The involvement of psychological factors in the etiology of chronic diseases is rousing the interest of the scientific community (Conversano, 2019; Martino et al., 2019b; Merlo, 2019; Lenzo et al., 2020; Vicario et al., 2020), leading to an increase in research on neuropsychological correlates of a number of chronic illnesses including cardiovascular disease (Eikeseth et al., 2020), diabetes mellitus (Martino et al., 2019a), bone health (Catalano et al., 2018; Fiegl et al., 2019; Kelly et al., 2019, 2020; Lauriola et al., 2019; Williams et al., 2020), fibromyalgia (Veltri et al., 2012; Palagini et al., 2016; Conversano et al., 2019; Marchi et al., 2019), as well as neuropsychological problems such as attention and hyperactivity deficit (Fabio et al., 2018; Di Giuseppe et al., 2020c) and post-traumatic stress disorder (Carmassi et al., 2014, 2018; Settineri et al., 2018; Conversano et al., 2020a; Merlo et al., 2020; Orrù et al., 2020). A number of recent studies have demonstrated that personality traits and implicit emotion regulation are associated with development, progression, recurrence, and severity of chronic illness (Koole and Rothermund, 2011; Ciuluvica et al., 2019; Settineri et al., 2019; Rymarczyk et al., 2020). For instance, the adaptiveness of defense mechanisms determines greater quality of life, adherence to treatment, and improved survival rates in cancer patients (Porcerelli et al., 2017; Zimmerman et al., 2019), which suggests the need for the systematic assessment of defensive functioning in chronic diseases (Di Giuseppe et al., 2020b). Adverse childhood experiences are also risk factors for metabolic alterations and obesity (Pervanidou and Chrousos, 2012; Davis et al., 2014). In particular, research in clinical psychology demonstrates high comorbidity between cardio-metabolic diseases and major depressive disorder (MDD). The occurrence of stressful life events (SLEs) appears to be related to cardio-metabolic complications and comorbidities, as they directly affect life stress and compensatory behaviors (Rich-Edwards et al., 2012; Kessler and Bromet, 2013; Kesebir, 2014; Rock et al., 2014). Furthermore, the impact of traumatic events on well-being is associated with the nature, timing, duration, and course of the SLE (Phifer and Norris, 1989; Fisher et al., 2010). Adults who experienced their most distressing trauma in childhood exhibited more severe symptoms of PTSD and lower subjective happiness as compared to adults who experienced it in a later stage of development (Ogle et al., 2013). Research has demonstrated that higher serum triglyceride and lower HDL-cholesterol concentrations can be observed in depressed patients with SLEs as compared to depressed patients without SLEs (Péterfalvi et al., 2019). Moreover, high LDLC and low serum levels of HDL-C were found to be associated with physical and sexual abuse, whereas raised TG and lower HDL-C were found to be associated with childhood neglect and emotional abuse (Li et al., 2019). Cardio-metabolic diseases are also associated with poor performance and cognitive dysfunction in memory, attention, visuo-spatial abilities, and executive functions (Yaffe et al., 2009; Yates et al., 2012; Olson et al., 2017; Guicciardi et al., 2019; Wooten et al., 2019). Such a significant corpus of research has inspired reflection on how personality traits, defined as individual differences in characteristic patterns of thinking, feeling, and behaving (American Psychiatric Association, 2013), may affect the physical and psychological conditions of chronic patients.
Psychodynamic research has highlighted the role of personality in the development and progression of psychopathological and organic diseases (Price et al., 2001; Coughlin, 2011; Dell'Osso et al., 2012; Radziej et al., 2015; Boldrini et al., 2019; Catalano et al., 2019; Martino et al., 2020d). A number of studies have analyzed how personality characteristics may increase the risk of specific somatic diseases or the individual's general susceptibility to diseases (Friedman and Rosenman, 1959; Greer and Morris, 1975; Denollet et al., 1995; Horwood et al., 2015). Scholars have in recent years hypothesized that the occurrence of cancer is more frequent in individuals with cancer-prone personalities, also known as a Type C Personality (Eysenck, 1994; Watson et al., 1999; Lemogne et al., 2013). This hypothesis has been confirmed by research on defense mechanisms which has demonstrated that individuals who use mature defensive functioning, defined as the use of high-adaptive defensive strategies that lead the subject to the best adjustment and possible resolution of internal and external stressors, report higher physical and psychological functioning (Garssen, 2004; Paika et al., 2010; Petric et al., 2011; Perry et al., 2015; Di Giuseppe et al., 2019). Conversely, maladaptive defense style, defined as a combination of immature defensive strategies activated to keep the individual unaware of experiencing unmanageable feelings, desires, and thoughts, was shown to predict sleep disturbance, worse clinical conditions, and lower survival rates in cancer patients (Beresford et al., 2006; Hyphantis et al., 2011, 2013a,b; Hyphantis et al., 2016; Conversano et al., 2020c). In particular, the high use of repression leads to impairment of endocrine and immune functions and is common in patients with shorter disease-free intervals, shorter survival, and a more unfavorable cancer staging at endpoint (Bahnson and Bahnson, 1966; Kreitler et al., 1993; Weihs et al., 2000; Giese-Davis, 2008; Boscarino and Figley, 2009).
One aspect of personality commonly studied in patients with chronic diseases is alexithymia, which is defined as the inability to distinguish between emotions, thoughts, and physiological responses to stimuli. Alexithymia has been found to be associated with several medical conditions (Lumley et al., 2005; Willemsen et al., 2008; Honkalampi et al., 2010; Pouwer et al., 2010; Tolmunen et al., 2011; Mazaheri et al., 2012; Sapozhnikova et al., 2012; Shinkov et al., 2018). Alexithymia is associated with hyperarousal, physical symptoms, and unhealthy compulsive behaviors. Moreover, psychological treatments have poor outcomes in alexithymic patients, posing the question as to whether alexithymia can be improved through treatment (Lumley et al., 2007). Recent studies have found that alexithymic patients ranged from 25 to 50% among patients with Type 2 Diabetes Mellitus (Martino et al., 2020c) whereas this was not observed in patients with Inflammatory Bowel Disease (Martino et al., 2020b). This association between alexithymia and metabolic control was suggested by the negative correlation with HbA1c values. Since HbA1c reflects the mean serum glucose levels over time, it may be speculated that alexithymia may more probably be identified in patients with uncontrolled diabetes. Conversely, the attempt to restore euglycemia, in particular in subjects with high HbA1c and high serum glucose levels, may expose patients to hypoglycemic risk. Thus, the contribution of hypoglycemia, usually a manifestation of inadequately controlled diabetes, may not be ruled out. However, the study by Martino et al. was focused on a homogeneous T2DM population taking metformin and at relatively low hypoglycemic risk. Furthermore, alexithymia was found to be associated with anxiety and depression, especially in patients with poor compliance and adherence, concurring in a worse clinical picture and course of chronic diseases (Leweke et al., 2012; Hintistan et al., 2013; Mnif et al., 2014; Stanton and Hoyt, 2017; Rosa et al., 2019; Martino et al., 2020a).
Among other factors which contribute both to the onset and to the course of chronic illness, stressful life events are involved in the pathogenesis of both psychological and organic diseases (McFarlane, 2010; Afari et al., 2014; Marazziti et al., 2015). In addition, suffering from a chronic medical condition is a stressful factor per se and its influence on individual psychological well-being has been widely documented (Alonzo, 2000; Chaturvedi et al., 2017). Research has found that depression and psychosocial stressors promote inflammation and oxidative/nitrosative stress, decreased immunosurveillance and dysfunctional activation of the autonomic nervous system and of the hypothalamic-pituitaryadrenal axis (Piccinni et al., 2012; Bartolato et al., 2017). Accordingly, recent studies of the general population have demonstrated clinical levels of psychological distress, post-traumatic symptoms and somatization in response to the stressful condition of quarantining (Di Giuseppe et al., 2020d; Prout et al., 2020), confirming the effect of stress on physical and psychological well-being. Moreover, sociodemographic characteristics further contribute to increase hyperarousal and distress, with young people and women showing higher a prevalence of anxiety, depression and post-traumatic stress symptoms (Brooks et al., 2020; Conversano et al., 2020b) as well as a higher risk of developing chronic diseases (Abad-Díez et al., 2014; Holzer et al., 2017; Di Giuseppe et al., 2020a).
Taking these findings together, we assume that psychological and organic issues are intercorrelated and a comprehensive understanding of chronic medical conditions should consider all aspects of the illness (Yoo and Ryff, 2019). Effective therapy should be tailored to the needs of the patient, as suggested by personalized medicine. This approach promotes earlier diagnoses, risk assessment, and optimal treatments in order to ensure better patient care and lower costs (Vogenberg et al., 2010; Zilcha-Mano, 2020). In this perspective, psychotherapeutic interventions should be considered as an essential part of the treatment, since they are effective in reducing symptoms of psychological distress that, in turn, may affect disease progression and mortality (Lingiardi et al., 2010; Barrera and Spiegel, 2014; Salvatore et al., 2015; Gelo and Salvatore, 2016; Tanzilli et al., 2018; Perry et al., 2020; Yonatan-Leus et al., 2020). As suggested by Fonagy, we should use “the opportunities provided by bioscience and computational psychiatry to creatively explore and assess the value of protocol-directed combinations of specific treatment components to address the key problems of individual patients” (Fonagy, 2015).
Statements
Author contributions
CC and MD contributed in equal part to the development, conceptualization, literature review, and writing of the manuscript. All authors contributed to the article and approved the submitted version.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
References
1
Abad-DíezJ. M.Calderón-LarrañagaA.Poncel-FalcóA.Poblador-PlouB.Calderón-MezaJ. M.Sicras-MainarA.et al. (2014). Age and gender differences in the prevalence and patterns of multimorbidity in the older population. BMC Geriatr.14:75. 10.1186/1471-2318-14-75
2
AfariN.AhumadaS.WrightL. J.MostoufiS.GolnariG.ReisV.et al. (2014). Psychological trauma and functional somatic syndromes: a systematic review and meta-analysis. Psychosom. Med.76, 2–11. 10.1097/PSY.0000000000000010
3
AlonzoA. A. (2000). The experience of chronic illness and post-traumatic stress disorder: the consequences of cumulative adversity. Soc. Sci. Med.50, 1475–1484. 10.1016/S0277-9536(99)00399-8
4
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edn.Washington, DC: American Psychiatric Association.
5
BahnsonC. B.BahnsonM. B. (1966). Role of the ego defenses: denial and repression in the etiology of malignant neoplasm. Ann. N.Y. Acad. Sci.125, 827–845. 10.1111/j.1749-6632.1966.tb45434.x
6
BarreraI.SpiegelD. (2014). Review of psychotherapeutic interventions on depression in cancer patients and their impact on disease progression. Int. Rev. Psychiatry26, 31–43. 10.3109/09540261.2013.864259
7
BartolatoB.HyphantisT. N.ValpioneS.PeriniG.MaesM.MorrisG.et al. (2017). Depression in cancer: the many biobehavioral pathways driving tumor progression. Cancer Treat. Rev.52, 58–70. 10.1016/j.ctrv.2016.11.004
8
BeresfordT.AlfersJ.MangumL.ClappL.MartinB. (2006). Cancer survival probability as a function of ego defense (adaptive) mechanisms versus depressive symptoms. Psychosomatics47, 247–253. 10.1176/appi.psy.47.3.247
9
BoldriniT.TanzilliA.PontilloM.ChirumboloA.VicariS.LingiardiV. (2019). Comorbid personality disorders in individuals with an at-risk mental state for psychosis: a meta-analytic review. Front. Psychiatry10:429. 10.3389/fpsyt.2019.00429
10
BoscarinoJ. A.FigleyC. R. (2009). The impact of repression, hostility, and post-traumatic stress disorder on all-cause mortality a prospective 16- year follow-up study. J. Nerv. Ment. Dis.197, 461–466. 10.1097/NMD.0b013e3181a61f3e
11
BrooksS. K.WebsterR. K.SmithL. E.WoodlandL.WesselyS.GreenbergN.et al. (2020). The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet395, 912–920. 10.1016/S0140-6736(20)30460-8
12
CarmassiC.GesiC.CorsiM.CremoneI. M.BertelloniC. A.MassimettiE.et al. (2018). Exploring PTSD in emergency operators of a major University Hospital in Italy: a preliminary report on the role of gender, age, and education. Ann. Gen. Psychiatry17:17. 10.1186/s12991-018-0184-4
13
CarmassiC.StrattaP.MassimettiG.BertelloniC. A.ConversanoC.CremoneI. M.et al. (2014). New DSM-5 maladaptive symptoms in PTSD: gender differences and correlations with mood spectrum symptoms in a sample of high school students following survival of an earthquake. Ann. Gen. Psychiatry13, 1–9. 10.1186/s12991-014-0028-9
14
CatalanoA.MartinoG.BelloneF.GaudioA.LascoC.LangherV.et al. (2018). Anxiety levels predict fracture risk in postmenopausal women assessed for osteoporosis. Menopause25, 1110–1115. 10.1097/GME.0000000000001123
15
CatalanoA.MartinoG.BelloneF.PapaliaM.LascoC.BasileG.et al. (2019). Neuropsychological assessment in elderly men with benign prostatic hyperplasia treated with dutasteride. Clin. Drug Invest.39, 97–102. 10.1007/s40261-018-0720-7
16
ChaturvediS.ClancyM.SchaeferN.OluwoleO.McCraeK. R. (2017). Depression and post-traumatic stress disorder in individuals with hereditary hemorrhagic telangiectasia: a cross-sectional survey. Thrombosis Res.153, 14–18. 10.1016/j.thromres.2017.03.003
17
CiuluvicaC.FulcheriM.AmerioP. (2019). Expressive suppression and negative affect, pathways of emotional dysregulation in psoriasis patients. Front. Psychol.10:1907. 10.3389/fpsyg.2019.01907
18
ConversanoC. (2019). Common psychological factors in chronic diseases. Front. Psychol.10:2727. 10.3389/fpsyg.2019.02727
19
ConversanoC.CiacchiniR.OrrùG.Di GiuseppeM.GemignaniA.PoliA. (2020a). Mindfulness, compassion, and self-compassion among health care professionals: What's new? A systematic review. Front. Psychol.11:1683. 10.3389/fpsyg.2020.01683
20
ConversanoC.Di GiuseppeM.CiacchiniR.MiccoliM.GemignaniA.OrrùG. (2020b). Mindfulness as psychological resource against the traumatic experience of COVID-19. Front. Psychol.11:1900. 10.3389/fpsyg.2020.01900
21
ConversanoC.Di GiuseppeM.MiccoliM.CiacchiniR.Di SilvestreA.Lo SterzoR.et al. (2020c). Retrospective analyses of psychological distress and defense style among cancer patients. Clin. Neuropsychiatry17, 217–224. 10.36131/cnfioritieditore20200403
22
ConversanoC.PoliA.CiacchiniR.HitchcottP.BazzichiL.GemignaniA. (2019). A psychoeducational intervention is a treatment for fibromyalgia syndrome. Clin. Exp. Rheumatol.37, S98–S104.
23
CoughlinS. S. (2011). Post-traumatic stress disorder and cardiovascular disease. Open Cardiovasc. Med. J.5, 164–170. 10.2174/1874192401105010164
24
DavisC. R.DearingE.UsherN.TrifilettiS.ZaichenkoL.OllenE.et al. (2014). Detailed assessments of childhood adversity enhance prediction of central obesity independent of gender, race, adult psychosocial risk and health behaviors. Metabolism63, 199–206. 10.1016/j.metabol.2013.08.013
25
Dell'OssoL.CasuG.CarliniM.ConversanoC.GremigniP.CarmassiC. (2012). Sexual obsessions and suicidal behaviors in patients with mood disorders, panic disorder and schizophrenia. Ann. Gen. Psychiatry11:27. 10.1186/1744-859X-11-27
26
DenolletJ.SysS. U.BrutsaertD. L. (1995). Personality and mortality after myocardial infarction. Psychosom. Med.57, 582–591. 10.1097/00006842-199511000-00011
27
Di GiuseppeM.Di SilvestreA.Lo SterzoR.HitchcottP.GemignaniA.ConversanoC. (2019). Qualitative and quantitative analysis of the defense profile in breast cancer women: a pilot study. Health Psychol. Open6:2055102919854667. 10.1177/2055102919854667
28
Di GiuseppeM.PerryJ. C.ConversanoC.GeloO. C. G.GennaroA. (2020a). Defense mechanisms, gender, and adaptiveness in emerging personality disorders in adolescent outpatients. J. Nerv. Ment. Dis.208, 933–941. 10.1097/NMD.0000000000001230
29
Di GiuseppeM.PerryJ. C.LucchesiM.MicheliniM.VitielloS.PiantanidaA.et al. (2020b). Preliminary reliability and validity of the DMRS-SR-30, a novel self-report measure based on the defense mechanisms rating scales. Front. Psychiatry11:870. 10.3389/fpsyt.2020.00870
30
Di GiuseppeM.ProutT. A.FabianiM.KuiT. (2020c). Defensive profile of parents of children with externalizing problems receiving Regulation-Focused Psychotherapy for Children (RFP-C): a pilot study. Mediterr. J. Clin. Psychol. 8. 10.6092/2282-1619/mjcp-2515
31
Di GiuseppeM.Zilcha-ManoS.ProutT. A.PerryJ. C.OrrùG.ConversanoC. (2020d). Psychological impact of coronavirus disease 2019 among Italians during the first week of lockdown. Front. Psychiatry11:576597. 10.3389/fpsyt.2020.576597
32
EikesethF. F.SætrenS. S.BenjaminB. R.Ulltveit-Moe EikenæsI.SÃtterlinS.HummelenB. (2020). The test-retest reliability of heart rate variability and its association with personality functioning. Front. Psychiatry11:558145. 10.3389/fpsyt.2020.558145
33
EysenckH. J. (1994). Cancer, personality and stress: prediction and prevention. Adv. Behav. Res. Ther.16, 167–215. 10.1016/0146-6402(94)00001-8
34
FabioR. A.CaprìT.MohammadhasaniN.GangemiA.GaglianoA.MartinoG. (2018). Frequency bands in seeing and remembering: comparing ADHD and typically developing children. Nuropsychol. Trends24, 97–116. 10.7358/neur-2018-024-fabi
35
FieglS.LahmannC.O'RourkeT.ProbstT.PiehC. (2019). Depression according to ICD-10 clinical interview vs. depression according to the epidemiologic studies depression scale to predict pain therapy outcomes. Front. Psychol.10:1862. 10.3389/fpsyg.2019.01862
36
FisherH. L.JonesP. B.FearonP.CraigT. K.DazzanP.MorganK.et al. (2010). The varying impact of type, timing and frequency of exposure to childhood adversity on its association with adult psychotic disorder. Psychol. Med.40, 1967–1978. 10.1017/S0033291710000231
37
FonagyP. (2015). The effectiveness of psychodynamic psychotherapies: an update. World Psychiatry14, 137–150. 10.1002/wps.20235
38
FriedmanM.RosenmanR. H. (1959). Association of specific overt behavior pattern with blood and cardiovascular findings. J. Am. Med. Assoc.169, 1286–1296. 10.1001/jama.1959.03000290012005
39
GarssenB. (2004). Psychological factors and cancer development: evidence after 30 years of research. Clin. Psychol. Rev.24, 315–338. 10.1016/j.cpr.2004.01.002
40
GeloO. C.SalvatoreS. (2016). A dynamic systems approach to psychotherapy: a meta-theoretical framework for explaining psychotherapy change processes. J. Couns. Psychol. 63, 379–395. 10.1037/cou0000150
41
Giese-DavisJ. C. (2008). Exploring emotion-regulation and autonomic physiology in metastatic breast cancer patients: repression, suppression, and restraint of hostility. Pers. Individ. Dif.44, 226–237. 10.1016/j.paid.2007.08.002
42
GreerS.MorrisT. (1975). Psychological attributes of women who develop breast cancer: a controlled study. J. Psychosom. Res.19, 147–153. 10.1016/0022-3999(75)90062-8
43
GuicciardiM.CrisafulliA.DonedduA.FaddaD.LecisR. (2019). Effects of metabolic syndrome on cognitive performance of adults during exercise. Front. Psychol.10:1845. 10.3389/fpsyg.2019.01845
44
HintistanS.CilingirD.BirinciN. (2013). Alexithymia among elderly patients with diabetes. Pak. J. Med. Sci.29:1344. 10.12669/pjms.296.2159
45
HolzerB. M.SiebenhuenerK.BoppM.MinderC. E. (2017). Evidence-based design recommendations for prevalence studies on multimorbidity: improving comparability of estimates. Popul Health Metrics15:9. 10.1186/s12963-017-0126-4
46
HonkalampiK.Koivumaa-HonkanenH.LehtoS. M.HintikkaJ.HaatainenK.RissanenT.et al. (2010). Is alexithymia a risk factor for major depression, personality disorder, or alcohol use disorders? A prospective populationbased study. J. Psychosom. Res.68, 269–273. 10.1016/j.jpsychores.2009.05.010
47
HorwoodS.AnglimJ.TooleyG. (2015). Type D personality and the five-factor model: a facet-level analysis. Pers. Individ. Differ.83, 50–54. 10.1016/j.paid.2015.03.041
48
HyphantisT.AlmyroudiA.PaikaV.DegnerL. F.CarvalhoA. F.PavlidisN. (2013a). Anxiety, depression and defense mechanisms associated with treatment decisional preferences and quality of life in non-metastatic breast cancer: a 1-year prospective study. Psychooncology22, 2009–2015. 10.1002/pon.3308
49
HyphantisT.GouliaP.ZerdesI.SolomouS.AndreoulakisE.CarvalhoA. F.et al. (2016). Sense of coherence and defense style predict sleep difficulties in early non-metastatic colorectal cancer. Dig. Dis. Sci.61, 273–282. 10.1007/s10620-015-3843-1
50
HyphantisT.PaikaV.AlmyroudiA.KampletsasE. O.PavlidisN. (2011). Personality variables as predictors of early non-metastatic colorectal cancer patients' psychological distress and health-related quality of life: a one-year prospective study. J. Psychosom. Res.70, 411–421. 10.1016/j.jpsychores.2010.09.011
51
HyphantisT.PapadimitriouI.PetrakisD.FountzilasG.RepanaD.AssimakopoulosK.et al. (2013b). Psychiatric manifestations, personality traits and health-related quality of life in cancer of unknown primary site. Psychooncology22, 2009–2015. 10.1002/pon.3244
52
KellyR. R.McDonaldL. T.JensenN. R.SidlesS. J.LaRueA. C. (2019). Impacts of psychological stress on osteoporosis: clinical implications and treatment interactions. Front. Psychiatry10:200. 10.3389/fpsyt.2019.00200
53
KellyR. R.SidlesS. J.LaRueA. (2020). Effects of neurological disorders on bone health. Front. Psychol.11:612366. 10.3389/fpsyg.2020.612366
54
KesebirS. (2014). Metabolic syndrome and childhood trauma: also comorbidity and complication in mood disorder. World J. Clin. Cases. 2, 332–337. 10.12998/wjcc.v2.i8.332
55
KesslerR. C.BrometE. J. (2013). The epidemiology of depression across cultures. Annu. Rev. Public Health34, 119–138. 10.1146/annurev-publhealth-031912-114409
56
KooleS. L.RothermundK. (2011). “I feel better but I don't know why”: the psychology of implicit emotion regulation. Cogn. Emot.25, 389–399. 10.1080/02699931.2010.550505
57
KreitlerS.ChaitchikS.KreitlersH. (1993). Repressiveness: cause or result of cancer?Psychooncology2, 43–54. 10.1002/pon.2960020107
58
LauriolaM.TomaiM.PalmaR.La SpinaG.FogliaA.PanettaC.et al. (2019). Intolerance of uncertainty and anxiety-related dispositions predict pain during upper endoscopy. Front. Psychol.10:1112. 10.3389/fpsyg.2019.01112
59
LemogneC.ConsoliS. M.Geoffroy-PerezB.Coeuret-PellicerM.NabiH.MerchiorM.et al. (2013). Personality and the risk of cancer: a 16-years follow-up study of the GAZEL cohort. Psychosom. Med.75, 262–271. 10.1097/PSY.0b013e31828b5366
60
LenzoV.SardellaA.MartinoG.QuattropaniM. C. (2020). A systematic review of metacognitive beliefs in chronic medical conditions. Front. Psychol.10:2875. 10.3389/fpsyg.2019.02875
61
LewekeF.LeichsenringF.KruseJ.HermesS. (2012). Is alexithymia associated with specific mental disorders?Psychopathology45, 22–28. 10.1159/000325170
62
LiL.Pinto PereiraS. M.PowerC. (2019). Childhood maltreatment and biomarkers for cardiometabolic disease in mid-adulthood in a prospective British birth cohort: associations and potential explanations. BMJ Open9:e024079. 10.1136/bmjopen-2018-024079
63
LingiardiV.GazzilloF.ColliA.De BeiF.TanzilliA.Di GiuseppeM.et al. (2010). Diagnosis and assessment of personality, therapeutic alliance and clinical exchange in psychotherapy research. Res. Psychother.2, 97–124.
64
LumleyM. A.GustavsonB. J.PartridgeR. T.Labouvie-ViefG. (2005). Assessing alexithymia and related emotional ability constructs using multiple methods: interrelationships among measures. Emotion5:329. 10.1037/1528-3542.5.3.329
65
LumleyM. A.NeelyL. C.BurgerA. J. (2007). The assessment of alexithymia in medical settings: implications for understanding and treating health problems. J. Pers. Asses.89, 230–246. 10.1080/00223890701629698
66
MarazzitiD.TomaiuoloF.Dell'OssoL.DemiV.CampanaS.PiccalugaE.et al. (2015). Neuropsychological testing in interventional cardiology staff after long-term exposure to ionizing radiation. J. Int. Neuropsychol. Soc.21:670. 10.1017/S135561771500082X
67
MarchiL.MarzettiF.OrrùG.LemmettiS.MiccoliM.CiacchiniR.et al. (2019). Alexithymia and psychological distress in patients with fibromyalgia and rheumatic disease. Front. Psychol.10:1735. 10.3389/fpsyg.2019.01735
68
MartinoG.CaputoA.BelloneF.QuattropaniM. C.VicarioC. M. (2020a). Going beyond the visible in type 2 diabetes mellitus: defense mechanisms and their associations with depression and health-related quality of life. Front. Psychol.11:267. 10.3389/fpsyg.2020.00267
69
MartinoG.CaputoA.SchwarzP.FriesW.BelloneF.QuattropaniM. C.et al. (2020b). Alexithymia and inflammatory bowel disease: a systematic review. Front. Psychol.11:1763. 10.3389/fpsyg.2020.01763
70
MartinoG.CaputoA.VicarioC. M.CatalanoA.SchwarzP.QuattropaniM. C. (2020c). The relationship between alexithymia and type 2 diabetes: a systematic review. Front. Psychol.11:2026. 10.3389/fpsyg.2020.02026
71
MartinoG.CatalanoA.AgostinoR. M.BelloneF.MorabitoN.LascoC. G.et al. (2020d). Quality of life and psychological functioning in postmenopausal women undergoing aromatase inhibitor treatment for early breast cancer. PLoS ONE15:e0230681. 10.1371/journal.pone.0230681
72
MartinoG.CatalanoA.BelloneF.RussoG. T.VicarioC. M.LascoA.et al. (2019a). As time goes by: anxiety negatively affects the perceived quality of life in patients with type 2 diabetes of long duration. Front. Psychol.10:1779. 10.3389/fpsyg.2019.01779
73
MartinoG.LangherV.CazzatoV.VicarioC. M. (2019b). Editorial: Psychological factors as determinants of medical conditions. Front. Psychol.10:2502. 10.3389/fpsyg.2019.02502
74
MazaheriM.AfsharH.WeinlandS.MohammadiN.AdibiP. (2012). Alexithymia and functional gastrointestinal disorders (FGID). Med. Arch.66:28. 10.5455/medarh.2012.66.28-32
75
McFarlaneA. C. (2010). The long-term costs of traumatic stress: intertwined physical and psychological consequences. World Psychiatry9, 3–10. 10.1002/j.2051-5545.2010.tb00254.x
76
MerloE. M. (2019). Opinion article: The role of psychological features in chronic diseases, advances and perspectives. Mediterr. J. Clin. Psychol. 7, 1–6. 10.6092/2282-1619/2019.7.2341
77
MerloE. M.StoianA.MotofeiI. G.SettineriS. (2020). Clinical psychological figures in healthcare professionals: resilience and maladjustment as the “cost of care”. Front. Psychol.11:607783. 10.3389/fpsyg.2020.607783
78
MnifL.DamakR.MnifF.OuanesS.AbidM.JaouaA.et al. (2014). Alexithymia impact on type 1 and type 2 diabetes: a case-control study. Ann. Endocrinol.75, 213–219. 10.1016/j.ando.2014.06.001
79
OgleC. M.RubinD. C.SieglerI. C. (2013). The impact of the developmental timing of trauma exposure on PTSD symptoms and psychosocial functioning among older adults. Dev. Psychol.49, 2191–2200. 10.1037/a0031985
80
OlsonE. A.MullenS. P.RaineL. B.KramerA. F.HillmanC. H.McAuleyE. (2017). Integrated social- and neurocognitive model of physical activity behavior in older adults with metabolic disease. Ann. Behav. Med.51, 272–281. 10.1007/s12160-016-9850-4
81
OrrùG.CiacchiniR.GemignaniA.ConversanoC. (2020). Psychological intervention measures during the COVID-19 pandemic. Clin. Neuropsychiatry17, 76–79. 10.36131/CN20200208
82
PaikaV.AlmyroudiA.TomensonB.CreedF.KampletsasE. O.SiafakaV.et al. (2010). Personality variables are associated with colorectal cancer patients' quality of life independent of psychological distress and disease severity. Psychooncology19, 273–282. 10.1002/pon.1563
83
PalaginiL.CarmassiC.ConversanoC.GesiC.BazzichiL.GiacomelliC.et al. (2016). Transdiagnostic factors across fibromyalgia and mental disorders: sleep disturbances may play a key role. A clinical review. Clin. Exp. Rheumatol. 34(2 Suppl 96), S140–S144.
84
PerryJ. C.BanonE.BondM. (2020). Change in defense mechanisms and depression in a pilot study of antidepressive medications plus 20 sessions of psychotherapy for recurrent major depression. J. Nerv. Ment. Dis.208, 261–268. 10.1097/NMD.0000000000001112
85
PerryJ. C.MetzgerJ.SigalJ. J. (2015). Defensive functioning among women with breast cancer and matched community controls. Psychiatry78, 156–169. 10.1080/00332747.2015.1051445
86
PervanidouP.ChrousosG. P. (2012). Metabolic consequences of stress during childhood and adolescence. Metabolism61, 611–619. 10.1016/j.metabol.2011.10.005
87
PéterfalviÁ.NémethN.HerczegR.TényiT.MisetaA.CzéhB.et al. (2019). Examining the influence of early life stress on serum lipid profiles and cognitive functioning in depressed patients. Front. Psychol.10:1798. 10.3389/fpsyg.2019.01798
88
PetricD.FranciskovicT.JureticM.SukovicZ.GraovacM.RackiS.et al. (2011). Defense mechanisms in alcohol dependent patients with oral and oropharinegal cancer. Coll Antropol.35, 809–816.
89
PhiferJ. F.NorrisF. H. (1989). Psychological symptoms in older adults following natural disaster: nature, timing, duration, and course. J. Gerontol. 44, S207–S212. 10.1093/geronj/44.6.S207
90
PiccinniA.OrigliaN.VeltriA.VizzaccaroC.MarazzitiD.Catena-Dell'OssoM.et al. (2012). Plasma β-amyloid peptides levels: a pilot study in bipolar depressed patients. J. Affect. Disord.138, 160–164. 10.1016/j.jad.2011.12.042
91
PorcerelliJ. H.CramerP.PorcerelliD. J.ArterberyV. E. (2017). Defense mechanisms and utilization in cancer patients undergoing radiation therapy. A pilot study. J. Nerv. Ment. Dis.205, 466–470. 10.1097/NMD.0000000000000674
92
PouwerF.KupperN.AdriaanseM. C. (2010). Does emotional stress cause type 2 diabetes mellitus? A review from the european depression in diabetes (EDID) research consortium. Discov. Med.9, 112–118.
93
PriceM. A.TennantC. C.ButowP. N.SmithR. C.KennedyS. J.KossoffM. B.et al. (2001). The role of psychosocial factors in the development of breast carcinoma: Part II. Life event stressors, social support, defense style, and emotional control and their interactions. Cancer91, 686–697. 10.1002/1097-0142(20010215)91:4<686::AID-CNCR1052>3.0.CO;2-0
94
ProutT. A.Zilcha-ManoS.Aafjes-van DoornK.BékésV.Christman-CohenI.WhistlerK.et al. (2020). Identifying predictors of psychological distress during COVID-19: a machine learning approach. Front. Psychol.11:586202. 10.3389/fpsyg.2020.586202
95
RadziejK.SchmidG.DinkelA.ZwergalA.LahmannC. (2015). Psychological traumatization and adverse life events in patients with organic and functional vestibular symptoms. J.Psychosom. Res.79, 123–129. 10.1016/j.jpsychores.2015.05.005
96
Rich-EdwardsJ. W.MasonS.RexrodeK.SpiegelmanD.HibertE.KawachiI.et al. (2012). Physical and sexual abuse in childhood as predictors of early onset cardiovascular events in women. Circulation126, 920–927. 10.1161/CIRCULATIONAHA.111.076877
97
RockP. L.RoiserJ. P.RiedelW. J.BlackwellA. D. (2014). Cognitive impairment in depression: a systematic review and meta-analysis. Psychol. Med.44, 2029–2040. 10.1017/S0033291713002535
98
RosaV.TomaiM.LauriolaM.MartinoG.Di TraniM. (2019). Body mass index, personality traits, and body image in Italian pre-adolescents: an opportunity for overweight prevention. Psihologija52, 379–393. 10.2298/PSI181121009R
99
RymarczykK.TurbaczA.StrusW.CieciuchJ. (2020). Type C personality: conceptual refinement and preliminary operationalization. Front. Psychol.11:552740. 10.3389/fpsyg.2020.552740
100
SalvatoreS.TschacherW.GeloO. C.KochS. C. (2015). Editorial: dynamic systems theory and embodiment in psychotherapy research. A new look at process and outcome. Front. Psychol.6:914. 10.3389/fpsyg.2015.00914
101
SapozhnikovaI. E.TarlovskaiaE. I.MadianovI. V.VedenskaiaT. P. (2012). The degree of alexithymia in type 2 diabetes mellitus patients and its association with medical and demographic parameters. Ter. Arkh.84, 23–27.
102
SettineriS.FrisoneF.AlibrandiA.MerloE. M. (2019). Emotional suppression and oneiric expression in psychosomatic disorders: early manifestations in emerging adulthood and young patients. Front. Psychol.10:1897. 10.3389/fpsyg.2019.01897
103
SettineriS.MerloE. M.FrisoneF.MarchettiD.VerrocchioM. C.PellegrinoM. G.et al. (2018). The experience of health and suffering in the medical profession. Mediterr. J. Clin. Psychol. 6. 10.6092/2282-1619/2018.6.1874
104
ShinkovA.BorissovaA. M.KovatchevaR.VlahovJ.DakovskaL.AtanassovaI.et al. (2018). Increased prevalence of depression and anxiety among subjects with metabolic syndrome and known type 2 diabetes mellitus - a population based study. Postgrad.Med.130, 251–257. 10.1080/00325481.2018.1410054
105
StantonA. L.HoytM. A. (2017). Psychological Adjustment to Chronic Disease. Perceived Health and Adaptation in Chronic Disease. New York, NY: Routledge.
106
TanzilliA.LingiardiV.HilsenrothM. (2018). Patient SWAP-200 personality dimensions and FFM traits: do they predict therapist responses?Pers. Dis.9, 250–262. 10.1037/per0000260
107
TolmunenT.HelisteM.LehtoS. M.HintikkaJ.HonkalampiK.KauhanenJ. (2011). Stability of alexithymia in the general population: an 11-year follow-up. Compr. Psychiatry52, 536–541. 10.1016/j.comppsych.2010.09.007
108
VeltriA.ScarpelliniP.PiccinniA.ConversanoC.GiacomelliC.BombardieriS.et al. (2012). Methodological approach to depressive symptoms in fibromyalgia patients. Clin. Exp. Rheumatol.30, S136–S142.
109
VicarioC. M.NitscheM. A.SalehinejadM. A.AvanzinoL.MartinoG. (2020). Time processing, interoception, and insula activation: a mini-review on clinical disorders. Front. Psychol.11:1893. 10.3389/fpsyg.2020.01893
110
VogenbergF. R.Isaacson BarashC.PurselM. (2010). Personalized medicine: part 1: evolution and development into theranostics. P & T35, 560–576.
111
WatsonM.HavilandJ. S.GreerS.DavidsonJ.BlissJ. M. (1999). Influence of psychological response on survival in breast cancer: a population-based cohort study. Lancet354, 1331–1336. 10.1016/S0140-6736(98)11392-2
112
WeihsK. L.EnrightT. M.SimmensS. J.ReissD. (2000). Negative affectivity, restriction of emotions, and site of metastases predict mortality in recurrent breast cancer. J. Psychosom. Res.49, 59–68. 10.1016/S0022-3999(00)00143-4
113
WillemsenR.RoseeuwD.VanderlindenJ. (2008). Alexithymia and dermatology: the state of the art. Int. J. Dermatol.47, 903–910. 10.1111/j.1365-4632.2008.03726.x
114
WilliamsL. J.QuirkS.KoivumaaH.HonkanenR.PascoJ. A.StuartA. L.et al. (2020). Personality disorder and physical health comorbidities: a link with bone health?Front. Psychiatry11:602342. 10.3389/fpsyt.2020.602342
115
WootenT.FerlandT.PooleV.MilbergW.McGlincheyR.DeGutisJ.et al. (2019). Metabolic risk in older adults is associated with impaired sustained attention. Neuropsychology33, 947–955. 10.1037/neu0000554
116
YaffeK.WestonA. L.BlackwellT.KruegerK. A. (2009). The metabolic syndrome and development of cognitive impairment among older women. Arch. Neurol.66, 324–328. 10.1001/archneurol.2008.566
117
YatesK. F.SweatV.YauP. L.TurchianoM. M.ConvitA. (2012). Impact of metabolic syndrome on cognition and brain: a selected review of the literature. Arterioscler. Thromb. Vasc. Biol.32, 2060–2067. 10.1161/ATVBAHA.112.252759
118
Yonatan-LeusR.StraussA. Y.Cooper-KazazR. (2020). Psychodynamic psychotherapy is associated with sustained reduction in health care utilization and cost. Clin. Psychol. Psychother.10.1002/cpp.2527. [Epub ahead of print].
119
YooJ.RyffC. D. (2019). Longitudinal profiles of psychological well-being and health: findings from Japan. Front. Psychol.10:2746. 10.3389/fpsyg.2019.02746
120
Zilcha-ManoS. (2020). Toward personalized psychotherapy: the importance of the trait-like/state-like distinction for understanding therapeutic change. Am. Psychol.10.1037/amp0000629. [Epub ahead of print].
121
ZimmermanT. N.PorcerelliJ. H.ArterberyV. E. (2019). Defensive functioning in cancer patients, cancer survivors, and controls. Psychoanal. Psychol.36, 259–262. 10.1037/pap0000225
Summary
Keywords
chronic disease, personality, defense mechanisms, depression, alexitimia, psychosomatic, post-traumatic stress disorder
Citation
Conversano C and Di Giuseppe M (2021) Psychological Factors as Determinants of Chronic Conditions: Clinical and Psychodynamic Advances. Front. Psychol. 12:635708. doi: 10.3389/fpsyg.2021.635708
Received
30 November 2020
Accepted
08 January 2021
Published
28 January 2021
Volume
12 - 2021
Edited by
Gabriella Martino, University of Messina, Italy
Reviewed by
Amanda C. LaRue, Medical University of South Carolina, United States
Updates
Copyright
© 2021 Conversano and Di Giuseppe.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Mariagrazia Di Giuseppe mariagrazia.digiuseppe@gmail.com
This article was submitted to Psychopathology, a section of the journal Frontiers in Psychology
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.