At Neuroticism's Core May Be This Underlying Source of Anxiety

Trying to understand the basis for neuroticism remains a major challenge in psychology and mental health fields in general. Some may argue that it’s an inherent tendency baked into your genes and therefore unchangeable and unchanging throughout life. However, might there be more to neuroticism than personality psychologists have been unable to determine?

According to University of Sydney’s Rachel Menzies and colleagues (2022), it is anxiety about death that serves as a “transdiagnostic” quality, or one that underlies many “mental health conditions”. Unfortunately, treatment for these conditions fails to “address the underlying fear of death,” leading to what some authors refer to as the ‘revolving door’ in clinical practice. Some of the symptoms of major disorders that Menzies et al. document as related to death anxiety range from social avoidance to compulsive washing. The revolving door metaphor refers to the fact that, lacking treatment for this basic source of anxiety, the symptoms of one disorder may be alleviated only to be replaced at a later time by those of another condition.

Neuroticism and Death Anxiety

Short of having a documented or documentable psychological disorder, individuals who constantly worry and fret fail to experience the pleasures in life as deeply as they might. Always imagining the things that could go wrong, they are also on the lookout for threats or dangers.

Perhaps you have an acquaintance with whom you need to buy a joint gift for an upcoming party. Having decided which store to venture out to, you are forced to roam from shelf to shelf with this person. As you point to item after item, you are met with criticism about each one: This top is "too bright", this other one is "too blah", and the other possibilities are "too expensive", this is "too cheap", and none of them are good enough. “Just pick something!” you mutter under your breath as the minutes tick by.

It may be a stretch to imagine that this person’s indecisiveness is due to an underlying fear of death, but if it is part of a larger set of tendencies that you’ve seen on many different occasions, this would fit into the Australian research team’s definition of neuroticism. As such, the core of this neurotic personality trait could very well be traced to the kind of hypervigilance and constant need for checking associated with death anxiety. Indeed, as the authors note, “death anxiety is associated with a number of important psychosocial outcomes in a number of areas, including reduced self-esteem, attachment stability, and meaning in life as well as poorer quality of life.”

How to Tap Into Death Anxiety

In daily life in Western culture, it is rare to confront directly people’s feelings about death, despite being inundated with news stories, crime dramas, horror movies, and other constant reminders about mortality. Yet, psychological measures of this basic form of anxiety have chronically suffered from lack of clarity, empirical support, and even sufficient research attention. Early work in this area was stymied by a confusing miscellany of terms in which “fear” and “anxiety” were used interchangeably even though they don’t necessarily refer to the same psychological entity.

As noted by the authors, in describing the 21 separate measures of this quality from 89 different studies, an earlier review concluded that: “not one measure of death anxiety demonstrated both adequate psychometric properties and clinical relevance.” Undaunted by this fact, Menzies and her team set out to develop and validate their own measure, based in part on the previous literature. The reason for this quest, as they observe is the need to be able to quantify, in people seeking treatment, their own “maladaptive beliefs regarding death.”

You might ask, how could anyone’s thoughts about death be anything but maladaptive? Can anyone really contemplate their mortality without becoming at least a little uncomfortable? Of course, all of this is a matter of degree, but ideally an individual can view death as a natural part of life, not to be feared or, as Emily Dickinson observed, an entity that could “kindly stop for me.” A measure of death anxiety, the Menzie research team maintain, should be able to capture the maladaptive nature of beliefs about death as well as problematic feelings and actions.

Tying this back to neuroticism, Menzie and her collaborators tested their 18-item death anxiety scale against previously validated measures of this personality trait as well as other, related, qualities such as stress, anxiety, and depression. Their samples consisted of nearly 1,000 community and treatment-seeking samples of adults across a range of ages from 18 to 68

With this background, you can now take the resulting Death Anxiety Beliefs and Behaviours Scale (DABBSS), using the instructions specific to each group:

Rate each statement from 1 (strongly disagree) to 5 (strongly agree):

1. I feel anxious about death

2. The thought that I will die someday is terrifying

3. I am scared of dying

4. Death frightens me

Indicate how frequently you are troubled by each thought from 1 (strongly disagree) to 5 (strongly agree):

1. It would be terrible to not have time to experience everything I want to

2. It would be horrible to die alone

3. My death will be a painful experience

4. I could not cope with growing old without my loved ones

5. I will lose a loved one suddenly and it will destroy me

6. On my deathbed, I will not be able to face death as bravely as I should

7. I would not cope if someone I care for developed a fatal illness

Indicate how frequently you would avoid each of these situations on a scale of 1 (never avoid) to 5 (always avoid):

1. Watching or reading news stories about dying

2. Thinking about being diagnosed with a terminal illness

3. Reading a novel with a character who is dying

4. Thinking about a loved one dying

5. Watching a film or TV show with a character who is dying

6. Thinking about myself dying

7. Reading a memoir or essay by someone diagnosed with a terminal illness

Did your responses surprise you at all? Had you not realized that you don’t even like Disney movies in which a major character such as a parent dies or is killed? On average, the validity samples in the Menzies et al. study scored at about the midpoint of each scale (average score was approximately 53), and ranging from slightly over 2 to just over 4. Perhaps not surprisingly, scores on the last set of 7, representing death-related behaviors were lower than death-related beliefs; affect scores (the first 4) had the lowest average (at the exact midpoint of 3).

Turning next to the question of how these scores would relate to neuroticism, the correlation to a standard measure was .35, lower than its relationship to level of anxiety or stress (.41 and .38) but higher than depression. Unfortunately, the authors did not conduct statistical tests that would rule out inter-relationships among the criterion measures, but they did show in a separate analysis that the DABBS scores distinguished significantly between clinical and non-clinical samples.

Turning Death Anxiety Into Acceptance

With the DABBS now available for further testing, it’s likely that future studies will probe in more depth not only its statistical qualities but its clinical utility. For the moment, it nevertheless provides a new angle on identifying and understanding the features that may lie at the heart of neuroticism and its more clinical manifestations in anxiety and depression.

Most useful, from a clinical standpoint, are the items that tap into death-related beliefs (the second grouping). In keeping with the cognitive behavioral approach, treatment could focus on pulling out those maladaptive beliefs and helping individuals reframe them in more neutral ways. If you scored high on several of these items, you could ask yourself why you felt so strongly about them (e.g. seeing death as “horrible”) and then try to imagine ways in which death could “kindly stop" for you and those you love.

Returning to the example of your neurotic shopping companion, it would hardly be appropriate to pull out the DABBS to do a quick death anxiety check. However, you might gain a better understanding of why someone would be so hesitant about making a firm choice, perhaps out of a conviction that something indeed bad would happen if they picked out the wrong gift such as receiving a nasty comment from those present at the occasion. Noting that insecure attachment is part of the constellation around death anxiety, Menzies et al. might support such an interpretation.

To sum up, high levels of neuroticism may come from surprising sources. Addressing anxiety regarding death as one of them may help individuals reshape and reframe their outlook not only on death but on life itself.