Is There Such Thing as an Arthritis Personality?

Posted on 19 March 2010

Since the early twentieth century, the debate has been on: are people with certain personality traits more likely to contract rheumatoid arthritis or does rheumatoid arthritis induce certain personality traits? The answer may be more complicated than you think…

Rheumatoid arthritis is a maddening disease.
Despite all of the exciting breakthroughs in the field of immunology, the cause and cure of RA remains elusive. And then there’s the temperamental nature of RA—waxing and waning, virtually impossible to predict. It is understandable how many people—including some respected researchers—believe that a person’s personality determines who contracts RA and who doesn’t…that there is an actual “arthritis personality”.
Personality=Arthritis

The Mind/Body Connection

The idea that the mind influences one health is not a new concept. Hippocrates, the father of modern medicine said:

“The patient was the real thing, the disease not an entity but a fluctuating condition of the patient’s body, a battle between the substance of disease and the natural self-healing tendency of the body.”

And there is some rationale for the link between personality and illness. Nowadays, even the most conservative doctors will admit that an aggressive, “Type A” personality can lead to hypertension, heart attacks or strokes. There is rising credence to the idea of a “Cancer Personality” (e.g. repressed anger, excessive need for approval) although it should be emphasized this has not been clinically proven. And then there is rheumatoid arthritis—capricious and temperamental, illogical and cruel—a sort of Freudian symbol for women…and, of course, women are usually its’ victim.

In fact, in some of the early research on arthritis and personality, you can find Freud’s indelible mark. Only women were tested, the arthritic personality said to be:

* self-conscious
* rigid
* inhibited
* shy
* conforming
* frigid

Later researchers concluded that the study was flawed by faulty research methods in that there was an inadequate definition of arthritis and that the personality information gathered during the interviews were inconsistent. Still, the idea of an “arthritis personality” was established.

The Birth of Psychoneuroimmunology

In 1964, psychiatrist George Solomon started the field of “psychoneuroimmunology”—the science that explores connections between personality and the immune system. He and Rudolf Moos of Stanford University conducted a study on women with RA and their non-arthritic sisters. He found that certain personality traits of the arthritic women were not found in the non-arthritic sisters. This time, the arthritic personality was said to be:

* passive
* self-sacrificing
* overly sensitive to the anger of others
* compliant
* anxious
* depressed
* unable to express anger

Solomon and Moos then concluded that people who are genetically predisposed to RA but are emotionally healthy could actually prevent the disease.

It must be kept in mind that these women were tested after contracting RA; it did not seem to occur to Solomon and Moos that their personalities could have changed in response to the disease. It is also interesting that—again—only women were tested. As a psychiatrist, it is possible that Dr. Solomon could have given credence to the Freudian idea of the “hysterical woman”, i.e. women being so swayed by their emotions that they could actually cause themselves to become ill and disabled.

This tendency for doctors to disregard women’s complaints as “being in their head” still occurs today. In a recent study, women were found to be twice as likely to die from a heart attack than men. Apparently, when men complain of chest pain, they are immediately hooked up to an ECG but when women complain of chest pain, doctors tend to attribute it to stress. Many women leave their doctors with a prescription for antidepressants—if anything at all

The Granola Effect

Psychiatrists aren’t the only people who blame RA on personality. Naturopaths, homeopaths, holistic “healers” and the like, also believe that a person’s personality can result in chronic disease, including RA. According to naturopath David Hoffman, the arthritic personality consists of:

* static anxiety
* rationalization
* dependency
* reduced ability to express emotions openly
* infantile aggression

Hoffman also believes that “friction in the joints” is directly attributable to the patient’s “friction with other people”. Since there has not been a single replicated study in which holistic medicine produced a measurable effect on RA, one is tempted to believe that the reason naturopaths blame the patient’s personality is to provide a ready-made excuse when their treatments fail (i.e. the patient doesn’t improve because she refuses to “change her personality”).

Arthritis=Personality

“Learned Helplessness”

The chronic pain, stiffness and malaise of RA can produce incredible stress. In a now infamous study, dogs were placed in cages with electrified bottoms. Intermittently, the researchers would shock the dogs. At first, the dogs would struggle and try to escape. After realizing that there was no escape, however, the dogs stopped struggling, and simply huddled on the floor…even when there was a means of escape. This rather cruel experiment lead to the theory of “learned helplessness”.

Other studies have confirmed that if there is a repeated inability to do something about stress, a pattern of behavior develops that is characterized by “giving up”. Eventually, the victim is unable to clearly assess the causes of stress or to formulate solutions for dealing with them. The relentless, seemingly inescapable pain of RA is a perfect example of a persistent stressor; its victims can easily conclude that any action on their part is futile.

While “learned helplessness” may be too generalized a term, depression is a common problem with RA patients; it has been estimated that at least 40% will experience a period of severe depression. Many of the personality traits espoused by Solomon and others: difficulty in expressing emotion, overly sensitive, inhibition—even “infantile aggression”—are likely the effects of depression.

Self-Conception and RA

If these traits are the result of arthritis-induced depression, can one’s personality be altered for a healthier outcome? Probably not. In a recent study in Sweden, researchers tested two groups. The first group had what was considered a “positive” personality, showing traits such as a “fighting spirit”, acceptance (as opposed to giving in), and revaluation. The second group demonstrated “negative” personality traits: they were reserved, tended to “protest” their fate and felt there was a significant deprivation of life. It was believed that there would be a correlation between the “positive” thinkers and lesser symptoms. However, disease indicators correlated only weakly with self-conceptions; there was little if any difference in the severity of the “positive” thinkers and the “negative” thinkers.

The Efficacy of Coping

In the same study, however, researchers noted that while personality had little to do with severity, it could make a significant difference in coping. The attitudes demonstrated by the “positive” thinkers helped them to deal with RA in a way that allowed them to function as normally as possible. In yet another study on personality traits, it was found that certain traits helped patients cope with RA more effectively than others. The traits—both “positive” and “negative” are:

* Neuroticism
Anxious, self-pitying, tense, touchy, unstable, worrying

* Extraversion
Active, assertive, energetic, enthusiastic, outgoing, talkative.

* Openness to Experience
Curious, imaginative, insightful, having wide interests.

* Agreeableness
Appreciative, forgiving, generous, kind, sympathetic, trusting.

* Conscientiousness
Efficient, organized, reliable, responsible.

It was found that the subjects who exhibited “positive” traits—extraversion, openness to experience, agreeableness and conscientiousness—managed their RA much better than those who exhibited neuroticism; that, while there was no difference in the severity of their symptoms, they were able to live their lives more freely. It also found that the more perceived control the subject had over RA, the more effectively he or she coped with pain.

Should we then conclude that there is no such thing as an “arthritis personality”? Yes and no. As of yet, there is no replicated clinical evidence that personality traits can trigger RA. However, many people with RA report that a major stressor (death in the family, divorce etc ) in their lives occurred just before onset of the disease. Even though there is no convincing evidence of a link between stress and severity of symptoms, it is known that stress can alter the immune system. Also, a link has been found between RA patients who have a history of depression or anxiety disorders and increased fatigue.

So far, psychoneuroimmunology and the treatment of RA has a fairly dismal record. The concept of an “arthritis personality” is not a harmless one, either. Many people with RA are beset with guilt—they do not need the added stress of believing that they “caused” their arthritis—nor do they need their families, friends and coworkers believing that RA is simply neurotic behavior, that, if they would just “think positive”, they would be cured. As far as studying the links between personality and RA, most patients with RA would probably prefer already-scarce funding to go towards finding a genuine cure.

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