Abstracts
This article describes some prevalent personality dimensions of recently diagnosed multiple sclerosis patients. A sample of 33 female recently diagnosed with relapsing-remitting multiple sclerosis (RRMS) was assessed with the NEO-FFI personality scale. Beck depression (BDI) and anxiety (BAI) scales were also used. No significant levels of anxiety or depression were identified in this group. As for personality factors, conscientiousness was the most common factor found, whereas openness to experience was the least observed. Literature on the relationship between personality and MS is scarce and there are no Brazilian studies on this subject. Some personality traits might complicate or facilitate the experience of living with a chronic, disabling and uncertain neurological condition such as MS.
multiple sclerosis; personality; NEO-FFI
Este artigo descreve alguns traços prevalentes de personalidade em pacientes com esclerose múltipla recém-diagnosticada. Uma amostra de 33 mulheres recentemente diagnosticadas com a forma clínica remitente-recorrente da esclerose múltipla (EMRR) foi avaliada com a escala de personalidade NEO-FFI. As escalas de Beck de depressão e de ansiedade também foram usadas. Não foram identificados níveis significativos de ansiedade ou depressão neste grupo. Em relação aos fatores de personalidade, a conscienciosidade se mostrou como o traço mais prevalente, enquanto a abertura à experiência foi o menos observado nesta amostra. A literatura acerca desta relação esclerose múltipla-personalidade é pouco expressiva e não há estudos brasileiros sobre este tema. Acredita-se que alguns traços de personalidade possam dificultar ou facilitar a experiência de estar vivendo com uma condição neurológica crônica, incapacitante e de curso incerto como a esclerose múltipla.
esclerose múltipla; personalidade; NEO-FFI
Traditionally, most studies on psychological aspects of neurological diseases focus cognitive and psychiatric changes. On the other hand, other important aspects also related to the patient are rather scarce. Therefore, studies on personality characteristics associated with neurological conditions are unusual11 Ožura A, Erdberg P, Šega S. Personality characteristics of multiple sclerosis patients: a Rorschach investigation. Clin Neurol Neurosurg. 2010;112(7):629-32..
Personality consists of stable characteristics that make behavior consistent over time.
It is what makes us unique22 Pervin L, Oliver J. Personalidade: teoria e pesquisa. 8a ed. Porto
Alegre: Artmed; 2004.. Despite
the fact that our personality changes for the better with age – according to the
American Psychological Association (APA) – living with a disabling and chronic
disease might affect this consistency over time. Thus, misfortune in general may play a
significant role in one’s personality. Accordingly, most authors agree that
personality characteristics might affect psychological functioning while the patient is
adjusting to a chronic disease33 Rätsep T, Kallasmaa T, Pulver A, Gross-Paju K. Personality as a
predictor of coping efforts in patients with multiple sclerosis. Mult Scler.
2000;6(6):397-402. http://dx.doi.org/10.1177/135245850000600607
https://doi.org/10.1177/1352458500006006...
,44 Bogle N, Percy M, Morrison W. Will I make it through this choppy
water? a psychological characteristic as a predetermining factor to coping with
multiple sclerosis. Axone. 1999;20(3):63-6.,55 Peyser JM, Edwards KR, Poser CM. Psychological profiles in patients
with multiple sclerosis. A preliminary investigation. Arch Neurol.
1980;37(7):437-40.
http://dx.doi.org/10.1001/archneur.1980.00500560067009
https://doi.org/10.1001/archneur.1980.00...
,66 Strober LB, Christodoulou C, Benedict RH, Westervelt HYJ, Melville
P, Scherl WF. et al. Unemployment in multiple sclerosis: the contribution of
personality and disease. Mult Scler. 2012;18(5):647-53.
http://dx.doi.org/10.1177/1352458511426735
https://doi.org/10.1177/1352458511426735...
.
LIVING WITH MULTIPLE SCLEROSIS (MS)
MS is an inflammatory demyelinating disease of the central nervous system (CNS). Relapses can be recurrent. The clinical course of MS is uncertain. In general, after relapses, which may last days, weeks or even months11 Ožura A, Erdberg P, Šega S. Personality characteristics of multiple sclerosis patients: a Rorschach investigation. Clin Neurol Neurosurg. 2010;112(7):629-32., some patients recover completely and go back to living a normal life. For others, though, the course of this disease can be progressive throughout the years.
Usually the first MS relapse can happen within an age range that goes from 18 to 55
years, although it occurs more frequently among people with 20 to 40 years of age,
according to clinical criteria33 Rätsep T, Kallasmaa T, Pulver A, Gross-Paju K. Personality as a
predictor of coping efforts in patients with multiple sclerosis. Mult Scler.
2000;6(6):397-402. http://dx.doi.org/10.1177/135245850000600607
https://doi.org/10.1177/1352458500006006...
.
These patients are usually studying, starting or developing a career and/or starting
a family. They are struggling to gain social responsibility and financial
independence44 Bogle N, Percy M, Morrison W. Will I make it through this choppy
water? a psychological characteristic as a predetermining factor to coping with
multiple sclerosis. Axone. 1999;20(3):63-6.. Uncertainty in
MS relapses and progress of the disease can threaten life projects. Eventually,
getting acquainted with personality traits of MS patients is a useful piece of
information, because they help understand how they cope with MS. This knowledge adds
value to therapeutic approach and treatment55 Peyser JM, Edwards KR, Poser CM. Psychological profiles in patients
with multiple sclerosis. A preliminary investigation. Arch Neurol.
1980;37(7):437-40.
http://dx.doi.org/10.1001/archneur.1980.00500560067009
https://doi.org/10.1001/archneur.1980.00...
. For instance, a recent study investigated employment
status of MS patients and its relationship with their personality
characteristics66 Strober LB, Christodoulou C, Benedict RH, Westervelt HYJ, Melville
P, Scherl WF. et al. Unemployment in multiple sclerosis: the contribution of
personality and disease. Mult Scler. 2012;18(5):647-53.
http://dx.doi.org/10.1177/1352458511426735
https://doi.org/10.1177/1352458511426735...
. Persistence
was the trait strongly related with employability.
MS patients often experience apprehension on a daily basis through the possibility of relapses. They even take a careful lifestyle because they do not know if or when a new relapse might occur. Thus, living with MS for many patients can become a tough challenge.
While in the past most studies used the Minnesota Multiphasic Personality
Inventory (MMPI), a personality inventory designed to identify
psychiatric disorders; currently, the Five Factor Model (FFM) is the most popular,
empirically supported and scientifically useful personality taxonomy. The FFM
personality measure that received the most empirical attention is the NEO-PI, which
has a revised version (NEO PI-R) as well as a shorter version, the NEO-FFI (NEO five
Factor Inventory)77 McCrae RR, John OP. An introduction to the five-factor model and its
applications. J Pers. 1992;60(2):175-215.. This tool has
been validated and used extensively in cross-cultural studies. Preliminary use of
the NEO-FFI scales in MS has revealed associations between personality and chronic
fatigue and depression88 Merkelbach S, König J, Sittinger H. Personality traits in
multiple sclerosis patients with and without fatigue experience. Acta Neurol
Scand. 2003;107(3):195-201.
http://dx.doi.org/10.1034/j.1600-0404.2003.02037.x
https://doi.org/10.1034/j.1600-0404.2003...
.
This model is a comprehensive description of the basic personality structure. The
five major personality dimensions of personality are: Neuroticism (N), Extraversion
(E), Openness to Experience (O), Agreeableness (A) and Conscientiousness (C)77 McCrae RR, John OP. An introduction to the five-factor model and its
applications. J Pers. 1992;60(2):175-215.. The FFM was developed from the
lexical approach of the personality structure. Such approach is based on factor
analyses of trait terms commonly and widely used by people to describe themselves
and others, derived from the English language dictionaries88 Merkelbach S, König J, Sittinger H. Personality traits in
multiple sclerosis patients with and without fatigue experience. Acta Neurol
Scand. 2003;107(3):195-201.
http://dx.doi.org/10.1034/j.1600-0404.2003.02037.x
https://doi.org/10.1034/j.1600-0404.2003...
. The central hypothesis of the lexical approach is
that important personality traits are encoded in natural language99 Goldberg LR. An alternative “description of
personality”: the big-five factor structure. J Pers Soc Psychol.
1990;59(6):1216-29.
http://dx.doi.org/10.1037/0022-3514.59.6.1216
https://doi.org/10.1037/0022-3514.59.6.1...
.
Neuroticism, for instance, is a tendency to experience negative emotions, such as hostility, anger and sadness. Extraversion describes an outgoing and sociable nature. A person who is open to experience is generally curious, imaginative and seeks novelty. Agreeableness is a tendency to cooperate rather than compete. Finally, conscientiousness means lack of impulsivity, tidiness and a goal-oriented mind.
The commercially available tool designed to assess FFM dimensions is the Revised NEO Personality Inventory or NEO-PI-R, developed by Paul Costa and Robert McCrae launched in 1992. In Brazil, this personality scale was validated for the Brazilian population by Carmen Flores-Mendoza in 2007.
This inventory has already been used in some studies with MS patients. In 2011, an
important study with 419 MS patients was published. The authors wanted to determine
if the NEO-FFI was a reliable and valid assessment tool. They found adequate
estimates of internal consistency, factorial validity, and self-informant
correlation that supported its use with this population1010 Koroktov D, Hannah TE. the five-factor model of personality:
strengths and limitations in predicting health status, sick-role and illness
behavior. Pers Individ Dif. 2004;36(1):187-99.
http://dx.doi.org/10.1016/S0191-8869(03)00078-3
https://doi.org/10.1016/S0191-8869(03)00...
,1111 Schwartz ES, Chapman BP, Duberstein PR, Weinstock-Guttman B,
Benedict RH. The NEO-FFI in Multiple Sclerosis: internal consistency, factorial
validity and correspondence between self and informant reports. Assessment.
2011;18(1):39-49. http://dx.doi.org/10.1177/1073191110368482
https://doi.org/10.1177/1073191110368482...
.
Significant psychological distress is commonly seen in MS patients. This study is a preliminary investigation of personality traits and multiple sclerosis in Brazil. We have examined the frequency distribution of 5 personality dimensions in recently diagnosed relapsing-remitting multiple sclerosis (RRMS) patients, using the shortened version of the NEO-PI personality inventory, the NEO-FFI.
METHOD
Participants
This preliminary study had a cross-sectional, observational and descriptive
design. The subjects came from the outpatient Neurology service of the
university hospital HUGG (Hospital Universitário Gaffree & Guinle).
They were diagnosed with definite MS by their neurologists1212 McDonald WI, Compston A, Edan G, Goodkin D, Hartung HP, Lublin FD et
al. Recommended diagnostic criteria for multiple sclerosis: guidelines from the
International Panel on the diagnosis of multiple sclerosis. Ann Neurol.
2001;50(1):121-7. http://dx.doi.org/10.1002/ana.1032
https://doi.org/10.1002/ana.1032...
and then invited by the latter to take part
in this study, respecting inclusion/exclusion criteria. Patients with other
neurological diseases or other neurofunctional disturbances, a history of
psychiatric conditions, with past or current drug abuse prior to MS onset, head
trauma, significant depression and/or anxiety levels and visual/auditory
deficits that could interfere in the performance of the tests were excluded. All
patients presented a low Expanded Disability Status Scale (EDSS) (≤ 3.5)
and had their first relapse within 2 months to 3 years before the assessment.
The inclusion criteria were used to reduce confounds resulting from interactions
between personality traits and other aspects such as previous psychological co
morbidities or/and motor impairment that would change the patients’
lifestyle. This data collection at one specific point in time attempted to
assess patients’ personality traits free from major confounding
factors.
Our convenience sample of MS patients initially consisted of 40 MS patients. After assessing this group, there were only 7 (seven) men. Due to the very small number of male subjects in this study, the authors decided to remove this group from statistical analysis. They have not considered this number representative in order to make significant inferences. The 33 female MS patients remained. All patients came from the outpatient neurology clinic of the university hospital, respecting exclusion and inclusion criteria. All patients gave informed consent to take part in this study.
This study was approved by the Ethical Committee of Gafree & Guinle University Hospital.
Instruments
Patients went through a semi-structured interview in order to provide clinical and demographic information. Then, they received the NEO-FFI inventory. This personality scale is a 60-item self-report questionnaire answered on a five-point Likert scale, which ranges from strongly agree (1) to strongly disagree (5). Participants were tested by the same psychologist. A parallel study that assessed cognitive changes in early MS used Beck inventories for anxiety (BAI) and depression (BDI) in the same group. Those scores were used in this study. Moreover, the purpose of this study was not to assess cognitive aspects in MS. However, the same MS group used in the present study also went through neuropsychological assessment – through a brief neuropsychological battery – in an ongoing investigation on cognition in recent MS.
Neuropsychological Assessment
The brief neuropsychological assessment battery applied in the same group of MS
patients on a parallel ongoing study was previously used by Paes1313 Paes RA. Frequency of cognitive changes in three courses of Multiple
Sclerosis – Relapsing Remitting, Primary Progressive and Benign –
using a brief neuropsychological battery (BNB) [doctor’s
thesis]. Frequência de alterações cognitivas em três
formas clínicas da Esclerose Múltipla – Remitente-Recorrente,
Progressiva Primária e Benigna – usando uma bateria
neuropsicológica breve. Rio de Janeiro: Universidade Federal do Rio de
Janeiro; 2011. and Rodrigues et al.1414 Rodrigues DN, Paes RA, Vasconcelos CCF, Landeira-Fernandes J,
Alvarenga RMP. Different cognitive profiles of Brazilian patients with
relapsing-remitting and primary progressive multiple sclerosis. Arq
Neuropsiquiatr. 2011;69(4):590-5.
http://dx.doi.org/10.1590/S0004-282X2011000500004
https://doi.org/10.1590/S0004-282X201100...
. This battery focused tests
with higher sensitivity and specificity, according to Negreiros et al.1515 Negreiros MA, Mattos P, Landeira-Fernandez J, Paes RA, Alvarenga RP.
A brief Neuropsychological screening test battery for cognitive dysfunction in
Brazilian multiple sclerosis patients. Brain Inj. 2008;22(5):419-26.
http://dx.doi.org/10.1080/02699050801998243
https://doi.org/10.1080/0269905080199824...
and Paes et al.1616 Paes RA, Alvarenga RMP, Vasconcelos CCF, Negreiros MA,
Landeira-Fernandez J. [Neuropsychology of primary progressive multiple
sclerosis]. Rev Neurol. 2009;49(7):343-8. Spanish.. The tests were: (a) Rey
Auditory Verbal Learning Test (RAVLT); (b) Digit Symbol
Modalities Test (SDMT); (c) Hooper Visual
Organization Test (HVOT); and (d) Controlled
Oral Word Association Test (COWAT).
RESULTS
Demographic data of this sample of MS patients is shown in Table 1. The mean age of this group was congruent with MS profile and with data found in other studies (36.96 years). Educational level was rather high due to the social environment of this group (15.86 years), which was the metropolitan area of Rio de Janeiro. The EDSS scores were expectedly low, according to inclusion criteria. (Median = 1.5) with minimum score of 0 and maximum of 3.5. The 33 women of this sample were not impaired. Mean length of the disease was 21.09 months, in order to set the MS recent status. Patients did not present significant levels of anxiety and depression, minimizing the risk of psychiatric co-morbidity (a confounding variable in personality assessment) (Table 2). Frequency distribution and percentages of the five dimensions scored by NEO-FFI found in the sample are presented in Table 3 and in Figure.
Accumulated frequency of NEO-FFI in 33 recently-diagnosed relapsing-remitting multiple sclerosis (RRMS) female patients.
Frequency distribution of the 5 factors of personality assessed by NEO-FFI in the sample with 33 female relapsing-remitting multiple sclerosis (RRMS) patients classified by percentile.
DISCUSSION
This study investigated personality factors of recently diagnosed MS patients using
NEO-FFI, a scale based on the FFM of the personality, also known as the Big Five.
The most frequent dimensions seen in this group were: conscientiousness,
agreeableness and neuroticism. Bruce and colleagues studied the association between
personality factors (assessed by NEO-FFI) and adherence to treatment, with a
predominantly feminine sample of RRMS patients1717 Bruce JM, Hancock LM, Arnett P, Lynch SG. Treatment adherence in
multiple sclerosis: association with emotional status, personality and
cognition. J Behav Med. 2010;33(3):219-27.
http://dx.doi.org/10.1007/s10865-010-9247-y
https://doi.org/10.1007/s10865-010-9247-...
. Their findings showed that patients with good
adherence also presented high levels of agreeableness, consciousness and
neuroticism.
Conscientiousness obtained the highest frequency, which means that these patients
lack impulsivity. Hawkes, in 2005, however, found a rather different result while
examining impulsiveness or risk-disregarding behavior in MS patients. Smoking,
alcohol consumption and high cholesterol were some of the variables considered.
According to this study, MS patients neglected healthy behaviors compared to healthy
controls1818 Hawkes CH. Are multiple sclerosis patients risk-takers? QJM.
2005;98(12):895-911. http://dx.doi.org/10.1093/qjmed/hci135
https://doi.org/10.1093/qjmed/hci135...
. Another study of
2013 found similar results as to low conscientiousness in MS patients. The authors
parted from the hypothesis that personality plays a role on the relationship between
brain volume and cognitive/neuropsychiatric MS features. For instance, patients with
low conscientiousness were at a higher risk for developing MS-associated
neuropsychiatric symptoms1919 Benedict RH, Schwartz CE, Duberstein P, Healy B, Hoogs M, Bergsland
M et al. Influence of personality on the relationship between gray matter volume
and neuropsychiatric symptoms in multiple sclerosis. Psychosom Med.
2013;75(3):253-61.
http://dx.doi.org/10.1097/PSY.0b013e31828837cc
https://doi.org/10.1097/PSY.0b013e318288...
.
Agreeableness was the second trait most frequently seen in this group. Agreeable
people are more cooperative than competitive. On the other hand, agreeableness also
means vulnerability in competitive settings. Other studies on personality of MS
patients found a similar pattern11 Ožura A, Erdberg P, Šega S. Personality characteristics
of multiple sclerosis patients: a Rorschach investigation. Clin Neurol
Neurosurg. 2010;112(7):629-32.,2020 Lode K, Bru E, Klevan G, Myhr KM, Nyland H, Larsen JP. Coping with
multiple sclerosis: a 5-year follow-up study. Acta Neurol Scand.
2010;122(5):336-42.
http://dx.doi.org/10.1111/j.1600-0404.2009.01313.x
https://doi.org/10.1111/j.1600-0404.2009...
,2121 Fragoso YD, Silva EO, Finkelsztejn A. Correlation between fatigue
and self-esteem in patients with multiple sclerosis. Arq Neuropsiquiatr.
2009;67(3B):818-21.
http://dx.doi.org/10.1590/S0004-282X2009000500007
https://doi.org/10.1590/S0004-282X200900...
. An avoidant personality style was identified in this
group of MS patients. In general, agreeable people can have low self esteem, if this
trait is due to confrontation avoidance. Moreover, it increases the fatigue
sensation2121 Fragoso YD, Silva EO, Finkelsztejn A. Correlation between fatigue
and self-esteem in patients with multiple sclerosis. Arq Neuropsiquiatr.
2009;67(3B):818-21.
http://dx.doi.org/10.1590/S0004-282X2009000500007
https://doi.org/10.1590/S0004-282X200900...
. The avoidant
personality style is also associated with poor problem-solving strategies2222 O’Brien MT. Multiple sclerosis: the relationship among
self-esteem social support and coping behavior. Appl Nursing Res.
1993;6(2):54-63.
http://dx.doi.org/10.1016/S0897-1897(05)80103-X
https://doi.org/10.1016/S0897-1897(05)80...
,2323 McCabe MP, McKern S, McDonald E. Coping and psychological adjustment
among people with multiple sclerosis. J Psychosom Res. 2004;56(3):355-61.
http://dx.doi.org/10.1016/S0022-3999(03)00132-6
https://doi.org/10.1016/S0022-3999(03)00...
,2424 Goretti B, Portaccio E, Zipoli V, Hakiki B, Siracusa G, Sorbi S et
al. Coping strategies, psychological variables and their relationship with
quality of life in multiple sclerosis. Neurolog Sci. 2009;30(1):15-20.
http://dx.doi.org/10.1007/s10072-008-0009-3
https://doi.org/10.1007/s10072-008-0009-...
.
Neuroticism seems to be the personality dimension that most interferes with
adjustment to disease. The present study showed neuroticism as a common trait among
our MS patients group. McCray and colleagues presented interesting aspects of
neuroticism, using the NEO-FFI. According to these authors, high levels of
neuroticism were seen more often in depressed patients2525 McCray LW, Bogner HR, Sammel MD, Gallo JJ. The role of patient
personality in the identification of depression in older primary care patients.
Int J Geriatr Psychiatry. 2007;22(11):1095-100.
http://dx.doi.org/10.1002/gps.1791
https://doi.org/10.1002/gps.1791...
. In the present group of MS patients, no clinical
depression was detected. Beck scales for anxiety and depression have not shown
consistent signs of either condition. Investigating personality during the initial
stage of the disease enables us to witness a functional structure, struggling to
adapt to MS. Early MS is more commonly related to signs of anxiety than
depression2626 Beiske AG, Svensson E; Sandanger I, Czujiko B, Pedersen ED, Aarseth
JH et al. Depression and anxiety amongst multiple sclerosis patients. Eur J
Neurology. 2008;15(3):239-45.
http://dx.doi.org/10.1111/j.1468-1331.2007.02041.x
https://doi.org/10.1111/j.1468-1331.2007...
,2727 Potagas C, Mitsonis C, Watier L, Dellatolas G, Retziou A,
Mitropoulos P et al. Influence of anxiety and reported stressful life events on
relapses in multiple sclerosis: a prospective study. Multiple Scler.
2008;14(9):1262-8. http://dx.doi.org/10.1177/1352458508095331
https://doi.org/10.1177/1352458508095331...
,2828 Mendes MF, Tilbery CP, Balsimelli S, Moreira MA, Barão-Cruz AM.
Depression in relapsing remitting multiple sclerosis. Arq Neuropsiquiatr.
2003;61(3A):591-5.
http://dx.doi.org/10.1590/S0004-282X2003000400012
https://doi.org/10.1590/S0004-282X200300...
.
Clinical psychologists can notice in daily practice that neurotic people do not feel
emotionally equipped to solve problems effectively. This perception was confirmed in
a quite recent study published in 2010. The authors found out that neurotic
individuals tend to feel more fatigued and also end up showing higher levels of
inflammatory markers, such as interleukin 6 (IL-6)2929 Merkelbach S, König J, Sittinger H. Personality traits in
multiple sclerosis patients with and without fatigue experience. Acta Neurol
Scand. 2003;107(3):195-201.
http://dx.doi.org/10.1034/j.1600-0404.2003.02037.x
https://doi.org/10.1034/j.1600-0404.2003...
. The latter aspect is considered a risk factor to the
development of depression symptoms3030 Sutin AR, Terraciano A, Deiana B, Naitza S, Ferruci L, Uda M et al.
High neuroticism and low conscientiousness are associated with Interleukin-6.
Psychol Med. 2010;40(9):1485-93.
http://dx.doi.org/10.1017/S0033291709992029
https://doi.org/10.1017/S003329170999202...
.
Openness to experience (OE) rarely appeared as a significant trait when relationship
of personality and disease is concerned. No study highlighted the importance of this
particular dimension. OE is usually low in MS patients, what was confirmed in the
present study. MS patients in this group were more conservative and traditional, not
inclined to novelty. A high OE score is associated with flexibility, curiosity and
preference for variety3131 Bruce JM, Lynch SG. Personality traits in multiple sclerosis:
Association with mood and anxiety disorders. J Psychosom Res. 2011;70(5):479-85.
http://dx.doi.org/10.1016/j.jpsychores.2010.12.010
https://doi.org/10.1016/j.jpsychores.201...
.
It is also worth mentioning that a recent study used imaging (fMRI) of MS patients to have grounds to suggest that neural activity related to specific personality dimension is a preserved neurophysiologic characteristic in RRMS patients at an early stage of the disease3232 Costa PT, McCrae RR. NEO PI-R: inventário de personalidade NEO revisado e inventário de cinco fatores. São Paulo: Vetor; 2007.
Early identification of certain personality traits could help care professionals in preventing or minimizing secondary neuropsychiatric disorders, such as anxiety and depression through providing early psychological support. A deeper understanding of this neurological disease could also shed some light to treatment adherence1616 Paes RA, Alvarenga RMP, Vasconcelos CCF, Negreiros MA, Landeira-Fernandez J. [Neuropsychology of primary progressive multiple sclerosis]. Rev Neurol. 2009;49(7):343-8. Spanish..
This study had its limitations such as a small sample. It could be extended in time, through a longitudinal design and it could be applied to other clinical courses of MS. Multidisciplinary professional teams assisting MS patients could take into consideration their individual characteristics in adjusting to this chronic and impairing condition. Currently, many studies are pointing to the fact that it is no longer possible to underestimate the emerging role of personality in clinical neuroscience.
References
-
1Ožura A, Erdberg P, Šega S. Personality characteristics of multiple sclerosis patients: a Rorschach investigation. Clin Neurol Neurosurg. 2010;112(7):629-32.
-
2Pervin L, Oliver J. Personalidade: teoria e pesquisa. 8a ed. Porto Alegre: Artmed; 2004.
-
3Rätsep T, Kallasmaa T, Pulver A, Gross-Paju K. Personality as a predictor of coping efforts in patients with multiple sclerosis. Mult Scler. 2000;6(6):397-402. http://dx.doi.org/10.1177/135245850000600607
» https://doi.org/10.1177/135245850000600607 -
4Bogle N, Percy M, Morrison W. Will I make it through this choppy water? a psychological characteristic as a predetermining factor to coping with multiple sclerosis. Axone. 1999;20(3):63-6.
-
5Peyser JM, Edwards KR, Poser CM. Psychological profiles in patients with multiple sclerosis. A preliminary investigation. Arch Neurol. 1980;37(7):437-40. http://dx.doi.org/10.1001/archneur.1980.00500560067009
» https://doi.org/10.1001/archneur.1980.00500560067009 -
6Strober LB, Christodoulou C, Benedict RH, Westervelt HYJ, Melville P, Scherl WF. et al. Unemployment in multiple sclerosis: the contribution of personality and disease. Mult Scler. 2012;18(5):647-53. http://dx.doi.org/10.1177/1352458511426735
» https://doi.org/10.1177/1352458511426735 -
7McCrae RR, John OP. An introduction to the five-factor model and its applications. J Pers. 1992;60(2):175-215.
-
8Merkelbach S, König J, Sittinger H. Personality traits in multiple sclerosis patients with and without fatigue experience. Acta Neurol Scand. 2003;107(3):195-201. http://dx.doi.org/10.1034/j.1600-0404.2003.02037.x
» https://doi.org/10.1034/j.1600-0404.2003.02037.x -
9Goldberg LR. An alternative “description of personality”: the big-five factor structure. J Pers Soc Psychol. 1990;59(6):1216-29. http://dx.doi.org/10.1037/0022-3514.59.6.1216
» https://doi.org/10.1037/0022-3514.59.6.1216 -
10Koroktov D, Hannah TE. the five-factor model of personality: strengths and limitations in predicting health status, sick-role and illness behavior. Pers Individ Dif. 2004;36(1):187-99. http://dx.doi.org/10.1016/S0191-8869(03)00078-3
» https://doi.org/10.1016/S0191-8869(03)00078-3 -
11Schwartz ES, Chapman BP, Duberstein PR, Weinstock-Guttman B, Benedict RH. The NEO-FFI in Multiple Sclerosis: internal consistency, factorial validity and correspondence between self and informant reports. Assessment. 2011;18(1):39-49. http://dx.doi.org/10.1177/1073191110368482
» https://doi.org/10.1177/1073191110368482 -
12McDonald WI, Compston A, Edan G, Goodkin D, Hartung HP, Lublin FD et al. Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis. Ann Neurol. 2001;50(1):121-7. http://dx.doi.org/10.1002/ana.1032
» https://doi.org/10.1002/ana.1032 -
13Paes RA. Frequency of cognitive changes in three courses of Multiple Sclerosis – Relapsing Remitting, Primary Progressive and Benign – using a brief neuropsychological battery (BNB) [doctor’s thesis]. Frequência de alterações cognitivas em três formas clínicas da Esclerose Múltipla – Remitente-Recorrente, Progressiva Primária e Benigna – usando uma bateria neuropsicológica breve. Rio de Janeiro: Universidade Federal do Rio de Janeiro; 2011.
-
14Rodrigues DN, Paes RA, Vasconcelos CCF, Landeira-Fernandes J, Alvarenga RMP. Different cognitive profiles of Brazilian patients with relapsing-remitting and primary progressive multiple sclerosis. Arq Neuropsiquiatr. 2011;69(4):590-5. http://dx.doi.org/10.1590/S0004-282X2011000500004
» https://doi.org/10.1590/S0004-282X2011000500004 -
15Negreiros MA, Mattos P, Landeira-Fernandez J, Paes RA, Alvarenga RP. A brief Neuropsychological screening test battery for cognitive dysfunction in Brazilian multiple sclerosis patients. Brain Inj. 2008;22(5):419-26. http://dx.doi.org/10.1080/02699050801998243
» https://doi.org/10.1080/02699050801998243 -
16Paes RA, Alvarenga RMP, Vasconcelos CCF, Negreiros MA, Landeira-Fernandez J. [Neuropsychology of primary progressive multiple sclerosis]. Rev Neurol. 2009;49(7):343-8. Spanish.
-
17Bruce JM, Hancock LM, Arnett P, Lynch SG. Treatment adherence in multiple sclerosis: association with emotional status, personality and cognition. J Behav Med. 2010;33(3):219-27. http://dx.doi.org/10.1007/s10865-010-9247-y
» https://doi.org/10.1007/s10865-010-9247-y -
18Hawkes CH. Are multiple sclerosis patients risk-takers? QJM. 2005;98(12):895-911. http://dx.doi.org/10.1093/qjmed/hci135
» https://doi.org/10.1093/qjmed/hci135 -
19Benedict RH, Schwartz CE, Duberstein P, Healy B, Hoogs M, Bergsland M et al. Influence of personality on the relationship between gray matter volume and neuropsychiatric symptoms in multiple sclerosis. Psychosom Med. 2013;75(3):253-61. http://dx.doi.org/10.1097/PSY.0b013e31828837cc
» https://doi.org/10.1097/PSY.0b013e31828837cc -
20Lode K, Bru E, Klevan G, Myhr KM, Nyland H, Larsen JP. Coping with multiple sclerosis: a 5-year follow-up study. Acta Neurol Scand. 2010;122(5):336-42. http://dx.doi.org/10.1111/j.1600-0404.2009.01313.x
» https://doi.org/10.1111/j.1600-0404.2009.01313.x -
21Fragoso YD, Silva EO, Finkelsztejn A. Correlation between fatigue and self-esteem in patients with multiple sclerosis. Arq Neuropsiquiatr. 2009;67(3B):818-21. http://dx.doi.org/10.1590/S0004-282X2009000500007
» https://doi.org/10.1590/S0004-282X2009000500007 -
22O’Brien MT. Multiple sclerosis: the relationship among self-esteem social support and coping behavior. Appl Nursing Res. 1993;6(2):54-63. http://dx.doi.org/10.1016/S0897-1897(05)80103-X
» https://doi.org/10.1016/S0897-1897(05)80103-X -
23McCabe MP, McKern S, McDonald E. Coping and psychological adjustment among people with multiple sclerosis. J Psychosom Res. 2004;56(3):355-61. http://dx.doi.org/10.1016/S0022-3999(03)00132-6
» https://doi.org/10.1016/S0022-3999(03)00132-6 -
24Goretti B, Portaccio E, Zipoli V, Hakiki B, Siracusa G, Sorbi S et al. Coping strategies, psychological variables and their relationship with quality of life in multiple sclerosis. Neurolog Sci. 2009;30(1):15-20. http://dx.doi.org/10.1007/s10072-008-0009-3
» https://doi.org/10.1007/s10072-008-0009-3 -
25McCray LW, Bogner HR, Sammel MD, Gallo JJ. The role of patient personality in the identification of depression in older primary care patients. Int J Geriatr Psychiatry. 2007;22(11):1095-100. http://dx.doi.org/10.1002/gps.1791
» https://doi.org/10.1002/gps.1791 -
26Beiske AG, Svensson E; Sandanger I, Czujiko B, Pedersen ED, Aarseth JH et al. Depression and anxiety amongst multiple sclerosis patients. Eur J Neurology. 2008;15(3):239-45. http://dx.doi.org/10.1111/j.1468-1331.2007.02041.x
» https://doi.org/10.1111/j.1468-1331.2007.02041.x -
27Potagas C, Mitsonis C, Watier L, Dellatolas G, Retziou A, Mitropoulos P et al. Influence of anxiety and reported stressful life events on relapses in multiple sclerosis: a prospective study. Multiple Scler. 2008;14(9):1262-8. http://dx.doi.org/10.1177/1352458508095331
» https://doi.org/10.1177/1352458508095331 -
28Mendes MF, Tilbery CP, Balsimelli S, Moreira MA, Barão-Cruz AM. Depression in relapsing remitting multiple sclerosis. Arq Neuropsiquiatr. 2003;61(3A):591-5. http://dx.doi.org/10.1590/S0004-282X2003000400012
» https://doi.org/10.1590/S0004-282X2003000400012 -
29Merkelbach S, König J, Sittinger H. Personality traits in multiple sclerosis patients with and without fatigue experience. Acta Neurol Scand. 2003;107(3):195-201. http://dx.doi.org/10.1034/j.1600-0404.2003.02037.x
» https://doi.org/10.1034/j.1600-0404.2003.02037.x -
30Sutin AR, Terraciano A, Deiana B, Naitza S, Ferruci L, Uda M et al. High neuroticism and low conscientiousness are associated with Interleukin-6. Psychol Med. 2010;40(9):1485-93. http://dx.doi.org/10.1017/S0033291709992029
» https://doi.org/10.1017/S0033291709992029 -
31Bruce JM, Lynch SG. Personality traits in multiple sclerosis: Association with mood and anxiety disorders. J Psychosom Res. 2011;70(5):479-85. http://dx.doi.org/10.1016/j.jpsychores.2010.12.010
» https://doi.org/10.1016/j.jpsychores.2010.12.010 -
32Costa PT, McCrae RR. NEO PI-R: inventário de personalidade NEO revisado e inventário de cinco fatores. São Paulo: Vetor; 2007
-
33Gioia MC, Cerasa A, Valentino P, Fera F, Nisticò R, Liguori M et al. Neurofunctional correlates of personality traits in relapsing-remitting multiple sclerosis: an fMRI study. Brain Cogn. 2009;71(3):320-27. http://dx.doi.org/10.1016/j.bandc.2009.07.009
» https://doi.org/10.1016/j.bandc.2009.07.009
Publication Dates
-
Publication in this collection
Mar 2015
History
-
Received
15 May 2014 -
Reviewed
31 Oct 2014 -
Accepted
19 Nov 2014