psychophysiological pathways, there appears to be a sufficient basis for examining these attributes in relation to behavioral pathways as well. In some instances, evidence for associations between suspected personality risk factors and pathogenic behaviors was generated through efforts to introduce statistical controls for factors that might confound personality-disease relations deriving from physiological mechanisms. In other cases, the examination of associations between personality and health damaging behaviors appears to have been exploratory, or based on the general negative or maladaptive connotation of a personality descriptor. Research based on explicit theory linking personality attributes to health behavior or reactions to illness (e.g., S. M. Miller et al., 1996) might be expected to yield more consistent and robust findings.
In addition to the benefits of a more theoretical approach to work in this area, it may be useful to give greater consideration to the proper role of personality in this research. Some research appears to reflect a premature focus on one particular personality disposition, to the exclusion of others, and to rely too heavily on it alone in attempting to predict measures of health-related behavioral processes. Other research is based on a normative health behavior model in which personality is included in a list of relevant background variables in the absence of a systematic examination of potential points of connection between personality and the key elements of the behavioral model. If research guided by psychophysiological models has provided any lesson at all for more behavioral approaches, it is that personality is neither an overriding factor in physical illness nor an inconsequential one.
The major constructs and research approaches used in the study of personality, stress, and disease have evolved only to a modest degree in recent years. Current concerns about lack of theory, measurement problems, and other issues do not differ dramatically from those raised in reviews published decades ago. Nonetheless, although the robustness of beliefs in the importance of stress-related personality attributes is not always matched by effect sizes or theoretical sophistication, research in this area has progressed. Assertions that once were based on a single, prospective epidemiologic investigation, or on a handful of psychophysiologic experiments, are now based on consistent patterns of findings from large numbers of studies. There is a greater tendency to select for study types of stressors that appear psychologically relevant to the particular personality attribute under investigation. Personality factors that were once vaguely conceptualized as capable of exacerbating stress responses are now embedded in detailed theoretical frameworks positing specific stress promoting processes. In short, it would seem that the study of personality, stress, and disease is alive and reasonably well.
We thank Michael Diefenbach and Ann O'Leary for their helpful comments on an earlier draft of this chapter. Thanks also to Jennifer Betancourt for her help in preparing the manuscript.
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