Of all of our personal qualities, the traits associated with neuroticism are usually thought to be among the most dangerous to our well-being. If you’re high on neuroticism, you tend to be a worrier, anxious about even the slightest problems and constantly on edge. These are not qualities that are conducive to the best physical conditions, especially those that are sensitive to life stresses. You’re told that the only way you can reduce your risk is by practicing relaxation, turning down your worry dial until you feel calm, collected, and ready to face all of life’s many challenges. It turns out that the formula for a healthy personality isn’t quite this straightforward, however. The findings from a large nationally representative sample of midlife adults shows that worrying might not be so bad for you, as long as it’s the right kind of worrying. The findings come from a 2013 study led by University of Rochester Psychiatry researcher Nicholas Turiano and his Purdue University collaborators and published in the journal Brain, Behavior, and Immunity (see next page)..
The most widely-accepted general personality theory, known as the Five Factor Model (FFM), proposes that our personalities can best be profiled along the dimensions of Conscientiousness, Agreeableness, Neuroticism, Openness to Experience, and Extraversion. Within each of these dimensions are six sub-dimensions, producing a total of 30 personality facets. To come up with a complete personality diagnosis, according to the FFM, you therefore need to understand your scores on each of the 30 facets, because they all interact jointly to produce the person you are today. Knowing that you’re high on one or more of the six neuroticism facets only tells part of the story. And it’s that part of the story that makes all the difference when it comes to your health.
Before we get to the whole story, it might be helpful for you to figure out just how high you score on a measure of neuroticism. Without going into the whole neuroticism scale, which would be beyond the scope of this blog, you can give yourself a quick test. This won’t give you all of the 6 neuroticism facets, but it will show you how you would rate on the measure used in the Turiano et al. study. Rate yourself from 1 to 4, with 1 meaning “a lot” and 4 meaning “not at all:” moody, worrying, nervous, and calm (reversed). A high score means you are low on neuroticism and a low score means you’re emotionally more stable.
As I said earlier, there’s the right kind of worrying and the kind that is not so great. The best kind of neuroticism for your health turns out to be the kind that combines with high scores on the Conscientious factor. To rate yourself on this, use the same 1 to 4 scale as you did for Neuroticism on the following adjectives: organized, responsible, hardworking, and careless (reversed). Now you have what you need to find out where you rate on both, so read on to find out what this means for your health.
The sample in the study reported by Turiano and his colleagues came from the Midlife in the United States longitudinal study of health and well-being. The MIDUS study began in 1995 on over 7100 adults ages 45 and older (MIDUS I), with the goal of documenting the condition of the nation’s middle-aged adults. The investigators then received further funding to conduct follow-ups, and were able to reach over 4900 of the original participants in 2004 (MIDUS II). The interdisciplinary nature of MIDUS, the fact that it had a longitudinal component, and its inclusion of the midlife years has made it an important data source for studies spanning such wide-ranging areas as genetics, personality, mental and physical health, and sociodemographic factors.
The Turiano team set themselves the task of finding out which combination of FFM personality traits would be most conducive to good health. In order to do this, they looked for the links between those traits and a set of biological measures indicative of high risk of certain chronic health conditions. The key measure they used to indicate health risk was interleukin-6 (IL-6), an measure of immune system index that plays an important role in a variety of chronic diseases such as heart disease and cancer. To remain free of these chronic diseases, you want your IL-6 to be as low as possible.
Previous personality-health studies found that IL-6 and other risk marker such as C-reactive protein (a risk factor for heart disease) were higher in people who had high scores on depression, anxiety, hostility and low scores on measures of self-esteem. People high in neuroticism, in other words, have higher IL-6 and those higher in conscientiousness have lower IL-6.
The Turiano et al study found that when you cross neuroticism with conscientiousness, the risk picture changes substantially compared to looking at each one individually. They tested over 7100 adults in MIDUS I in the mid-90s, and nearly 5,000 of the original participants in MIDUS II about 10 years later. They also assessed a host of relevant health-related behaviors including smoking, alcohol use, body mass index (BMI), medications, and alcohol use as well as the demographic factors of age, race/ethnicity, and education.
With such a sizable sample followed over time, Turiano and his team were able to explore the joint effects on IL-6 of neuroticism and conscientiousness. In that intersection of personality factors lie the people who worry a lot, but who also are super-careful. I wouldn’t go so far as to call them hypochondriacs, but I would venture to guess that they’re high on a quality called health anxiety, meaning they become concerned about developing poor health. It makes sense that although they tend to worry, they worry about the right things. They watch what they eat, take care to exercise, avoid harmful habits, and probably did so for their entire lives. If something in their bodies doesn’t feel right, they are likely to consult a health professional.
The findings bore out this expectation. People high on neuroticism who were also high on conscientiousness turned out, when followed on average 5 years later, in fact to have lower IL-6 levels. Most of the effect was accounted for by people at the extreme on both scales (i.e. people with personality scores closest to 1).
You’re probably thinking, and rightly so, that maybe the conscientious neurotics had lower IL-6 levels because they took better care of themselves. That was partly true. Taking the health behaviors of alcohol, BMI and smoking into account reduced the statistical effect by about 30%, and taking demographic factors into account reduced it even further. However, the effect remained, and also fit with the results of related studies carried out on different samples.
It appears that you can be a “healthy neurotic.” Turiano and his group concluded that the health anxiety that people high in neuroticism feel may be adaptive when it’s accompanied by high conscientiousness. Neuroticism leads you to worry but conscientiousness leads you to be self-disciplined and to take action when your behavior veers into the unhealthy range. The unhealthy neurotics are the ones whose low conscientiousness means that they have fewer healthy coping mechanisms. When they’re stressed and unhappy, they turn to overeating, drinking, and smoking. However, not all of the personality-IL 6 relationship could be accounted for by these health behaviors; in fact about 70% of the relationship was due to personality, or some unmeasured variables, alone. For example, it’s possible that other known health culprits could play a role such as lack of sleep, or even relationship conflict.
The upshot for you is that by looking at your own personality, you might gain insight into ways to improve your health. Contrary to popular belief, people can change in adulthood even in their fundamental personality traits. After testing yourself on these two power-packed personality traits, see what you can do to build that healthy neuroticism to take maximum advantage of the conscientiousness boost. While you’re at it, don’t forget to that better health habits can buy you an additional 30% benefit.
When all is said and done, being healthy isn’t just a matter of not worrying, it’s a matter of worrying about the right things. (Continued on next page)
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Copyright Susan Krauss Whitbourne, Ph.D. 2013
Turiano, N. A., Mroczek, D. K., Moynihan, J., & Chapman, B. P. (2013). Big 5 personality traits and interleukin-6: Evidence for 'healthy neuroticism' in a US population sample. Brain, Behavior, and Immunity, 28, 83-89. doi: 10.1016/j.bbi.2012.10.020
Zimprich, D., Allemand, M., & Lachman, M. E. (2012). Factorial structure and age-related psychometrics of the MIDUS personality adjective items across the life span. Psychological Assessment, 24(1), 173-186. doi:10.1037/a0025265