, and affective disorders were much more common among psychiatrically referred children. There was an association (chi 2 = 37.1, p less than .001) between abnormally high CBCL scores and diagnoses derived from the interview with the parent, but the association between the CBCL and the child interview was not significant. Over all, the results support the validity of the DISC-P, and to a lesser extent that of the DISC-C, in discriminating psychiatric from pediatric referrals, at the level of both symptoms and severe diagnoses, but not at the mild/moderate level of diagnosis.

Long-term relations of personality and health: dynamisms, mechanisms, tropisms

There is now little doubt that individuals who are well-adjusted, socially stable, and well-integrated into their communities are at significantly lower risk for disease and premature mortality than those who are more unstable, impulsive, isolated, and alienated. The reasons for these associations, however, are complex and the pathways insufficiently studied. This article employs a life-span data set to explore how childhood personality relates to health-related growth and development (dynamisms), patterns of reactions and health behaviors (mechanisms), and movements toward and away from suitable environments (tropisms). Illustrations from the 7-decade Terman longitudinal data reveal important areas in which previous, cross-sectional research has misinterpreted associations between personality and health. In particular, Sociability has been overrated as a life-span health risk factor, Conscientiousness has been underrated, and Neuroticism has been confused. Without sufficient attention to the processes underlying the associations between personality and health, significant suboptimal allocations of intervention resources result.

Anxiety and depressive disorders and the five-factor model of personality: a higher- and lower-order personality trait investigation in a community sample

We describe in detail normal personality traits in persons with psychiatrist-ascertained anxiety and depressive disorders in a general population sample. We investigated Revised NEO Personality Inventory traits in 731 community subjects examined by psychiatrists with the Schedules for Clinical Assessment in Neuropsychiatry. All of the lifetime disorders of interest (simple phobia, social phobia, agoraphobia, panic disorder, obsessive-compulsive disorder (OCD), generalized anxiety disorder, major depressive disorder (MDD), and dysthymia) were associated with high neuroticism. Social phobia, agoraphobia, and dysthymia were associated with low extraversion, and OCD was associated with high openness to experience. In addition, lower-order facets of extraversion (E), openness (O), agreeableness (A), and conscientiousness (C) were associated with certain disorders (specifically, low assertiveness (E) and high openness to feelings (O) with MDD, low trust (A) with social phobia and agoraphobia, low self-discipline (C) with several of the disorders, and low competence and achievement striving (C) with social phobia). Neuroticism in particular was related to acuity of disorder. Longitudinal study is necessary to differentiate state versus pathoplastic effects.