Richard G. Petty, MD

Personality Style, Coping and Posttraumatic Stress Disorder

I have written a fair amount about posttraumatic stress disorder (PTSD) not only because it can be such a nasty problem, but also because it is beginning to give up many of its secrets, and it is one of the illnesses that can really show the benefits of Integrated Medicine.

There is new research just published in the journal Psychosomatic Medicine. The report is a prospective study that was done in Israel.

180 undergraduate students at the University of Haifa were coincidentally evaluated 2 weeks before a terrorist explosion in a bus heading toward their university and reevaluated 1 week, 1 month, and 6 months after the explosion.

The findings were that there were premorbid personality characteristics that predicted the development of PTSD. This is in line with the research showing both genetic and neurological predispositions to developing PTSD. The research also indicated that
some people have more robust coping styles than others. And finally, as
expected, there is a relationship to how close people were to the

This is all useful information, and once again shows the futility of trying to psychological reactions to only genes, only the brain, only past experience or only the environment.

Any comprehensive understanding needs us to incorporate all of those factors.

Going to College with Attention Deficit Disorder

I’ve recommended
before: it always contains a treasure trove of practical tips for
people who have or whose family members have attention deficit disorder
(ADD) or attention deficit hyperactivity disorder (ADHD).

This month features an interesting
article by Marissa Kantor on planning for college. This is a tough time
for everyone. The structure of high school and home life are replaced
by a far more free wheeling life style where mom and the school
teachers are no longer there to act as surrogate frontal lobes. Marissa
lists seven essential life skills. Her list is terrific, but I would
like to extend it to what I see as the Fifteen Essential Skills that
anyone with ADD or ADHD needs to master before he or she can head off
to college. The keys to success are organization, stability and

1.    Learning to manage not just
time, but energy: what to do and when, and also how much effort to put
into individual tasks: people need to be taught how to use and
organizer and how not to lose it!

2.    Having good sleep habits:
getting enough and waking up on time: There is more and more evidence
that people with ADD and ADHD are prone to sleep disturbances that may
increase the risk of a mood or anxiety disorder

3.    Managing money

4.    Taking regular physical
exercise is an important aspect of living a balanced life: many people
trace their adult inactivity to their college days

5.    Being able to cook simple, nutritious meals

6.    Doing laundry on a regular schedule

7.    Being able to keep track of appointments

8.    Remembering and fulfilling deadlines

9.    Being able to keep on target with academic assignments

10.    Working with teachers, tutors
and counselors: who must all be aware that the person has a difficulty
which may need some special help

11.    Using medications – or other
treatment strategies – appropriately and getting medicines refilled
before they run out: we studiously avoid making medication changes
during school time, and particularly when exams are looming; another
good reason for not stopping and re-starting medicines during vacations

12.    Avoiding the temptations of
alcohol, substance abuse and relaxed attitudes toward sex are really
important and also the most difficult to achieve: have a look at my
article about some of the potentially disastrous consequences of
untreated ADD/ADHD; even with treatment, young people are likely to be
a least somewhat predisposed to these problems

13.    Maintaining healthy
relationships: it is very valuable for young people to learn about the
impacts of positive and negative inter-personal relationships before
they leave for college. They may well meet toxic people in college, and
we can help them identify, void and detach from them

14.    Maintaining a spiritual life
can be very helpful to the young person with ADD/ADHD: they may well
have had an active spiritual life while at home, and it’s a good thing
to encourage some continuing form of spiritual awareness or spiritual
practice. Not only is it a stabilizing factor, but it is important for
people to be in the habit of thinking about thing outside themselves

15.    ADD/ADHD is not all bad: we
don’t want to romanticize a very real difficulty, but before the young person leaves for college it is well worth getting into the habit
of seeing that there may be some positive aspects to the illness. Does
the person with ADD/ADHD have a particularly entrepreneurial or
creative flair, or an affinity with nature or with animals? Consciously
thinking about the positives years in advance can pay enormous
dividends during the early years in college.

Each of these items could easily
fill a whole article. But something for family members to keep in mind
is this: ADD/ADHD can be a serious problem that requires serious
treatments. It can be a Labor of Hercules to keep young people on
track, but remember that if you are a parent, you will likely have some
leverage, particularly if you are helping them financially.

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Temperament, Depression, Class and Resilience

Within the first few weeks of life, infants show marked individual differences in their level of activity, their responsiveness to change in the environment and their irritability. Some clearly enjoy being touched and mold their bodies to the person holding them, while other stiffen and squirm and do less to adjust their bodies to another person. These mood-related personality characteristics are called temperaments. There is some evidence that temperament is one of the basic building blocks of the personality. Temperament appears to consist of inborn traits, but they can be modified by parental contact: there is actually a reciprocal relationship between child and parent. The child modifies the behavior and attitude of the parent.

It is commonly said that a child’s temperament is as fixed as handedness or eye color, but this is inaccurate: we have overwhelming evidence that temperament can be changed by environmental influences. This makes sense. In Healing, Meaning and Purpose, we discuss the implications of the new findings about genes in the brain: they do not so much determine behavior as predispose you to the way that you will handle the environment. An important questions is just how plastic is human temperament? To what extent can you overcome your genetic programming and early rearing? Some recent research has indicated that the environment of the first three years of life is not as critical to later development as we used to believe. But I think that it’s dangerous to read too much into this research. Early emotional deprivation may leave the deepest scars and also be associated with physical deprivation. If a developing brain is deprived of key nutrients, it is difficult to catch up later.

More and more research is finding key genes that contribute to temperament. There is important evidence from animal research that the temperament of infant female rats can predict life span in those who develop spontaneous tumors. It is difficult to extrapolate from that to humans, but it is a further demonstration of the incredibly subtle interactions between genes, the environment, behavior and physical illness.

Some important recent research has examined the impact of temperament on the clinical features of bipolar disorder and of ADHD and autistic spectrum disorders. As expected, people with ADHD reported high levels of novelty seeking and high levels of harm avoidance. Patients with autism spectrum disorders were low on measures of novelty seeking, they had little dependence on rewards and high harm avoidance. Cluster B personality disorders, the dramatic, emotional, or erratic disorders ones (antisocial, borderline, narcissistic and histrionic), were more common in people with ADHD and the other clusters A and C were more common in autistic spectrum disorders. This tells us that these tow clinical conditions can have some specific effects on the structure of temperament, and on the risk of developing specific personality disorders.

In a new study in next month’s issue of the Journal of Personality, Kati Heinonen and colleagues from the Department of Psychology at University of Helsinki, have found a correlation between adult pessimism and childhood temperament in low socioeconomic status (SES) families. It is no surprise to learn that children raised in higher socioeconomic groups have a more optimistic outlook on life. But this is what is interesting, and the thing that will launch a great many more studies. It was discovered that the effect of childhood socioeconomic status on pessimism tended to remain the same despite opportunities for socioeconomic fluidity. A person from a low SES childhood who moved upwards in status was less likely to be optimistic as an adult than someone from a high SES childhood who remained in a high SES environment. The inverse also held true, as people from a high SES childhood who moved downwards in socioeconomic status were more optimistic than those who remained in low SES. This indicates that children who had the chance to develop coping strategies during childhood and subsequently developed a sense of mastery and control that protected them in adulthood from the adverse effects of lower SES. By contrast children from lower SES backgrounds who are subsequently upwardly mobile may not have had the opportunities to develop those psychological resources. They are thus unable to benefit as much as possible from later experiences of success.

We already know that pessimism is related to physical and mental health, so this new study provides a critical link between socioeconomic status and long-term outcome. This is essential information for policy makers and for parents interested in helping children develop more effective coping strategies.

This research really proves that some of the excessive optimism of the self-help movement can sometimes be misplaced: just wanting something to be different does not make it so. If you had a lousy up-bringing in impoverished surroundings, it will make it more difficult to bounce back and learn essential coping skills.

More difficult, but not impossible.

Research on resilience has provided us with a great deal of information about developing mastery and coping skills in the face of being in a low SES, and we shall return to some of that work in the near future.

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