Personality and Depression

Article excerpt

Objective: To examine the implications of the association between personality and depression for the understanding, assessment, and treatment of major depression.

Method: A broad range of peer-reviewed manuscripts relevant to personality and depression was reviewed. Particular emphasis was placed on etiology, stability, diagnosis, and treatment implications.

Results: Personality features in depressed samples reliably differ from those of healthy samples. The associations between personality and depression are consistent with a variety of causal models; these models can best be compared through longitudinal research. Research demonstrates that attention to personality features can be useful in diagnosis and treatment. Indeed, personality information has been on the forefront of recent efforts to advance the current diagnostic classification system. Moreover, personality dimensions have shown recent promise in the prediction of differential treatment outcome. For example, neuroticism is associated with preferential response to pharmacotherapy rather than psychotherapy.

Conclusions: Consideration of personality features is crucial to the understanding and management of major depression.

Can J Psychiatry 2008;53(1):14-25

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Clinical Implications

* Personality features can play a role in the diagnosis of depression.

* Personality assessment can play a role in treatment selection.

* Matching patient personality with treatment type maximizes response.

Limitations

* To date, research has utilized widely diverse designs, resulting in different estimates of the relation between personality and depression.

* Results from treatment outcome studies are frequently limited by low levels of experimental control and statistical power.

* Results from treatment outcome studies may not generalize to everyday practice.

Key Words: depression, personality disorders, personality, etiology, diagnosis, treatment selection

Clinicians and researchers alike have long noted the prevalence of personality pathology in individuals with MDD. Indeed, the clarification of the personality features associated with major depression, and the implications of these associations for the understanding and care of major depression, have been the focus of much empirical work. Which personality features are common to individuals with MDD? What is the causal significance of this cooccurrence? Can clinicians make use of personality information during the assessment or treatment of depressed individuals? This review aims to shed some light upon these questions, through a review of personality models and their associations with major depression, the etiological connections that may underlie these associations, and the implications that personality may have for the diagnosis and treatment of MDD. It will quickly become apparent that previous research has generated more uncertainty than resolution. One key point, nonetheless, emerges clearly from this literature: consideration of personality features is critical to the understanding of depression and potentially of considerable utility in the optimization of its treatment.

Models of Personality

Personality Disorders

With the introduction of DSM-III and the advent of the multiaxial system, personality features of clinical relevance were coded categorically as PDs on Axis II.1 This system, with some modification, continues to be used in DSM-IV.2 General criteria for PD describe a stable, pervasive, and inflexible pattern of atypical individual experience, manifested in cognition, affect, social functioning, and (or) impulse control. Individual criteria exist for specific PDs, which are divided into 3 clusters: cluster A includes paranoid, schizoid, and schizotypal PDs; cluster B includes antisocial, borderline, histrionic, and narcissistic PDs; and cluster C includes avoidant, dependent, and obsessive-compulsive PDs. …