Ciro Conversano
Mariagrazia Di Giuseppe- Department of Surgical, Medical and Molecular Pathology, Critical and Care Medicine, University of Pisa, Pisa, Italy
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).
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
Abad-Díez, J. M., Calderón-Larrañaga, A., Poncel-Falcó, A., Poblador-Plou, B., Calderón-Meza, J. M., Sicras-Mainar, A., et al. (2014). Age and gender differences in the prevalence and patterns of multimorbidity in the older population. BMC Geriatr. 14:75. doi: 10.1186/1471-2318-14-75
Afari, N., Ahumada, S., Wright, L. J., Mostoufi, S., Golnari, G., Reis, V., et al. (2014). Psychological trauma and functional somatic syndromes: a systematic review and meta-analysis. Psychosom. Med. 76, 2–11. doi: 10.1097/PSY.0000000000000010
Alonzo, A. A. (2000). The experience of chronic illness and post-traumatic stress disorder: the consequences of cumulative adversity. Soc. Sci. Med. 50, 1475–1484. doi: 10.1016/S0277-9536(99)00399-8
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edn. Washington, DC: American Psychiatric Association.
Bahnson, C. B., and Bahnson, M. B. (1966). Role of the ego defenses: denial and repression in the etiology of malignant neoplasm. Ann. N.Y. Acad. Sci. 125, 827–845. doi: 10.1111/j.1749-6632.1966.tb45434.x
Barrera, I., and Spiegel, D. (2014). Review of psychotherapeutic interventions on depression in cancer patients and their impact on disease progression. Int. Rev. Psychiatry 26, 31–43. doi: 10.3109/09540261.2013.864259
Bartolato, B., Hyphantis, T. N., Valpione, S., Perini, G., Maes, M., Morris, G., et al. (2017). Depression in cancer: the many biobehavioral pathways driving tumor progression. Cancer Treat. Rev. 52, 58–70. doi: 10.1016/j.ctrv.2016.11.004
Beresford, T., Alfers, J., Mangum, L., Clapp, L., and Martin, B. (2006). Cancer survival probability as a function of ego defense (adaptive) mechanisms versus depressive symptoms. Psychosomatics 47, 247–253. doi: 10.1176/appi.psy.47.3.247
Boldrini, T., Tanzilli, A., Pontillo, M., Chirumbolo, A., Vicari, S., and Lingiardi, V. (2019). Comorbid personality disorders in individuals with an at-risk mental state for psychosis: a meta-analytic review. Front. Psychiatry 10:429. doi: 10.3389/fpsyt.2019.00429
Boscarino, J. A., and Figley, C. 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. doi: 10.1097/NMD.0b013e3181a61f3e
Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., et al. (2020). The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet 395, 912–920. doi: 10.1016/S0140-6736(20)30460-8
Carmassi, C., Gesi, C., Corsi, M., Cremone, I. M., Bertelloni, C. A., Massimetti, E., 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. Psychiatry 17:17. doi: 10.1186/s12991-018-0184-4
Carmassi, C., Stratta, P., Massimetti, G., Bertelloni, C. A., Conversano, C., Cremone, I. 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. Psychiatry 13, 1–9. doi: 10.1186/s12991-014-0028-9
Catalano, A., Martino, G., Bellone, F., Gaudio, A., Lasco, C., Langher, V., et al. (2018). Anxiety levels predict fracture risk in postmenopausal women assessed for osteoporosis. Menopause 25, 1110–1115. doi: 10.1097/GME.0000000000001123
Catalano, A., Martino, G., Bellone, F., Papalia, M., Lasco, C., Basile, G., et al. (2019). Neuropsychological assessment in elderly men with benign prostatic hyperplasia treated with dutasteride. Clin. Drug Invest. 39, 97–102. doi: 10.1007/s40261-018-0720-7
Chaturvedi, S., Clancy, M., Schaefer, N., Oluwole, O., and McCrae, K. R. (2017). Depression and post-traumatic stress disorder in individuals with hereditary hemorrhagic telangiectasia: a cross-sectional survey. Thrombosis Res. 153, 14–18. doi: 10.1016/j.thromres.2017.03.003
Ciuluvica, C., Fulcheri, M., and Amerio, P. (2019). Expressive suppression and negative affect, pathways of emotional dysregulation in psoriasis patients. Front. Psychol. 10:1907. doi: 10.3389/fpsyg.2019.01907
Conversano, C. (2019). Common psychological factors in chronic diseases. Front. Psychol. 10:2727. doi: 10.3389/fpsyg.2019.02727
Conversano, C., Ciacchini, R., Orrù, G., Di Giuseppe, M., Gemignani, A., and Poli, A. (2020a). Mindfulness, compassion, and self-compassion among health care professionals: What's new? A systematic review. Front. Psychol. 11:1683. doi: 10.3389/fpsyg.2020.01683
Conversano, C., Di Giuseppe, M., Ciacchini, R., Miccoli, M., Gemignani, A., and Orrù, G. (2020b). Mindfulness as psychological resource against the traumatic experience of COVID-19. Front. Psychol. 11:1900. doi: 10.3389/fpsyg.2020.01900
Conversano, C., Di Giuseppe, M., Miccoli, M., Ciacchini, R., Di Silvestre, A., Lo Sterzo, R., et al. (2020c). Retrospective analyses of psychological distress and defense style among cancer patients. Clin. Neuropsychiatry 17, 217–224. doi: 10.36131/cnfioritieditore20200403
Conversano, C., Poli, A., Ciacchini, R., Hitchcott, P., Bazzichi, L., and Gemignani, A. (2019). A psychoeducational intervention is a treatment for fibromyalgia syndrome. Clin. Exp. Rheumatol. 37, S98–S104.
Coughlin, S. S. (2011). Post-traumatic stress disorder and cardiovascular disease. Open Cardiovasc. Med. J. 5, 164–170. doi: 10.2174/1874192401105010164
Davis, C. R., Dearing, E., Usher, N., Trifiletti, S., Zaichenko, L., Ollen, E., et al. (2014). Detailed assessments of childhood adversity enhance prediction of central obesity independent of gender, race, adult psychosocial risk and health behaviors. Metabolism 63, 199–206. doi: 10.1016/j.metabol.2013.08.013
Dell'Osso, L., Casu, G., Carlini, M., Conversano, C., Gremigni, P., and Carmassi, C. (2012). Sexual obsessions and suicidal behaviors in patients with mood disorders, panic disorder and schizophrenia. Ann. Gen. Psychiatry 11:27. doi: 10.1186/1744-859X-11-27
Denollet, J., Sys, S. U., and Brutsaert, D. L. (1995). Personality and mortality after myocardial infarction. Psychosom. Med. 57, 582–591. doi: 10.1097/00006842-199511000-00011
Di Giuseppe, M., Di Silvestre, A., Lo Sterzo, R., Hitchcott, P., Gemignani, A., and Conversano, C. (2019). Qualitative and quantitative analysis of the defense profile in breast cancer women: a pilot study. Health Psychol. Open 6:2055102919854667. doi: 10.1177/2055102919854667
Di Giuseppe, M., Perry, J. C., Conversano, C., Gelo, O. C. G., and Gennaro, A. (2020a). Defense mechanisms, gender, and adaptiveness in emerging personality disorders in adolescent outpatients. J. Nerv. Ment. Dis. 208, 933–941. doi: 10.1097/NMD.0000000000001230
Di Giuseppe, M., Perry, J. C., Lucchesi, M., Michelini, M., Vitiello, S., Piantanida, A., 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. Psychiatry 11:870. doi: 10.3389/fpsyt.2020.00870
Di Giuseppe, M., Prout, T. A., Fabiani, M., and Kui, T. (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. doi: 10.6092/2282-1619/mjcp-2515
Di Giuseppe, M., Zilcha-Mano, S., Prout, T. A., Perry, J. C., Orrù, G., and Conversano, C. (2020d). Psychological impact of coronavirus disease 2019 among Italians during the first week of lockdown. Front. Psychiatry 11:576597. doi: 10.3389/fpsyt.2020.576597
Eikeseth, F. F., Sætren, S. S., Benjamin, B. R., Ulltveit-Moe Eikenæs, I., SÃtterlin, S., and Hummelen, B. (2020). The test-retest reliability of heart rate variability and its association with personality functioning. Front. Psychiatry 11:558145. doi: 10.3389/fpsyt.2020.558145
Eysenck, H. J. (1994). Cancer, personality and stress: prediction and prevention. Adv. Behav. Res. Ther. 16, 167–215. doi: 10.1016/0146-6402(94)00001-8
Fabio, R. A., Caprì, T., Mohammadhasani, N., Gangemi, A., Gagliano, A., and Martino, G. (2018). Frequency bands in seeing and remembering: comparing ADHD and typically developing children. Nuropsychol. Trends 24, 97–116. doi: 10.7358/neur-2018-024-fabi
Fiegl, S., Lahmann, C., O'Rourke, T., Probst, T., and Pieh, C. (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. doi: 10.3389/fpsyg.2019.01862
Fisher, H. L., Jones, P. B., Fearon, P., Craig, T. K., Dazzan, P., Morgan, K., 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. doi: 10.1017/S0033291710000231
Fonagy, P. (2015). The effectiveness of psychodynamic psychotherapies: an update. World Psychiatry 14, 137–150. doi: 10.1002/wps.20235
Friedman, M., and Rosenman, R. H. (1959). Association of specific overt behavior pattern with blood and cardiovascular findings. J. Am. Med. Assoc. 169, 1286–1296. doi: 10.1001/jama.1959.03000290012005
Garssen, B. (2004). Psychological factors and cancer development: evidence after 30 years of research. Clin. Psychol. Rev. 24, 315–338. doi: 10.1016/j.cpr.2004.01.002
Gelo, O. C., and Salvatore, S. (2016). A dynamic systems approach to psychotherapy: a meta-theoretical framework for explaining psychotherapy change processes. J. Couns. Psychol. 63, 379–395. doi: 10.1037/cou0000150
Giese-Davis, J. 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. doi: 10.1016/j.paid.2007.08.002
Greer, S., and Morris, T. (1975). Psychological attributes of women who develop breast cancer: a controlled study. J. Psychosom. Res. 19, 147–153. doi: 10.1016/0022-3999(75)90062-8
Guicciardi, M., Crisafulli, A., Doneddu, A., Fadda, D., and Lecis, R. (2019). Effects of metabolic syndrome on cognitive performance of adults during exercise. Front. Psychol. 10:1845. doi: 10.3389/fpsyg.2019.01845
Hintistan, S., Cilingir, D., and Birinci, N. (2013). Alexithymia among elderly patients with diabetes. Pak. J. Med. Sci. 29:1344. doi: 10.12669/pjms.296.2159
Holzer, B. M., Siebenhuener, K., Bopp, M., and Minder, C. E. (2017). Evidence-based design recommendations for prevalence studies on multimorbidity: improving comparability of estimates. Popul Health Metrics 15:9. doi: 10.1186/s12963-017-0126-4
Honkalampi, K., Koivumaa-Honkanen, H., Lehto, S. M., Hintikka, J., Haatainen, K., Rissanen, T., 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. doi: 10.1016/j.jpsychores.2009.05.010
Horwood, S., Anglim, J., and Tooley, G. (2015). Type D personality and the five-factor model: a facet-level analysis. Pers. Individ. Differ. 83, 50–54. doi: 10.1016/j.paid.2015.03.041
Hyphantis, T., Almyroudi, A., Paika, V., Degner, L. F., Carvalho, A. F., and Pavlidis, N. (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. Psychooncology 22, 2009–2015. doi: 10.1002/pon.3308
Hyphantis, T., Goulia, P., Zerdes, I., Solomou, S., Andreoulakis, E., Carvalho, A. 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. doi: 10.1007/s10620-015-3843-1
Hyphantis, T., Paika, V., Almyroudi, A., Kampletsas, E. O., and Pavlidis, N. (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. doi: 10.1016/j.jpsychores.2010.09.011
Hyphantis, T., Papadimitriou, I., Petrakis, D., Fountzilas, G., Repana, D., Assimakopoulos, K., et al. (2013b). Psychiatric manifestations, personality traits and health-related quality of life in cancer of unknown primary site. Psychooncology 22, 2009–2015. doi: 10.1002/pon.3244
Kelly, R. R., McDonald, L. T., Jensen, N. R., Sidles, S. J., and LaRue, A. C. (2019). Impacts of psychological stress on osteoporosis: clinical implications and treatment interactions. Front. Psychiatry 10:200. doi: 10.3389/fpsyt.2019.00200
Kelly, R. R., Sidles, S. J., and LaRue, A. (2020). Effects of neurological disorders on bone health. Front. Psychol. 11:612366. doi: 10.3389/fpsyg.2020.612366
Kesebir, S. (2014). Metabolic syndrome and childhood trauma: also comorbidity and complication in mood disorder. World J. Clin. Cases. 2, 332–337. doi: 10.12998/wjcc.v2.i8.332
Kessler, R. C., and Bromet, E. J. (2013). The epidemiology of depression across cultures. Annu. Rev. Public Health 34, 119–138. doi: 10.1146/annurev-publhealth-031912-114409
Koole, S. L., and Rothermund, K. (2011). “I feel better but I don't know why”: the psychology of implicit emotion regulation. Cogn. Emot. 25, 389–399. doi: 10.1080/02699931.2010.550505
Kreitler, S., Chaitchik, S., and Kreitlers, H. (1993). Repressiveness: cause or result of cancer? Psychooncology 2, 43–54. doi: 10.1002/pon.2960020107
Lauriola, M., Tomai, M., Palma, R., La Spina, G., Foglia, A., Panetta, C., et al. (2019). Intolerance of uncertainty and anxiety-related dispositions predict pain during upper endoscopy. Front. Psychol. 10:1112. doi: 10.3389/fpsyg.2019.01112
Lemogne, C., Consoli, S. M., Geoffroy-Perez, B., Coeuret-Pellicer, M., Nabi, H., Merchior, M., et al. (2013). Personality and the risk of cancer: a 16-years follow-up study of the GAZEL cohort. Psychosom. Med. 75, 262–271. doi: 10.1097/PSY.0b013e31828b5366
Lenzo, V., Sardella, A., Martino, G., and Quattropani, M. C. (2020). A systematic review of metacognitive beliefs in chronic medical conditions. Front. Psychol. 10:2875. doi: 10.3389/fpsyg.2019.02875
Leweke, F., Leichsenring, F., Kruse, J., and Hermes, S. (2012). Is alexithymia associated with specific mental disorders? Psychopathology 45, 22–28. doi: 10.1159/000325170
Li, L., Pinto Pereira, S. M., and Power, C. (2019). Childhood maltreatment and biomarkers for cardiometabolic disease in mid-adulthood in a prospective British birth cohort: associations and potential explanations. BMJ Open 9:e024079. doi: 10.1136/bmjopen-2018-024079
Lingiardi, V., Gazzillo, F., Colli, A., De Bei, F., Tanzilli, A., Di Giuseppe, M., et al. (2010). Diagnosis and assessment of personality, therapeutic alliance and clinical exchange in psychotherapy research. Res. Psychother. 2, 97–124.
Lumley, M. A., Gustavson, B. J., Partridge, R. T., and Labouvie-Vief, G. (2005). Assessing alexithymia and related emotional ability constructs using multiple methods: interrelationships among measures. Emotion 5:329. doi: 10.1037/1528-3542.5.3.329
Lumley, M. A., Neely, L. C., and Burger, A. J. (2007). The assessment of alexithymia in medical settings: implications for understanding and treating health problems. J. Pers. Asses. 89, 230–246. doi: 10.1080/00223890701629698
Marazziti, D., Tomaiuolo, F., Dell'Osso, L., Demi, V., Campana, S., Piccaluga, E., et al. (2015). Neuropsychological testing in interventional cardiology staff after long-term exposure to ionizing radiation. J. Int. Neuropsychol. Soc. 21:670. doi: 10.1017/S135561771500082X
Marchi, L., Marzetti, F., Orrù, G., Lemmetti, S., Miccoli, M., Ciacchini, R., et al. (2019). Alexithymia and psychological distress in patients with fibromyalgia and rheumatic disease. Front. Psychol. 10:1735. doi: 10.3389/fpsyg.2019.01735
Martino, G., Caputo, A., Bellone, F., Quattropani, M. C., and Vicario, C. 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. doi: 10.3389/fpsyg.2020.00267
Martino, G., Caputo, A., Schwarz, P., Fries, W., Bellone, F., Quattropani, M. C., et al. (2020b). Alexithymia and inflammatory bowel disease: a systematic review. Front. Psychol. 11:1763. doi: 10.3389/fpsyg.2020.01763
Martino, G., Caputo, A., Vicario, C. M., Catalano, A., Schwarz, P., and Quattropani, M. C. (2020c). The relationship between alexithymia and type 2 diabetes: a systematic review. Front. Psychol. 11:2026. doi: 10.3389/fpsyg.2020.02026
Martino, G., Catalano, A., Agostino, R. M., Bellone, F., Morabito, N., Lasco, C. G., et al. (2020d). Quality of life and psychological functioning in postmenopausal women undergoing aromatase inhibitor treatment for early breast cancer. PLoS ONE 15:e0230681. doi: 10.1371/journal.pone.0230681
Martino, G., Catalano, A., Bellone, F., Russo, G. T., Vicario, C. M., Lasco, A., 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. doi: 10.3389/fpsyg.2019.01779
Martino, G., Langher, V., Cazzato, V., and Vicario, C. M. (2019b). Editorial: Psychological factors as determinants of medical conditions. Front. Psychol. 10:2502. doi: 10.3389/fpsyg.2019.02502
Mazaheri, M., Afshar, H., Weinland, S., Mohammadi, N., and Adibi, P. (2012). Alexithymia and functional gastrointestinal disorders (FGID). Med. Arch. 66:28. doi: 10.5455/medarh.2012.66.28-32
McFarlane, A. C. (2010). The long-term costs of traumatic stress: intertwined physical and psychological consequences. World Psychiatry 9, 3–10. doi: 10.1002/j.2051-5545.2010.tb00254.x
Merlo, E. M. (2019). Opinion article: The role of psychological features in chronic diseases, advances and perspectives. Mediterr. J. Clin. Psychol. 7, 1–6. doi: 10.6092/2282-1619/2019.7.2341
Merlo, E. M., Stoian, A., Motofei, I. G., and Settineri, S. (2020). Clinical psychological figures in healthcare professionals: resilience and maladjustment as the “cost of care”. Front. Psychol. 11:607783. doi: 10.3389/fpsyg.2020.607783
Mnif, L., Damak, R., Mnif, F., Ouanes, S., Abid, M., Jaoua, A., et al. (2014). Alexithymia impact on type 1 and type 2 diabetes: a case-control study. Ann. Endocrinol. 75, 213–219. doi: 10.1016/j.ando.2014.06.001
Ogle, C. M., Rubin, D. C., and Siegler, I. 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. doi: 10.1037/a0031985
Olson, E. A., Mullen, S. P., Raine, L. B., Kramer, A. F., Hillman, C. H., and McAuley, E. (2017). Integrated social- and neurocognitive model of physical activity behavior in older adults with metabolic disease. Ann. Behav. Med. 51, 272–281. doi: 10.1007/s12160-016-9850-4
Orrù, G., Ciacchini, R., Gemignani, A., and Conversano, C. (2020). Psychological intervention measures during the COVID-19 pandemic. Clin. Neuropsychiatry 17, 76–79. doi: 10.36131/CN20200208
Paika, V., Almyroudi, A., Tomenson, B., Creed, F., Kampletsas, E. O., Siafaka, V., et al. (2010). Personality variables are associated with colorectal cancer patients' quality of life independent of psychological distress and disease severity. Psychooncology 19, 273–282. doi: 10.1002/pon.1563
Palagini, L., Carmassi, C., Conversano, C., Gesi, C., Bazzichi, L., Giacomelli, C., 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.
Perry, J. C., Banon, E., and Bond, M. (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. doi: 10.1097/NMD.0000000000001112
Perry, J. C., Metzger, J., and Sigal, J. J. (2015). Defensive functioning among women with breast cancer and matched community controls. Psychiatry 78, 156–169. doi: 10.1080/00332747.2015.1051445
Pervanidou, P., and Chrousos, G. P. (2012). Metabolic consequences of stress during childhood and adolescence. Metabolism 61, 611–619. doi: 10.1016/j.metabol.2011.10.005
Péterfalvi, Á., Németh, N., Herczeg, R., Tényi, T., Miseta, A., Czéh, B., et al. (2019). Examining the influence of early life stress on serum lipid profiles and cognitive functioning in depressed patients. Front. Psychol. 10:1798. doi: 10.3389/fpsyg.2019.01798
Petric, D., Franciskovic, T., Juretic, M., Sukovic, Z., Graovac, M., Racki, S., et al. (2011). Defense mechanisms in alcohol dependent patients with oral and oropharinegal cancer. Coll Antropol. 35, 809–816.
Phifer, J. F., and Norris, F. H. (1989). Psychological symptoms in older adults following natural disaster: nature, timing, duration, and course. J. Gerontol. 44, S207–S212. doi: 10.1093/geronj/44.6.S207
Piccinni, A., Origlia, N., Veltri, A., Vizzaccaro, C., Marazziti, D., Catena-Dell'Osso, M., et al. (2012). Plasma β-amyloid peptides levels: a pilot study in bipolar depressed patients. J. Affect. Disord. 138, 160–164. doi: 10.1016/j.jad.2011.12.042
Porcerelli, J. H., Cramer, P., Porcerelli, D. J., and Arterbery, V. E. (2017). Defense mechanisms and utilization in cancer patients undergoing radiation therapy. A pilot study. J. Nerv. Ment. Dis. 205, 466–470. doi: 10.1097/NMD.0000000000000674
Pouwer, F., Kupper, N., and Adriaanse, M. 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.
Price, M. A., Tennant, C. C., Butow, P. N., Smith, R. C., Kennedy, S. J., Kossoff, M. 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. Cancer 91, 686–697. doi: 10.1002/1097-0142(20010215)91:4<686::AID-CNCR1052>3.0.CO;2-0
Prout, T. A., Zilcha-Mano, S., Aafjes-van Doorn, K., Békés, V., Christman-Cohen, I., Whistler, K., et al. (2020). Identifying predictors of psychological distress during COVID-19: a machine learning approach. Front. Psychol. 11:586202. doi: 10.3389/fpsyg.2020.586202
Radziej, K., Schmid, G., Dinkel, A., Zwergal, A., and Lahmann, C. (2015). Psychological traumatization and adverse life events in patients with organic and functional vestibular symptoms. J.Psychosom. Res. 79, 123–129. doi: 10.1016/j.jpsychores.2015.05.005
Rich-Edwards, J. W., Mason, S., Rexrode, K., Spiegelman, D., Hibert, E., Kawachi, I., et al. (2012). Physical and sexual abuse in childhood as predictors of early onset cardiovascular events in women. Circulation 126, 920–927. doi: 10.1161/CIRCULATIONAHA.111.076877
Rock, P. L., Roiser, J. P., Riedel, W. J., and Blackwell, A. D. (2014). Cognitive impairment in depression: a systematic review and meta-analysis. Psychol. Med. 44, 2029–2040. doi: 10.1017/S0033291713002535
Rosa, V., Tomai, M., Lauriola, M., Martino, G., and Di Trani, M. (2019). Body mass index, personality traits, and body image in Italian pre-adolescents: an opportunity for overweight prevention. Psihologija 52, 379–393. doi: 10.2298/PSI181121009R
Rymarczyk, K., Turbacz, A., Strus, W., and Cieciuch, J. (2020). Type C personality: conceptual refinement and preliminary operationalization. Front. Psychol. 11:552740. doi: 10.3389/fpsyg.2020.552740
Salvatore, S., Tschacher, W., Gelo, O. C., and Koch, S. C. (2015). Editorial: dynamic systems theory and embodiment in psychotherapy research. A new look at process and outcome. Front. Psychol. 6:914. doi: 10.3389/fpsyg.2015.00914
Sapozhnikova, I. E., Tarlovskaia, E. I., Madianov, I. V., and Vedenskaia, T. 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.
Settineri, S., Frisone, F., Alibrandi, A., and Merlo, E. M. (2019). Emotional suppression and oneiric expression in psychosomatic disorders: early manifestations in emerging adulthood and young patients. Front. Psychol. 10:1897. doi: 10.3389/fpsyg.2019.01897
Settineri, S., Merlo, E. M., Frisone, F., Marchetti, D., Verrocchio, M. C., Pellegrino, M. G., et al. (2018). The experience of health and suffering in the medical profession. Mediterr. J. Clin. Psychol. 6. doi: 10.6092/2282-1619/2018.6.1874
Shinkov, A., Borissova, A. M., Kovatcheva, R., Vlahov, J., Dakovska, L., Atanassova, I., 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. doi: 10.1080/00325481.2018.1410054
Stanton, A. L., and Hoyt, M. A. (2017). Psychological Adjustment to Chronic Disease. Perceived Health and Adaptation in Chronic Disease. New York, NY: Routledge.
Tanzilli, A., Lingiardi, V., and Hilsenroth, M. (2018). Patient SWAP-200 personality dimensions and FFM traits: do they predict therapist responses? Pers. Dis. 9, 250–262. doi: 10.1037/per0000260
Tolmunen, T., Heliste, M., Lehto, S. M., Hintikka, J., Honkalampi, K., and Kauhanen, J. (2011). Stability of alexithymia in the general population: an 11-year follow-up. Compr. Psychiatry 52, 536–541. doi: 10.1016/j.comppsych.2010.09.007
Veltri, A., Scarpellini, P., Piccinni, A., Conversano, C., Giacomelli, C., Bombardieri, S., et al. (2012). Methodological approach to depressive symptoms in fibromyalgia patients. Clin. Exp. Rheumatol. 30, S136–S142.
Vicario, C. M., Nitsche, M. A., Salehinejad, M. A., Avanzino, L., and Martino, G. (2020). Time processing, interoception, and insula activation: a mini-review on clinical disorders. Front. Psychol. 11:1893. doi: 10.3389/fpsyg.2020.01893
Vogenberg, F. R., Isaacson Barash, C., and Pursel, M. (2010). Personalized medicine: part 1: evolution and development into theranostics. P & T 35, 560–576.
Watson, M., Haviland, J. S., Greer, S., Davidson, J., and Bliss, J. M. (1999). Influence of psychological response on survival in breast cancer: a population-based cohort study. Lancet 354, 1331–1336. doi: 10.1016/S0140-6736(98)11392-2
Weihs, K. L., Enright, T. M., Simmens, S. J., and Reiss, D. (2000). Negative affectivity, restriction of emotions, and site of metastases predict mortality in recurrent breast cancer. J. Psychosom. Res. 49, 59–68. doi: 10.1016/S0022-3999(00)00143-4
Willemsen, R., Roseeuw, D., and Vanderlinden, J. (2008). Alexithymia and dermatology: the state of the art. Int. J. Dermatol. 47, 903–910. doi: 10.1111/j.1365-4632.2008.03726.x
Williams, L. J., Quirk, S., Koivumaa, H., Honkanen, R., Pasco, J. A., Stuart, A. L., et al. (2020). Personality disorder and physical health comorbidities: a link with bone health? Front. Psychiatry 11:602342. doi: 10.3389/fpsyt.2020.602342
Wooten, T., Ferland, T., Poole, V., Milberg, W., McGlinchey, R., DeGutis, J., et al. (2019). Metabolic risk in older adults is associated with impaired sustained attention. Neuropsychology 33, 947–955. doi: 10.1037/neu0000554
Yaffe, K., Weston, A. L., Blackwell, T., and Krueger, K. A. (2009). The metabolic syndrome and development of cognitive impairment among older women. Arch. Neurol. 66, 324–328. doi: 10.1001/archneurol.2008.566
Yates, K. F., Sweat, V., Yau, P. L., Turchiano, M. M., and Convit, A. (2012). Impact of metabolic syndrome on cognition and brain: a selected review of the literature. Arterioscler. Thromb. Vasc. Biol. 32, 2060–2067. doi: 10.1161/ATVBAHA.112.252759
Yonatan-Leus, R., Strauss, A. Y., and Cooper-Kazaz, R. (2020). Psychodynamic psychotherapy is associated with sustained reduction in health care utilization and cost. Clin. Psychol. Psychother. doi: 10.1002/cpp.2527. [Epub ahead of print].
Yoo, J., and Ryff, C. D. (2019). Longitudinal profiles of psychological well-being and health: findings from Japan. Front. Psychol. 10:2746. doi: 10.3389/fpsyg.2019.02746
Zilcha-Mano, S. (2020). Toward personalized psychotherapy: the importance of the trait-like/state-like distinction for understanding therapeutic change. Am. Psychol. doi: 10.1037/amp0000629. [Epub ahead of print].
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.
Edited by:
Gabriella Martino, University of Messina, ItalyReviewed by:
Amanda C. LaRue, Medical University of South Carolina, United StatesCopyright © 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