The Five-Factor Model personality traits in schizophrenia: A meta-analysis
Introduction
Schizophrenia is a complex psychiatric disorder that has positive and negative symptoms, cognitive impairment and poor social functioning. Historically, early psychopathologists such as Bleuler and Kraepelin observed a deterioration of personality in patients with schizophrenia. Personality is considered to be one of important factors for the pathogenesis of schizophrenia because it may influence patients' symptoms, cognition and social functioning (Compton et al., 2015, Gurrera et al., 2014). Furthermore, personality features predict the onset and course of the illness (Gleeson et al., 2005, Lonnqvist et al., 2009, Van Os and Jones, 2001).
The five major personality traits of the Five-Factor Model (FFM) are Neuroticism (N): vulnerability to emotional instability and self-consciousness; Extraversion (E): predisposition towards sociability, assertiveness and social interaction; Openness (O): cognitive disposition to creativity and aesthetics; Agreeableness (A): tendency towards being sympathetic, trusting and altruistic; and Conscientiousness (C): tendency towards dutifulness and competence (Costa and McCrae, 1992). The Revised NEO Personality Inventory (NEO-PI-R) and the NEO Five-Factor Inventory (NEO-FFI), the shorter version of the NEO-PI-R, are well-established self-report questionnaires that measure these five major personality traits. Personality trait analyses using the FFM have reported potential differences between patients with schizophrenia and healthy subjects (Akdag et al., 2003, Boyette et al., 2013, Brenner et al., 2009, Brenner et al., 2011, Gurrera et al., 2000, Gurrera et al., 2014, Herran et al., 2006, Kentros et al., 1997, Kirihara et al., 2012, Onitsuka et al., 2005, Pillmann et al., 2003, Suslow et al., 2014). Although not all of the results of these studies reached statistical significance, patients with schizophrenia tended to show higher scores on N and lower scores on E, O, A and C than healthy subjects. Particularly, high N and low E in patients with schizophrenia were relatively consistent among studies, although differences in the other personality traits were inconsistent among studies. Thus, several subsequent studies focused on only N and/or E on the basis of the relatively consistent findings among previous studies. These personality differences have been shown to be longitudinally stable, suggesting they are not due to acute state effects (Boyette et al., 2015). Premorbid personality traits of high N and low E were associated with a risk of the development of schizophrenia (Goodwin et al., 2003, Krabbendam et al., 2002, Lonnqvist et al., 2009, Malmberg et al., 1998, Van Os and Jones, 2001), and premorbid high E was associated with a risk of bipolar disorder (Lonnqvist et al., 2009). In addition, first-degree relatives of patients with schizophrenia and related disorders scored higher levels of N than healthy subjects (Boyette et al., 2013, Maier et al., 1994). Individuals with schizotypal personality disorder (SPD) scored higher levels of N and lower levels of E, A and C than those without SPD (Gurrera et al., 2005). Furthermore, N was positively and E and A were negatively related to schizotypal personality trait (schizotypy) scores in general population (Asai et al., 2011, Ross et al., 2002). These findings suggest that personality traits of schizophrenia are considered to span a continuum and a common genetic factor might confer a risk for schizophrenia, as well as for personality traits related to schizophrenia. Therefore, studying disorder-related personality traits may help to improve our understanding of schizophrenia. However, in addition to the N and E traits other traits (O, A and C) might also be meaningful in schizophrenia. The limited sample sizes in previous studies have made it difficult to reveal distinctive personality traits in schizophrenia. We need to solve two issues to obtain a definitive conclusion: low statistical power derived from small sample sizes and the impact of possible confounding factors, such as gender distribution and mean age in each study, on the outcome. To resolve these issues, we performed a meta-analysis to find differences in personality traits assessed by the Temperament and Character Inventory (TCI) between patients with schizophrenia and healthy subjects (Ohi et al., 2012), and this method could successfully detect distinctive personality traits in schizophrenia.
In this study, a meta-analysis was undertaken to determine whether patients with schizophrenia have a distinctive personality trait profile assessed by NEO compared with healthy subjects. In addition, we examined whether a between-studies effect of age or gender would indicate a moderating influence of these variables on the outcomes.
Section snippets
Meta-analysis of studies assessed by NEO between patients with schizophrenia and controls
We first searched for the studies that we used for our meta-analysis in the PubMed and PsycINFO databases, with the search terms “NEO”, “NEO-FFI”, “NEO-PI-R”, “Big five”, “Neuroticism”, “Extraversion”, “Openness”, “Agreeableness” or “Conscientiousness” and “schizophrenia”. Our search data encompassed all publications up to March 2016. Additionally, references cited in the publications that we obtained were searched to identify additional potentially relevant studies that might not be listed in
Results
We found 277 relevant articles in PubMed and PsycINFO using the search terms mentioned in the Methods section. Of these, a total of nine studies met the inclusion criteria (Supplementary Fig. S1) for our meta-analysis (with a total of 460 patients with schizophrenia and 486 healthy subjects) (Akdag et al., 2003, Boyette et al., 2013, Brenner et al., 2009, Camisa et al., 2005, Gurrera et al., 2000, Gurrera et al., 2014, Kirihara et al., 2012, Pillmann et al., 2003, Suslow et al., 2014).
Discussion
This is the first pooled study on comparisons of NEO FFM personality traits between patients with schizophrenia and healthy subjects. Although there was significant heterogeneity in all personality traits among studies, our results suggest that patients with schizophrenia have distinguishable personality traits compared with healthy subjects. Leave-one-out sensitivity analysis revealed that the differences other than A between patients and controls were not caused by each individual study.
Conflicts of interest
No conflicts of interest.
References (44)
- et al.
The startle reflex in schizophrenia: habituation and personality correlates
Schizophr. Res.
(2003) - et al.
The hierarchic structure in schizotypy and the five-factor model of personality
Psychiatry Res.
(2011) - et al.
Do people with a first episode of psychosis differ in personality profiles?
Schizophr. Res.
(2006) - et al.
Associations between the five-factor model personality traits and psychotic experiences in patients with psychotic disorders, their siblings and controls
Psychiatry Res.
(2013) - et al.
Three year stability of five-factor model personality traits in relation to changes in symptom levels in patients with schizophrenia or related disorders
Psychiatry Res.
(2015) - et al.
Cortisol response to a psychosocial stressor in schizophrenia: blunted, delayed, or normal?
Psychoneuroendocrinology
(2009) - et al.
Cortisol response and coping style predict quality of life in schizophrenia
Schizophr. Res.
(2011) - et al.
Personality traits in schizophrenia and related personality disorders
Psychiatry Res.
(2005) - et al.
Personality domains, duration of untreated psychosis, functioning, and symptom severity in first-episode psychosis
Schizophr. Res.
(2015) - et al.
Cloninger’s psychobiological model of temperament and character and the five-factor model of personality
Pers. Individ Differ.
(2000)
The five-factor model in schizotypal personality disorder
Schizophr. Res.
Cognitive task performance and symptoms contribute to personality abnormalities in first hospitalized schizophrenia
J. Psychiatr. Res.
Neurophysiological impairment in emotional face processing is associated with low extraversion in schizophrenia
Prog. Neuropsychopharmacol. Biol. Psychiatry
Personality variations in healthy relatives of schizophrenics
Schizophr. Res.
Personality traits and schizophrenia: evidence from a case-control study and meta-analysis
Psychiatry Res.
Temperament and character in individuals at ultra-high risk for psychosis and with first-episode schizophrenia: associations with psychopathology, psychosocial functioning, and aspects of psychological health
Compr. Psychiatry
Using implicit association tests for the assessment of implicit personality self-concepts of extraversion and neuroticism in schizophrenia
Psychiatry Res.
Relationships between Cloninger’s, Zuckerman’s, and Eysenck’s dimensions of personality
Personal. Individ. Differ.
Sex differences in schizophrenia
Int. Rev. Psychiatry
Comprehensive Meta-analysis Version 2
Potentials and limitations of research synthesis
NEO-PI-R professional manual: revised NEO personality inventory (NEO-PI-R) and NEO five-factor inventory (NEO-FFI)
Cited by (49)
Subcortical neural mechanisms of childhood trauma impacts on personality traits
2024, Asian Journal of PsychiatryNeuroticism and Extraversion are modifiable by treatment in individuals at-risk for psychosis or with first-episode psychotic disorder
2024, Personality and Individual DifferencesPersonality traits in psychotic illness and their clinical correlates: A systematic review
2023, Schizophrenia ResearchPredictors of full recovery in patients with early stage schizophrenia spectrum disorders
2023, Psychiatry Research