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PERSONALITY
AND DISEASE
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PERSONALITY
AND DISEASE
Scientific Proof vs.
Wishful Thinking
Edited by
CHRISTOFFER JOHANSEN
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CONTENTS
List of Contributors ix
About the Editor xi
Prefacexiii
1. A Brief Historical Overview on Links Between Personality

and Health 1
Jesper Dammeyer and Ingo Zettler
A Brief Historical Overview on (Assumed) Links Between Personality and Health 1
Current Models of Links Between Personality and Health: (Basic) Personality Traits 4
Other Personality Constructs Linked to Health 9
Summing-Up12
References13
2. How to Measure the Personality 17

Per Bech
Introduction17
Psychometrics18
From Psychometrics to Clinimetrics 19
The Scalability of Eysenck’s Neuroticism Scale 21
The Scalability of Eysenck’s Extraversion/Introversion Scale 24
The Scalability of Eysenck’s Psychoticism Scale 25
Distinguishing Between Traits and States 26
Other Attempts to Describe Personality Traits 26
Item Banks 28
Conclusion29
References29
3. Personality as Determinant of Smoking, Alcohol Consumption,

Physical Activity, and Diet Preferences 33
Christian Hakulinen and Markus Jokela
Introduction33
Smoking34
Alcohol Consumption 36
v
vi Contents
Physical Activity 37
Diet Preferences 39
Mechanisms Explaining the Association Between Personality
and Health Behaviors 40
Conclusion41
References45
4. Personality and Cardiovascular Disease 49

Pernille E. Bidstrup, Ivalu K. Sørensen and Emil Wolsk
Introduction49
Cardiovascular Disease 49
Personality50
Potential Mechanisms 51
Reviewing the Evidence 53
Discussion62
Conclusions64
Public Health Implications 64
References65
5. Personality and Type 2 Diabetes: An Overview of the

Epidemiological Evidence 69
Mika Kivimäki, G. David Batty and Markus Jokela
Introduction69
The Big Five Personality Traits 71
Plausible Mechanisms Linking Personality to Increased Risk of
Developing Diabetes 72
The Influence of Personality on Diabetes Risk: Metaanalyses
of Individual-Participant Data for Personality as a Risk Factor
for Incidence Diabetes 75
The Influence of Chronic Disease on Personality: Evidence for
Type 2 Diabetes as a Risk Factor for Changes in Personality 78
Conclusions and Practical Implications 78
Acknowledgments80
References80
6. Personality and Dementia: Personality as Risk Factor

or as Early Manifestation in Dementing Disorders? 83
Lianne M. Reus, Lena Johansson and Pieter J. Visser
Personality Alterations in Dementia 84
Personality as a Risk Factor for Dementia 105
Contents vii
Discussion106
Personality Changes as a Direct Result of the Disease 106
Personality Changes as a Risk Factor for the Development of Dementia 106
Methodological Limitations of Personality Research in Dementia 107
Conclusion107
References108
7. Personality, Asthma, and Allergies 111

Adrian Furnham and Helen Cheng
Introduction111
Biopsychosocial Medicine 112
Placebo Effects and Real Treatments 115
Randomized, Double-Blind Control Trials 116
Personality and Illness 118
Asthma125
Allergies127
Conclusion131
References132
8. The Personality and Risk for Cancer 135

Christoffer Johansen
What Is a Risk Factor for Cancer? 139
Mechanisms147
References150
9. Personality and Social Relationships: As Thick as Thieves 153

Marcus Mund, Bertus F. Jeronimus and Franz J. Neyer
A Taxonomy of Social Relationships 155
Conceptions of Personality 156
Personality as a System Within Systems 157
My Partner and Me: Personality and Partner Relationships 157
My Friends and Me: Personality and Friendships 162
Interim Conclusion: What Does All This Mean and How Does It
Relate to Health? 165
Adding Another Level of Complexity: The Role of Life Transitions 166
Future Directions and Open Questions 172
Conclusion175
References175
viii Contents
10. Personality Genetics 185

Jaime Derringer
Introduction185
Estimating Heritability 185
Identifying Genes 188
The Relationship Between Personality and Health 196
Issues of Complexity 198
References201
11. The Enduring Appeal of Psychosocial Explanations

of Physical Illness 205
Roderick D. Buchanan, Nick Haslam and Wade Pickren
Research in the Mind, Body, and Health Before World War II 207
The Bridge Between the Mind and Body: The Idea of “Stress” 209
Risk, Lifestyle, and the Diseases of Modernity 211
Stress, Health, and Personality 213
Preventative Medicine 215
The Seductive Power of Personality as an Explanation of Disease 216
Conclusion220
References220
12. What Mechanisms Explain the Links Between

Personality and Health? 223
Deborah J. Wiebe, Anna Song and Maria D. Ramirez Loyola
Mechanisms Linking Personality and Health 224
Selected Illustrations of Mechanisms Linking Personality and Health 227
Concluding Thoughts 235
References238
Index247
LIST OF CONTRIBUTORS
G. David Batty
Department of Epidemiology and Public Health, University College London, London,
United Kingdom
Per Bech
Psychiatric Research Unit, Mental Health Centre North Zealand, University of
Copenhagen, Hillerød, Denmark
Pernille E. Bidstrup
Cancer Survivorship Unit, Danish Cancer Society Research Center, Copenhagen,
Denmark
Roderick D. Buchanan
History and Philosophy of Science Program, School of Historical and Philosophical
Studies, University of Melbourne, Melbourne,VIC, Australia
Helen Cheng
Department of Psychology, University College London, London, United Kingdom; ESRC
Centre for Learning and Life Chances in Knowledge Economies and Societies, Institute of
Education, University College London, London, United Kingdom
Jesper Dammeyer
Department of Psychology, University of Copenhagen, Copenhagen, Denmark
Jaime Derringer
Assistant Professor of Psychology, University of Illinois at Urbana-Champaign, Champaign,
IL, United States
Adrian Furnham
Department of Psychology, University College London, London, United Kingdom;
Norwegian Business School, Olso, Norway
Christian Hakulinen
Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
Nick Haslam
Melbourne School of Psychological Sciences, University of Melbourne, Melbourne,VIC,
Australia
Bertus F. Jeronimus
University of Groningen, Department of Developmental Psychology, Groningen, The
Netherlands; University of Groningen, University Medical Center Groningen, Department
of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE),
Groningen, The Netherlands
Christoffer Johansen
Oncology Clinic, Finsen Center, Rigshospitalet, Copenhagen, Denmark; The Danish
Cancer Society Research Center, Copenhagen, Denmark
ix
x List of Contributors
Lena Johansson
Neuropsychiatric Epidemiology Unit, Sahlgrenska Academy, Centre for Ageing and Health
(AgeCap) at the University of Gothenburg, Gothenburg, Sweden
Markus Jokela
Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
Mika Kivimäki
Department of Epidemiology and Public Health, University College London, London,
United Kingdom; Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
Marcus Mund
Friedrich-Schiller-Universität Jena, Department of Personality Psychology and
Psychological Assessment Germany, Jena, Germany
Franz J. Neyer
Friedrich-Schiller-Universität Jena, Department of Personality Psychology and
Psychological Assessment Germany, Jena, Germany
Wade Pickren
Center for Faculty Excellence, Ithaca College, Ithaca, NY, United States
Maria D. Ramirez Loyola
Psychological Sciences and the Health Sciences Research Institute, University of
California, Merced, CA, United States
Lianne M. Reus
Department of Neurology and Alzheimer Centre,VU University Medical Centre,
Amsterdam, The Netherlands
Anna Song
Ivalu K. Sørensen
National Institute of Public Health, University of Southern Denmark, Copenhagen,
Denmark
Pieter J. Visser
Department of Neurology and Alzheimer Centre,VU University Medical Centre,
Amsterdam, The Netherlands; Department of Psychiatry, Maastricht University, Maastricht,
The Netherlands
Deborah J. Wiebe
Emil Wolsk
Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
Ingo Zettler
ABOUT THE EDITOR
Christoffer Johansen is a professor in the oncology clinic at Rigshospitalet,

Copenhagen, and is responsible for the first Psychosocial Cancer Research
Unit at the Institute of Cancer Epidemiology with the Danish Cancer
Society (EPI). He has 450+ peer-reviewed publications and 4 published
books on cancer, with an h factor of 60. He holds several editor positions in
cancer survivorship journals, is past president of The International Society of
Psycho-Oncology, and has served on scientific advisory boards for The
Netherlands Cancer Institute, The Karolinska Institute, and The Hamburg
Cancer Research Center, Eppendorf. He additionally has been a senior advi-
sor to the Danish National Board of Health. In his scientific career, Christoffer
Johansen received and managed grants for more than 25 million dollars.
Dr. Johansen received his MD in 1986, his PhD in psychosocial cancer
epidemiology in 1994, and his Doctor of Medical Sciences in environmental
cancer epidemiology in 2004 from the University of Copenhagen. His main
research areas are psychological and social factors in relation to cancer, elec-
tromagnetic fields and cancer, and genetic factors in relation to brain tumors.
xi

PREFACE
It took a long time to get to this idea—that it was reasonable and worth-
while to organize an anthology considering the empirical basis for under-
standing how personality as a concept and a measurable phenomenon, or
maybe only traits of this concept, is associated with various health out-
comes. I was driven by my own research results, which frankly speaking
were far from what I expected, and by a phone call from San Diego,
California, USA. Nikki Levy from Elsevier called me and asked if I was
willing to organize and edit an anthology on the concept. I was in a restau-
rant in Copenhagen with a colleague and at first interpreted the call as a
joke. After a while I realized that it was genuine, and I was quite happy that
a publishing company so far from Copenhagen had chosen me.This cannot
be a hidden truth, I was in fact honored.
Some 25 years ago I was passing by a distinguished colleague in the long
corridors of the old Danish Cancer Register, when he asked me if it was
not true that I was interested in psychology and cancer. We were standing
in an area where, in former times, a circus had its winter quarters; the floor
was square, shaped with Italian piazza stones, and the roof was dome shaped,
ensuring that the artists could rehearse their breathtaking tricks. I looked at
him curiously, because I did not really understand his question; I was almost
isolated at the Register, being the only scientist investigating coping, which
was at that time a new concept in psychological phenomena, in colorectal
cancer patients. The entire institution was occupied at the time with classi-
cal cancer epidemiologists researching risk factors for various cancers by
either applying the new case–control concept or establishing large cohorts
of healthy citizens to investigate diet, physical activity, sexual viruses, and
occupational and environmental risk factors. I was somehow on the side-
lines, carrying out a cross-sectional study looking at the association between
coping and social factors, or at least that was my understanding of the study
at that time. I must have had one big question mark on my face because this
person, Professor Jørgen H. Olsen, who later became my supervisor and the
Director of the Danish Cancer Society Research Center (2011–17), took
the pile of papers he had in his hands and put them away on a table. He then
took off his coat and his black scarf and, while wiping his glasses, explained
to me how a paper that he had just had accepted for publication in the
xiii
xiv Preface
New England Journal of Cancer (Olsen, Boice, Seersholm, Bautz, & Fraumeni,
1995) contained a dataset that I could potentially use for a study in my field
of psychology. This dataset was constructed based on information on all
childhood cancer patients in the Nordic countries. By linking the personal
identification number (PIN; a unique person identifier) of each child to the
PIN of his or her parents, it was possible to discover if the parents of child-
hood cancer patients had an increased risk for cancer themselves, thereby
pointing to a potential genetic causation, if such an increased risk was pres-
ent. The results did not indicate any excess risk among those parents of
leukemia, lymphoma, or brain tumor children other than the well-known
associations within rare cancer types. The idea that my colleague was dis-
cussing came from the ongoing debate about stress. Would it be possible to
discover if any of these parents had a higher risk of cancer related to the
stress of being a parent to a cancer child, and what about mortality in these
parents if the child died? Would we find an excess death rate or would
everything be as expected? The research question was interesting and
showed that a quite complicated and often discussed topic such as stress
could be boiled down to exposure to a major life event. I had never been in
this research area before, but suddenly found myself deeply involved in an
ongoing controversy between people who defended the position that the
mind causes cancer and those who defended the standpoint that it was the
methodology by which the research question was investigated that deter-
mined the outcome of each study.
I compiled the Danish part of this large dataset and identified more than
11,000 parents who had experienced a child with cancer. At that time, it
was considered a privilege to have access to nationwide and population-
based incidence rates of cancer and we performed statistical analysis under
the assumption that a concept of comparing the observed rates with the
expected rates was sufficient to analyze such a large dataset, thinking that all
factors of interest had a random distribution. We looked at close to 50 years
of cancer incidence and observed that the rates of cancer overall, and when
broken down into various cancer sites, did not differ from what we expected
based on national cancer statistics and national census data of population
numbers in both genders and all age groups. I was surprised, and did not
know how to present this finding, as I was convinced that this severe expo-
sure to a parent, including the diagnostic period, treatment periods of up to
2 years of hospitalization involving the child and at least one parent, the
difficulties of getting the family and all its members to survive in any aspect
of the concept, and the ongoing fear of problems and recurrence if the child
Preface xv
survived, would show a clear association with an increased risk for cancer.
I did not know how to react properly, in a scientifically sound way, and was
further surprised when we discovered that even the death of the child,
which happened for thousands of those parents, did not increase the cancer
risk. To be more specific, we looked at each cancer type and found no
increase in the incidence rates of hormone-associated cancers, like breast
and prostate cancer, nor for immune system-associated cancers, like leuke-
mia or cervical cancer, or lifestyle cancers such as lung, bladder, or liver
cancer.The study included a mixture of young parents and parents who had
had their child diagnosed back in 1943, when the registration of cancer
patients began in Denmark, being the oldest cancer registry in the world
(Johansen & Olsen, 1997).
I discussed these findings with Professor Olsen and slowly accepted
that even my negative study, so to speak, had many positive aspects. Human
beings could cope with such enormous challenges without foreseeing an
increased risk for cancer. What a wonderful thought to come out with.
But what about dying; did the parents die from any other causes more
often than their gender- and age-comparable fellow citizens? That ques-
tion led me into a collaboration with a statistical artist, Mr. Svend Bang,
who showed me how it was possible to calculate, for the first time in
Denmark, cause-specific death rates. He worked in a small office charac-
terized by piles of papers and documents and satisfied a desire to smoke a
cigarette on the premises of the Danish Cancer Society, where it was for-
bidden to smoke, by holding his arm out of the window. His coffee cup
had an imprint of his lips and seemed to be an extension of his somatic
self. In addition to these characteristics he was a magician at constructing
programs in SAS, which could compute the most difficult of problems.
Later, he also developed the so-called primary cancer rates, which have a
deep meaning in relation to the science associated with studying the inci-
dence of and risks for cancer.
We found that more than 2000 parents had died, but had absolutely no
excess mortality for any type of death or for any cause of death. I was aston-
ished when it was shown that for some lifestyle-associated causes of death,
such as cardiovascular diseases, we observed a significantly reduced mortal-
ity, pointing to a “healthy parent effect,” a term we introduced but that was
never really accepted in the scientific community. It was a term by which
we could show how the communicable effect (not infectious but socially
speaking) of a cancer disease in one child could potentially change the
entire lifestyle of a family.
xvi Preface
I became obsessed, not in a psychiatric way but scientifically, with this

question, whether the mind was capable of influencing health, and this was
my first major research area—an area for which the conditions in Denmark
and other Scandinavian countries are extremely well suited to investigate.
Why is this so? The main characteristic of Scandinavian countries is a
relatively homogeneous population of some 23 million people, living in
Denmark, Finland, Iceland, Norway, and Sweden. Around the mid-1960s
these countries decided to establish a PIN system assigning a 10-digit
unique number to all residents to individualize and simplify their taxation
and social services data. This number consists of the date of birth and one
digit indicating the sex, and is used for all interactions between the indi-
vidual and the public administration at the national, regional, and munici-
pality levels. In addition, the PIN is used for transactions with banks,
employers, and the health system, including general practitioners (GPs), spe-
cialized hospitals, and pharmacies, where subsidized and prescribed medica-
tions can be bought. For research purposes, access to this wealth of data
presents a gold mine of information, which has been used for decades in
both clinical and epidemiological research. All studies can be conducted as
morbidity studies but not mortality studies; mortality outcomes are an add-
on.What does this mean? Well, it is more precise to have information on the
diagnosis of a disease by a specialist or a GP than information based on a
death certificate as almost no one is autopsied anymore.The disease causing
the death, noted on the death certificate, is the best and most qualified guess,
but far from the truth.Therefore, morbidity data are one league above mor-
tality statistics when discussing scientific rigor and quality.
Eventually, the mind and cancer story took off. I organized and con-
ducted studies in major life events/stresses, in depression, and in personality
as risk factors for cancer. From having a quite simplistic statistical approach
we came closer to more fashionable and insightful analytic strategies and
discovered in none of these studies an overall risk for cancer. However, we
found that persons who experienced a psychological problem, in terms of
stress, depression, or a trait in their personality, making it difficult for them
to be part of normal social circumstances or enter into and interact in social
life seemed to have an increased risk for lifestyle-associated cancers. These
persons, we hypothesized, had a lifestyle characterized by a higher con-
sumption of alcohol and tobacco smoking, both well-described and serious
risk factors for, e.g., lung cancer or liver cancer. The psychological factor
did not cause cancer; it was the lifestyle associated with this factor that had
an impact on the risk for these specific cancers. When talking about cause
Preface xvii
and effect, the mind could not independently cause any cancer; it needed an
intermediate—the lifestyle. Therefore, we declared that the mind was not a
risk factor for cancer and, in addition, highlighted the methodological
aspects of this discussion as the science I organized slowly became more and
more sophisticated. Another example is our study on some 1300 survivors
from the German concentration camps confirming the link between life-
style and subsequent cancer disease (Olsen, Nielsen, Dalton, & Johansen,
2015).
The first time I presented these preliminary data was at the International
Psycho-Oncology Society Congress in Kobe, Japan, just after the earth-
quake in 1995, and I remember that I did not understand the full extent of
the greater significance of this first dataset in the area of mind and cancer.
I stayed at a large hotel and was invited by James Holland, a distinguished
professor in oncology from New York (actually James Holland together
with colleagues initiated some of the first trials of leukemia chemotherapy
treatment in cancer), to share a glass of whisky as he stated that my data were
the first solid data presented at this meeting. My insight was further increased
when the discussion about the validity and reliability of this first study took
off. It suddenly became a discussion not of the findings but of the method-
ological issues, which seemed much more important. What we showed was
that self-reported mind factors (“I have been exposed to stress” or “I have
been depressed”) were not useful because the recall of diseased individuals
was biased by the disease, e.g., a cancer patient tries to explain the cause of
his or her cancer by the risk factors typically discussed publicly as causing
this particular cancer. Studies relying on the subjects and asking them to
recall their exposures showed a positive association with cancer, whereas
studies conducted prospectively and using exposure information from a
source independent of the subject under study did not confirm the associa-
tion. As I stated earlier, it suddenly became a discussion of methodology as
the reason for the different viewpoints on the association of mind and can-
cer. In my mind, this is also true for the association of the mind, including
personality factors, and other health outcomes such as cardiovascular dis-
ease, asthma, allergies, diabetes, or neurological diseases.
This discussion has been carried forward into the entire concept of
psychology and survival of cancer or any other chronic or acute disease.
There is a culturally based belief that the mind may help us to survive, and
thus a healthy mind, positive thinking, and open-minded, cooperative per-
sonality fares better than a more closed, introverted personality. Two studies
from the mid-1980s appearing in The Lancet and Archives of Internal Medicine,
xviii Preface
scientific journals that most scientists would love to publish in, showed that
cancer patients randomized to either groups headed by a psychiatrist
(Spiegel, Bloom, Kraemer, & Gottheil, 1989) or groups undergoing psycho-
education (Fawzy et al., 1990), compared with a control condition, lived
longer.The reaction was like a tsunami, as a rush of studies, volunteers, vari-
ous forms of self-educated therapists, and money went into the psychologi-
cal oncology research area. I also had my first, aforementioned, grant based
on these two studies. This discussion is also relevant in relation to the per-
sonality as the “exposure” under study. How much influence we can assign
to the personality becomes the next question, and one could reasonably
argue that “exposure” has no interest if it results in no behavior. Behavior
seems to be the acting agent and thereby we can have a discussion of how
or if we should divide personality from behavior. I am not quite sure how
this dilemma should be solved.
In former times, my position was quite radical, seen from a method-
ological point of view. I would not be quoted for supporting the idea that
the mind causes disease, especially cancer, and I was surprised to learn that
a large community of scientists believed and supported the notion that can-
cer is a psychological disease, assuming that the mind can initiate or pro-
mote malformations at a genetic level, causing mutations in the genes of the
human cell. I have always had and still have problems with this position, and
do not find that the psycho/neuro/immunological literature has shown,
convincingly, that psychological or mind exposures can cause somatic
changes that have such severity that mutations may occur. On the other
hand, the topics chosen for this anthology illustrate that for some of these
health outcomes we do have data supporting the idea that the personality
may influence the risk for the disease.
In shaping an anthology, an editor should always consider how the vari-
ous subjects align, and I looked for distinguished scientists who had contrib-
uted to this field. It was difficult to recruit volunteers to write chapters for
some topics, as these areas have lost credibility as intellectual investments for
many academic institutions. They do not add to the H index and thus have
no interest. You will find chapters illustrating some basic aspects of the
entire field. Chapters of a more general nature, however, touch on personal-
ity as a phenomenon, and in another part of the anthology chapters review
and discuss the knowledge we have. I was raised as a scientist in the era of
environmental cancer epidemiology, which also was the basis for the
International Agency for Research in Cancer, the cancer research institution
Preface xix
under the World Health Organization. Here criteria were established for
causality, and if you apply these criteria to the chapters considering knowl-
edge about personality measures and the risk or prognosis of chronic dis-
eases, you may discuss the strength of the evidence. I have accepted the
interpretation of the contributors, but ask readers to make their own obser-
vations and reflections.
The anthology has a general section, and also a specific section in this
research area. I have chosen some subjects and have left others out. My
choice.
I asked a couple of colleagues from the Institute of Psychology at the
university to describe the concept of personality as such. I mean, does this
phenomenon exist or is it a construct, an abstraction constructed with the
purpose of understanding why one human being is different from another?
I don’t know, but I think the chapter by Professor Dammeyer and col-
leagues illustrates this basic aspect and gives some of the background
needed for entering this arena. Along this line, I identified Professor
Roderick from the University of Melbourne, who has written an amazing
book on the destiny of Professor Eysenck, probably the most influential
personality researcher of the past century. I think the chapter on the con-
cepts in a discussion related to our culture, values, and interpretation of
the world is of general interest. Then there is the issue of measuring, the
psychometrics of the personality. I could not think of someone more
skilled and knowledgeable in this area than Professor Bech from the
University of Copenhagen. Professor Bech has a long track record of
studying scales: what do we measure and how, and what are the pitfalls in
our search for a measure of personality. This chapter also touches on the
development of such scales. In all types of research investigating associa-
tions we search for the underlying mechanisms, and I was happy when
Professor Wiebe from the University of California agreed to take respon-
sibility for the chapter entitled “What Mechanisms Explain the Links
Between Personality Factors and Health.” The chapter illustrates various
ideas and explanations that are also part of our search for understanding
our observations. As you will read, behavior is probably a major factor
explaining the association between our personality and various health
outcomes. What, then, is a healthy personality, could be the next question.
To address this difficult aspect, I have had tremendous help from Professor
Schustack from California State University. Her chapter mirrors the topics
touched upon in the chapter by Professor Wiebe. To further highlight and
xx Preface
illustrate the behavioral aspect of personality and health outcomes, I was

happy that another colleague, Professor Hakulinen from the University of
Helsinki, Finland, agreed to contribute with a text that dives deeper into
this area. And to go even deeper into the mechanisms and understanding
of the field, it was recommended that I ask Professor Derringer from the
University of Illinois for a contribution, which I find compelling and an
eye-opener. Even this aspect of life the personality, has genetic features,
which in the future we will probably hear more about. In my mind the
social construct, and the ability to link to other persons, is of major inter-
est in light of the research into social networks, social support, and dyadic
aspects of chronic disease, and thus a chapter on personality and relation-
ships by Professor Neyer and colleagues from Frederick Schiller University
in Jena, Germany, is the final contribution in this general section of the
anthology.
Next, I have organized a section that goes through the evidence we have
concerning major chronic diseases. I asked a young colleague of mine to
write a chapter on personality and cardiovascular diseases: Pernille Bidstrup
is a senior researcher from the Danish Cancer Society Research Center,
University of Copenhagen, who I supervised during her Ph.D. and who has
the talent of combing mathematical skills with psychological understanding.
Professor Kivimaki, based at the University College London, took on the
job of describing the knowledge concerning the field of diabetes, and
Professor Visser from Maastrict University in Holland further illustrates our
knowledge in a chapter on personality and dementia. I had a rapid and posi-
tive reply from Professor Furnham from the University College London.
Professor Furnham has experience in the field of personality and risk for
asthma and allergies, and these chronic conditions are also of interest when
investigating explanations for the rapid increase in incidence and prevalence
of these disorders. I myself took on the chapter on personality and risk for
cancer, since this is one of the areas in the “mind and risk for cancer” discus-
sion in which I have been scientifically active.
I hope you will find this book of interest and I want to thank my editor,
Nikki Levy, and Barbara Makinster for their help during the process.Thank
you to the contributors who took on the job of writing the chapters. Also
thank you to the Danish Cancer Society for numerous grants, as well as the
Department of Oncology at Rigshospitalet in Copenhagen. I also thank my
wife, Annette Preisler, for supporting the project and giving me the time
and space in our life that this book has occupied—kiss.
Preface xxi
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the parents of children with cancer. The New England Journal of Medicine, 333,
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Spiegel, D., Bloom, J. R., Kraemer, H. C., & Gottheil, E. (1989). Effect of psychosocial treat-
ment on survival of patients with metastatic breast cancer. Lancet, 2, 888–891.

CHAPTER 1
A Brief Historical Overview

on Links Between Personality
and Health
Jesper Dammeyer, Ingo Zettler
A BRIEF HISTORICAL OVERVIEW ON (ASSUMED)

LINKS BETWEEN PERSONALITY AND HEALTH
For centuries, people have been interested in, and believed in, links between
personality and health. However, not until recently such links have been
investigated via thorough empirical studies. Personality is often understood
as a set of (relatively) stable individual differences, encompassing factors
such as gender, mental abilities, or traits. Personality factors have been found
to be associated with the way people think, feel, or act with regard to virtu-
ally all areas of humans’ lives, including health. In this chapter, we provide a
brief historical overview on theories, models, and empirical findings that
have linked personality to health.
The Neolithic Age, Ancient Greece, and the Middle Ages

Ancient excavations from prehistoric Neolithic times have found human
skulls with small drilled or scraped holes, caused by a surgical intervention
called “trepanation” (Prioreschi, 1991). A dominating theory is that these
holes were made in order for evil spirits causing mental disorders to leave
the ailing body.Thus, very early in the history of civilization human believed
in close links between the mind and the body.
In ancient Greece, Hippocrates (c.460–370 BC) introduced a theory of
four temperaments, which is the first written theory on links between per-
sonality and health known today, although his temperament theory took its
origin in the even older Egyptian and Mesopotamian philosophy of
“humorism” (Sudhoff, 1926). Hippocrates’ temperament theory suggests
that four bodily fluids (called humors)—namely, black bile, yellow bile,
phlegm, and blood—directly affect an individual’s personality, behavior, and
Personality and Disease

ISBN 978-0-12-805300-3 © 2018 Elsevier Inc.
https://doi.org/10.1016/B978-0-12-805300-3.00001-3 All rights reserved. 1
2 Personality and Disease
health (Johansson & Lynøe, 2008). Thus, in contrast to theorizing around

trepanation, Hippocrates did not attribute mental illness (or other diseases)
to evil spirits but to physiological reasons, in terms of imbalances of circulat-
ing body fluids that also affected one’s personality.
Based on Hippocrates’ theory, another ancient Greek physician, surgeon,
and philosopher, Galen (c. AD 129–200), described in his dissertation De
temperamentis—the first typology of temperaments. This typology was based
on the four humors and considered the balance and imbalance of tempera-
ment pairs. According to Galen, the imbalance of pairs resulted in one of the
four temperament categories (or personality types): sanguine (being optimis-
tic and social), choleric (being short-tempered and irritable), melancholic
(being analytical and quiet), and phlegmatic (being relaxed and peaceful).
Hippocrates’ and Galen’s humoral theory was dominant in Greek,
Roman, as well as Islamic philosophy and medicine for many centuries. Not
until the 19th century with the advent of modern medicine was Hippocrates’
and Galen’s theory substantially challenged, although it continued to be
used by some researchers and practitioners in the 20th century (Marks,
Murray, Evan, & Willig, 2000).
However, the Middles Ages should briefly be mentioned here, in which
the religious belief that diseases reflect punishment by the Christian God
dominated. Nonetheless, even in the Middle Ages, the (less religious) belief
in a connection between physical illnesses and underlying personality (as
introduced by Hippocrates and Galen) managed to coexist with established
Christianity (Morrison & Bennett, 2006).
The Renaissance and the Age of Enlightenment

Even in light of the scientific revolution commencing in the 1600s follow-
ing the Renaissance and onwards, increased knowledge about physiology
and medicine, i.e., more solid empirically based models linking personality
and health, was not developed before the 20th century. One explanation for
such a late introduction and interest in the empirical study of links between
personality and health might be the dominance of dualism in medicine.
More precisely, the highly influential philosopher René Descartes (1596–
1650), like the ancient Greeks, believed that the body and mind were sepa-
rate entities, though interactions might be possible. The mind (including
personality) was immaterial and distinct from the body, and, thus, the body
was the object for scientific investigation and the mind was left for theolo-
gians and religion (Descartes, 1641, pp. 1–62). Descartes’ (and others’) dual-
istic view probably fed a mechanical and biomedical model of health—leaving
Links Between Personality and Health 3
little or no space for scientific investigations of how personality, cognition,

or social and cultural factors affect health.
Personality and Health in the 20th Century

In the last century, more and more theories or models about human person-
ality have been introduced. Besides psychoanalytic and psychodynamic
approaches (for an overview, see Mitchell & Black, 1996), which will not be
described herein, the most influential theories and models subsume similar
personality characteristics to a broader trait. An important difference
between such models and earlier ones was that the new models were, at least
to some degree, based on empirical studies. Gordon Allport (1897–1967) is
considered to be the founder of this empirical approach to personality psy-
chology and the forerunner of modern personality trait models (see below).
He is known for using what was later called, the “lexical hypothesis,” stating
that individual differences are reflected in language terms. Allport et al., as
well as researchers following this idea, read through dictionaries, searching
for personality-descriptive words. These words were then further catego-
rized (e.g., to delete exact synonyms), and a smaller subset of them was
finally presented to people who should rate themselves or others based on
these words (Allport, 1961).
In line with Allport’s work, Hans Eysenck (1916–97) made significant
contributions to modern personality psychology and was one of the first to
analyze personality differences using psychometric methods. Eysenck’s per-
sonality model first consisted of two factors, Extraversion (E, the tendency
to enjoy social events and interaction) and Neuroticism (N, the tendency to
experience negative emotions), which he argued were biologically/geneti-
cally based and reflected Hippocrates’ four temperaments: high N and high
E = choleric type, high N and low E = melancholic type, low N and high
E = sanguine type, and low N and low E = phlegmatic type (Eysenck &
Himmelweit, 1947). A third dimension, psychoticism, was later added by
Eysenck to the model, but it received little empirical support and will not
be discussed further herein.
Another early attempt following an empirical approach is the Type A
and Type B personality theory (Friedman & Rosenman, 1959). Being car-
diologists, Friedman and Rosenman suggested that Type A personalities had
a greater risk of developing coronary heart disease. Individuals with a Type
A personality were described as being more ambitious, aggressive, competi-
tive, impatient, and outgoing, and, in turn, as high-achieving “workaholics”
who were more likely to push themselves with deadlines. Individuals with
a Type B personality, by contrast, were described as more reflective, relaxed,

and, in turn, as people focusing less on winning or losing when facing com-
petition. Even though the Type A and Type B theory was empirically sup-
ported in some early studies, later empirical studies have not been able to
replicate the empirical evidence (Šmigelskas, Žemaitienė, Julkunen, &
Kauhanen, 2015). Consequently, the theory is only rarely used in research
nowadays.
CURRENT MODELS OF LINKS BETWEEN PERSONALITY

AND HEALTH: (BASIC) PERSONALITY TRAITS
In recent decades, the most influential personality models—and also in gen-
eral those most strongly supported empirically—have been models propos-
ing basic personality traits. As described above, such models of basic
personality structure have typically emerged from lexical studies in which
people are asked to describe themselves or others via personality-descriptive
adjectives (typically put in different contexts) initially found in dictionaries.
These self- and/or other ratings are then grouped in a way (typically, using
factor analytic techniques) such that similar adjectives (characteristics) form
a trait, while the so-formed traits should be unrelated to each other.
Over the last decades, and due to better empirical studies, a personality
model consisting of five traits has become an even more influential model
than Eysenck’s “Big Three” (John, Naumann, & Soto, 2008). The five-factor
model comprises the five basic traits of Openness to Experience (sometimes
called Intellect), Conscientiousness, Extraversion, Agreeableness, and
Neuroticism (sometimes reversed and then labeled “Emotional Stability”).
To date, the five-factor model is the most investigated model. In the follow-
ing, we will provide a brief description of each of the “Big Five” traits and
a short introduction to research investigating their associations to health.
Openness to Experience: People high in Openness to Experience are typi-
cally creative, intellectual, curious, and have a preference for novelty. In
contrast, people low in Openness to Experience are rather closed-minded
and dogmatic.While, compared with the other four Big Five traits, Openness
to Experience is, in general, associated with fewer health-related variables, it
has been suggested that people high in Openness to Experience are better
in adjusting to new situations, which might promote cognitive, emotional,
and physical well-being (Duberstein et al., 2003; Jerram & Coleman, 1999;
Steel, Schmidt, & Shultz, 2008), as well as greater longevity (Iwasa et al.,
2008; Taylor et al., 2009). For instance, Taylor et al. (2009) studied survival
among 1035 elderly people in Edinburgh, who completed a Big Five per-
sonality questionnaire. The study found a 28% lower rate of all causes of
mortality for each standard deviation increase in their Openness to
Experience score.
Conscientiousness: People high in Conscientiousness are typically disci-
plined, organized, and responsible and might even be perceived as obsessive
and stubborn in some (extreme) cases. In contrast, people low in
Conscientiousness are rather flexible and spontaneous but might also be
perceived as untidy and unreliable. There is increasing empirical evidence
that low levels in Conscientiousness are linked to negative health behaviors
such as drinking, smoking, or lack of exercising (e.g., Friedman et al., 1993;
Hampson, Goldberg, Vogt, & Dubanoski, 2007), as well as negative health-
related outcomes such as diabetes, hypertension, urinary problems, stroke,
and even earlier mortality (e.g., Bogg & Roberts, 2004; Löckenhoff, Sutin,
Ferrucci, & Costa, 2008; Taylor et al., 2009; Terracciano, Löckenhoff,
Zonderman, Ferrucci, & Costa, 2008; Wilson, Schneider, Arnold, Bienias, &
Bennett, 2007). For instance, Löckenhoff et al., (2008) examined the asso-
ciation between the Big Five traits and subjective ratings of mental and
physical health in two US samples of older adults (n = 393 and n = 648).
Overall, high scores on Conscientiousness were modestly but positively
associated with high self-rated health (correlations overall between 0.10 and
0.20). Broadly speaking, the main explanation for this is that people low in
Conscientiousness are not so good at planning, sticking to plans, and, gener-
ally, having self-control, so that they tend to ignore potentially negative
consequences of their behavior in the long run.
Extraversion: People high in Extraversion are typically more outgoing,
show more energy, show positive emotions, and are more social and talk-
ative than people who score low in Extraversion. Those being high in
Extraversion are often perceived as attention-seeking, while those being
low in Extraversion are often perceived as reserved and reflective. Research
has indicated that Extraversion is positively linked to health. Indeed, people
high in Extraversion report better mental health and subjective well-being
(Steel et al., 2008), also in terms of lower symptoms of depression (Jylha &
Isometsa, 2006). For example, in a study by Jylha and Isometsa (2006), 441
randomly selected Finnish individuals between 20 and 70 years completed
questionnaires assessing personality traits, depression and anxiety, respec-
tively. In this study, scores on Extraversion correlated negatively and moder-
ately with symptoms of depression (0.47) and anxiety (0.36) and weakly
with self-reported lifetime mental disorder (0.17) and use of health-care
services for psychiatric reasons in the preceding 12 months (0.14). Studies

have also shown links between high Extraversion and good self-rated global
health (Jerram & Coleman, 1999; Korotkov & Hannah, 2004); however,
associations between Extraversion and physical health are not always found.
Agreeableness: People with high levels in Agreeableness are more coop-
erative, friendly, and compassionate compared with individuals with low
levels. Those being high on agreeableness are more likely to be perceived as
naive or submissive, as opposed to those who are low. Such people are often
perceived as more competitive and challenging. A number of studies have
linked high levels in Agreeableness to better mental health (Löckenhoff
et al., 2008; Steel et al., 2008), which might be a consequence of these
people’s tendency toward altruism and willingness to cooperate with others.
Associations with physical health are often relatively small (Löckenhoff,
Duberstein, Friedman, & Costa, 2011).
Neuroticism: People with high levels in Neuroticism more easily experi-
ence anger and anxiety compared with people with low levels, who are
more stable emotionally. People low on Neuroticism are often perceived as
stable and calm but perhaps even as being unconcerned. By contrast, those
with high levels are more likely to be perceived not only as reactive, excit-
able, and dynamic but also as more unstable and insecure.
People high on Neuroticism report worse subjective health, both physi-
cally and mentally (Duberstein et al., 2003; Jerram & Coleman, 1999;
Löckenhoff et al., 2008). For example, in the Jylha and Isometsa (2006)
study mentioned above, strong positive correlations were found between
Neuroticism and symptoms of depression (0.71) and anxiety (0.69) and
moderate correlations with self-reported lifetime mental disorder (0.30)
and health-care use for psychiatric reasons in the past 12 months (0.24).
With regard to physical disorders, studies have reported that people high in
Neuroticism have a higher risk of developing hypertension (Spiro, Aldwin,
Ward, & Mroczek, 1995), obesity, and metabolic syndromes (Hampson &
Friedman, 2008), as well as having increased mortality compared with those
who are low in Neuroticism. One explanation is that levels of Neuroticism
reflect an individual’s reaction or overreaction to stressors (Kling, Ryff,
Love, & Essex, 2003; Mroczek & Almeida, 2004) such as by smoking. Indeed,
studies have shown that smoking accounts for 25% of the association
between Neuroticism and mortality (Mroczek, Spiro, & Turiano, 2009).
Summing-up, research linking the Big Five to health-related outcomes
has first of all strongly indicated that low levels of Conscientiousness and
high levels of Neuroticism are related to unhealthy behaviors and illness,
diseases, and ultimately mortality (e.g., Roberts, Kuncel, Shiner, Caspi, &
Goldberg, 2007). Concerning the other traits, Extraversion has often been
found to be positively related to variables in the realm of well-being, while
findings for Agreeableness and Openness are more specific and less strong
overall.
The HEXACO Model and Links Between Personality Traits

and Personality Disorders
In recent years, a slight adaption and extension of the five-factor model has
received increasing attention, namely, the HEXACO model of personality
(Ashton & Lee, 2007). The HEXACO model suggests that there are six
basic traits. Three of them (Extraversion, Conscientiousness, and Openness
to Experience) virtually mirror their counterparts from the five-factor
model, while two HEXACO traits (Emotionality and Agreeableness) com-
prise slightly different items than their Big Five counterparts. Finally, one
trait, Honesty–Humility, is added as a sixth basic trait. Honesty–Humility
comprises aspects such as honesty, modesty, and loyalty on the one side and
deceitfulness, greed, and slyness on the other (Ashton & Lee, 2008).
According to the HEXACO theory, Honesty–Humility thus reflects active
cooperativeness (or active reciprocal altruism), while Agreeableness reflects
reactive cooperativeness (or reactive reciprocal altruism).
The reconstruction of Emotionality and Agreeableness, as well as the
addition of the Honesty–Humility trait in the HEXACO model, seems to
have some important implications for health-related issues. For instance, the
HEXACO traits seem to relate relatively clearly to the five maladaptive
personality domains suggested by the DSM-5 (The Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition) Personality and Personality
Disorders Workgroup (Ashton, Lee, de Vries, Hendrickse, & Born, 2012).
Even though personality traits describe variations of normal human behav-
ior, the traits also reflect symptoms of personality disorders. In particular,
Honesty–Humility has been linked to Antagonism, Emotionality and
Agreeableness to Negative Affectivity, Extraversion to Detachment,
Conscientiousness to Disinhibition, and Openness to Experience, although
only weakly, to Psychoticism (Ashton et al., 2012). In addition, further
research has supported a link between Honesty–Humility (reflecting active
cooperativeness) with Borderline Personality Disorder (Hepp et al., 2014).
While the HEXACO model is a somewhat improved empirical model of
personality, as compared with the five-factor model (e.g., Ashton & Lee,
2008), research on its links to health is still at an early stage.
Trait-Level Change and Health

While personality traits are assumed to be relatively stable over time, they do
also show some general changes over the life span, overall supporting the
idea of people becoming more mature with age (Roberts, Walton, &
Viechtbauer, 2006).1 In recent years, researchers have started to investigate
how these general trait-level changes affect health. For instance, Hampson,
Tildesley, Andrews, Luckyx, and Mroczek (2010) found that a decrease in
Agreeableness was associated with an increased risk of substance use, and
Mroczek and Spiro (2007) found that both levels, and increases in levels, of
Neuroticism predicted mortality. Persons who had a high score on
Neuroticism and an increasing score of Neuroticism over time were found
to have a higher mortality rate. Furthermore, Siegler et al. (2003) found that
decreases in Agreeableness predicted a higher risk of obesity, a lower rate of
exercising, more high-fat diets, as well as other physical health risk factors.
Finally, in a national (US) sample comprising 3900 participants and looking
at Big Five personality traits change over a 10-year period, Turiano et al.
(2012) found that changes in Agreeableness, Conscientiousness, and
Extraversion predicted self-rated health. For instance, while all traits except
Agreeableness predicted limitation in work activities at work or at home
because of physical health, decreases in Conscientiousness also predicted
limitation in work activities. Finally, a recent metaanalysis investigated the
extent to which personality traits change due to (clinical) interventions,
pointing to changes in Neuroticism and Extraversion in particular (Roberts
et al., 2017).
These longitudinal studies of personality change and health risk suggest
multiway interactions, as well as nonlinear relationships among personality,
social, and biological factors. All of which underlines the fact that the links
between personality and health cannot be understood from cross-sectional
correlations of single factors but need to be understood as more complex
developmental biopsychosocial pathways (Turiano et al., 2012). The next
decade of research will hopefully shed more light onto the most important
of these pathways.
1 Besides these general changes (e.g., reflecting that most people show higher levels in
Conscientiousness in later adulthood as compared with early adulthood) some people
do also show some substantial individual trait-level changes (e.g., some people might
be among those with the lowest levels in Conscientiousness in early adulthood but
among those with the highest levels in Conscientiousness in adulthood). However,
these individual-level trait changes will not be discussed further here.
Implications for Prevention and Treatment

A better understanding of the developmental pathways of personality traits
and health may lead to better individual prevention and treatments of health
problems. Identifying combinations of potentially problematic characteris-
tics already in childhood and monitoring trait changes are two perspectives.
For instance, relaxation techniques, increasing self-control programs, or
effective ways to deal with stress might be helpful for individuals scoring
high on Neuroticism (Moffitt et al., 2011). Preliminary intervention studies
have generally shown promising results (Baumeister, Gailliot, DeWall, &
Oaten, 2006; Conrod, Stewart, Comeau, & Maclean, 2006). For instance, in
the Conrod et al. (2006) study, including 297 Canadian high-school stu-
dents, a cognitive-behavioral intervention program targeting personality
factors (sensation seeking, anxiety sensitivity, and hopelessness) was found to
be effective in reducing youth alcohol misuse (reduced drinking rate, quan-
tity, binge drinking, and problem drinking). However, a number of limita-
tions exist and more research is needed before programs should be
implemented. In particular, personality traits often interact not only with
each other but also with other factors over time, which should be taken into
account more consistently.
OTHER PERSONALITY CONSTRUCTS LINKED TO HEALTH

Of course, researchers have also linked other personality constructs than
basic traits to health. Examples span across constructs such as aggression,
anger, anxiety, cynicism, hostility, nervousness, repression, and trust
(Goodwin & Friedman, 2006). Next, we will briefly sketch the main knowl-
edge on the links between some of these personality constructs and health.
Gender
In most western countries, the average life expectancy of women is higher
than that of men. For instance, men are nearly twice as likely to die from a
heart disease before the age of 65 and three times more likely to die from
violence compared with women. In contrast, and perhaps surprisingly, men
self-report better health, they have less frequently contact with medical
health services, and they experience less acute illness than women (Reddy,
Fleming, & Adesso, 1992, pp. 3–33). Overall, gender is an individual differ-
ence construct with clear links to health-related behaviors and health (e.g.,
Powell-Griner, Anderson, & Murphy, 1997). Several biological, psychologi-
cal, and cultural reasons have been discussed in this regard. One example of
a psychological/cultural aspect is that, in many societies, men are expected

not to acknowledge weakness (Courtenay, 2000) and this might affect health
behavior and response to illness symptoms.
Mental Abilities
Similarly to gender, links between mental abilities and health have been
found consistently. Indeed, intelligence test scores (IQ) in childhood have
been found to predict differences in adult mortality, including, for instance,
deaths from cancers and cardiovascular diseases, even after statistically con-
trolling for socioeconomic variables (Gottfredson & Deary, 2004). A large-
scale epidemiological study in Australia found that, while controlling for a
large number of other psychological and demographic variables, each addi-
tional IQ point was linked to a 1% decrease in the risk of early death
(O’Toole & Stankov, 1992).
One explanation why intelligence is linked to health is that high skills in
abstract thinking, learning, problem-solving, or reasoning (i.e., aspects of
mental abilities) are useful in relation to health self-care. High mental ability
is helpful in recognizing risk behavior. It leads to responses in a timely man-
ner, it limits damages, and it modifies behavior and environments in order to
prevent health problems (Gottfredson & Deary, 2004). For instance, people
with a high IQ are better at finding and understanding information about
the risks from smoking, at planning and arranging the avoidance of smoking
or ceasing to smoke, and if ill, knowing how to access and follow a treatment
program. Another example is diabetes. For instance, Taylor, Frier, Gold, and
Deary (2003) found that intelligence measured at the time of diagnosis cor-
relates with diabetes knowledge measured one year later (Taylor et al., 2003).
Similarly,Williams, Baker, Parker, and Nurss (1998) found that many patients
with low academic skills and diabetes were less likely to understand funda-
mental symptoms and how to control and take care of the diabetes.
Emotional Intelligence
Another individual difference factor, which has been received attention in
recent research, is emotional intelligence (EI). EI is defined as the ability to
recognize and discern own and other people’s emotions and to use emo-
tional information to guide thinking and behavior. High EI is associated
with outcomes such as better social and personal relationships. More spe-
cifically, intrapersonal aspects of EI, such as mood regulation, are associated
with, for instance, higher levels of life satisfaction and lower levels of depres-
sion (Austin, Saklofske, & Egan, 2004). Thus, EI appears to be an important
factor for health outcomes. However, in the study by Austin et al. (2004)
among 500 Canadians and 204 Scottish participants, it was found that qual-
ity of social network, life satisfaction, alcohol consumption, number of doc-
tor consultations, and health status were more strongly related to personality
traits than EI. Conversely, EI was more strongly associated with social net-
work size than were personality traits.This finding is in line with a criticism
of EI, claiming that EI adds little or nothing to the prediction of general life
outcomes (Landy, 2005). Finally, it should be noted that others have intro-
duced different conceptualizations of EI, e.g., as a blend of personality char-
acteristics or as a competence.
Motivation
“Motivation” is an umbrella term covering a number of more specific fac-
tors. One of these is self-efficacy, which is the extent or strength of one’s
belief in one’s own ability to complete tasks and to reach goals (Bandura,
1977). Self-efficacy has been found to be important for change and main-
taining positive health behavior, thus preventing diseases, and in the case of
a disease occurring, the likelihood of adhering to a treatment program
(Schwarzer & Fuchs, 1995). For instance, perceived self-efficacy level has
been reported to predict outcomes of a controlled-drinking program
(Sitharthan & Kavanagh, 1990) and in general to be a powerful resource in
coping with stress (Lazarus & Folkman, 1987). Another example is that lev-
els of self-efficacy beliefs are associated with physical exercise and maintain-
ing the exercise for an extended time. In a study by McAuley (1993), for
instance, 82 middle-aged participants completed a five-month exercise pro-
gram, as well as physiological and self-efficacy assessments. Five months after
completion of the program, the researchers interviewed the participants
about their exercise participation over the preceding week. Self-efficacy
significantly predicted exercise behavior at follow-up when controlling for
biological and behavioral factors.
Future Directions in Personality and Health Research

Robust empirical studies on links between personality and health have only
begun to appear within the last few decades. Thus, not only more research
is needed in general but also some methodological challenges should be
addressed. Weston, Hill, and Jackson (2014) point to three overall issues.
First, many existing studies of personality and health use cross-sectional
designs and thus cannot distinguish between personality characteristics as
risk factors or as by-products (or even as consequences) of a disease. It is
important to have data on the personality dimensions before the onset of a

disease in order to know how the disease can affect the personality factor
level and vice versa.Though longitudinal studies by definition take time and
are typically more expensive than cross-sectional studies, they are crucial in
developing the field of research. Second, only a small number of diseases
have been investigated with regard to personality factors. For instance, rela-
tively few studies have examined two of the most common and costly dis-
eases, stroke and diabetes (Weston et al., 2014). Third, existing research fails
to include a broad range of personality constructs. The dominant focus has
been the Big Five traits, especially Conscientiousness and Neuroticism, but
future research should also look more closely at different constructs and the
combination of, and interaction between, these. For instance, a personality
trait might operate as a risk factor in childhood but not later in life, being a
risk factor in combinations with some traits but not others, for one disease
but not for another, or for women but not for men.
SUMMING-UP
Personality traits can be defined as relatively stable behavioral, emotional, and
cognitive characteristics of an individual. Health can similarly be character-
ized by behaviors (abilities to work and activities of daily living), cognitions,
and emotions (subjective thinking and feeling of being “fit” and “full of
energy”; Morrison & Bennett, 2006). Therefore, links between personality
traits and health as found in recent empirical research are not surprising.
This chapter has sketched some theories or models of personality
and has especially aimed to provide a broad introduction to the currently
most supported links between basic personality characteristics and health
factors. However, research has just begun to understand the complexity of
mechanisms involved in the associations between personality factors and
health (e.g., Hampson, 2012; Hill & Roberts, 2011; Hill, Turiano, Hurd,
Mroczek, & Roberts, 2011). Generally, the empirical support for recent
personality theories/models, as well as for some links between personality
factors and health, seems promising for the future. The former dominance
of religious and nonempirically based theories has been decreased in many
societies at large. In the future, research will probably aim to combine dif-
ferent scientific and methodological approaches in order to build a broader
fundamental understanding of the links between personality and health.
One current example is the increasing empirical research in so-called “alter-
native medical practices” such as yoga, meditation, and healing.
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CHAPTER 2
How to Measure the Personality

Per Bech
Psychiatric Research Unit, Mental Health Centre North Zealand, University of Copenhagen, Hillerød, Denmark
INTRODUCTION
In his book on Freud as the inventor of the modern mind, Kramer (2006)
refers to “ego traits” as the phenomenological aspect of “ego strengths,”
covering the elements of the different temperaments (melancholic, san-
guine, choleric, phlegmatic). Freud’s “neuroticism” as a personality trait
overlaps, according to Kramer, with depressive disorder by including com-
ponents of self-doubt, anxiety, or other negative emotions.
In the field of psychology, the term personality is considered as a more or
less static pattern covering thinking, emotions, and behavior. According to
Lazarus (1971), we speak of personality structures in the same way as when
we say that a person is more or less intelligent.When measuring personality
we are, again according to Lazarus (1971), referring to a quantitative dimen-
sion in the same way as we consider intelligence to be a psychological trait.
In clinical psychiatry we have the term personality disorders, which we
describe qualitatively as types rather than traits. Feighner et al. (1972) intro-
duced the typological use of algorithms in psychiatric research and used
Antisocial Personality Disorder (ASPD) as an example. The ASPD was
defined as a chronic disorder requiring a minimum of five out of nine mani-
festations to be definitely present. In diagnostic and statistical manual of
mental disorders. Fifth edition (DSM-5) (American Psychiatric Association,
2013) personality disorders are still considered as being derived from cate-
gorical algorithms. However, in the DSM-5 the five-factor model (Costa &
Widiger, 2001) is included as an alternative proposal. This five-factor model
lists five personality traits or factors, namely (1) neuroticism, (2) extraver-
sion, (3) openness, (4) agreeableness, and (5) conscientiousness. The DSM-5
decision to officially delete personality dimensions when describing per-
sonality disorders is based on the fact that we have no acceptable sharp
cutoff between personality traits and personality disorders.
Among the five personality traits identified by the five-factor model, the
traits of neuroticism and extraversion are the most distinct and best studied
ISBN 978-0-12-805300-3 © 2018 Elsevier Inc.
https://doi.org/10.1016/B978-0-12-805300-3.00002-5 All rights reserved. 17
as regards the measurement of personality dimensionality (Bech, 2016).The

psychometric measurement of neuroticism and extraversion is therefore the
focus of this chapter on how to measure personality.
PSYCHOMETRICS
The emergence of psychometrics is ascribed to Wilhelm Wundt (1820–1920)
who is regarded as the first experimental psychologist (Bech, 2012). He
founded the psychological laboratory at the University of Leipzig in 1879.
Actually, Wundt’s work was based on Fechner’s Law (Fechner, 1860), which
showed a mathematical relationship between psychological experience and
physical stimulus. Thus the psychological sensation increases as a logarithm
of the physical stimulus value. In Wundt’s laboratory, Emil Kraepelin (1856–
1926) was one of the first scientists to measure symptoms by rating scales in
order to identify the shared phenomenology of schizophrenia versus manic-
depressive disorder. Also in Wundt’s laboratory, another scientist, Charles
Spearman (1863–1945) developed factor analysis (Spearman, 1904) based on
the statistical model of correlation coefficients. Using factor analysis,
Spearman (1927) identified a general factor of intelligence.
Unfortunately, Fechner’s law about a logarithmic relationship between
mental and biological phenomena, and especially Spearman’s factor analysis
was seen as giving a Platonistic, ideal, mathematical structure of personality
traits, and as not corresponding to daily clinical reality (Bech, 2012).
The use of mathematical methods in clinical psychiatry only possesses
clinical validity when referring to the daily clinical reality. It was the work
of Alfred Binet (1857–1911) on the measurement of intelligence that had
clinical significance because Binet (Binet & Simon, 1905) used experienced
school teachers as an index of validity and not mathematical correlation
coefficients when developing his intelligence tests (Bech, 2012).
Throughout the history of measuring personality we have the dilemma
of on the one hand the use of factor analysis for construct validity of a scale
and on the other hand the use of criterion-related validity with reference to
experienced clinicians.
In this situation the psychometric view of intelligence put forth by Kline
(1991) is worth considering. At the end of his monograph on intelligence,
Kline (1991) admits that the concept of intelligence was in use long before
Wundt established his psychological laboratory, but that the attempt to measure
it with mathematical methods was not a redundant abstraction as mathematics
gives a more precise and exact description than ordinary clinical language.
How to Measure the Personality 19
FROM PSYCHOMETRICS TO CLINIMETRICS

In his monograph on clinimetrics, Feinstein (1987) considers the term
validity to have a rather problematic role in the ordinarily psychometric
literature. Thus, in psychometric textbooks, Feinstein (1987) has found that
the psychometric validity covers issues such as consistency, accuracy, or
suitability.
Feinstein (1987) has found clinical validity (content validity) as the
validity-based term to be tested by a judgment evaluation from experienced
clinicians or a panel of experts in the field under examination or from other
authorities, e.g., the DSM classification system (American Psychiatric
Association, 1980).
The term construct validity is in clinimetric issues secondary to clinical
validity. Construct validity refers to the measurement-based aspect of the
phenomenon assessed to have clinical validity (Bech, 2016). The construct
validity of a scale is tested by item response theory (IRT) models (Bech,
2012). The first IRT model was developed by Rasch (1960). As a psycho-
metric rating scale model, the Rasch analysis was introduced in clinical
psychiatry (Bech et al., 1981) when testing the dimension of depression
severity of the six clinically valid items in the Hamilton Depression Scale
(HAM-D6) as captured by Bech et al. (1975).
Fig. 2.1 shows the locations across the dimension of depression severity
of all six items in HAM-D6.The items are essentially mapped in three com-
partments in Fig. 2.1. At the low end of the dimension of depression (left
wing), the HAM-D6 items of depressed mood and lack of interests are
located. In the intermediate compartment, the HAM-D6 items of fatigue
and anxiety are located. At the severe end, the HAM-D6 items of guilt feel-
ings and psychomotor retardation are located.
In the Rasch model, the null hypothesis is that the rank order of the six
items in Fig. 2.1 is absent.The measurement validity (scalability) is therefore
accepted by a P-value of 0.01 or higher (i.e., rejecting the null hypothesis)
in the Rasch analysis, which was obtained by Bech et al. (1981). During the
Rasch analysis, it is tested to what extent the rank order of items in Fig. 2.1
is maintained during the weekly ratings in a trial of antidepressive
treatment.
Mokken (1971) developed a nonparametric IRT model in which the
rank order of items (e.g., in the HAM-D6) is tested by a coefficient of
homogeneity (Bech, 2012). According to Mokken (1971), a coefficient of
homogeneity between 0.30 and 0.39 is only just acceptable. A coefficient
20
High prevalence Low prevalence
Lack of interests Anxiety Retardation
Depressive mood Fatigue Feelings of guilt
Low severity Location on the depression severity dimension High severity
Figure 2.1 The mathematical description of the HAM-D6.

How to Measure the Personality 21
of 0.40 or higher is acceptable and considered as the evidence of measure-

ment validity referred to as scalability (Stochl, Jones, & Croudace, 2012).
The HAM-D6 (Fig. 2.1) has also been tested by the Mokken analysis with
a coefficient of homogeneity of 0.40 or higher (Bech, 2016).
These two IRT models of Rasch (1960) and Mokken (1971) are the
most evidence-based models for the testing of measurement validity or
construct validity. Scalability implies that the scale can be considered as a
“yard stick” when used in different groups of persons.
THE SCALABILITY OF EYSENCK’S NEUROTICISM SCALE

The dimension of neuroticism has been most intensively studied by Hans
Eysenck (1952, 1965). It was actually, as discussed by Eysenck (1965), the
work of Wundt (1903) that inspired him to focus on neuroticism versus
psychoticism and on extraversion versus introversion. Wundt (1903) struc-
tured the temperaments (melancholic, phlegmatic, choleric, and sanguine),
which were referred to as early as Hippocrates. Thus, Wundt (1903) com-
bined these temperaments into the personality dimensions of neuroticism
versus psychoticism and extraversion versus introversion.
The first version of Eysenck’s neuroticism scale was named the Maudsley
Personality Inventory (Eysenck, 1952). The second version, the Eysenck
Personality Inventory (Eysenck & Eysenck, 1969), is the one frequently
referred to in the literature, but the third version, the Eysenck Personality
Questionnaire (EPQ), (Eysenck & Eysenck, 1975, 1976) is the master ver-
sion. The neuroticism scale from the EPQ contains 23 items with dichoto-
mous scoring (no = 0, yes = 1).The items are negatively worded, analogue to
symptom assessment in scales, which measure negative mental health. The
theoretical score range therefore goes from 0 to 23. A score from 0 to 13 is
considered to indicate a relative lack of neuroticism (Eysenck & Eysenck,
1975). Fig. 2.2 shows the 12 items included in the short EPQ neuroticism
scale published by Eysenck et al. (1985) in their revised version, the EPQ-R.
The item numbers of the individual neuroticism items correspond to those
of the EPQ (Eysenck & Eysenck, 1975). The score range of the short EPQ
neuroticism scale goes from 0 to 12; a score from 0 to 6 is considered to
indicate a relative lack of neuroticism.
The clinical validity of the EPQ neuroticism scale has been evaluated by
Bech, Jorgensen, Jeppesen, Loldrup Poulsen, and Vanggaard (1986). In this
evaluation, an assessment provided by a psychiatrist experienced in the field
of neurosis was used as an index of clinical validity. In this study, several
NEUROTICISM
(3) Does your mood oen go up and down?
(7) Do you ever feel ‘just miserable’ for no reason?
(15) Are you an irritable person?
(19) Are your feelings easily hurt?
(23) Do you oen feel ‘fed-up’?
(27) Are you oen troubled about feelings of guilt?
(31) Would you call yourself a nervous person?
(34) Are you a worrier?
(41) Would you call yourself tense or ‘highly-strung’?
(66) Do you worry a lot about your looks?
(75) Do you suffer from ‘nerves’?
(77) Do you oen feel lonely?
INTROVERSION EXTRAVERSION
(21) Tend to be in background (5) Are you a talkave person?

(29) Prefer reading to meeng people (10) Are you rather lively?
(42) Quiet when you are with other people (14) Can you usually let yourself go and enjoy
yourself at a lively party?
(17) Do you enjoy meeng new people?
(40) Do you usually take the iniave in making
new friends?
(45) Can you easily get some life into a rather dull
party?
(52) Do you like mixing with people?
(70) Can you get a party going?
(82) Do you like plenty of bustle and excitement
around you?
(86) Do other people think of you as being very
lively?
PSYCHOTICISM
(22) Would you take drugs which may have strange or dangerous effects?
(43) Do you think marriage is old-fashioned and should be done away with?
(67) Do you think people spend too much me safeguarding their future
with savings and insurances?
(83) Would you like other people to be afraid of you?
(30) Do you have enemies who want to harm you?

(63) Have you ever taken advantage of someone?
(76) Do your friendships break up easily without it being your fault?
(87) Do people tell you a lot of lies?
Figure 2.2 The Eysenck personality dimensions.
other personality dimensions were examined, but only the Eysenck neu-
roticism scale proved to be significantly associated with the experienced
psychiatrist’s judgment.
The psychometric scalability of the Eysenck neuroticism scale was eval-
uated by use of the Mokken’s nonparametric IRT model (Bech, Kessing, &
Bukh, 2016). In total 185 patients with first-episode depression evaluated
∼5 months after discharge from hospital were examined. The coefficient of
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For the peace that is from above....
For the peace of the whole world....
For this holy temple, and for them that with faith....
That this oil may be blessed by the might, and operation, and
descent of the Holy Ghost, let us pray to the Lord.
For the servant of God, name, and for his visitation by God, and
for the coming upon him of the grace of the Holy Ghost, let us pray
to the Lord.
For his deliverance and ours from every affliction, passion, and
want.
Help us, save us, have mercy on us, and keep us, O God....
Commemorating our most holy, most pure....
Then the first of the priests saith the prayer of oil over the cruet.
Note. Be it known that in the great church they pour wine instead
of water into the cruet of prayer-unction.
Let us pray to the Lord.
Lord, have mercy.
O Lord, who, through thy mercy and compassions, healest the
infirmities of our souls and bodies; do thou thyself, O Master, sanctify
this oil, that it may be to them that are anointed therewith for healing,
and for the removal of every passion, of defilement of flesh and
spirit, and of every ill, and that thereby may be glorified thy holy
name, of the Father, and of the Son, and of the Holy Ghost, now and
ever, and to ages of ages. Amen.
And the other priests likewise read this prayer, but quietly to
themselves.
And while the prayer is being said by the priests, they sing these
troparia.
Tone iv.
Thou that alone art quick to help, O Christ, make manifest from on
high a speedy visitation to thine ailing servant: deliver him from
sicknesses and bitter pains, and raise him up, that, without ceasing,
he may praise and glorify thee, through the God-bearing one’s
entreaties, O thou sole lover of mankind.
With blinded spiritual eyes to thee, O Christ, I come, as he that
from his birth was blind; and penitentially to thee I cry, Be merciful to
us, thou that alone the good physician art.
Tone iii.
My soul, that, Lord, by every kind of sin and unbecoming deeds is
paralys’d, O by thy godlike intervention do thou raise, as thou of old
a paralytic didst upraise, that I, being sav’d, may cry to thee, Give
healing unto me, O Christ compassionate.
Tone ii.
O just one, as the Lord’s disciple, thou the gospel didst receive; as
martyr, dost possess that which unwritten is; a daring, as God’s
brother, hast; as hierarch, hast to pray: do thou beseech Christ God
to save our souls.
Tone iv.
The Father’s sole-begotten, who is God the Word, in latter days
hath come to us, O James divine, declaring thee first pastor and
instructor of them that of Jerusalem were; a faithful steward too of
ghostly mysteries. Therefore, apostle, we all reverence thee.
Tone iii.
To them of Myra, saint, thou didst appear a hierurgist; for Christ’s
evangel, thou, O venerated one, fulfilling, didst for thy people yield
thy soul, and save the innocent from death. For this cause art thou
sanctified as a great mystic of the grace of God.
The same tone.
O pain-enduring one, that overcame the heathen, in dangers hath
the world thee found a champion great. Therefore, as thou didst
humble Lyev’s pride, and in the strife make Nestor brave, so, saint
Demetrius, pray Christ God to give great mercy unto us.
The same tone.
Thou holy pain-enduring one, physician too, O Pantelimon,
mediate with God the merciful, that he may grant our souls remission
of iniquities.
Tone viii.
Ye saints that were unmercenary and wonders wrought, make
visitation in our weaknesses. Freely ye have receiv’d: O freely give
to us.
Tone ii.
Who can narrate thy mightiness, O virgin one? for thou dost
wonders gush, and pourest cures, and prayest for our souls, O thou
divine and friend of Christ.
Warm advocate and assailless wall, the spring of mercy and the
world’s defence, to thee unceasingly we cry, God-bearing Queen,
prevent thou us, and us from dangers free, thou that alone art quick
to intercede.
Deacon. Let us attend.
The first priest. Peace to all.
Choir. And to thy spirit.
Deacon. Wisdom, let us attend.
Reader, the prokimenon, tone i.
Let thy mercy, O Lord, come upon us like as we have put our trust
in thee.
Verse.
Rejoice, O ye righteous, in the Lord, for praise becometh the
upright.
The epistle.
The lection of the catholic message of James.
And be it known that the epistle is read by the deacon, section lvii,
Brethren, take for an example.... ending, availeth much.[15]
The first priest. Peace to thee. Alleluia.
Tone viii. Verse. I will sing unto thee of mercy and judgment, O
Lord.
The gospel from Luke, section liii.
At that time, a certain lawyer.... ending, do thou likewise.[16]
Then, Have mercy upon us, O God, according to thy great mercy,
we pray thee, hear and have mercy.
Lord, have mercy, thrice.
Furthermore let us pray for mercy, life, peace, health, salvation,
visitation, and forgiveness of sins for the servant of God, name.
That to him may be remitted every iniquity, voluntary and
involuntary, let us pray to the Lord.
And the exclamation.
For a merciful and man-loving God thou art, and to thee we
ascribe glory, to the Father, and to the Son, and to the Holy Ghost,
now and ever, and to ages of ages. Amen.
Deacon. Let us pray to the Lord.
Lord have mercy.
Priest, the prayer.
O thou that art unbeginning, eternal, and in the holy of holies, who
didst send down thine only-begotten Son, who healeth every infirmity
and every wound of our souls and bodies; do thou send down thy
Holy Ghost, and sanctify this oil, and let it be unto thine anointed
servant, name, for a perfect deliverance from his sins, and for the
inheritance of the kingdom of heaven.
Be it known that some say this prayer only thus far, with the
exclamation,
For it is thine to have mercy.....
But others say even unto the end,
For thou art God great and wonderful, who keepest thy testament
and thy mercy unto them that love thee, granting deliverance from
sins through thy holy child, Jesus Christ, who regenerateth us from
sin, enlighteneth the blind, setteth up them that are cast down, loveth
the righteous, and is merciful to sinners, who hath called us out of
darkness and the shadow of death, saying unto them that are in
bonds, Come forth, and to them that are in darkness, Be ye unveiled.
For he hath shined in our hearts the light of the knowledge of his
countenance, in that for our sake he was made manifest upon earth,
and dwelt among men; and to them that accepted thee gave he
power to become the children of God; and hath bestowed upon us a
sonship through the laver of regeneration, and made us to have no
participation in the domination of the devil. For thou wast not pleased
that we should be cleansed through blood, but hast given, through
holy oil, an image of his cross, that we may be a flock of Christ, a
royal priesthood, a holy nation, cleansing us by water, and
sanctifying us by thy holy spirit. Do thou thyself, O Master Lord, give
grace unto us in this thy service, as thou didst give unto Moses, thine
accepted, and unto Samuel, thy beloved, and unto John, thine elect,
and unto all who in every generation have been acceptable unto
thee. And so make us to be ministers of thy new testament upon this
oil, which thou hast made thine own through the precious blood of
thy Christ, that, putting away worldly lusts, we may die unto sin and
live unto righteousness, so that we may be led of the proposed oil to
be invested in him with the anointing of sanctification. May this oil, O
Lord, be an oil of gladness, an oil of sanctification, a royal investiture,
a cuirass of power, an averting of every diabolical operation, an
inviolable seal, a rejoicing of the heart, an eternal joy, that they that
are anointed with this oil of regeneration may be terrible to
adversaries, and may shine in the brightness of thy saints, having no
spot or wrinkle; and may they attain unto thine eternal rest, and gain
the prize of the calling from on high.
For it is thine to have mercy, and to save us, O our God, and to
thee we ascribe glory, with thine only-begotten Son, and with thy
most holy, and good, and life-creating Spirit, now and ever, and to
ages of ages, Amen.
And after the prayer; the priest taketh a twig, and, dipping it in the
holy oil, anointeth the sick person in the form of a cross, on the
forehead, on the nostrils, on the cheeks, on the lips, on the breast,
on the hands on both sides, saying this prayer.
Holy Father, physician of souls and bodies, who didst send thine
only-begotten Son, our Lord Jesus Christ, who healeth every
infirmity, and delivereth from death; do thou heal thy servant, name,
from the bodily and spiritual weakness that presseth upon him, and
quicken him by the grace of thy Christ; through the prayers of our
most holy Lady, the God-bearing and ever-virgin Mary; through the
intercession of the honourable, heavenly bodiless powers; through
the power of the precious and life-effecting cross; of the honourable
glorious prophet, Forerunner, and Baptist John; of the holy, glorious,
and all-praised apostles; of the holy glorious, and excellently
victorious martyrs; of our venerable and god-bearing fathers; of the
holy and unmercenary physicians, Cosmas and Damian, Cyrus and
John, Pantelimon and Hermolaus, Sampson and Diomed, Photius
and Anicetas; of the holy and righteous god-progenitors, Joakim and
Anna, and of all the Saints.
For thou art the fount of healing, O our God, and to thee we
ascribe glory, with thine only-begotten Son, and with thy
consubstantial Spirit, now and ever, and to ages of ages. Amen.
This prayer is said by each priest after he hath said his gospel and
prayer, while he anointeth the sick person with oil.
The second priest. Peace to all.
Prokimenon, tone ii.
The Lord is my strength and song, and is become for salvation
unto me.
Verse. When thou chastenest, thou hast chastened me, O Lord;
but thou hast not given me up unto death.
The epistle to the Romans, section cxvi.
Brethren, we that are strong ought.... ending, received us to the
glory of God.[17]
The second priest. Peace to thee.
Alleluia, tone v.
Verse. I will sing of thy mercy, O Lord, for ever.
The second priest.
The gospel from Luke, section xciv.
At that time, Jesus passed through.... ending, to save that which
was lost.[18]
And the deacon.
Have mercy upon us, O God.... Page 98.
Furthermore let us pray for mercy, life....
That to him may be remitted....
For a merciful and man-loving God....
Priest, the prayer.
O God, great and most high, who art worshipped by all creation, thou
true fountain of wisdom, and impenetrable depth of goodness, and
boundless ocean of benignity; do thou thyself, O man-loving Master,
O God of things eternal and wonderful, whom none among men by
thinking can comprehend, look upon us, and hearken unto us, thine
unworthy servants, and wheresoever in thy great name we bring this
oil, do thou send down thy gift of healing, and the remission of sins,
and heal him in the plentitude of thy mercy. Yea, O Lord, thou good
physician, thou sole merciful one and lover of mankind, who
repentest thee concerning our ills, who knowest that the intention of
man inclineth unto evil from his youth up, who desirest not the death
of a sinner, but that he should return and live, who for the salvation
of sinners, being God, becamest man, and for thy creature wast
thyself created: thou art he that hath said, I came not to call the
righteous but sinners to repentance: thou art he that hath sought the
lost sheep: thou art he that hath diligently sought the lost drachma,
and found it: thou art he that hath said, He that cometh unto me I will
in no wise cast out: thou art he that did not loathe the sinful woman,
who watered thy revered feet with tears: thou art he that hath said,
As often as thou fallest, arise, and be saved: thou art he that hath
said, There is joy in heaven over, one sinner that repenteth: do thou
thyself, O benign Master, look down from the height of thy sanctuary,
visiting us, thy sinful and unworthy servants, at this hour, with the
grace of thy Holy Ghost, and be present with thy servant, name, who
acknowledgeth his iniquities, and in faith draweth nigh unto thee;
and, accepting him in thine own love to man, in whatsoever he hath
offended, by word, or deed, or intention, making remission, do thou
cleanse him, and make him pure from every sin, and, being ever
present with him, keep the remaining time of his life, that walking in
thy statutes, he may never become a derision to the devil, so that in
him may be glorified thy most holy name.
Exclamation.
For it is thine to have mercy, and to save us, O Christ God, and to
thee we ascribe glory, with thine unbeginning Father, and with thy
most holy, and good, and life-creating Spirit, now and ever, and to
ages of ages. Amen.
And after the prayer the second priest straightway taketh a second
twig, and, dipping it in the holy oil, anointeth the sick person, saying
the prayer,
Holy Father, physician of souls and bodies....
Vide page 101.
And the deacon. Let us attend.
The third priest. Peace to all.
Prokimenon, tone iii.
The Lord is my light, and my Saviour, whom shall I fear?
Verse. The Lord is the defence of my life, of whom shall I be
afraid.
The epistle to the Corinthians, section cliii.
Brethren, ye are the body of Christ.... ending, Charity never faileth.
[19]
The third priest. Peace to thee.

Deacon. Wisdom. Alleluia, tone ii.
Verse. In thee, O Lord, have I trusted, let me never be
confounded.
The third priest readeth.
The gospel from Matthew, section xxxiv. from the paragraph,
At that time, Jesus called.... ending, freely give.[20]
And the deacon straightway saith this ectenia.
Have mercy upon us, O God....
And, with a loud voice, For a merciful....
The priest saith the prayer.
Master Almighty, holy King, who chastenest, and killest not, who
supportest them that are falling, and settest up them that are cast
down, who restorest the bodily afflictions of men; we entreat thee, O
our God, that thou wouldest send down thy mercy upon this oil, and
upon them that are anointed therewith in thy name, that it may be to
them for the healing of soul and body, and for the cleansing and
removal of every passion, and of every sickness and wound, and of
every defilement of flesh and spirit. Yea, O Lord, send down from
heaven thy healing power; touch the body; allay the fever; soothe the
suffering; and banish every lurking weakness. Be the physician of
thy servant, name, raise him from a bed of suffering, and from a
couch of ailment whole and perfectly restored, granting him in thy
church to be acceptable, and one that doeth thy will.
Exclamation.
For it is thine to have mercy and to save us, O our God, and to
thee we ascribe glory, to the Father, and to the Son, and to the Holy
Ghost, now and ever, and to ages of ages. Amen.
And after the prayer the third priest taketh a third twig, and,
dipping it in the holy oil, anointeth the sick person, saying the prayer,
Vide page 101.
The fourth priest.
Peace to all.
Prokimenon, tone iv.
In whatsover day that I call upon thee, O hearken unto me
speedily.
Verse. O Lord, hearken unto my prayer, and unto my crying.
The epistle to the Corinthians, section clxxxii.
Brethren, ye are the temple.... ending, holiness in the fear of God.
[21]
Priest. Peace to thee.

Alleluia, tone ii.
Verse. I waited patiently for the Lord, and he inclined unto me.
The fourth priest.
The gospel from Matthew, section xxvi.
At that time, Jesus came into Peter’s house.... ending, his
disciples followed him.[22]
And the deacon. Have mercy upon us, O God....
Page 98.
And the exclamation, For a merciful....
Priest, the prayer.
O good and man-loving, benign and most merciful Lord, great in
mercy and plenteous in goodness, O Father of compassions and
God of every consolation, who hast empowered us, through thy holy
apostles, to heal the weaknesses of the people by prayer with oil; do
thou thyself appoint this oil for the healing of them that are anointed
therewith, for the alleviation of every sickness and every wound, for
deliverance from evils of them that expect salvation that is from thee.
Yea, O Master, Lord our God, we beseech thee, thou almighty one,
to save us all, and, thou that alone art the physician of souls and
bodies, to sanctify us all; thou that healest every sickness, do thou
heal thy servant, name; raise him from the bed of suffering through
the mercy of thy grace; visit him through thy mercy and
compassions; remove from him every ailment and weakness, that,
being raised by thy mighty hand, he may serve thee with all
thanksgiving, as also that we, now participating in thine unspeakable
love to man, may sing and glorify thee, who doest great and
wonderful, glorious and transcendent things.
For it is thine to have mercy, and to save us, O our God....
And after the prayer the fourth priest straightway taketh a fourth
twig, and, dipping it in the holy oil, anointeth the sick person, saying
the prayer,
Holy Father, physician of souls.... Vide page 101.
The fifth priest. Peace to all.
Prokimenon, tone v.
Thou, O Lord, shalt keep us and shalt protect us, from this
generation, and for ever.
Verse. Save me, O Lord, for the righteous are become few.
Deacon. Wisdom.
The epistle to the Corinthians, section clxviii.
Brethren, we would not have you ignorant.... ending, by many on
our behalf.[23]
Priest. Peace to thee.
Alleluia, tone v.
Verse. I will sing of thy mercy, O Lord, for ever.
The gospel from Matthew, section cvi.
The Lord spake this parable, Then shall the kingdom.... ending,
wherein the Son of man cometh.[24]
And the deacon.
Have mercy upon us, O God.... Page 98.
And the exclamation.
For a merciful....
Priest, this prayer.
O Lord our God, who chastenest and again healest, who raisest the
poor from the earth, and liftest up the beggar from the dunghill, O
Father of the orphans, and haven of the tempest-tost, and physician
of them that are sick; who painlessly bearest our weaknesses, and
takest away our sicknesses; who shewest mercy with gentleness,
overlookest transgressions, and takest away unrighteousness; who
art quick to help and slow to anger; who didst breathe upon thy
disciples, and say, Receive ye the Holy Ghost, whosoever sins ye
remit, they are remitted unto them; who acceptest the repentance of
sinners, and hast power to forgive many and grievous sins, and
vouchsafest healing unto all that continue in weakness and
protracted sickness; who me also, thine humble, sinful, and unworthy
servant, involved in many sins, and overwhelmed with lusts of
pleasures, hast called to the holy and exceeding great degree of the
priesthood, and to enter in within the veil into the holy of holies,
where the holy Angels desire to stoop to look, and hear the
evangelical voice of the Lord God, and behold as eye-witnesses the
presence of the holy oblation, and be enraptured with the divine and
sacred liturgy; who hast counted me worthy to minister the sacred
rite of thy most heavenly mystery, and to offer unto thee gifts and
sacrifices for our sins, and for the ignorances of the people, and to
mediate for thy rational flock, that, through thy great and
unspeakable love to man, thou mayest cleanse their iniquities; do
thou thyself, O most good King, attend unto my prayer at this hour,
and on this holy day, and in every time and place, and accept the
voice of my prayer, and grant healing unto thy servant, name, who is
in weakness of soul and body, vouchsafing unto him remission of
sins and forgiveness of voluntary and involuntary iniquities: heal his
incurable wounds, and every sickness and every sore, bestowing
upon him spiritual healing. It was thou who didst touch the mother-in-
law of Peter, and the fever left her, and she arose and ministered
unto thee: do thou thyself, O Master, bestow a remedy upon thy
servant, name, and an alleviation of every mortal pain, and
remember thine abundant compassions, and thy mercy. Remember
that the intention of man inclineth constantly toward evil from his
youth up, and that none is to be found sinless upon earth; for thou
alone art without sin, who didst come and save the race of men, and
deliver us from the servitude of the enemy. For if thou shouldest
enter into judgment with thy servants, there is none that would be
found pure from defilement, but every mouth would be shut, not
having wherewith to answer; for all our righteousness is as filthy rags
before thee. For this cause remember not, Lord, the sins of our
youth; for thou art the hope of the hopeless, and the rest of them that
are weary and heavy-laden with transgressions, and to thee we
ascribe glory, with thine unbeginning Father, and with thy most holy,
and good, and life-creating Spirit, now and ever, and to ages of ages.
Amen.
And after the prayer the fifth priest straightway taketh a fifth twig,
and, dipping it in the holy oil, anointeth the sick person, saying the
prayer,
Vide page 101.
And the sixth priest. Peace to all.
Prokimenon, tone vi.
Have mercy upon me, O God, according to great mercy.
Verse. Create in me a clean heart, O God, and renew a right spirit
within me.
The epistle to the Galatians, section ccxiii.
Brethren, the fruit of the spirit.... ending, so fulfil the law of Christ.
[25]
The sixth priest. Peace to thee.

Deacon. Wisdom, let us attend.
Alleluia, tone vi.
Verse. Blessed is the man that feareth the Lord, in his
commandments he rejoiceth exceedingly.
Deacon. Wisdom, standing, let us hear the holy gospel.
The gospel from Matthew, section lxii.
At that time, Jesus went.... ending, from that very hour.[26]
And the deacon.
Have mercy upon us, O God....
Exclamation. For a merciful...
The priest, this prayer.
We give thanks unto thee, O Lord our God, thou good lover of
mankind, and physician of our souls and bodies, who painlessly
bearest our sicknesses, and by whose stripes we have all been
healed; thou good shepherd, who camest to seek the wandering
sheep; who givest consolation unto the faint-hearted, and life unto
them that are broken down; who didst heal the source of the issue of
blood that had lasted twelve years; who didst deliver the daughter of
the Chananitish woman from the ruthless demon; who didst forgive
the debt unto the two debtors, and give remission unto the sinful
woman; who didst bestow healing upon the paralytic, with the
remission of his sins; who didst justify the publican by a word, and
didst accept the thief in his last confession; who takest away the sins
of the world, and wast nailed on the cross; to thee we pray, and thee
we beseech, Do thou thyself, O God, in thy goodness, loosen,
forgive, and pardon the transgressions and sins of thy servant,
name, and his voluntary and involuntary iniquities, those in
knowledge and in ignorance, those by trespass and disobedience,
those by night and by day; or if he be under the curse of a priest, or
of a father or a mother; or if by the glance of the eye, or a movement
of the eyelid; or by the contact of adultery, or the tasting of
prodigality, or in any excitement of flesh and spirit he have estranged
himself from thy will, and from thy holiness. And if he have sinned,
and in like manner we also, as the good God that rememberest not
evil and the lover of mankind, do thou pardon, not leaving him and
us to fall into a dissolute life, neither to walk in ways of destruction.
Yea, O Master Lord, hear me, a sinner, at this hour on behalf of thy
servant, name, and overlook, as the God that rememberest not evil,
all his iniquities; deliver him from eternal torment; fill his mouth with
thy praise; open his lips to the glorification of thy name; extend his
hands to the doing of thy commandments; direct his feet in the path
of thy gospel, confirming all his members and his intention by thy
grace. For thou art our God, who, by thy holy apostles, hast
commanded us, saying, Whatsoever ye shall bind on earth, shall be
bound in the heavens, and whatsoever ye shall loose on earth shall
be loosed in the heavens; and again, Unto whomsoever ye remit
sins, they are remitted unto them, and, If ye bind them, they are
bound. And, as thou didst hearken unto Ezekias in the affliction of
his soul in the hour of his death, and didst not despise his prayer, so
hearken unto me, thine humble, and sinful, and unworthy servant at
this hour. For thou, O Lord Jesus Christ, art he that, in thy goodness
and love to man, biddeth to forgive until seventy times seven them
that fall into sins; and thou repentest thee concerning our evils, and
rejoicest over the return of the wanderer. For, as is thy greatness, so
also is thy mercy, and to thee we ascribe glory, with thine
unbeginning Father, and with thy most holy, and good, and life-
creating Spirit, now and ever, and to ages of ages. Amen.
And after the prayer the sixth priest straightway taketh a sixth twig,
and, dipping it in the holy oil, anointeth the sick person, saying the
prayer,
Vide page 101.
And the seventh priest. Peace to all.
Prokimenon, tone vii.
O Lord, rebuke me not in thy fury, neither chasten me in thine
anger.
Verse. Have mercy upon me, O Lord, for I am weak.
The epistle to the Thessalonians, section cclxxiii.
Brethren, we exhort you.... ending, the coming of our Lord Jesus
Christ.[27]
And the seventh priest. Peace to thee.
Deacon. Wisdom.
Alleluia, tone vii.
Verse. The Lord hear thee in the day of trouble, the name of the
God of Jacob defend thee.
The gospel from Matthew, section xxx.
At that time, Jesus, passing by.... ending, sinners to repentance.
[28]

And the exclamation. For a merciful....
The deacon saith, Let us pray to the Lord.
The priest, this prayer.
O Master, Lord our God, physician of souls and bodies, who
restorest from long-continued sufferings, healest every sickness and
every wound among the people, willest that all men should be saved
and come to a knowledge of the truth, and desirest not the death of a
sinner, but that he should return and live. For, thou, Lord, in the old
testament didst appoint repentance unto sinners, to David, and to
the Ninevites, and to them that were before these; but during the
course of thine incarnate dispensation, didst not call the righteous
but sinners to repentance, even accepting the publican, the harlot,
the thief, and the blaspheming persecutor, the great Paul, through
repentance. Thou, through repentance, didst accept Peter, the
leader and thine apostle, who denied thee thrice, and didst make
promise unto him, saying, Thou art Peter, and upon this rock will I
build my church, and the gates of hades shall not prevail against it,
and I will give to thee the keys of the kingdom of heaven. Wherefore
we also, O good one and the lover of mankind, being bold according
to thine undeceiving promises, pray unto thee, and supplicate at this
hour. Hearken unto our prayer and accept it as incense offered unto
thee, and visit thy servant, name, and if he have sinned by word, or
deed, or intention, or in the night, or in the day, if he be under the
curse of a priest, or be fallen under his own curse, or be embittered
by a curse, and have forsworn himself, we supplicate thee, and to
thee we pray, Pardon, forgive, and loosen him, O God, overlooking
his transgressions, and the sins which in knowledge and in
ignorance have been done by him. And in whatsoever he have
transgressed thy commandments, or have sinned, because he
beareth flesh and liveth in the world, or because of the operation of
the devil, do thou thyself, as the good and man-loving God, loosen
him; for there is no man that liveth and sinneth not: thou only art
without sin, thy righteousness is an everlasting righteousness, and
thy word is the truth. For thou didst not form man for destruction, but
for the keeping of thy commandments, and for the inheritance of life
incorruptible, and to thee we ascribe glory, with the Father, and with
the Holy Ghost, now and ever, and to ages of ages. Amen.
And after the prayer the seventh priest taketh a seventh twig, and,
dipping it in the holy oil, anointeth the sick person, saying the prayer,
Vide page 101.
And after this, the sick person that receiveth the sacred unction, if
he be able, cometh himself into the midst of the priests, or, held by
his own people, standeth, or sitteth. And if he be not able, the priests
themselves stand around him lying on the bed. And the president,
taking the holy gospel and opening it, layeth the text upon the head
of the sick person, the book being held by all the priests. And he that
is the leader doth not lay on his hand, but he saith this prayer with a
loud voice.
O Holy King, O loving-kind and most merciful Lord Jesus Christ, Son
and Word of the living God, who desirest not the death of a sinner,
but that he should return and live; I lay not my sinful hand upon the
head of him that cometh to thee in sins, and beseecheth of thee
through us remission of sins, but thy strong and mighty hand which
is in this holy gospel which my fellow-ministers hold upon the head of
thy servant, name, and I pray with them and entreat thy merciful love
to man, which remembereth not evil, O God, our Saviour, who,
through thy prophet Nathan, didst grant remission of his iniquities
unto the repentant David, and didst accept the prayer of repentance
of Manasse; and do thou thyself, in thy wonted love to man, accept
thy servant, name, who bewaileth on account of his own offences,
and overlook all his iniquities. For thou art our God, who hast bidden
to forgive until seventy times seven them that have fallen into sins;
for as is thy greatness, so also is thy mercy, and to thee is due every
glory, honour, and worship, now and ever, and to ages of ages.
Amen.
And taking the gospel from the head of the sick person, they
present it to him to kiss.
And that to him may be remitted....
Exclamation.
For a merciful and man-loving....
Then they sing, Glory, idiomelon, tone iv.
Having a fountain of remedies, O holy unmercenary ones, ye
bestow healings unto all that are in need, as being counted worthy of
mighty gifts from the ever-flowing fountain of our Saviour. For the
Lord hath said unto you, as unto co-emulators of the apostles,
Behold, I have given unto you power over unclean spirits, so as to
cast them out, and to heal every sickness and every wound.
Therefore in his commandments having virtuously liv’d, freely ye
receiv’d, freely ye bestow, healing the sufferings of our souls and
bodies.
Both now, tone the same.
Attend unto the supplications of thy servants, thou altogether
undefiled one, quelling the uprisings of evils against us, and
releasing us from every affliction; for thee we have alone a sure and
certain confirmation, and we have gain’d thy mediation that we may
not be put to shame, O Queen, who call upon thee. Be instant in
supplication for them that faithfully exclaim to thee, Hail, Queen, thou
aid of all, the joy and safeguard, and salvation of our souls.
Glory. Both now. Lord, have mercy, thrice. Bless.
And the dismissal.
Christ our true God, through the prayers of his most pure Mother,
through the power of the honourable and life-effecting cross, of the
holy, glorious, and all-praised James, apostle and first highpriest of
Jerusalem, the brother of God, and of all the Saints, save us and
have mercy upon us, as being good and the lover of mankind.
And he that receiveth the prayer oil maketh reverence, saying,
Bless me, holy fathers, and forgive me, a sinner.
Thrice.
And, having received from them blessing and forgiveness, he
departeth, thanking God.

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Personality and Disease: Scientific

Proof vs. Wishful Thinking Johansen

Copyright © 2018 Elsevier Inc. All rights reserved.

Library of Congress Cataloging-in-Publication Data

British Library Cataloguing-in-Publication Data

For information on all Academic Press publications visit our

Publisher: Nikki Levy

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1. A Brief Historical Overview on Links Between Personality

2. How to Measure the Personality 17

3. Personality as Determinant of Smoking, Alcohol Consumption,

4. Personality and Cardiovascular Disease 49

5. Personality and Type 2 Diabetes: An Overview of the

6. Personality and Dementia: Personality as Risk Factor

7. Personality, Asthma, and Allergies 111

8. The Personality and Risk for Cancer 135

9. Personality and Social Relationships: As Thick as Thieves 153

10. Personality Genetics 185

11. The Enduring Appeal of Psychosocial Explanations

12. What Mechanisms Explain the Links Between

Christoffer Johansen is a professor in the oncology clinic at Rigshospitalet,

I became obsessed, not in a psychiatric way but scientifically, with this

illustrate the behavioral aspect of personality and health outcomes, I was

A Brief Historical Overview

A BRIEF HISTORICAL OVERVIEW ON (ASSUMED)

The Neolithic Age, Ancient Greece, and the Middle Ages

Personality and Disease

health (Johansson & Lynøe, 2008). Thus, in contrast to theorizing around

The Renaissance and the Age of Enlightenment

little or no space for scientific investigations of how personality, cognition,

Personality and Health in the 20th Century

a Type B personality, by contrast, were described as more reflective, relaxed,

CURRENT MODELS OF LINKS BETWEEN PERSONALITY

services for psychiatric reasons in the preceding 12 months (0.14). Studies

The HEXACO Model and Links Between Personality Traits

Trait-Level Change and Health

Implications for Prevention and Treatment

OTHER PERSONALITY CONSTRUCTS LINKED TO HEALTH

a psychological/cultural aspect is that, in many societies, men are expected

Future Directions in Personality and Health Research

important to have data on the personality dimensions before the onset of a

How to Measure the Personality

as regards the measurement of personality dimensionality (Bech, 2016).The

FROM PSYCHOMETRICS TO CLINIMETRICS

Lack of interests Anxiety Retardation

Depressive mood Fatigue Feelings of guilt

Low severity Location on the depression severity dimension High severity

Figure 2.1 The mathematical description of the HAM-D6.

of 0.40 or higher is acceptable and considered as the evidence of measure-

THE SCALABILITY OF EYSENCK’S NEUROTICISM SCALE

(21) Tend to be in background (5) Are you a talkave person?

(30) Do you have enemies who want to harm you?

Figure 2.2 The Eysenck personality dimensions.

The third priest. Peace to thee.

Priest. Peace to thee.

The sixth priest. Peace to thee.

And the deacon. Have mercy upon us, O God....

You might also like

1. A Brief Historical Overview on Links Between Personality

2. How to Measure the Personality 17

3. Personality as Determinant of Smoking, Alcohol Consumption,

4. Personality and Cardiovascular Disease 49

5. Personality and Type 2 Diabetes: An Overview of the

6. Personality and Dementia: Personality as Risk Factor

7. Personality, Asthma, and Allergies 111

8. The Personality and Risk for Cancer 135

9. Personality and Social Relationships: As Thick as Thieves 153

10. Personality Genetics 185

11. The Enduring Appeal of Psychosocial Explanations

12. What Mechanisms Explain the Links Between

(21) Tend to be in background (5) Are you a talkave person?