Disordered Personality Traits in Primary Headaches

Article excerpt

Previous research has shown an association between primary headaches and some extreme features of normal personality traits, however, studies of the relationship between these headaches and the disordered or abnormal personality traits are still needed. This study sought to examine the disordered personality trait profiles in patients with migraine, tension-type headaches compared to healthy controls. Disordered personality traits were assessed using the Dimensional Assessment of Personality Pathology (DAPP; Livesley & Jackson, in press), a self-report measure of abnormal personality function that subsumes major models of normal personality, in 41 patients with chronic headaches (CTH), 34 frequent episodic tension-type headaches (FETH) and 48 migraine without aura, as well as 37 headache-free healthy control subjects. All patient groups scored significantly higher than healthy controls on Submissiveness, Cognitive Distortion, Identity Problems, Intimacy Problems, Social Avoidance, and Self-Harm. In addition, the migraine group scored higher on Submissiveness than did the FETH group. Our findings thus confirmed personality dysfunctions in primary headache sufferers.

Psychological correlates of headaches have received a substantial amount of attention for over half a century, for example, patients suffering from migraine frequently report symptoms of anxiety, tension or depression (e.g., Mattsson & Ekselius, 2002; Merikangas, Stevens, & Angst, 1993; Wacogne, Lacost, Guillibert, Hugues, & LeJeunne, 2003; Waldie & Poulton, 2002). This is attenuated in patients with tension-type headaches (e.g., Holroyd et al. 2000). Despite this body of research, inconclusive findings have emerged. One explanation for this inconsistency may be a result of variations in methodology, including personality measurement. Both migraine and tension-type headaches appear to be related to increases in trait neuroticism or emotional instability (e.g., Brandt, Celentano, Stewart, Linet, & Folstein, 1990), and aggression (Nicholson, Gramling, Ong, & Buenevar, 2003). Many studies have been conducted using the three-factor model like the Eysenck Personality Questionnaire (Eysenck & Eysenck, 1992), or others like the Minnesota Multiphasic Personality Inventory (Butcher, Graham, Williams, & Ben-Porath, 1990). However, in recent years, the five-factor model has proven to be the comprehensive description of normal personality (Widiger & Costa, 1994). Hence, one group of investigators (Cao, Zhang, Wang, Wang, & Wang, 2002) examined the relationship between headaches and normal personality traits. They found increased Neuroticism-Anxiety in patients with tension-type headaches and migraine sufferers when compared to controls, which confirms the relationship between the normal personality traits and headache.

Normal and disordered personality can be conceptualized as lying along a continuum with personality disorder representing the extreme variants of normal traits (Livesley, 2001). The question therefore arises as which aspects of the disordered personality traits are associated with headaches. Thus we have assessed the disordered personality traits in several groups of headache sufferers as well as in a group of healthy volunteers, using the Dimensional Assessment of Personality Pathology (DAPP, Livesley & Jackson, in press). The DAPP is a self-report inventory that provides broad-ranged measures of 18 dimensions of personality pathology. The specificities of its scales might provide information as to which specific aspects of personality dysfunction are related to the individual primary headaches. Our purpose was to further explicate the relationship by a detailed facet-level analysis between disordered personality functioning and primary headaches such as migraine and tension-type headaches.

METHOD

SUBJECTS

This study consisted of 160 Chinese subjects. Thirty-seven healthy volunteers (controls, 21 women, aged 29. …