Should Personality Scores Be Part of Your Medical Record?

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How would you feel if your scores on tests for hostility and conscientiousness were routinely included in your medical record, just like your blood pressure and cholesterol numbers are? Would you feel any differently if you knew that the personality scores helped doctors better predict and manage your risk for type 2 diabetes, heart disease, or dementia? Those are some of the questions raised by a thought-provoking paper published this month in Personality Disorders: Theory, Research, and Treatment. The paper focuses on the pros and cons of including personality data in health risk prediction models.

It’s a timely topic. There’s a growing body of research evidence showing that personality traits are associated with various health outcomes.

Just last week, for example, a study reported that low optimism, high negativity, and high hostility were associated with an increased risk of developing type 2 diabetes in postmenopausal women. The study, published in the journal Menopause, was based on data from the NIH-sponsored Women’s Health Initiative.

“At this point, personality usually isn’t considered in models that predict the risk for medical diseases,” says Ben Chapman, Ph.D., M.P.H., M.S., lead author of the Personality Disorders paper and associate professor of psychiatry and public health sciences at the University of Rochester Medical Center. “But if we could increase the accuracy of those models with personality data, that would be a good thing.”

Connect the dots

There are several ways in which personality traits could affect physical health:

• Health behaviors. Your personality influences what you eat, how physically active you are, when you go to the doctor, and how well you stick to a treatment plan. “People who are very conscientious tend to take their health more seriously,” says Chapman. “Research has shown that conscientiousness is the most powerful predictor of the widest variety of health outcomes.”
• Stress. Your personality also affects how you perceive and cope with potential stressors. Consider the hard-charging, stress-prone Type A personality pattern, for example. “One critical aspect of Type A is hostility, and that seems to be related to cardiovascular risk factors and heart attacks,” Chapman says.
• Social engagement. Research shows that a strong social network is related to healthier physical and cognitive aging. “Personality traits such as extraversion and agreeableness are related to social habits,” Chapman says.

So, there’s ample evidence for a broad connection between personality and health. But researchers are still in the early stages of narrowing down exactly which personality traits are related to a specific disease and then using that information to improve doctors’ ability to predict patients’ risk of getting the disease.

Proof of concept?

Before personality traits are routinely used this way, researchers will need to make a convincing case for it. They’ll have to show that calculating someone’s risk for, say, diabetes or a heart attack is more accurate when personality measures are added to traditional health data, such as age, blood pressure, and lab test results.

That’s a tall order. In their paper, Chapman and his coauthors aimed to find personality traits that would improve their prediction of people’s risk for mild cognitive impairment (MCI). Individuals with MCI have problems with thinking and memory that are above-normal for their age, but not as severe as those seen in dementia. Some—but not all—eventually go on to develop dementia due to Alzheimer’s disease.

Chapman and his colleagues studied more than 300 primary care patients ages 65 and older who were not cognitively impaired when the research began. At the study’s outset, these patients completed the NEO Five-Factor Inventory. This widely used personality test assesses the Big Five personality domains —neuroticism, extraversion, openness to experience, conscientiousness, and agreeableness—as well as specific facets of each domain. The researchers then tracked which patients went on to develop MCI over the next four years.

MCI risk factors

The researchers found that personality was indeed related to MCI risk. “Greater anxiety and greater anger or hostility tended to increase the risk for worsening cognition,” Chapman says. In contrast, certain aspects of extraversion (interpersonal warmth), openness to experience (openness to emotions, a sense of aesthetics), and conscientiousness (dutifulness, self-discipline) were associated with a decreased risk.

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When the researchers added personality data to a traditional risk model for MCI, their ability to predict who would develop the condition improved slightly. But for MCI, the predictive power of traditional risk models is weak to begin with, and therein lies the rub. A small improvement on a not very good prediction is still not very good.

Still, future studies may be able to build upon these findings. In time, researchers may refine their ability to identify who is at high risk for MCI.

What’s the point?

Let’s say researchers do find a personality trait that’s strongly related to a certain disease. When added to traditional risk factors, it substantially improves doctors’ ability to tell which patients are at risk for that condition. What next?

“Although personality is somewhat malleable over long periods of time, change tends to decrease in older age,” says Chapman. For practical purposes, then, a personality trait would probably be treated more like a non-modifiable risk factor (such as genetics or age) rather than a modifiable one (such as diet or physical activity). Even if it’s not something the person is willing or able to change, it could still spur positive action.

For instance, the person might be motivated to make healthy lifestyle changes that help offset the risk and prevent or delay the disease. Or the person’s health care provider might start screening for the disease earlier or more frequently. If the disease occurs, it might be diagnosed at an early stage, when treatment often works best.

Theory to practice

But before any of that can occur, several hurdles must be overcome, including:

• Measurement issues. Health care providers will need quick, valid, reliable questionnaires to measure specific personality traits. And patients will need to understand the rationale for asking the questions. Otherwise, they’re likely to see them as irrelevant or intrusive, Chapman says.
• Provider training. Health care providers with little to no training in using personality information may apply it in inappropriate ways. Chapman says, “What I worry about is a scenario in which a health care provider can’t find a reason for a patient’s presenting symptoms but sees that the patient has a high neuroticism score. So, the provider simply says, ‘This person must be a hypochondriac.’”
• Patient objections. Much of the terminology used to describe personality traits is emotionally loaded. Patients might well be offended by a test result showing they are low in conscientiousness or high in hostility.

On the research side, Chapman notes that more communication between different scientific camps is needed. “Too often, people have a one-sided view,” he says. “A personality psychologist will say, ‘This is great. We should be getting personality data on everyone.’ A physician will say, ‘It’s a waste of time. Who cares about this squishy psychology stuff?’ I think it’s really important that this idea be viewed from a multidisciplinary perspective.”