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Anxiety and Personality: Strangers No More

News from the Johns Hopkins Department of Psychiatry and Behavioral Sciences

Dr. Bienvenu

Dr. Joseph Bienvenu

Humanity is in some ways like a deck of cards. And most clinicians, confronted with the hand they’re dealt from day to day, find that people fall into fairly standard suits, personality-wise. The idea of stable personality traits has been with us at least a century. Though questions of which categories are truest and how they form have sparked heated discussion ever since Freud and his social psychologist contemporary George Herbert Mead first wrestled with them, the thought that personality has some bearing on psychiatric illness has never been doubted.

It’s just been understudied.

Joseph Bienvenu, M.D.,Ph.D., wants that to change. Clinically, Bienvenu, a psychiatrist, diagnoses and treats anxiety disorders. His training as an epidemiologist, however, equips him to tease out parts that personality traits play in the “distress disorders” of anxiety and major depression. Bienvenu’s focus is on two traits: neuroticism—the tendency to experience negative emotion and cope poorly with stress—and being introverted or not.

His early work shed light on the basics, namely, showing that personality traits and problems like agoraphobia and panic disorder are somehow tied. Data for these first studies came from offshoots of the Baltimore Epidemiologic Catchment Area survey, which Uncle Sam commissioned in the 1980s to paint the first real picture of mental illness in this country.

Bienvenu’s more recent work goes a step further. It suggests that traits like high neuroticism and introversion signal an underlying genetic risk for anxiety disorders.

If a person is high in neuroticism, does that sort of personality bring on the phobias, the panic attacks?

Historically, there was that thought. But saying one causes the other is simplistic, I think. More likely, it’s that vulnerable personalities predict the disorders. Studies with twins are helpful here. We know—from comparing identical and fraternal twins—that personality traits have a genetic basis. But we’re also finding that the very genes that make someone prone to high neuroticism are the same ones to raise the risk, say, of generalized anxiety disorder. And it’s not just the one personality type. Our recent work suggests that genes underlying introversion also increase the chance of having social phobia or agoraphobia.

That screams “common biology.”

Yes, and it may be broader than we’ve thought. There’s an idea of a spectrum of genes that relates personality traits and most of the distress disorders. High neuroticism, for example, is common to so many of them—depression, social phobia, panic and generalized anxiety disorder. If we could hit on the biology behind neuroticism, wouldn’t that be a home run for understanding the distress disorders?

So can you use personality tests as predictors?

It looks that way. My Hopkins colleague Jim Fauerbach, for example, sampled personality in Hopkins burn unit patients. High neuroticism and introversion predicted the onset of PTSD within a year. And elsewhere, with UN peacekeepers in Europe, the findings were similar.

They should use that in Iraq!

It’d make a lot of sense for the military to measure neuroticism, not to exclude new recruits but to know who’s at high risk based on temperament.

Can personality change?

Yes. It appears “fixed” by age 35, but psychiatric disorders can bring on at least temporary change—we’ve known that for years in the context of depression. Then patients get a kind of a bias and selectively remember negative things. And for patients acutely ill with panic disorder, everything looks much scarier; they feel more vulnerable. Brain function itself may change, then go back toward baseline when they’re better.

Completely?

Almost, we think. The scars are small.

Could you change personality, do you think, to head off disorders?

Yes! One Australian study on young children at high risk showed that psychotherapy could do just that. We need more data though. Preventing anxiety disorders is very much on our minds. And because many of them tend to begin in young people, we’re looking at children and teens—more twin studies—first in baseline work to see how well high neuroticism predicts later disorders in young adults. This sort of research could be a basis for prevention.

I’m feeling sorry for the neurotic and introverted of this world.

Don’t. They have their strengths! People high in neuroticism are sensitive and tend to stay out of certain kinds of trouble—like accidents. And introverts really stick to projects without jabbering with others. Without them, this country would come to a halt. 

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