Personality style, differential vulnerability, and clinical course in immunological and cardiovascular disease

Abstract

Recent formulations of two broad personality styles, a dependent (anaclitic) and a self-critical (introjective) personality style (Blatt, 1974, 1990; Blatt & Shichman, 1983), provide a theoretical model for integrating a diversity of findings linking personality factors to the onset and clinical course of immunological and cardiovascular disease. The model of a dependent (anaclitic) personality style appears to provide a structure for integrating, within an independently established conceptual system, the use of repressive defenses, feelings of helplessness, emotional lability, and preoccupations with interpersonal relationships, which have each been found to be predictive factors in neoplastic disease. The model of a self-critical (introjective) personality style appears to provide a conceptual structure for integrating the diverse findings indicating that personality factors of social isolation and mistrust, along with preoccupations with anger, autonomy, assertion, control, and self-worth (e.g., failure and achievement), are important in cardiovascular disease. The formulation of these two personality styles also contributes to understanding the role of personality factors in vulnerability to these two types of disease by suggesting that dependent individuals are more responsive to interpersonal disruption and generally respond to this type of Stressor with passivity and resignation, while self-critical individuals are primarily responsive to loss of self-control and self-worth, and generally react to these Stressors with heightened behavioral and autonomic arousal. These formulations also suggest that these personality styles are linked to clinical course because they make it difficult for individuals to alter behavior and life-style habits in ways that could facilitate obtaining care from medical staff and assistance from social support systems to cope with the impact of the disease process. Furthermore, these formulations have implications for considering different types of psychological interventions as part of comprehensive treatment programs; they raise questions about the role of depression in neoplastic and cardiovascular disease; and they indicate directions that should be explored in future research on the role of personality factors in physical health and illness.