We conducted a systematic search on Pumped, Psyching, and Academic Search Complete from 1980 (the year PUTS was first included in the ADSM) and 201 2 (the year the literature search was performed). Manual examination of secondary sources such as the reference sections of selected articles and book chapters were also conducted. Results: Most of the reviewed studies dealing with personality traits as vulnerability and protective factors for P T SD examined the relationship between basic personality dimensions and severity of symptoms of PUTS.
These studies have applied three types of methodological designs: cross-sectional, post-trauma and pre- trauma longitudinal studies, with latter being the least common option. Conclusion: Finding that appears relatively consistent is that PUTS is positively elated to negative emotionality, neurotics, harm avoidance, novelty- seeking and self-transcendence, as well as to trait hostility/anger and trait anxiety.
On the other hand, PUTS symptoms are negatively associated with extroversion, conscientiousness, self-directness, the combination of high positive and low negative emotionality, as well as with hardiness and optimism, while postgraduates growth shows inverse relation to most of these traits. Furthermore, a number of studies have confirmed the existence of three distinct personality-based subtypes of PUTS: internalizing exterminating and low pathology PUTS.
These findings may help in further uncovering etiological mechanisms and in building new strategies for prevention, identification and reduction of health risks among this trauma population, as well as facilitating potential postgraduates growth. However, focusing on just a single dimensional perspective will unable us to generate comprehensive knowledge of the etiology, course and treatment of PUTS.
Key words: postgraduates stress disorder – PUTS -? personality -? vulnerability resilience – expression * * INTRODUCTION The idea of trauma experience as the only or leading etiological factor in the placement of PUTS has been rejected by empirical data (Johnson & Thompson 2008), adding to the fact that PUTS is still one of the most controversial diagnostic entities in psychiatry and in medicine in general (JovanovichВ± 1998, Brewing 201 1, JovanovichВ± 2012).
More specifically, epidemiological studies have documented high prevalence rates of exposure to traumatic events in the general population and confirmed that PUTS occurs following a wide range of extreme life events (e. G. , Burbles et al. 1991, Kessler et al. 1 995, 2005). Most important, though, are the consistent findings indicating that, although exposure to potentially traumatic events is common, development of PUTS is relatively rare, usually between 5 and in general population (e. G. , Davidson et al. 991, Burbles et al. 1998, Creamer et al. 2001 Lloyd & Turner 2003, Kessler et al. 2005). Elucidation of the factors responsible for some people developing PUTS while others exposed to similar threatening events do not may inform our understanding of key variables in the etiology of this condition, helping us in answering the longstanding question whether trauma reactions are the consequence of pre-trauma rationality defects, or if psychodrama largely overshadows the entire pre- trauma personality (Marker et al. 999). Previous studies have identified some pre-trauma and post-trauma variables of great importance in addition to the traumatic event itself, such as genetic factors, perceived lack of parental care, past history of trauma and psychological problems, unhealthy life styles, personality traits, intelligence, as well as post-trauma (and post- war) support, beliefs, expectations and attributions (Head & McFarland 1995, Joviality 2012, Joviality et al. 201 AAA).
It has been shown that one of he factors that might help explain why only some traumatized people develop psychiatric illness, individual differences in personality traits, plays an important role in the development, outcome and formation of specific Symptoms Of P T SD (e. G. , Breach et al. 2000, Cox et al. 2003, Gill 2005, Engendered & van den Hoot 2007, Miller & Erect 2007, wolf et al. 2012). 256 Maenad Jaw?I, Allover Braking, Ana Ivies, Radial Top & Mirror Javelin: (PUTS) Psychiatric Danube, 2012; Volvo. 24, No. , up 256-266 Personality traits are traditionally conceptualized as dimensions of individual preferences in tendencies to show consistent patterns of thoughts, feelings, and actions across developmental periods and contexts (McCrae & Costa 2003). Advances in the field of personality have put more emphasis on the interface be;en personality and psychopathology, including PUTS. This dimensional model assumes there are individual differences in personality structure regarding their vulnerability or resilience to mental distress, in this case P T SD.
It comprises three relevant steps in the psychotherapeutics process: possible deficits in personality structure and functioning, exposure o stressful or traumatic events and abnormal reactions. For those who are on the extreme vulnerability end Of the continuum, a smaller amount Of stress or trauma is needed for mental disturbances to appear, while resilient individuals would have to experience more severe stress or trauma before they develop PUTS or some other psychiatric illness (Jovanovich et al. 201 b).
Personality has been linked to affective dispositions, structural and biochemical systems in the brain and role in the etiology of psychopathology, while treatment options should be focused on helping individuals use their irrationalities resources and strengths to increase personal wellbeing and restore resilience. Because of a lack of consensus regarding the basic dimensions of personality and their interrelationships, the personality and PUTS literature is based on studies using different personality models which differ in terms of the factor Structure, number and definition of specific traits (Miller 2003).
In the following section we will briefly mention and define the most commonly used structural personality models and their traits in the research field of PUTS and personality. The five-factor model of personality MM) (Costa & McCrae 1 992) is the most popular structural personality model, confirmed across virtually all cultures and fairly stable over time (McCrae & Costa 2003). In addition, research suggests that the Big Five traits have a physiological and genetic basis and the heritability of its dimensions appears to be quite substantial (Boucher & McGee 2003, Aura et al. 012). The dimensions composing the 5-factor model are Neurotics, Extroversion, Agreeableness, Conscientiousness and Openness to Experience, which encompass 30 lower-order facets. The psychobiology model of personality s based on four temperament (Harm Avoidance, Novelty Seeking, Reward Dependence, Persistence) and three character dimensions (Self-directness, Cooperativeness, Self-transcendence) (Clinger et al. 1993). Temperament is considered to be biologically based emotional response patterns, such as fear, anger and attachment.
Character is a developmental construct consisting of self-concepts about the values and goals that influence the significance of what is experienced. Whereas temperament refers to inborn emotional predispositions, character is related to our intentional behavior repertoire (Clinger et al. 993, Safaris & Clinger 2010). The broader three-factor model of personality is based on the work of Telling (1985) and comprises three higher-order dimensions: Positive emotionality/ Extroversion (PEN), Negative emotionality/Neurotics (MEN) and Constraint/ Inhibition (CON).
These dimensions are represented in other models of personality (Miller 2003), have substantial heritability (Robinson et al. 1 992) and long-term stability in adulthood (Watson & Walker 1996). The three-factor model has been extensively investigated regarding the development and expression of P T SD (e. G. Miller 2003, Miller & Reside 2007, Wolf et al. 2012). Based on previous empirical studies, the aim of this review was to update the field on the influence of personality traits on four related aspects of PUTS: vulnerability, resilience, postgraduates growth (PET) and behavioral expressions associated with PUTS.
However, it is noteworthy to mention that the role of personality in PUTS falls into dimensional perspective and represents a part of the transcriptional integrative model of PUTS based on the seven perspective explanatory approach as well as on the method of multiple working hypotheses (Javelin et al. AAA,b). METHOD OF REVIEW The literature search was aimed at identifying published evaluations of the influence of personality on PUTS.
We focused on published, peer-reviewed English-language studies because we expected them to be the most methodologically rigorous and thus yield the strongest conclusions in regard to personality and PUTS. Relevant studies were identified through extensive, computerized database searches of Pumped, Psychology, and Academic Search Complete for articles published between 1980 (the year PUTS was first included in the ADSM) and 201 2 (the year the literature search was conducted), sing the specific search terms ‘postgraduates stress disorder’, ‘PUTS’, ‘personality’, and ‘temperament’.
To narrow the search, the titles and abstracts and, if necessary, the full articles were then examined in order to exclude the papers that did not report on the direct relationship between personality and PUTS. In order to ensure a thorough search procedure, manual examination of secondary sources such as the reference sections of selected articles and book chapters were also conducted. Furthermore, references were included that were known to the authors and were directly elevate to the review, but that had not otherwise been detected using the previous search strategies.
Studies offering evidence representing expert opinion (such as case studies) were excluded on the basis that they appear low down on the ‘hierarchy of evidence’ adopted by the National Service Framework for Mental Health (Department of Health 1999). The investigation of the literature did not include published abstracts. 257 Maenad Jaggy, Allover Braking, Ana Ivies, Radial Topic & Mirror Javelin: (PUTS) psychiatric Danube, 2012; Volvo. 24, NO. 3, up 256-266 PERSONALITY TRAITS AS VULNERABILITY FACTORS
Generally, vulnerability factor refers to a measurable attribute of individuals, their interpersonal relationships, or their social and physical environments that increases the likelihood of negative or undesirable current or future outcomes (Lane et al. 2007). Therefore, a personality trait that demonstrates a positive association with PUTS in a sample of individuals who have experienced a traumatic event may qualify as a vulnerability factor. Research findings on basic dimensions of personality Most of the reviewed studies dealing with traits as vulnerability factors for
PUTS examined the relationship be;en basic personality dimensions and severity of symptoms of PUTS. Despite growing evidence of the association between PUTS and personality, some questions still remain open, such as whether personality-based vulnerability factors for PUTS are unique or they are the same as those related to many other mental disorders (Jovanovich et al. 201 AAA). Several studies examined dimensions derived from the Essence’s model of personality (e. G. , Holler & Terrier 2001, Broadly et al. 2004, Engendered et al. 006, parasol et al. 2006, Www et al. 2011 Extroversion/ Introversion, Neurotics and Psychotics. Extroversion is characterized by being outgoing, social, talkative and high on positive affect. Neurotics describes a tendency to react with strong emotion to adverse events. Individuals who are high on this dimension are more sensitive to stress because their responses are more rapid, more intense and slower to return to baseline. Conversely, those who are low on trait neurotics find it easier to “shake off’ stressful events (Paris 2000).
Psychotics is characterized by non-conformity, anger, hostility, irresponsibility and impulsiveness. In a jurisdictional study conducted on holocaust survivors, Broadly et al. 2004) found that only higher neurotics was associated with significant PUTS. The same was shown in a cross-sectional study on Chinese students after a snowstorm disaster (Www et al. 2011 Similarly, this finding was confirmed in two longitudinal studies of young adults (Parasol et al. 2006) and women after miscarriage or stillbirth.
On the other hand, both neurotics and psychotics were linked to PUTS in one cross-sectional study conducted on war veterans (Easels & Motto 1990). In their postpartum prospective study on victims of traffic accidents, Holler & Terrier (2001) showed that both eroticism and psychotics were sign efficiently correlated with postgraduates symptoms. A number of consulted studies examined the relationship between PUTS symptoms and personality dimensions according to the Five-factor model of personality (FM) by Costa & McCrae (e. G. , Delbert et al. 1993, Her et al. 994, Lawrence & Breach 2003, Knee>eve et al. 2005, Chunk et al. 2006, 2007, 2011). Two dimensions of the model correspond to Essence s model: Extroversion/lumberperson and Neurotics. Other dimensions are: Agreeableness, Conscientiousness and Openness to experience. Agreeableness is a tendency to be pleasant in social situation, conscientiousness includes traits like self-discipline, carefulness, thoroughness, self-organization and need for achievement, while openness can be defined as the tendency to be interested in new situations, new ideas and new experiences.
Delbert et al. (1993) sorted Vietnam veterans into three groups based on trauma exposure level and found no significant difference among the personality profiles between them, but a normative profile was presented and it was characterized by an extremely high neurotics score and an extremely low agreeableness score. In their cross-sectional study on persons with PUTS, Her et al. (1994) found that only neurotics was significantly associated with PUTS. Kneeled et al. (2005) conducted a longitudinal study on Yugoslavian students exposed to air attacks.
While there was no significant correlation between personality traits and subsequent avoidance scores, openness to experience positively predicted intrusion scores 1 year after the attacks. In a postpartum prospective study, Lawrence & Breach (2003) obtained rues Its which suggested that neurotics was the most important personality dimension in predicting PUTS. Chunk et al. 2006) examined the association be;en five personality traits and PUTS symptoms among older people after myocardial infarction.
Regression analyses showed that higher neurotics predicted reciprocating and avoidance symptoms, while higher neurotics and less agreeableness predicted hyperbolas symptoms. Chunk et al. (2007) compared a no-PUTS group, a partials group and a full-PUTS group of patients after myocardial infarction. Patients with full-PUTS were significantly more neurotic than those with no-PUTS and partial-PUTS. Patients with full- PUTS were less agreeable than patients with no-PUTS.
There were no significant differences in extroversion, openness to experience and conscientiousness. Nevertheless, several studies established a link between low extroversion and P T SD outcomes (e. G. , Breach et al. 2000, D¶rifle et al. 2008). To conclude, the overall findings from these studies suggest that neurotics accounts for the risk of developing PUTS symptoms. As for other personality dimensions, the results are inconsistent and further research is needed.
Four temperament and three character dimensions from the Psychobiology model of personality by Clinger are often a subject of search in studies dealing with predictive factors of PUTS. The four dimensions are: Harm Avoidance (a tendency to respond intensely to previously established signals of adverse stimuli and to learn passively to avoid punishment, novelty, and non-rewarding situations), Novelty Seeking (a tendency to respond with intense 258 Maenad Jake, Allover Braking, Ana Ivies, Radial Topic & Mirror Javelin: (PUTS) Psychiatric Danube, 2012; Volvo. 4, No. 3, up 256-266 excitement to novel stimuli or potential relief from punishment), Reward Dependence (a tendency to respond intensely to signals of reward, especially social reward, and to maintain behavior previously associated with reward or with relief from punishment) and Persistence (persevering, ambitious vs.. Easily discouraged, underachieving) (Gill 2005). Character dimensions are: Self- directness (liable, purposeful vs.. Blaming, aimless), Cooperativeness (tolerant, helpful vs.. Prejudiced, revengeful) and Self-transcendence (self- forgetful, spiritual vs.. Elf-conscious, materialistic). Irishman & Fruehauf (1997) compared data of Vietnam veterans suffering from combat combat-related P T SD with normative data and veterans were found to be high on harm avoidance, low on reward dependence, and high on novelty seeking. High harm-avoidance and high novelty-seeking scores were predictive of increased PUTS severity. Similarly, Wang et al. (1997) found substantially elevated novelty seeking and harm avoidance scores as well as moderately lower reward dependence scores in the PUTS Vietnam veterans compared to national norms.
In a longitudinal study on undergraduate students exposed to a terrorist explosion (Gill 2005), regression analysis showed that harm avoidance was positively associated with the risk for developing PUTS, and hat novelty-seeking was negatively associated with this risk. North et al. (2008) conducted a longitudinal study and found that symptoms of PUTS are related to harm avoidance, self-transcendence, and self-directness. In a cross-sectional study, Yon et al. (2009) showed that patients with PUTS achieve significantly higher scores on harm avoidance and self-transcendence and lower scores on self-directness and cooperativeness.
Verve et al. (2010) confirmed that persons with PUTS have higher mean scores of novelty seeking, harm avoidance and self-transcendence. A study Of bombing Orvis’s (North et al. 201 2) showed that positioning PUTS was associated with low clandestineness and low cooperativeness, and also with high self- transcendence and harm avoidance in most configurations. Finding that appears relatively consistent in studies of different designs, carried out on different samples, is that P T SD is related to high harm avoidance, novelty- seeking and self-transcendence, while for other personality dimensions, such unambiguous conclusion cannot be made.
Several studies were based on the Three-factor model derived from Telling ” s conceptualization of these omissions: Positive emotionality/Extroversion (PEN), Negative emotionality/ Neurotics (MEN) and Constraint/limitation (CON). PEN refers to individual differences in the capacity to experience positive emotions and tendencies towards active involvement in the social and work environments. It corresponds to the dimension of Extroversion in Essence and Costa & McCrae models of personality. MEN is orthogonal to PEN and refers to dispositions toward negative mood and emotion and a tendency towards adversarial interactions with others.