Clinical relevance of personality in psychotic disorders

Do personality traits in people diagnosed with psychotic disorders matter with regard to their experience of psychosis and treatment?

Personality traits, as defined by the Five Factor Model, were reviewed in relation to clinically relevant aspects of psychosis. Higher levels of Neuroticism - being prone to worry and experiencing negative emotion - were linked to higher symptom severity, passive coping, greater self-stigma, and lower quality of life. Higher levels of Extraversion - the tendency toward positive emotions and sociability - were linked to opposite outcomes. New insights into other traits emerged from our research on two cohorts. Higher levels of Openness, reflecting curiosity about unusual ideas and experiences, seemed to weaken the link between the frequency of delusions and hallucinations and the distress they caused. Agreeableness - a general concern for social harmony - was found to be relevant for self-reported insight. That is: higher Agreeableness, higher Neuroticism and lower Extraversion were all linked to greater individual awareness of the disorder and recognition of the need for treatment. Impaired insight was also associated with symptoms as measured by professionals. Both patient and professional perspectives are meaningful, and it’s important to realize that symptoms and personality traits may affect each other. Therefore, the described personality effects were controlled for symptoms and investigated over time, which revealed changes in effect sizes. Causal exploration indicated interrelatedness between symptom domains and personality traits, such as depressive symptoms inflating the level of Neuroticism.

Personality indeed matters for experiences and therapy in psychosis, together with symptoms.