International Journal of Developmental Disabilities

ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/yjdd20

Trait resilience as a moderator between

personality dysfunction and caregiving stress
in caregivers of children and adults with
developmental disabilities

Claudia I. Iacob, Ruxandra Folostina & Eugen Avram

To cite this article: Claudia I. Iacob, Ruxandra Folostina & Eugen Avram (2022): Trait resilience
as a moderator between personality dysfunction and caregiving stress in caregivers of children
and adults with developmental disabilities, International Journal of Developmental Disabilities, DOI:
10.1080/20473869.2022.2092934

To link to this article: https://doi.org/10.1080/20473869.2022.2092934

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Trait resilience as a moderator between
personality dysfunction and caregiving
stress in caregivers of children and adults
with developmental disabilities
Claudia I. Iacob1 , Ruxandra Folostina2 and Eugen Avram1
1
Department of Applied Psychology and Psychotherapy, University of Bucharest, Bucharest, Romania;
2
Department of Special Education, University of Bucharest, Bucharest, Romania

Background: Long-term care of a relative with a disability is associated with negative consequences on the
caregiver’s mental health. Therefore, investigating how some personality traits, such as resilience, protect
caregivers with dysfunctional personality traits from caregiving stress is necessary. This study examines the
moderating role of resilience in the relationship between caregiver’s personality dysfunction and care stress.
Methods: A total of 224 family caregivers of children and adults with developmental disabilities participated in
this cross-sectional research. They completed self-report measures of resilience, personality dysfunction, and
care stress. Results: The results show that medium and high levels of resilience protect familial caregivers
from the adverse effects of personality dysfunction on stress. The relationship is maintained for three of the
five dysfunctional personality traits (antagonism, disinhibition, and psychoticism). Conclusions: From a theor-
etical point of view, the results show the contribution of the dimensional personality model to the study of
caregiving stress. From a practical standpoint, the results can be used to optimise the resilience of familial
caregivers, providing them with tools to take better care of their relatives.
Keywords: family caregiving; caregiving stress; resilience; personality dysfunction; developmental disabilities

Introduction condition and who provides assistance for the person in

Caring for a person with a disability is often associated
with a caregiving burden and stress for familial care-
givers of children, adults and older adults with disabil-
ities (del-Pino-Casado et al. 2021, Masefield et al.
2020, Sit et al. 2020). In addition, the caregiver’s per-
sonality is an essential factor in the care process
(Baharudin et al. 2019) and individual differences in
personality shape not only the caregiver’s responses to
care tasks (Lautenschlager et al. 2013) but also the evo-
lution of the vulnerable relative’s disease (Norton et al.
2013). This research addresses family or informal care-
givers, defined as any individual (relative, partner,
friend, neighbour) who has a personal relationship with
someone diagnosed with a chronic or disabling
Correspondence to: Ruxandra Folostina, Department of Special
Education, Faculty of Psychology and Educational Sciences, University
of Bucharest, Panduri Avenue, No. 90, Sector 5, Bucharest, Romania.
Email: ruxandra.folostina@fpse.unibuc.ro.
#The first two authors had an equal contribution to the manuscript.
Supplemental data for this article is available online at https://doi.
org/10.1080/20473869.2022.2092934
need (Family Caregiver Alliance n.d.).
The most studied personality model used in the care-
giving field is the Big Five personality traits: openness,
conscientiousness, extraversion, agreeableness, and
neuroticism (Costa and McCrae 1992). The majority of
personality studies in this area were conducted on care-
givers of adults and older adults with disabilities
(Baharudin et al. 2019, Kim et al. 2016, L€ockenhoff
et al. 2011). In caregivers of terminally ill cancer
patients, extraversion was a protective factor against
perceived burden (Kim et al. 2016). Researchers have
studied the association between the traits in the five
personality factors model and the mental and physical
health reported by the caregiver. Personality explains
about a quarter of the mental health variance and 10%
of the physical health variance of caregivers of the eld-
erly with multiple difficulties in functioning. These var-
iables correlate negatively with neuroticism and
positively with extraversion, conscientiousness, agree-
ableness, and openness to experience (L€ockenhoff et al.

# The British Society of Developmental Disabilities 2022

DOI 10.1080/20473869.2022.2092934 International Journal of Developmental Disabilities 2022 VOL. 0 NO. 0 1
Claudia I. Iacob et al. Trait resilience as a moderator between personality dysfunction and caregiving stress
2011). People with high scores on conscientiousness are
more organised and disciplined, cope better with diffi-
cult situations created by psycho-behavioural symp-
toms, and report a diminished burden of care
(Baharudin et al. 2019).
The personality traits of caregivers impact their
lives, perception of care and the disease evolution of
the disabled person. A longitudinal study, which fol-
lowed 161 caregivers of older adults over an average of
5.6 years, concluded that the latter had a more pro-
nounced cognitive decline when cared for by relatives
with high neuroticism. This effect was maintained for
the caregivers’ spouses in the stratified models.
Conversely, people cared for by caregivers with high
extraversion had a slower cognitive decline (Norton
et al. 2013).
Although there is a scarcity of studies investigating
caregiver personality in carers of children and adults
with developmental disabilities (i.e. DDs), we assume
the results would be similar due to the resemblance in
the caregiving process between people with cognitive
decline and people with DDs. This category of disabil-
ity contains conditions characterised by significant
impairment in more than one area of development (e.g.
physical, sensory, cognitive, language and communica-
tion, behaviour); they are diagnosed during the develop-
mental period and have life-long manifestations
(Crocker and Rubin 1989). Examples of DDs are autism
spectrum disorders, intellectual disability, genetic disor-
ders such as Down syndrome, and ADHD (attention-
deficit/hyperactivity disorder). Caring for a person with
a DD is challenging for the caregiver’s mental health
and resilience resources (Namkung et al. 2018, Piazza
et al. 2014, Scherer et al. 2019), which is why it is rele-
vant to investigate the personality-related vulnerabil-
ity factors.
According to the diathesis-stress model (Zuckerman
1999), personality can be a psychological vulnerability
to mental health issues. Some personality traits (or pre-
dispositions) can make caregivers more or less vulner-
able to the appearance of psychological symptoms
when these traits interact with long-term care stressors
(e.g. the disability of the person, the existence of co-
caregivers, the duration of the care process). Even in
the general population, personality pathology involves
pervasive interaction difficulties, which have negative
consequences on professional functioning (McGurk
et al. 2013), social and personal life (Zanarini et al.
2015), and global functioning (Skodol 2018).
Following the criticisms received for the categor-
ical conceptualisation of personality pathology
(Watson et al. 2008, Widiger and Mullins-Sweatt
2010), the American Psychiatric Association intro-
duced an alternative and dimensional model of per-
sonality disorders (AMPD) in the latest version of the
DSM-5 manual for the diagnosis of mental disorders
2 International Journal of Developmental Disabilities 2022
(American Psychiatric Association 2013). The model
contains five general traits (i.e. negative affectivity,
detachment, antagonism, disinhibition, and psychoti-
cism) and 25 specific traits (American Psychiatric
Association, 2013). The more dysfunctional traits a
person has or, the more severe a dysfunctional trait
is, the more pronounced the personality dysfunction
(i.e. PD) is in everyday life. When the manifestation
of these traits is rigid, pervasive, relatively stable
over time, and cannot be explained by other medical
disorders/conditions or ingested substances, the gen-
eral diagnostic criteria for a personality disorder are
met (American Psychiatric Association 2013).
Negative affectivity (i.e. NA) refers to frequent feel-
ings of negative emotions (e.g. anger, guilt, depression),
with behavioural (e.g. self-harm) and interpersonal (e.g.
dependence on others for decision-making) manifesta-
tions. Detachment involves avoiding socio-emotional
experiences, including interpersonal interactions and
reduced emotional expression. Antagonism is the dys-
functional pole of pleasantness and is reflected in
behaviours that alienate other people, such as exagger-
ating one’s importance, the expectation of being treated
specially, the lack of consideration for others’ needs,
and the tendency to use others for one’s interests.
Disinhibition refers to impulsive behaviours that do not
consider the past or consequences. Finally,
Psychoticism refers to the tendency to exhibit unusual,
bizarre, eccentric behaviours, accompanied by alteration
of mental processes (e.g. dissociation) and contents that
are not justified by the culture in which the person
grew up (e.g. unusual beliefs) (American Psychiatric
Association 2013).
The five general traits helped identify or explain
maladaptive behaviours or limited emotional recogni-
tion abilities. For example, antagonism is negatively
associated with the ability of people to identify the
emotions of others and detachment with low identifica-
tion of positive emotions by female participants (da
Costa et al. 2018). NA, detachment, and disinhibition
have significantly higher levels in young people with
compulsive buying behaviours than those without
(Duroy et al. 2018). Compared with the Big Five model
(Costa and McCrae 1992), NA, detachment, and psy-
choticism have incremental validity in explaining the
psychiatric symptoms during hospitalisation. In the
same patients, AMPD traits predict depression, anxiety,
somatisation, emotional regulation difficulties, and the
severity of functional disability (Fowler et al. 2017).
To our knowledge, AMPD has not been applied to
the familial caregiving population. Data on the preva-
lence of psychiatric disorders in family caregivers are
contradictory, and we do not know which disorders are
more common among this vulnerable group; however,
there is consensus regarding their high risk for
VOL. 0 NO. 0
 Claudia I. Iacob et al.
psychiatric morbidities such as depression and anxiety
(Tuithof et al. 2015, Vaingankar et al. 2016).
If caregivers have dysfunctional personality traits,
we can deduce that there is a significant probability that
they negatively impact the relationship with their vul-
nerable relatives and, implicitly, their care, as shown in
the case of some traits in the model of the five person-
ality factors (L€ockenhoff et al. 2011, Norton et al.
2013). Moreover, caregivers are vulnerable to becoming
patients themselves. Such data are useful for identifying
populations at high risk of pathology and prioritising
interventions.
One of the most investigated and validated protec-
tion factors against stress is resilience. When resilience
was conceptualised as a trait and used to investigate the
relationship to stress in adolescents newly diagnosed
with type 1 diabetes and their parents over 12 months,
the following were observed: (1) resilience scores
remained unchanged in 12 months, which was to be
expected given that the instrument used to measure
resilience captures features, so the diagnosis did not sig-
nificantly influence resilience; (2) caregivers with high
resilience and stress at the time of the first test reported
low levels of stress on the second test; (3) caregivers
with low resilience and high stress on the first test
reported moderate levels of stress on the second test
(Yi-Frazier et al. 2018). In short, stress decreased in
both groups. However, the decrease was more consist-
ent in caregivers with high resilience, supporting the
protective role of resilience in reducing stress in famil-
ial caregivers.
In a longitudinal study of 205 mothers of children
with Duchenne/Becker muscular dystrophy, the authors
concluded that at 1-year and 2-year follow-up, mothers’
adaptation to the children’s degenerative disease was
predicted by trait resilience (i.e. TR) and positive per-
ception of the disease; even after controlling for the
impact of maternal age and family income (Peay et al.
2016. According to the authors, mothers who had good
resilience and felt that the child’s illness positively
impacted the family adapted better to the situation.
Moreover, both predictors had similar values in the
three test moments, proving their stability over time
(Peay et al. 2016).
As a trait, resilience moderates various variables and
mental health. For example, it moderated the relation-
ship between the stigma associated with diagnosis and
the emotional distress of familial caregivers (N ¼ 125)
of patients with schizophrenia. The stigma-distress rela-
tionship was stronger when the resilience was low
(Chen et al. 2016). Although TR is relatively stable
(Hu et al. 2015), its relationship to stress can be
impacted by various factors, such as social support
(Ong et al. 2018), family income (McConnell et al.
2014), care hours, and educational level (Rajan et al.
2016). Moreover, because environmental factors explain
International Journal of Developmental Disabilities
Trait resilience as a moderator between personality dysfunction and caregiving stress
part of its variability, resilience can be improved or
optimised through specific interventions (Joyce
et al. 2018).
Given the above results and the importance of per-
sonality in the care process, one can ask what the rela-
tionship between stress and PD is overall and how
resilience, one of the most well-known factors for
resisting stress, moderates this relationship.
Consequently, this study aimed to examine the moderat-
ing role of TR on the relationship between PD (as a
predictor) and caregiving stress (as a criterion) in care-
givers of children and adults with DDs. The research
hypothesis assumes that resilience acts as a buffer in
the relationship between predictor and criterion, weak-
ening their connection. More specifically, we wanted to
see, on each of the five general features of AMPD,
what is the relationship with stress and if resilience
moderates this relationship.
Methods
Participants and design
This study has a cross-sectional design based on a con-
venience sample of familial caregivers (parents and
grandparents) of children and adults with DDs. Two
hundred twenty-four caregivers participated, of which
203 were women (90.6%) and 21 were men (9.4%).
Their ages ranged from 21 to 78 years, with
M ¼ 44.47 years and SD ¼ 10.05. Most participants
were married or involved in a romantic relationship (i.e.
72.8%). Regarding the educational level, approximately
45% of the participants reported higher education, 34%
reported secondary education (i.e. high school gradu-
ation), and 21% had graduated from vocational and
middle schools. The monthly family incomes were dis-
tributed as follows: 33% had over 800 euros per month,
47% had between 600 and 800 euros per month, and
20% had under 600 euros per month. The medium
income in Romania in 2020 was approximately 650
euros per month (National Institute of Statistics 2020).
The persons with disabilities were between 3 to
49 years old, with M ¼ 14.5 years and SD ¼ 9.16. The
majority were underaged (i.e. 69.2%), and 30.8% were
aged between 18 and 49 years. The distribution by sex
was approximately equal: 132 were male (59%), and 92
were female (41%). Their diagnoses varied: 34.8% had
an autism spectrum disorder, 29% had an identified
genetic disorder (e.g. Down syndrome, Williams syn-
drome, Angelman syndrome), 14.3% had an intellectual
disability, 4.5% had ADHD, and the remaining 17.4%
had other DDs (e.g. spastic paraparesis, congenital vis-
ual impairment).
Instruments
Perceived caregiving stress was assessed with the
Kingston Caregiver Stress Scale (KCSS; Kilik and
Hopkins 2006), used as a self-report scale. It consists of
2022 VOL. 0 NO. 0 3
Claudia I. Iacob et al. Trait resilience as a moderator between personality dysfunction and caregiving stress
10 items scored on a 5-point Likert scale (1 ¼ 'no
stress', 5 ¼ 'extremely stressed'). Items are related to
caregiving (items 1 to 7), familial issues (items 8 and
9) and financial difficulties (item 10). Scores range
from 10 to 50, with higher scores indicating higher
caregiving stress. The Cronbach’s a for this scale had
the value a ¼ .90, a very good value obtained on
this sample.
Personality dysfunction was measured with the short
form of the Personality Inventory for DSM-5 (PID-5-
BF; Krueger et al. 2012). It is a self-administered scale
with 25 items evaluating the five dysfunctional person-
ality traits proposed by AMPD (NA, detachment, antag-
onism, disinhibition, and psychoticism). The instrument
provides a total score for PD and partial scores for each
trait. Answers are rated on a 4-point Likert scale, from
0 ¼ false or often false to 3 ¼ often true. Five items
with direct scoring reflect each trait. The answers range
between 0 and 75 points, the high scores indicating an
increased level of PD. Examples include: ‘I react impul-
sively’, ‘I don’t know how to plan things’, ‘I don’t like
getting too close to people’. For the full scale, the value
of the Cronbach’s a was .90, with values from moderate
to robust (Taber 2018) for each subscale: negative
affectivity (a ¼ .79), detachment (a ¼ .73), antagonism
(a ¼ .61), disinhibition (a ¼ .75), and psychoticism (a
¼ .80)
Trait resilience was measured with the Resilience
Scale-14 (RS-14; Wagnild and Young 1993), which
consists of 14 items scored on a 7-point Likert scale,
from 1 (strongly disagree) to 7 (strongly agree). The
scores range from 14 to 98, with the following inter-
pretation, according to Wagnild (2009): 14–56 ¼ very
low level of resilience; 57–64 ¼ low level of resilience;
65–73 ¼ below-average level of resilience;
74–81 ¼ moderate level of resilience; 82–90 ¼ above-
average level of resilience; 91–98 ¼ high resilience
level. The Cronbach’s a had a very good value (a
¼ .94).
Socio-demographic data (i.e. participants’ age, gen-
der, relationship status, income, education level, care
length, and people with disabilities’ age, gender, and
diagnosis) were also obtained.
Procedure
The data collection was carried out between May 2018
and October 2019 in two ways: data were collected
online through a Google Form and a printed form. We
contacted 147 institutions and organisations in
Romania, with people with disabilities as beneficiaries
or clients. Fourteen responded positively, and a ques-
tionnaire package was sent to them. Seven of them
returned questionnaires completed by caregivers. In
addition, Google forms were sent to online care groups
for people with disabilities.
4 International Journal of Developmental Disabilities 2022
The participants read and signed an informed con-
sent form. They received information about the study’s
purpose and procedures, confidentiality, and the option
to withdraw from the research. They had the opportun-
ity to ask additional questions via email. The testing
was done individually—those who wanted to continue
completed a series of self-administered scales (online or
pencil-paper). All the instruments were administered at
the same time. Upon request, participants received a
report with their results on the scales.
The Research Ethics Committee approved this study
at the University of Bucharest (notice no. 36/
09.08.2019). All procedures were carried out following
the Declaration of Helsinki.
Data analysis
Statistical processing was performed with IBM SPSS
Statistics predictive analytics software (Version 25).
We first reported the main descriptive statistics, the
bivariate Pearson correlations between the variables and
the normality indicators (i.e. skewness and kurtosis).
Normality indicators’ values between 1.96 and þ1.96
were considered acceptable (George and Mallery 2010).
Then, we used Welch’s t-test to investigate whether
there are differences between the two groups (i.e. care-
givers of children and caregivers of adults) regarding
care stress, PD, and TR. The effect sizes are interpreted
following Cohen’s (1988) guidelines: values of 0.10 or
less indicate a small effect size, values between 0.30
and 0.50 indicate a medium effect size and values
greater than 0.50 indicate a large effect.
Next, we conducted a series of hierarchical regres-
sion analyses to investigate the moderating effect of TR
on the relationship between PD (overall score and each
of the five personality traits according to the AMPD)
and caregiving stress. We checked if the data met the
main assumption for the analyses. Specifically, we
examined the linearity of the relationship between the
main variables by examining the scatterplots. The
absence of multicollinearity was assumed if the vari-
ance inflation factor (VIF) had values below five and
the Tolerance values were above 0.1 (Kim 2019).
Outliers were screened using Mahalanobis’s distance,
Cook’s distance and Leverage values. If the partici-
pant’s scores were beyond the benchmarks for two out
of the three indicators, that participant was considered
an outlier. Homogeneity and homoscedasticity were
checked by inspecting the equal distribution of
errors plot.
In the first step of each regression, we controlled for
the potential effect of demographic variables (i.e. care-
giver’s age, gender, relationship status, income).
Caregiver’s gender was a dichotomous variable
(0 ¼ male, 1 ¼ female) and relationship status was
dummy coded (0 ¼ single, no partner; 1 ¼ married or
in a romantic relationship). The other variables were
VOL. 0 NO. 0
 Claudia I. Iacob et al. Trait resilience as a moderator between personality dysfunction and caregiving stress

Table 1. Descriptive statistics and correlations.

Variable 1 2 3 4 5 6 7 8 9 10
1 –
2 .32 –
3 .33 .78 –
4 .19 .83 .62 –
5 .15 .66 .29 .43 –
6 .28 .80 .54 .56 .48 –
7 .29 .84 .53 .61 .55 .62 –
8 .49 .28 .29 .21 .12 .25 .22 –
9 .01 .12 .01 .01 .11 .19 .20 .05 –
10 .11 .22 .25 .16 .13 .16 .15 .18 .05 –
Mean (SD) 24.2 (9.63) 20.9 (12.9) 5.99 (3.76) 4.63 (3.57) 3.59 (2.55) 3.42 (3.04) 3.32 (3.28) 80 (16) 44.47 (10.05) 3.62 (1.16)
Skewness .48 .77 .35 .53 1.03 .86 1.13 .87 .66 .26
Kurtosis .52 .23 .53 .70 .76 .27 .50 .05 .33 1.05
Note. 1 ¼ caregiving stress, 2 ¼ personality dysfunction, 3 ¼ NA, 4 ¼ detachment, 5 ¼ antagonism, 6 ¼ disinhibition, 7 ¼ psychoticism,
8 ¼ resilience, 9 ¼ age, 10 ¼ income;  p < .05,  p < .01,  p < .001.

Table 2. Between group differences for the investigated variables.

Children Adults
Dependent variable M SD M SD Welch's t df p Cohen's d
Caregiving stress 25.5 9.92 21.3 8.31 3.22 154 .002 .45
Personality dysfunction 21.1 13.37 20.6 11.72 .29 148 .76 .04
Resilience 79.7 16.91 80.9 13.83 .57 158 .56 .07
Note.  p < .01.

continuous. In the second step, we introduced the pre-
dictor variable (i.e. PD) and the moderator (i.e. TR). In
the third step, we tested for the contribution of the
interaction between predictor and moderator. A moder-
ating effect was found if the interaction terms were sig-
nificant (p < .05). This effect was then examined at
three levels of the moderator, using the O’Connor
(1998) syntax: low level (1SD under the mean),
medium level, and high level (þ1SD above the mean).
Results
Preliminary analyses
The main descriptive statistics for the investigated vari-
ables are rendered in Table 1. Caregiving stress has sig-
nificant correlations with both PD (r ¼ .32, p < .001)
and TR (r ¼ .49, p < .001), in the presumed direction.
The correlations are small to medium, except for the
ones among the five personality traits and the overall
PD score, as expected. The skewness and kurtosis indi-
cators have acceptable values between the interval
[1.96, þ1.96] (George and Mallery 2010).
Welch’s t test showed that caregivers of children
experience significantly more stress (M ¼ 25.5,
SD ¼ 9.92) than caregivers of adults with DDs
(M ¼ 21.3, SD ¼ 8.31): t(154) ¼ 3.22, p < .01, d ¼ .45.
There were no significant between-group differences
concerning PD and TR. The results are summarised in
Table 2.
Regarding regression assumptions, the scatterplots
depicting the relationship between each independent
variable and the dependent variable show that the lin-
earity assumption was met. Analyses of the collinearity
statistics indicate that multicollinearity is not a concern;
Tolerance values range between 0.86 and 0.97, and VIF
values are between 1.02 and 1.16 across all hierarchical
regressions). The equal distribution of error plots for
each regression shows that homogeneity and homosce-
dasticity assumptions were met. We screened for out-
liers using Mahalanobis’s distance, Cook’s distance and
Leverage values. Five outliers were detected by two out
of the three indicators. We tested the models with and
without the outliers, and the results did not differ sig-
nificantly. Further, we present the analyses with the
outliers included to preserve power. The hierarchical
regressions without the outliers can be consulted in
Supplementary material 1.
Trait resilience as a moderator between
personality dysfunction and caregiving stress
We conducted hierarchical regression to explore the
moderating effect of TR on overall PD and caregiving
stress. Across all the hierarchical regressions, the con-
tribution of socio-demographic variables is not signifi-
cant (R2 ¼ .036, F(4, 219) ¼ 2.06, p ¼ .08). The model
detailed in Table 3 explains 32.8% of caregiving stress
variance. Trait resilience moderates the relationship
between PD and caregiving stress (Model 3 DR2 ¼
.024, DF(1, 216) ¼ 7.76, p ¼ .006) and adds 2.4% of
explained variance. The results indicate that the higher
the resilience, the weaker the relationship between PD
and caregiving stress. This relationship is significant
only for medium and high levels of resilience (see
Figure S1 from Supplementary material 2). For the con-
tribution of each predictor to the model, see Table 3.

International Journal of Developmental Disabilities 2022 VOL. 0 NO. 0 5

Claudia I. Iacob et al. Trait resilience as a moderator between personality dysfunction and caregiving stress

Trait resilience as a moderator between relationship between antagonism and caregiving stress.
antagonism and caregiving stress For the contribution of each predictor to the model,
The entire model explains 31.5% of caregiving stress consult Table 4. It is worth noting that the caregiver's
variance. Trait resilience moderates the relationship gender becomes a significant predictor in models 2 and
between antagonism and caregiving stress (Model 3 3, where resilience, antagonism and their interaction
DR2 ¼ .035, DF(1, 216) ¼ 11.13, p ¼ .001) and adds are added.
3.5% of explained variance. The interaction effect is
significant only for medium and high levels of resili- Trait resilience as a moderator between
ence (see Figure S2 from Supplementary material 2). disinhibition and caregiving stress
Therefore, the higher the resilience, the weaker the The model detailed in Table 5 explains 31.7% of care-
giving stress variance. Trait resilience moderates the
Table 3. Hierarchical multiple regression for caregiving relationship between disinhibition and caregiving stress
stress: the interaction effect of personality dysfunction (Model 3 DR2 ¼ .022, DF(1, 216) ¼ 6.91, p ¼ .009)
and resilience.
and adds 2.2% of explained variance. As in previous
Model B SE B b p-value models, the relationship between disinhibition and
Model 1 (constant) 25.57 4.36 .000 stress decreases when resilience increases. The inter-
Age .01 .06 .01 .87
Income .76 .56 .09 .17 action effect is significant only for medium and high
Relationship status 1.95 1.50 .09 .19 levels of resilience (see also Figure S3 from
Gender 3.62 2.21 .11 .10
Model 2 (constant) 35.93 4.98 .000 Supplementary material 2).
Age .05 .05 .05 .35
Income .25 .49 .03 .61
Relationship status 1.03 1.29 .04 .42 Trait resilience as a moderator between
Gender 4.11 1.89 .12 .03 psychoticism and caregiving stress
Personality dysfunction .15 .04 .20 .001
Resilience .26 .03 .44 .000
This model explains 34.3% of caregiving stress vari-
Model 3 (constant) 52.35 7.66 .000 ance. Trait resilience moderates the relationship
Age .02 .05 .02 .71
Income .46 .49 .05 .34
between psychoticism and caregiving stress (Model 3
Relationship status 1.33 1.27 .06 .29 DR2 ¼ .036, DF(1, 216) ¼ 11.69, p ¼ .001), it weakens
Gender 3.57 1.87 .10 .05
Personality dysfunction .41 .20 .55 .04
their relationship and adds 3.6% of explained variance
Resilience .44 .07 .74 .000 to the model. From Figure S4 (Supplementary material
Interaction .007 .003 .74 .006
2), we can observe that the interaction effect remains
Note. B ¼ unstandardised beta coefficients; SE B ¼ unstandardised
beta coefficients standard error; b ¼ standardised beta coeffi-
significant only at medium and high levels of resilience.
cients;  p < .005,  p  .01;  p  .001. Model 1 R2 ¼ .036, The contributions of each predictor are detailed in
Model 2 DR2 ¼ .267, Model 3 DR2 ¼ .024. Table 6. Besides psychoticism and resilience, caregiver

Table 4. Hierarchical multiple regression for caregiving Table 5. Hierarchical multiple regression for caregiving
stress: the interaction effect of antagonism and resilience. stress: the interaction effect of disinhibition and resilience.

Model B SE B b p-value Model B SE B b p-value

Model 1 (constant) 25.57 4.36 .000 Model 1 (constant) 25.57 4.36 .000
Age .01 .06 .01 .87 Age .01 .06 .01 .87
Income .76 .56 .09 .17 Income .76 .56 .09 .17
Relationship status 1.95 1.50 .09 .19 Relationship status 1.95 1.50 .09 .19
Gender 3.62 2.21 .11 .10 Gender 3.62 2.21 .11 .10
Model 2 (constant) 40.49 4.79 .000 Model 2 (constant) 37.63 4.91 .000
Age .03 .05 .03 .50 Age .06 .05 .06 .28
Income .08 .50 .01 .86 Income .09 .49 .01 .84
Relationship status 1.41 1.31 .06 .28 Relationship status .66 1.31 .03 .61
Gender 4.53 1.95 .13 .02 Gender 4.11 1.90 .12 .03
Antagonism .45 .22 .12 .04 Disinhibition .57 .19 .18 .003
Resilience .28 .03 .47 .000 Resilience .27 .03 .45 .000
Model 3 (constant) 54.56 6.30 .000 Model 3 (constant) 48.39 6.34 .000
Age .02 .05 .02 .69 Age .04 .05 .04 .44
Income .21 .49 .02 .65 Income .32 .49 .03 .51
Relationship status 1.58 1.28 .07 .22 Relationship status .98 1.30 .04 .45
Gender 3.91 1.91 .11 .04 Gender 3.43 1.89 .10 .07
Antagonism 2.48 .90 .65 .007 Disinhibition 1.64 .86 .51 .05
Resilience .45 .06 .76 .000 Resilience .39 .05 .65 .000
Interaction .03 .01 .81 .001 Interaction .02 .01 .69 .009
Note. B ¼ unstandardised beta coefficients; SE B ¼ unstandardised Note. B ¼ unstandardised beta coefficients; SE B ¼ unstandardised
beta coefficients standard error; b ¼ standardised beta coeffi- beta coefficients standard error; b ¼ standardised beta coeffi-
cients;  p < .005,  p  .01;  p  .001. Model 1 R2 ¼ .036, cients;  p < .005,  p  .01;  p  .001. Model 1 R2 ¼ .036,
Model 2 DR2 ¼ .243, Model 3 DR2 ¼ .035. Model 2 DR2 ¼ .258, Model 3 DR2 ¼ .022.

6 International Journal of Developmental Disabilities 2022 VOL. 0 NO. 0

 Claudia I. Iacob et al. Trait resilience as a moderator between personality dysfunction and caregiving stress

gender also significantly predicts caregiving stress in The finding is consistent with other studies (Penning
models 2 and 3. and Wu 2016). PD and resilience levels did not differ
significantly across groups, which provided an argu-
Trait resilience as a moderator between ment favouring the moderation analyses on the overall
negative affectivity, respectively detachment, sample of participants.
and caregiving stress The separate effects of PD and resilience on stress
Trait resilience was not a moderator for the relationship were significant. Additionally, the moderation effect
between NA, detachment and caregiving stress, as the was significant at medium and high levels of resilience,
interaction terms were not significant. The results are which means that the negative impact of overall PD on
displayed in Table 7. care stress is attenuated in people with medium and
high levels of resilience but not in those who have low
Discussion resilience. Only antagonism, disinhibition, and psycho-
This study investigated the moderating role of TR on ticism had interaction effects with TR in explaining
the relationship between overall PD and care stress care stress at the trait level. Here also, resilience moder-
among family caregivers of children and adults with ated the relationships only at medium and high levels.
DDs. As expected, preliminary analyses showed that All the results were maintained even after controlling
caregivers of children with DDs experience signifi- for the demographic covariate variables (i.e. caregiver’s
cantly higher stress levels than caregivers of adults with age, income, relationship status, and gender). Among
DDs. This is due to the fact that caregivers have the demographic variables, only gender became a sig-
adapted to the caregiving tasks, the treatments are stabi- nificant predictor for caregiving stress, in models where
lised and the behavioural and emotional challenges of the personality traits and the interaction effects were
adults with DDs are not so variable as in adolescence. added. This is consistent with studies showing that
women caregivers experience higher stress levels com-
Table 6. Hierarchical multiple regression for caregiving pared with male caregivers (Pinquart and Sorensen
stress: the interaction effect of psychoticism
and resilience. 2006, Swinkels et al. 2019).
Overall, the results of this research are consistent
Model B SE B b p-value
with previous studies showing that negative personality
Model 1 (constant) 25.57 4.36 .000
Age .01 .06 .01 .87 traits such as neuroticism predict caregivers’ psycho-
Income .76 .56 .09 .17 logical reactions (e.g. stress, depression, anxiety, bur-
Relationship status 1.95 1.50 .09 .19
Gender 3.62 2.21 .11 .10
den) (Gallant and Connell 2003, Luchetti et al. 2021).
Model 2 (constant) 36.93 4.784 .000 Our results point in the same direction and highlight
Age .06 .056 .070 .23 that PD (as a whole and as each of the five general
Income .16 .489 .020 .73
Relationship status 1.08 1.289 .050 .40 traits of AMPD) predicts stress in familial caregivers.
Gender 4.39 1.893 .133 .02 In this way, evidence is provided to support the useful-
Psychoticism .63 .176 .216 .000
Resilience .27 .035 .449 .000 ness of AMPD in the study of caregivers' psychological
Model 3 (constant) 49.68 5.97 .000 reactions to the care process. However, as it is a dimen-
Age .04 .05 .04 .41
Income .38 .48 .04 .42 sional model, in which the simple presence or absence
Relationship status 1.25 1.25 .05 .32 of a feature does not imply it is equivalent to a psychi-
Gender 4.10 1.85 .12 .02
Psychoticism 1.97 .78 .67 .012
atric diagnosis, it avoids the pathology of the personal-
Resilience .42 .05 .69 .000 ity and the stigmatisation of the caregivers. This is an
Interaction .03 .01 .88 .001 argument favouring the model and probing other psy-
Note. B ¼ unstandardised beta coefficients; SE chological reactions. It is known that a diagnosis of per-
B ¼ unstandardised beta coefficients standard error; b ¼ stand-
ardised beta coefficients;  p < .005,  p  .01;  p  sonality disorder is stigmatising (Aviram et al. 2006)
.001. Model 1 R2 ¼ .036, Model 2 DR2 ¼ .271, Model 3 DR2 and treating personality traits on a continuum from
¼ .036.
functional to dysfunction reduces this stigma while also

Table 7. Hierarchical multiple regression for caregiving stress: the interaction effect of negative affectivity, respectively
detachment and resilience.

Independent variable Model R2 Adjusted R2 R2 change F change (df1, df2) p-value

NA 1 .036 .019 .036 2.06 (4, 219) .08
2 .300 .281 .263 40.83 (2, 217) .000
3 .303 .280 .003 .85 (1, 216) .35
Detachment 1 .036 .019 .036 2.06 (4, 219) .08
2 .273 .253 .237 35.30 (2, 217) .000
3 .283 .259 .010 2.87 (1, 216) .09
Note. NA: 1 ¼ age, income, relationship status, gender as predictors; 2 ¼ NA and resilience as additional predictors; 3 ¼ interaction effect
(NA x resilience) as additional predictor. Detachment: 1 ¼ age, income, relationship status, gender as predictors; 2 ¼ detachment and
resilience as additional predictors; 3 ¼ interaction effect (detachment x resilience) as additional predictor.  p < .001.

International Journal of Developmental Disabilities 2022 VOL. 0 NO. 0 7

Claudia I. Iacob et al. Trait resilience as a moderator between personality dysfunction and caregiving stress
highlighting the strengths and not just dysfunctional
features (Widiger and Mullins-Sweatt 2010).
Resilience, conceptualised as a trait or ability
acquired through exposure to adversity, has been repeat-
edly recognised as a protective factor against stress and
other negative consequences of care. Our data indicated
the same. Moreover, TR acted as a buffer in the relation-
ship between PD and stress, protecting caregivers from
its unfavourable impact on stress. The result is consistent
with research on other populations, showing that resili-
ence moderates the relationship between different varia-
bles (e.g. chronic pain, psychological health) and stress
(Garcıa-Izquierdo et al. 2018). This study's novelty con-
sists of investigating the interaction between two person-
ality characteristics in explaining caregivers' stress. At
low levels, resilience is not strong enough to mitigate the
negative impact of PD. This raises an argument in favour
of promoting programs to optimise psychological resili-
ence in caregivers.
Upon investigating the relationship of each trait in
AMPD, we found that NA and detachment predict stress
separately, without the relationship being moderated by
resilience. We know from previous research that these
two traits have been associated with depressive symp-
toms and anxiety (Few et al. 2013). However, our study
is the first to highlight the role of these traits in predict-
ing familial caregivers' stress. Furthermore, the effects
of antagonism, disinhibition and psychoticism on care-
giving stress were attenuated by medium and high levels
of resilience. These results strengthen the role of TR as a
protective factor against caregiving stress, even in the
presence of dysfunctional personality traits.
From a practical point of view, these results sustain the
implementation of programs for optimising the resilience
of caregivers. This can protect them from the negative
impact of PD and help them better manage stress reac-
tions. Even if we take into account TR, it has been shown
that environmental factors explain part of the variance of
this concept and that it can be optimised (Hu et al. 2015,
Joyce et al. 2018). One empirical study on family care-
givers showed that a resilience-enhancing program con-
taining five psychoeducation sessions and five social
support group sessions improved multiple outcomes,
such as family strain, hardiness, social support and family
_ and Temel 2016). Programs based on medi-
distress (Inci
tation were also helpful in reducing the caregiving burden
and increasing psychological resilience in Asian family
caregivers (Pandya 2019). Depending on the culture,
meditation protocol can be modified to accommodate the
participants’ compliance. For example, in Western cul-
tures, mindfulness-based meditation has gained much
popularity in the last years, and resilience programs
grounded in these procedures are effective for health
workers (Cleary et al. 2018).
8 International Journal of Developmental Disabilities 2022
Limitations and future research directions
The present study explains the link between PD, TR,
and caregiving stress. Although our results are encour-
aging and have practical implications, we believe there
are some limitations that we need to comment on.
The cross-sectional nature of the research design did
not allow us to probe the extent to which PD and TR
have changed over time, under the influence of the care
process, as an environmental factor that can facilitate
personality changes. As shown in the literature,
although personality traits have some stability over
time, they may change due to ageing and exposure to
environmental factors (Hopwood et al. 2011). So far,
we have not found research to track personality changes
in caregivers and the leading factors for change.
Research in this regard may be able to clarify such
issues. Similarly, since all the instruments were admin-
istered simultaneously, we cannot infer causal relation-
ships between the variables.
This sample of caregivers had, on average, low PD,
which could have favoured a moderating effect. It is
expected that, as PD increases, the protective role of
TR will decrease. More research in this direction can
clarify this hypothesis. There were also significant dif-
ferences between the stress levels, with the highest
scores reported in the children caregivers' group.
Therefore, in return, some effects could be diminished
by treating the two groups as one. The convenience
sampling method does not permit applying the results
on a broader group of family caregivers and may have
biased some outcomes. For example, most participants
were involved in a romantic relationship, a protective
factor for stress (Penning and Wu 2016). To diminish
the confounding bias, we controlled for the contribution
of demographic variables (including relationship status)
to the relationship between PD, resilience, and caregiv-
ing stress.
The instruments used in the study were self-adminis-
trated, which could have led to an over-reporting or
under-reporting of some effects. Such distortion has
been minimised in the present research by voluntary,
anonymous, and unpaid participation in the study. In
caregiving research, most studies measure stress
through self-report scales because the dominant per-
spective is that stress is a process that includes object-
ive environmental factors (e.g. low income) but
especially subjective factors that interact with each
other (e.g. perceived burden of care). Regarding the
scale of PD, there may be a concern that participants
underreported dysfunctional traits because they are
undesirable. However, studies have shown that, in the
instrument used to measure AMPD, clinicians reported
lower patient dysfunction than the patients themselves
(Samuel et al. 2018).
VOL. 0 NO. 0
 Claudia I. Iacob et al.
In conclusion, we consider this study as a first step
toward understanding the relationship between PD, TR,
and caregiving stress. Although the generalisation of
the results must be established by future research, our
data support the role resilience plays as a protective fac-
tor in the relationship between PD and caregiving
stress. Moreover, it highlights the need to optimise
resilience in familial caregivers to counteract the contri-
bution of dysfunctional personality traits to
stress reactions.
Disclosure statement
No potential conflict of interest was reported by
the authors.
Funding
This work was not funded.
Data availability
Data is available in Mendeley Data public repository:
http://dx.doi.org/10.17632/hr6mszn32n.1
This study was approved by the Research Ethics
Committee of the University of Bucharest.
ORCID
Claudia I. Iacob http://orcid.org/0000-0001-
9508-4881
Ruxandra Folostina http://orcid.org/0000-0002-
5543-2471
Eugen Avram http://orcid.org/0000-0002-3586-1914
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