Type D personality and self-esteem in conversion disorder: a case-control study

Abstract

Aim: In the present study, we aimed to investigate the differences in type D personality and self-esteem between patients with conversion disorder (CD) and the control group. Material and Method: We carried out the study with 100 patients diagnosed with CD and 100 matching healthy individuals. We used a sociodemographic information form, the Type D Personality Scale (DS-14), and the Rosenberg Self-Esteem Scale (RSES) as the data collection tools. Considering that the scales should have high discriminative powers, we calculated the cut-off points on each scale performing the ROC analysis. Results: The results showed that the patients with CD had significantly higher negative affectivity (NA), social inhibition (SI), and DS-14 total scores than the control group (p<0.001). Also, the patient group obtained significantly higher scores on the RSES than the control group, indicating lower self-esteem among the patients (p<0.001). Finally, we concluded significant positive correlations between the RSES scores and NA (r=0.549 p<0.001), SI (r=0.410 p<0.001) and DS-14 total scores (r=0.521 p<0.001). Conclusion: Overall, we found that CD patients had type D personality traits and low self-esteem. As the patients had decreased self-esteem, their DS-14 scores increased. Uncovering SI and NA to be high in these patients may drive physicians to take measures to mitigate these situations and adopt a different perspective on CD. In addition, the results may contribute to better addressing patients’ conversion symptoms and personality traits compatible with CD.

Keywords

• conversiyon disorder
• type D personality
• self-esteem

References

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Washington, DC: American Psychiatric Association; 2013.
2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Washington, DC: American Psychiatric Association; 1994.
3. Koelen JA, Eurelings-Bontekoe EH, van BroeckhuysenKloth SA, Snellen WM, Luyten P. Social cognition and levels of personality organization in patients with somatoform disorders: A case-control study. J Nerv Ment Dis 2014; 202: 217-23.
4. Sağduyu A, Rezaki M, Kaplan İ, Özgen G, Gursoy-Rezaki B. Sağlık ocağına başvuran hastalarda dissosiyatif (konversiyon) belirtiler. Turk Psikiyatri Derg 1997; 8: 161-9.
5. Akagi H, House A. The epidemiology of hysterical conversion. In: Halligan PW, Bass C, Marshall JC, eds. Contemporary approaches to the study of hysteria: clinical and theoretical perspectives. Oxford, UK: Oxford University Press; 2001: 73–8.
6. Van Eck van der Sluijs J, Ten Have M, Rijnders C, Van Marwijk H, De Graaf R, Van der Feltz-Cornelis C. Medically unexplained and explained physical symptoms in the general population: Association with prevalent and incident mental disorders. PLoS ONE 2015; 10: e0123274.
7. Okyayuz ÜH, Berksun O, Çevik A. Psikosomatik serviste yatarak tedavi gören hastaların bazı MMPI bulgularının aleksitimik özellikler açısından incelenmesi ve kontrol grubuyla karşılaştırılması. Ankara Üniversitesi DTCF Derg 1991; 35: 195-203.
8. Tschann JM, Kaiser P, Chesney MA, Alkon A, Boyce WT. Resilience and vulnerability among preschool children: Family functioning, temperament and behavior problems. J Am Acad Child Adolesc Psychiatry 1996; 35: 184- 92.

9. Krishnakumar P, Sumesh P, Mathews L. Temperamental traits associated with conversion disorder. Indian Pediatr 2006; 43: 895-9.
10. Yenilmez Y. The Relationship of temperament and character traits with impulsivity and anger style in conversion disorder. Thesis, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital, Department of Psychiatry, Istanbul; 2011.
11. Uğuz Ş. Other psychopathologies accompanying conversion disorder. Thesis, Çukurova University Faculty of Medicine, Department of Psychiatry, Adana; 1998.
12. TW Smith. Toward a more systematic, cumulative, and applicable science of personality and health: lessons from type D personality. Psychosom Med 2011; 73: 528–32.
13. Allen SF, Wetherell MA, Smith MA. A one-year prospective investigation of type D personality and self-reported physical health. Psychol Health 2019; 34: 773–95.
14. De Vroege L, de Heer EW, van der Thiel E, et al. Type D personality, concomitant depressive and anxiety disorders, and treatment outcomes in somatic symptom and related disorders: an observational longitudinal cohort study. Front Psychiatry 2019; 10: 417.
15. Denollet J. DS14: standard assessment of negative affectivity, social inhibition, and Type D personality. Psychosom Med 2005; 67: 89–97.
16. Park YM, Ko YH, Lee MS, Lee HJ, Kim L. Type-D personality can predict suicidality in patients with major depressive disorder. Psychiatry Investig 2014; 11: 232-6.
17. Michal M, Wiltink J, Till Y, et al. Type-D personality and depersonalization are associated with suicidal ideation in the German general population aged 35–74: results from the Gutenberg Heart Study. J Affect Disord 2010; 125: 227-33.
18. Denollet J, Trompetter HR, Kupper N. A review and conceptual model of the association of Type D personality with suicide risk. J Psychiatr Res 2021; 138: 291-300.
19. Ayaz S. Body image and self-esteem in patients with stoma: review. J Med Sci 2008; 28: 154–9.
20. Denollet J. Personality and coronary heart disease:the type D scale 16 (DS16). Ann Behav Med 1998; 20: 209-15.
21. Öncü E, Vasısayoğlu KS. D tipi kişilik ölçeğinin Türk toplumunda geçerlilik ve güvenirlilik çalışması. Ankara Med J 2018; 4: 646-56.
22. Rosenberg M. Conceiving The Self. New York: Basic Books; 1979.
23. Çuhadaroğlu F. Self-esteem in adolescents. Thesis, Hacettepe University Faculty of Medicine, Department of Psychiatry, Ankara; 1986.
24. Russo J, Katon W, Sullivan M, Clark M, Buchwald D. Severity of somatization and its relationship to psychiatric disorders and personality. Psychosomatics 1994; 35: 546-56.
25. Erten E, Yenilmez Y, Fistikci N, Saatcioglu O. The relationship between temperament and character in conversion disorder and comorbid depression. Compr Psychiatry 2013; 54: 354-61.
26. Güleç MY, İnanç L, Yanartaş O, Uzer A, Güleç H. Predictors of suicide in patients with conversion disorder. Compr Psychiatry 2014; 55: 457-62.
27. Garaigordobil M, Perez JI, Mozaz M. Self-concept, self-esteemand psychopatological symptoms. Psicothema 2008; 20: 114-23.
28. Mols F, Denollet J. Type D personality in the general population: A systematic review of health status, mechanisms of disease, and work related problems. Health Qual Life Outcomes 2010; 8: 9.
29. Pederson S, Denollet J. Type D Personality, cardiac events, and impaired quality of life: a review. Eur J Cardiovasc Prev Rehabil 2003; 10: 241-8.
30. Ozcetin A, Belli H, Ertem U, Bahcebasi T, Ataoglu A, Canan F. Childhood trauma and dissociation in women with pseudoseizure-type conversion disorder. Nord J Psychiatry 2009; 63: 462-8.
31. Feinstein A. Conversion disorder: Advances in our understanding. CMAJ 2011; 183: 915–20.