Psychiatry & Psychotherapy Podcast - The Big Five: Neuroticism Part 1

Episode Date: September 17, 2020

In today's podcast, we discuss the Big Five personality traits, focusing on neuroticism and how it fits into this set. We then explore each of the six domains of neuroticism and the research of how it manifests in other parts of one's life and affects relationships. By listening to this episode, you can earn 1.5 Psychiatry CME Credits. Link to blog. Link to YouTube video.

Hello and welcome to the Psychiatry and Psychotherapy Podcast. I'm here to talk about getting rid of burnout, increasing job satisfaction, and feeling like an expert in what you do. One thing that created a lot of burnout and angst for me was trying to get continued medical education right at the last minute. So why not join the CME membership and do CMEE while listening to this podcast? Go to Psychiatrypodcast.com, sign up, sign in, take the test, and the certification is email to you in seconds. Welcome back to the podcast. I am joined here with Alec Zane. Hey, everyone.

And he is a fourth-year medical student who has been working on an episode with me for a while. This is an episode on neuroticism. Neuroticism is one of the big five personality types. So the other ones are extroversion, which is like gregariousness, enthusiasm, assertiveness. social ability, there's agreeableness, which is compassion, politeness, you know, having a maternal orientation, caring more about others than yourself, cooperation, more than competitiveness, warmth, and then there's openness to experience, which is a combination of interest and ideas, interest in aesthetics, interest in ideas, creative pursuits.

And then conscientiousness, which is orderliness, industrialism. It's a good predictor of long-term success, especially academic attainment. And it is someone who's very organized, orderly. So this is on neuroticism. And neuroticism is a negative emotionality associated with a proclivity to anxiety, emotional pain. And so we have been digging into this. We have about 53 pages of notes. I think this will be two episodes,

but we'll try our best to make it entertaining. So in terms of neuroticism, there's different domains of neuroticism. And we're going to talk about each one individually. It's going to help you kind of get your mind around what neuroticism is, as it's defined in the research. And then once you understand how it's defined in the research, it can make sense of future studies that we're going to talk.

talk about. So the Neo PI3 is what we're going off. It's the gold standard of measurement. It's that big 250 question, you know, very detailed questionnaire that helps people understand what their big five is. And they have to find six domains of neuroticism. So, Alec, take me through N1 anxiety, number one anxiety. Go for it. So the way that the Neo, finds anxiety. That's the first facet of neuroticism. People who are high in this tend to be frightened easily. They tend to worry about things go wrong. They can be nervous or anxious in situations that would otherwise be unthreatening to normal people. They're often tense and jittery and struggle with frightening thoughts. And a person who's low in this, they tend to not worry. They're

rarely ever fearful or anxious and are rarely nervous. Yeah, and those are right out of like the questions pretty much. So someone who's low neuroticism, low anxiety, they have few fears, someone who's high, may approach dangerous situations with caution, which actually may have a survival advantage, but, you know, having few fears of things can also have survival advantage, just keep people moving forward, exploring, doing that kind of thing. So you can think of neuroticism anxiety as more as the trait anxiety, where it's kind of that chronic way of interacting with the world.

Okay, and to angry hostility. Tell me about people who are high in that first. Yeah, so angry and hostility. So neurotic people may be angered by the way that they are treated. They can often be hot-blooded or quick to anger, just disgusted by others, by the littlest things. And people can do them a lot of wrong. They can often feel bitterness or resentment. And yeah, overall, they're just frustrated by minor annoyances.

Yeah. And then someone who's low. And someone who is low will not be angry at either. easily. They tend to be a lot more tolerable about annoyances of everyday life. And they're not considered temperamental at all. Yeah. So that's the domain two. Domain three is depression. Tell me about someone who's higher in this sort of domain of neuroticism. So someone who's higher in the facet of depression, they can often feel worthless. They can feel, you. They can feel easily discouraged and easily give up when things go wrong. When it comes to a bad situation in their

life, they readily blame themselves. They often have a low opinion of self and life circumstances for them overall can feel bleak and hopeless. They can also experience a deep guilt or sinfulness about things they've done in the past. Yeah, so this is kind of that chronic, more than the episodic depression, right? And there's a lot of learned helplessness in this. And they blame themselves, high guilt, high feelings of self-criticalness, worthlessness, low opinion of themselves, hopeless. Okay. And anything about people who are low in depression, obviously all, they don't have any of those things or are the opposite of those things. Anything else you would want to add? Yeah, and they just rarely feel lonely or blue.

they're more okay with being by themselves, and they may seldom feel sad or depressed. Yeah. And I was thinking, you know, what are some of the positives of maybe having some more of the depression type things? They may be in, sometimes a little bit of depression can make actually reality

a little bit more clear. Like, for example, great wartime presidents often have a little bit of smoldering depression, and they see bad situations occurring before maybe people were more optimistic. Like people were more optimistic. Weren't like Winston Churchill who was like sounding the gong of like his concern over Hitler, right? That kind of thing. Winston Churchill had some depression that he struggled with throughout his life.

Okay. And for self-consciousness. So people were high in this. Yeah, so people who are high in self-consciousness, they have a constant worry about making a fool of themselves in front of others. They may often have a sense of inferiority when it comes to others. They often feel ashamed, and they can feel that what they've done is the wrong thing to do. On the other hand, people low in self-consciousness, they may feel comfortable around bosses or teachers, and they may seldom feel self-conscious in any situation.

Yeah, so you think about, you know, self-consciousness, people who are very self-conscious, are very, very shame-avoidant. And they easily feel a lot of shame. They easily feel very awkward, whereas someone who's the opposite of that may feel naturally more confident, more comfortable, and more at ease. So, you know, being sensitive to others' feelings can have advanced. advantages, such as being able to read people or just read very slight moments of, you know, micro moments of uncomfortableness in others and then respond to that in a sensitive way.

And people who maybe are lower in this may not pick up and feel the sort of those micro moments of embarrassment in other people. And so I like to think of a lot of these as, like what is the positives, what is the negatives, right? Because I think it's, there's strengths in both sides of this to some degree. Okay. The next one is impulsiveness. So tell me about someone who's more neurotic and high impulsivity. Okay, so an impulsive neurotic, these people often have trouble resisting cravings. They often need more than they need to, and they may indulge in their fair foods without control, self-control at all. And someone who's low in impulsiveness, they may have more control of their self and then they seldom give in to impulses at all.

They're okay with not receiving all they want and they're often content with what they receive. Yeah. These were related to the questions that were asked. So a lot of food questions. I'm specifically with impulsiveness, the high impulsiveness. People who are high impulsiveness, but maybe express that impulsiveness sexually often will not be accurate in the representation of that in a survey, right? So high shame impulsiveness thinks impulsive questions are often avoided in questionnaires if you want to get more accurate picture. But people tend to be more honest about their difficulty with impulsivity around food.

So I think that's probably why they have a lot of food questions. So you can think about the benefits of having low impulsiveness. they are able to keep things under control. Maybe they don't put themselves at undue risks. People with high impulsiveness, the benefit of that may be that they don't miss out on a high reward experience or venture, right? So there can be positives and negative, or they can be positives of both sides. Okay, the next, the final domain is vulnerability. So once again, all these domains add up to someone,

cumulative neuroticism score. So vulnerability. Tell me about high and low. So someone, a neurotic person who is high in vulnerability, they tend to not manage themselves well under stress. In stressful situations, they often find that they're indecisive, unwilling to make their own choices, and they often want others to solve their problems for them.

And on the other hand, anyone who's low in vulnerability, they will be more emotionally stable. They're able to handle themselves better in a crisis without help from anyone else. And they tend to make good decisions, even when everything else around them is going wrong. So overall, these people are capable of coping with most problems. So it seems like it's around stress. So someone who's low in vulnerability is cool, headed in emergencies where someone who is high takes on a lot of stress with different

environmental things going on and maybe the stress gets to them more. And so maybe they're a little bit more indecisive or they put the leadership on someone else. They want other people to fix them. Okay, so those are the six domains of neuroticism according to this inventory. and the construct of what neuroticism is. So one of the questions I had to myself when I was looking at this data was how stable is neuroticism from a very early age, like the age of three,

all the way into maybe mid-adulthood. So we actually found one study by Caspi at all. This is 2003. Once again, we put all these on our resource library for your further delight in consumption. Hopefully your curiosity is sparked a little bit. So in this study, they followed these three-year-olds for 23 years until they were 26.

So what were the main findings of this study? Yeah, so this is a study of 1,000 3-year-olds. So what they did is they took these children and they first grouped them into five temperament types. They were either grouped into uncontrolled, inhibited confident, reserved, or well-adjusted. So yes, 23 years later, they were re-examined as adults. Yeah, you know what?

I found that was so interesting. It was this, the uncontrolled three-year-olds, which were labeled as irritable, impulsive, emotional labile, and impersistent on tasks, not persistent on tasks. that was the only group that seemed to be linked to later on having neuroticism. And a lot of those things, you can think about like we just went through the six domains of neuroticism, impulsiveness, emotional ability, irritability, anger, right? Some of those are specifically domains of neuroticism.

So the effect size was 0.3 for neuroticism. if they were under control. And for those who were under controlled, they also looked at the effect size of other constructs like stress reaction, that was 0.15, negative emotionality, 0.27, alienation, 0.34. So those are small effect sizes of these 3-year-olds and how they were 23 years later.

Specifically, 0.3, so it's 0.3 standing. deviations from the mean, right? So in terms of like if they were having, if they were in this group, right, because they were grouped into the five different groups, the five different temperament groups that three years old, if they were in that under-controlled group, the irritable impulsive group, the emotionally layball group, they were a 0.3 standard deviation more likely to be higher in neuroticism later in life. Okay, that's what it means. So is that a huge effect size?

Not really. Not really. Point two is considered a small effect size. Point five is a moderate effect size. So somewhere between small and moderate. Point three is, you know, not huge. But it's there, right? And it's there as statistically significant.

So if you see an irritable, impulsive, emotionally lay about an in person on task three-year-old, does that mean that he's going to be neurotic? I would say to you, no. There's a slight increase risk of them being neurotic, but a lot of life goes on between three and 26 years old. And so they could move many directions, right? And so I think that's really important to know because sometimes we say like, oh, once neurotic, always neurotic. Or there's kind of like this thought in the literature that like if you have a personality at three years old, it's there. It's stuck.

And that doesn't take into account a lot of things that can happen. Okay. So let's go on to this next study. Tell me a little bit about this. Yeah, so this was another longitudinal study that looked at children's personality traits and how it affected their adjustment to school. So basically they looked and examined to see if personality traits could be predictors for school adjustments that were measured as social competence, internalizing problems,

and externalizing problems. Yeah, so this was looking at age. five and six. So five before school, six after. And what they did was they had other people rate the five and the six year old. So they had different informants, different roles, teacher, people were around the child, and they rated them. And so they were looking at, does some of these personality traits lead to better adjustment in school? So specifically what they found, this is a quote, the children's extroversion, conscientiousness,

and low neuroticness of predicted subsequent social competence, but not vice versa. Specifically, the effect size between neuroticism and social competence was negative 0.328, which once again, that's a third of a standard deviation. So not a huge amount, right? but it's still there. And then what I found was the correlation between age 5 and age 6

in the rating of the personality types was only 0.38, which is not huge. So even in one year there was a lot of change. Well, there was different people grading them. So there wasn't like one person, right, who was like the expert coming in, observing them, giving very similar. And the different roles, right?

So interesting study. Any thoughts on it? Yeah, it was just interesting to show how neuroticism can affect how a child develops. It just shows that, you know, neuroticism and personality traits in general can be a major factor in how, you know, a child approaches problems and how they deal with problems that they encounter within, you know, adjusting to school and everything. And, yeah, personality just plays a lot, a huge role in how children adjust. You know, I honestly think huge might be a little bit overstated.

Yeah, yeah. Because a 0.328 effect size isn't like huge. Right. It's there. It's impacting things, you know, But is that how that plays out long term? It's not a death sentence. Surely it's not a death sentence.

Like if you're listening to this and you're like, I have this child who's super sensitive and reacts to stress poorly and is highly anxious, you know, okay, that's probably a good reason to do more playdates, right, rather than less playdates. Get them around more kids. But 0.3 effect size is not huge. by any means it's a mild it's a mild effect size so i would say you know if you're if you're a parent even even that the fact that these things change over time the correlation only being like point four between one year of life you know so a lot can change over just one year of life

and how people rate the different personality types okay so then there was this meta-analysis that shows that overall neurotic system levels in the population decrease as an individual progresses from early to late adulthood. So tell me about this one. Yeah, so this is a meta-analysis. It looked at 92 different studies to determine whether there was a lot of change in personality traits across the life course. They looked at all five, big five personality traits. and what they found was that overall their tendency to be increases in dominance, which is a facet of extroversion, in conscientiousness, and emotional stability, aka a decrease in neuroticism, as individuals progress from early to late adulthood.

So the authors of this study, they attributed decreases in neuroticism, probably due to differences in changing values and social context within a given culture. Yeah. And do we know how big the decrease was? A D of, okay, so an effect size of 0.23? That's around early 20s to around 60s. Okay. So it's once again a mild effect size change.

It's like a 0.23 is it's small. so it's not like we're going to see a huge decrease. If you're two standard deviations above the mean in neuroticism, you know, you're going to see a slight shift, but will you notice it? Maybe, maybe not. All right, there was this other longitudinal study from the U.S. cohort study,

and they found an association between adverse childhood events, so that's the ACE score, and neuroticism scores later in life. So tell me about this one. Yeah, so this is another long-term study that they wanted to explore the impact of early life maltreatment on personality. So what they did is they took data from the ad health. This was a cohort study that took a nationally representative sample and followed health trajectories. And it followed them for many years, 1994 to 2008.

So participants, they followed participants from when they were early adolescents into young adulthood. They collected a lot of data on them. This data set included information on maltreatment and personality as well, which were the data sets that was used in this study. So what they found was regression studies showed that there were correlations, in fact, between later life neuroticism and previous sexual abuse and later life neuroticism and neglect of early lifehood needs. So the strength of the links is actually really, really important to look at.

The association between neuroticism and sexual abuse is almost 0.5 standard deviations, while the association with neglect is 0.32 standard deviations. And these were statistically significant. The association between neuroticism and being slapped as a kid, not significant, or being left alone as a kid, not significant. But specifically, those two relationships were pretty significantly linked. It's a good study. I really like this study.

It's a really good find. It's of 2,319 siblings. So a pretty good size. So before we move on, let's look at another study that looked at ACE scores. This one was by Grunznik, 2020. So a very recent study. And tell me a little bit about this one. Yeah.

So this study was also took longitudinal data. So this time this study took, data from the midlife development in the United States, the M-I-D-U-S study, which is a study that examined relationship between ACEs and outcome variables that included generativity, personality traits, personality traits, and effect. Yeah, so the results showed that having any adverse childhood experience was significantly associated with neuroticism. This time the effect was 0.1 and conscientiousness, which was negative 0.03, which is pretty small. It also found a dose-dependent relationship.

Higher A scores were more positively associated with neuroticism. So, for example, as you got up to three, you know, three adverse childhood events, the effect size one up to 0.33. And neuroticism was also associated with abuse, with an effect size of 0.2. So, in summary, all A scores were significantly and positively associated with neuroticism. All A scores were significantly and negatively

associated with conscientiousness. And I would say the neuroticism link seems to be a lot stronger than the conscientiousness link. in this specific study there were 6,323 adults in the sample and about 56 had a past adverse childhood event. These two studies together point to the impact of adverse childhood events, specifically it seems sexual abuse, seems to be pretty highly connected with neuroticism.

and, you know, in the time that we're in, child sexual abuse is kind of a hot topic in the news. A lot of people are very concerned about it. And there's good reason. It's very damaging to a young individual. It's damaging to their personality, how they're going to experience stress, their impulsiveness, their anger, their sort of baseline depression. Okay, in the next section, we're going to go through neuroticism and genetics. We really wanted to look at how closely tied these two things are. Like, are we just, like, genetically influenced, right?

How much are we genetically influenced? How much is neuroticism genetically influenced? And so there was one study early on in 1996 where they looked at the heritability of the Big Five with twins. And what do they find with mono-zagotic and dizigotic twins in this study? Yeah, so when they ran piercing correlations for the monozygotic versus the diazygotic, they actually found that correlations for the monosygotic exceeded those for digizigotic for all scales, except for modesty and self-discipline. And then this in itself suggests a genetic influence on most Neo-PIR scales.

And specifically for neuroticism, The data in this study suggests that neuroticism tends to be heritable by up to 41%. Okay, so let's look at this a little bit because so for the correlation between two monosagotic twins is 0.41. Whereas for dizigotic twins, it's 0.18. So you can see as the DNA becomes more similar, it goes to, from about 0.2 to 0.4. Okay, now there's different domains, and they've broken it down into the different domains.

And so in general, though, the domains go up about double, like we just talked about. Except for angry hostility, there is really no link in disagotic twins in this specific study. And that's kind of interesting. So this does suggest genetic linkage. Obviously, it's nowhere close to something like height.

It's 0.41 from 0.18 that jump is significant. It means that there is some genetic component, but it's not like deterministic by any means. Genes influence things, but it's not like you're going to be neurotic because your identical twin was neurotic or your parents were neurotic, so you're going to be neurotic. It influences things, but it's not like deterministic.

So in another study, they looked at monosagotic twins that were reared together or reared apart. And of course, if you're a monosigotic twin and you're reared apart, you don't have those early environmental factors going on. Whereas if you're reared together, not only do you have the same womb experience, but you have that same, you know, parental structure.

And so what they found was that they didn't look at neuroticism for this. But fortunately, they looked at other things, and we can kind of see if there's the link for other things. Like they looked at openness, and they found that monosagotic twins reared apart had a 0.43 correlation, deizogotic 0.23. whereas when they're reared together, openness went up to 0.51.14. So it's not a huge increase. So the environment didn't have that much to do with openness specifically. But if you look at agreeableness, agreeableness, the mono-zagatic twin that was reared apart,

correlation was 0.19, that's a got a 0.10. whereas when they were reared together for agreeableness, it was 0.47 and 0.11, meaning there was not a huge link for agreeableness specifically. The numbers were pretty low if they were not reared in the same household. Okay, so maybe that one has more of an environmental influence, agreeableness than compared to conscientiousness. So this shows that openness, there seems to be more of a genetic link, and they estimated the variance at about 40% in this article, whereas agreeableness was only about 12%, meaning most of agreeableness was found to be environmental.

Okay. Now, we don't have neuroticism for this type of study, but I think it's important to note that neuroticism is probably somewhere between the 40 and the 12%. somewhere around that area. And from the data that we shared prior, it was 41%. So that being said, we don't know exactly how much the environment, but we do know that sexual abuse neglect influenced neuroticism a whole lot more than conscientiousness.

So that's something to consider as well. So there are early environmental factors that really do change neuroticism, neuroticism. And even in those monosagotic twins, the correlation is not very high. For monosagotic twin in the prior study, it's 0.41 in the ones that were reared together. So tell me about this meta-analysis that looked at the field of personality, heritability, and tested for possible moderator effects of heritability estimates. Yeah, so this is a more recent meta-analysis done by Bukosovic

2015. It's good. So what it did is it took a total of 134 primary studies and it looked to see if there was significant genetic effect on individual differences in personality. So basically

meta-analysis were conducted for average personality hairability estimates and for each personality trait in three personality models. ice nix, intelligence, and the FFM. So yeah, heritability estimates were done for each of the five personality traits in the FFM. They looked both at twin and non-twin data, which differentiated this study from previous studies.

And what they found was that the average herability estimate was 0.39. This suggests that 39% of the individual differences in personality were due to genetics, while 61% could be due to environment. Once again, showing how much environment plays a role in personality development as well. Yeah. So in summary, what we've talked about is there are environmental and genetic factors that play a role. Environment, 60%, genetics, 40%. Roughly.

Okay, so finally, there was another study, 2015, where they looked at the big, personality traits and they looked at single nucleotide polymorphism and you know are there certain areas of the genome amongst all people high or low in certain personality types that are there specific genes that link all of these people together right so that's what they're looking at now what they could do with these huge computers right running these genome against each other. And they look at people with like high neuroticism. So the question is, does someone with high neuroticism have certain genes in common?

Do all these people with high neuroticism have certain genes in common? What do they find? Yeah. So what they found was actually interesting. So they looked at all five traits actually. And what they found was that neuroticism actually had significant. heritability estimates as well as openness. And they also found that there were no significant herability estimates for extraversion, agreeableness, or conscientiousness.

So in this study, what that means is that as they looked at the 527,000 single nucleotide polymorphisms across the genome, and they tested for the heritability of each personality trait, neuroticism had some similarities all people with high and all people high and neuroticism had similarities how much similarities do they have 15% whereas openness had 21% whereas extroversion agreeableness conscientiousness they didn't find that link you know and and why isn't it stronger might be the question in your mind well because personality is so complex we're not just looking at genes to start with We're looking at genes and environment, but we're not going to find one gene for neuroticism. It's probably going to be more like, here's the thousand genes that influence this.

And look, people high in neuroticism have 15% similarity in these genes. Meaning, you know, whereas someone with conscientiousness, agreeableness, extroversion, there's so many genes that there isn't even a scene link between. them, right? Because there can be so many different genes that are playing into someone having a specific genetic predisposition. Even though we talked about, environment is far more powerful in my mind than genes as well for personality. Okay, finally, they have found certain genes that they've looked at and they've looked at the link between them and neuroticism. So like we talked about in the last study, we found that there were some similarities to people with neuroticism. So they

started looking for the genes. Right. So one study found this gene, 5-H-T-L-P-R, repeat polymorphism of the serotonin transporter gene as a cause of anxiety-related traits. And, you know, We know that people with an issue with transporting serotonin may have high risks of things like anxiety. And so this plays a role in serotonergic processing and emotional processing. And so that was one study. Any comments on that one in particular? Yeah, it was just interesting to note that this transporter actually has become a target of psychopharmacological interventions for anxiety disorders. and some of this cycle farm will touch upon later.

Yeah. And that's kind of, we'll do a hint at what is to come. We will be talking about can we actually treat neuroticism, not depression, not an episode of depression, but neuroticism, right? Okay. Another study on meta-analysis showed a small but significant relationship between short 5-H-T-L-P-R-A-L-R-Aleals and individuals with long alleles. So they're short and long.

And these are, once again, the serotonin transporter. And they were trying to find out, you know, which one is associated with neuroticism. And they found out that it is both associated with neuroticism and major depression. All right, so we've showed that there's some genetic linkage with neuroticism. We've showed a specific gene. And so we found another study in which they looked at targeting this gene with medication for someone with neuroticism, major depression. What do they find?

So this is a study in 2016 that looked at the possibility of treatment of major depression associated with neuroticism with either quatyapine, extended release or Cetelepram? So the idea behind this was that SSRIs, they inhibit 5HTT. And since they theorized that Cetalopram would act on this receptor of 5HT-LPRS or LG carriers, the gene of interest within neuroticism, they theorize that it could decrease availability of functional 5HTT, decreasing amygnala response to negative emotions, thereby increasing positive emotions altogether.

So this was an eight-week parallel group, randomized double-blind comparative trial, and patients of both groups are slowly titrated up to max doses. So the results of the study showed that there weren't any significant. decreases in neuroticism after treatment with quotyping or it's satalopram. And it just shows the need for more research to be done in pharmacological treatment and genetics. Right. Well, first of all, I think the link between neuroticism and this gene are pretty weak in terms of

the association is not very strong. And then it's interesting to put out a negative review. people, very smart people trying out things to make a difference in the world, don't always make it. So what they found was that both treatments were pretty similar in the end, right? Right. Okay. Let's go on to the next study. There was a meta-analysis of genome-wined association studies for neuroticism that found novel locus for neuroticism.

Tell me about this one. Yeah, so similar to the other genetic studies we previously talked about. This one also looked for common genetic variants. I'm looking for single nucleotide polymorphisms that could predict neuroticism and could also predict MDD. So genome-wide, significant SMP found that a gene called MAG-I-1 gene was associated with neuroticism, actually. So this gene is expressed in neuronal tissue, particularly with the hippocampus in the brain. It often acts as a scaffolding protein in the neuride growth factor receptor mediated signaling pathway. Basically what that means is that it plays a role in neuronal development and has roles in neurite outgrowth and synaptogenesis.

And they theorized that this may be related to the neurodeveloper. developmental theory of mental illness. Very cool. So in a final study that adds some interesting information about the genetics here is this study on the correlations between pain and phenotypes and psychiatric traits such as depression and personality traits of neuroticism. So tell me a little bit about this study and then I'll tell you what I think was most interesting. Yeah, so this was a really recent study done this year.

What they did is they estimated genetic correlations of eight pain phenotypes with depressive symptoms, major depressive disorders, and neuroticism. So the eight pain phenotypes that they looked for were headache, facial pain, neck shoulder pain, back pain, stomach slash abdominal pain, hip pain, knee pain, and generalized pain all over the body. And what they found was that all pain phenotypes, except for hip pain and knee pain, had significant and positive genetic correlations with depressive symptoms, MDD, and neuroticism.

Yep. All pain phenotypes, except for hip pain and knee pain, had significant and positive genetic correlations with MDD and neuroticism. So the heritability was the strongest with pain all over the body, and facial pain was the next. I mean, these are not completely heritable. Point 3-1, right?

So not completely heritable. Depressive symptoms and headache. Then they have the correlations, which one's the most strongly correlated? Pain all over the body, right? Yeah. I'm not surprised. Headache being second with neck pain, shoulder pain. Actually, no, it goes pain all over the body, then stomach and abdominal pain.

And then head issues, headache. and head pain and neck pain and shoulder pain. And for neuroticism, the strongest link was between stomach or abdominal pain. That's interesting. Then from there, it went to headache, then pain all over the body. But really fascinating is the things that aren't linked, hip pain and knee pain. which I'll have to say when I have a patient who has isolated hip or knee pain, I normally think they need to see an orthopedic surgeon, get some injections, get some treatment,

rather than they need psychotherapy. But when someone comes in with all body pain or headaches, lots of tension, I think this person needs some psychotherapy along with, you know, other treatments. So that's a cool study. Okay, so we're going to be talking about neuroticism and psychopathology. So tell me why you thought this would be a good next sort of thing to look at. Yeah, so this is a very important point to make with neuroticism. So the studies that we're going to be talking about, there seem to be consistent and robust association with mental disorders across the lifespan.

And neuroticism has actually been shown to have moderate. to strong association with all major forms of psychopathology. Okay, so walk me through some of the details. Yeah, so this first study carried up by Kotov in 2010, they actually found that neuroticism was strongly associated with Axis 1 disorders. So basically this was a quantitative review of associations between personality traits in the Big Five and Big Three models, and specific depressive, anxiety, and substance use disorders. This quantitative review covered 66 different meta-analysis and 175 studies published from 1980 to 2007.

So, yeah, they took a lot of information into account, and they looked to see if personnel Electronidates had strong links to any MDD, generalized anxiety, PTSD, or dystimic disorders. So what they found was that all disorders actually were found to have a positive relationship with high neuroticism and low conscientiousness, with some effect sizes having Coen's D of greater than 2.0. So I'm looking at this table, and this might be an interesting one for you has to check out in the resource library when you look at this, when the summary of this notes. And if you look at neuroticism, it's most strongly, or the effect size, right? So if people are high in neuroticism, they're going to be high in these other things.

And the effect size is, you know, around two for a lot of these things, meaning two standard deviations, meaning these things are really, really linked. specifically like things like dyshthymia 1.9, generalized anxiety disorder, 2, PTSD, 2, panic disorder, pretty much 2, OCD 2, substance use disorder a little bit less, alcohol, 0.7, drugs, 1.1, MDD, 1.33. So that's with neuroticism. So all positively connected to neuroticism. I'm looking at extroversion.

And the interesting, the confidence interval for some of these passes, zero, so they're not linked. So extraversion is not linked, for example, with MDD. D dysthymia, extroversion is linked with pretty strongly, negative 1.47 meaning people who are high in extroversion tend to be less depressed, which makes sense because they're going out, they're gregarious, they're doing things, less panic, that makes sense, less anxiety stuff with extroversion, less OCD. And conscientiousness, just a review from last time, conscientiousness is,

people who are high in conscientiousness are about one stage. under deviation, less likely to have most mental disorders. Agreeableness tends to not be related very much, except for agreeableness, has a negative effect size with substance use like mixed substance use in drugs. And then openness, the only connections that I see that are very strong, not Not much is statistically significant. The only two that are are agoraphobia is negatively associated with openness. So 0.7 or negative, sorry, not negatively associated.

Agoraphobia has a negative 0.7 effect size with openness and dysthymic disorder has a negative 0.57 with openness. So that's cool. That's a really nice, that tells you a lot. That tells you a lot about these personality disorders, what their proclivities are for, right? We're not surprised that neuroticism is linked to things, especially chronic issues, especially trauma, because we know that effect size is moderate for things like sexual abuse, for things like neglect, that those things create or help create neuroticism. Yeah, anything else you wanted to pull out from this study? Yeah, so one interesting thing that was a little surprising was that neuroticism actually had a

relatively small effect on MDD. Comparatively to some of the other issues. Yeah, yeah, exactly. For me, that's a little bit less surprising because MDD is very episodic. and usually they can have a fairly normal life before the MDD starts in like middle middle life like in their 20s you know 20s 30s when it normally starts so that's not incredibly surprising for me because that when I think of neuroticism I think of these are chronic issues that are ongoing yeah okay we can move on to the next

then. So this is a meta-analysis that looked at association with each of the five personality traits and each of the 10 DSM-4 at the time personality diagnostic categories. Personality diagnostic categories included paranoid, schizoids, schizoids, schytytypo, antisocial, borderline, histrionic, narcissistic, avoidant, dependent, and OCD. OCPD. OCPD. Obsessive, compulsive, personality disorder. So this meta-analysis looked at a total of 12 studies in the 90s, and they used by

varied correlation coefficients as effect sizes. And what they found was that disorders that were characterized by emotional distress such as paranoid disorders, schizotypal, borderline, avoidant, or dependent, had positive associations with neuroticism. Yeah, and those positive associations are like 0.28 for paranoid, 0.3, 6 for schizetipal, 0.49 for borderline, 0.48 for avoidant, personality disorder. 0.41 for a dependent personality disorder.

Interestingly, obsessive compulsive disorder is pretty disconnected. 0.08. Also, I would have expected schizoid to be more connected, but it's not 0.13. Antisocials, barely connected as well, 0.09. If you move to some of the other facets of the big five, extraversion,

higher in Hystereonic 0.42 very low in can you guess it? Avoid in personality disorder for the win. 0.44. Openness

not very strong associations either way. There's some like 0.15 is probably one of the strongest associations between openness and histrionic personality disorder. agreeableness as negative associations pretty much across the board, except for a very slight positive association for dependency, dependent personality disorder 0.05. Otherwise, if you're high

agreeableness, you're less likely to be narcissistic, negative 0.27, you're less likely to be borderline. Negative 0.23.23. You're less likely to be antisocial, negative 0.35. You're less likely to be paranoid personality disorder. 0.34. And some of those make sense because people who are very low in agreeableness are going to be more psychopathic in nature. Or just like, you know, like if you get out to the fringes of agreeableness,

where they're just very low empathy. And so, yeah, you have that negative 0.35 with antisocial personality sort. and finally conscientiousness i think this is this is worthy to look at as well pretty much the only one that's positive for conscientiousness is obsessive compulsive personality disorder which is no surprise point two three all the other ones all the other ones are are are negative and uh but not very strongly negative So the only ones that are more strongly negative are borderline personality disorder, negative 0.23,

antisocial personality disorder negative 0.26. So there's a couple things to note from this. One is that the neurotic portion of the Big 5 is the most positively correlated with all of these, and some of them very strongly correlated, some of the highest numbers, like 0.48, with avoidant personality sort of that's very strong compared to the other correlations. Okay, that's my reflections. What are your reflections on it?

Yeah, I mean, it honestly just makes sense to me that neuroticism would be the, have the highest correlations. Just by definition, they are more affected by everyday stressors. And, you know, if you let yourself be affected by all these little things that go throughout the day, it will add up and take a toll on you eventually. So, yeah, it wasn't surprising that neuroticism actually had the most prominent and consistent effect sizes across all these disorders. Okay. So let's move on to the next study. They linked neuroticism with vulnerable narcissism.

So this was a study done by Miller in 2018. So to start the study, it's important to define what vulnerable narcissism is. So as they described, there are actually variable presentations in narcissism. Some emphasize grandiosity, while others emphasize fragility and negative affectivity. And this is the difference between narcissistic grandiosity versus narcissistic vulnerability. So there are multiple measures that have been. used to assess both types of narcissism. And vulnerable narcissistics, they tend to have greater internalizing symptoms,

and they face greater psychological distress, while grandiose narcissism is characterized by more externalizing behaviors. An example of this may include anger, outbursts to anything that threatens their ego. Yeah, so grandiose narcissism is traditionally associated with high extroversion, and low agreeableness, you know, charismatic out there in front of people. I think of them as either what I call the baby Jesus narcissist. It's the kid that's raised as if they were baby Jesus. You know, imagine never doing wrong in front of your mom even when you were obviously doing something really wrong.

Your mother protected you. It was always the other playmate's fault, you know. and so you kind of get this more grandiose component where you don't see your own failings. You maybe that high extraversion. Compare that to the baby Chihuahua narcissist, which is that like Chihuahua dog that's always fearful, like freaked out, but it has that bark,

you know, has to protect itself. And so that's more of the vulnerable narcissist. I also think about, about the grandiose narcissist probably fits in the category of more of the psychopathic narcissist. So you have that low trade agreeableness. The psychopathic narcissist is the one without the effective empathy. So they just are not reading other people and they're very concerned about themselves. You know, if you take psychopathy to the highest level, these people see other people as like insects and as, you know, people to get over on top of, to find some way of conning, right?

And if you're a kind, considerate, compassionate, high agreeableness person, that person may be very confusing you. We tend to want to think that everyone thinks like we do, right? Not everyone thinks like we do. Okay, let's keep you on. Yeah, so what this study did is they wanted to test the extent to which vulnerable narcissism is associated with elevated scores on neuroticism. So what they did is they measured narcissism with a hypersensitive narcissism scale, and they measured neuroticism with the Neo-PIR.

And what they found was that there were relationships, relationships between neuroticism and vulnerable narcissism in all samples within the study. Yeah, this kind of goes along with that sort of baby chihuahua complex narcissist picture that I'm giving with the vulnerable narcissist. It's like it's like that fearful, you know, the chihuahua is like that fearful, kind of very anxious, you know, scared of everything, finicky, very sensitive to slights, right? Yeah, okay. Anything else? Yeah, so they found that the five-factor model accounted for 50 to 73% of the variance in vulnerable narcissism scores,

with neuroticism actually accounting for a large majority of this variance. It itself averaged 65%. Very interesting. Very interesting. Wow. yeah that's a pretty strong correlation so they showed that you know they showed the other big five components and openness not really connected not a very strong correlation extroversion negative 0.25 so the vulnerable narcissists were likely to be a little bit less extroverted and agreeableness negative 0.28 so likely to be a less agreeable and conscientious is negative 0.16. So likely to be less conscientious.

Interestingly, like if you look at a lot of the big five characteristics compared to the personality types, if you had some like a resident who was coming into your program who was very high conscientiousness and you could tell, right, the only personality disorder they would be at risk is obsessive and compulsive. I mean, just by, you know, over, I mean, everyone's individual, and I'm sure you could find a high conscientious borderline or person who suffered from borderline person who's suffering. But most likely, a high conscientious person

is going to be not having a lot of the personality disorders and are less likely to have the mood disorders too. So that's interesting to me. Okay, let's talk a little bit about neuroticism. Some of these linkages with mood issues and maybe why. So tell me what you found. Yeah, so there are, in the current literature, there are various explanations that sort of try to explain why neuroticism may open

people to, you know, having more disorders. One of these is a vulnerability explanation. So this explanation states that personality traits, they increase, the personality traits themselves increase risk for later psychopathology. This says that neurotic people often do not manage themselves well under stress. They let the stress get to them and they feel the full negative effects of it. They often want others to solve their problems for them and they're often indecisive, which plays. not so well in their favor. Another possible explanation is the spectrum model.

So what this model says is that personality traits and mental disorders lay on a related spectra, meaning that mental disorders may actually possibly be seen as extreme versions of personality traits. Example of generalized anxiety disorder being an extreme version of the personalization. personality trait in neuroticism. And finally, another theory about why neuroticism can be related with psychopathology are that individuals with high neuroticism are more likely to use inefficient forms of coping. Yeah, it's long been established that neurotic individuals are more likely to use avoidance coping

mechanisms, such as self-blame and wishful thinking. So a more recent study looked to explore relationships between neuroticism, perfectionism, and coping strategies among patients with depression and anxiety. This was Munir, 2018. What they found on these patients in a psychiatric ward was that neuroticism was positively linked to maladaptive perfectionism and avoidant coping strategies. 0.51. Furthermore, maladaptive perfectionism was found to be a predictor of depression. The effects at 0.39, so moderately, and anxiety patients scored significantly higher on avoided coping strategies.

0.41 association. So, more neurotic patients have been shown to have lower perceived quality of social supports with an effect size of negative 0.304. This was another study at Kindler 2006 and decreased levels of marital satisfaction. 0.22. It's not a huge, it's a mild effect size.

And, you know, this all pointing together to kind of like the biopsychosocial model for this, right? So you got the biology, you got the genetic predisposition around 40%, environment, 60% of what's going on. And some of it is, you know, within the environment and within the experiences of the person, create ways that they're coping with things, ways that they're more vulnerable to things, they're stressed out more, and through the, coping mechanisms that are not as strong, they use strategies that are not as effective.

So they use a lot of cognitive distortions, which is why we'll find later CBT. Some mindfulness is good for these patients. And they have maladaptive perfectionism, so some all or nothing thinking, some like cognitive distortions there as well. and all this leads to perceived quality of social support being lower. So that might not be reality, right? They might have more or the same social support, but their perceived quality is lower.

That's important to differentiate. And they have decreased levels of marital satisfaction, which they're less satisfied in general. So is it really the marriage that's dysfunctional? or is it that patient that's maybe wired and environmentally prone to be more neurotic at this point in their life? I always wonder about that when I see couples, like am I treating the individuals? Am I treating the couple? Am I treating the family system?

And usually it's all of the above. Okay. So let's talk a little bit about the physical health. effects of neuroticism. Yeah, so in the current literature, there's actually a number of studies that show that neuroticism itself is associated with a wide range of physical health problems, actually. So one study carried out by Charles in 2008 found that neuroticism related to distress and emotional stability was correlated with physical symptoms and disease presence.

So they had more physical symptoms, more disease presence. Right, yeah. So they found that chronic emotional instability created physiological changes detrimental to health, actually. So this was a study of over 20,000 adult twins. Neuroticism was assessed first in 1973, and data on physical conditions was recorded 25 years later. Impressive. Yeah. These studies that follow people for this long and this many just blows my mind.

Yeah, it's such useful data too. It's just like, how do you do that? How do you keep, I mean, 1973, they didn't have like the computers that we have. Right? You have to imagine, in 1973, I don't think they had any computers. Right. Probably all by hand. So they did this all by hand, right?

notebooks and notebooks and notebooks and file cabinets and file cabinets. Okay, keep going. Crazy. Yeah, so what they found in their 25-year study is that the likelihood of having a physical condition was related to higher levels of prior neuroticism. Specifically, what they found was most highly associated was chronic fatigue syndrome, ulcers, and coronary heart disease. Chronic fatigue odds ratio 1.56, ulcers 1.56, ulcers 1.5.

point three corner artery z is 1.13. Okay. That's interesting. Chronic fatigue. I mean, I'm not surprised about that at all. We talked about that earlier, actually, and when we were talking about genetics and the linkage between full body pain, it often comes with chronic fatigue. I see those types of patients all the time. So what other studies have been done on this? Yeah, so there was actually a little more recent study. This was done by Shipley in 2007. So this was another prospective study that went over 20 years, this time of 5,000 adults. So what they did was they had the participants.

They took the Eisenick personality inventory from 1994 to 1995. And then mortality was then tested 21 years after baseline person. personality was taken. And what they found was that greater mortality from cardiovascular disease was still significant even when controlling for other things, such as occupational class, education, alcohol consumption, physical activity. Neuroticism was not found to be associated with death from stroke, respiratory disease, lung cancer, and other cancers. That's interesting. So specifically, cardiovascular disease. You know, it makes sense. It makes sense. It's, let's see, let's see what the hazard ratio is. It's like 1.12, but after adjustment, 1.1.

That's where around the hazard ratio was, okay. So around 1.1. And then for other things, like extraversion for all ages, extroversion after being adjusted is like 1.04. So not quite as strong as neuroticism by any means. Interestingly, in that 40 to 59 year old range, it's a little bit higher and then it decreases in the 60 year old range for extraversion. Maybe because they're so outgoing, they put themselves at a little bit more, they do, they might do more risky things. 1.1, sorry, 1.2 in the 40 to 59 for extraversion.

This is specifically talking about cardiovascular disease and the hazard ratio. Pretty interesting. Pretty interesting. It kind of makes me think about, there's a story that I heard about how they found out about type A personality. and it's they've there was this uh person who repaired leather on chairs and he was covering for his colleague or whatnot and um the leather keep getting worn out on these chairs in a cardiology office so he bust into the cardiologist says why what kind of patients do you have they're wearing

out the leather right in the middle you know on both sides of their legs so much faster than i've ever seen before. So a cardiologist's like, get out of my office, you know, and then like the cardiologist later dawns on him. Wait, why are they moving their legs back and forth like that all the time? Like all my patients, because all of them, while they were sitting in their chairs, waiting to see the cardiologist for their heart disease, or fidgeting, like restless, right? And so, I don't know, maybe there's a kind of a similar, here, you know, of someone who's highly neurotic, higher risk of cardiac issues. Yeah, interestingly, it's like if you look at the hazard ratio with hypertension,

I don't think it's that much bigger than this. So that's interesting. Okay, let's keep going. Yeah, and so a lot of data on physical health symptoms. And perhaps the biggest one is a study done by, Kelly in 2006. So what this study did is they took data from the National Comorbidity Survey, and they showed that neuroticism was associated with increased odds of arthritis, diabetes, kidney liver disease,

stomach gallbladder problems, and, again, ulcers. These are a lot stronger odds ratios. Diabetes 3.33, kidney liver disease, 2.56. Gobeladder, stomach issues 2.27 increased odds. Ulcers 3.23. These are pretty strong increased odds. And the associations were still significant after controlling for differences in demographic characteristics in comorbid mental disorders.

That's interesting. So do they have any idea on what it does the immune system? Right. So there actually have been studies that, show that neuroticism does affect the immune system and that it affects pro-inflammatory cytokines, actually. So in this study, carried out by Schmidt in 2018, showed that inflammatory cytokines, including IFN gamma, IL-5, and IL-12 levels were associated with overall neuroticism score. So what they did is they took 37 depressed patients and 1.75 non-depressed patients.

They had them complete a personality, Neo-PIR. And then they actually measured cytokines with blood draws right after. The blood draws included an assay that detected all sorts of cytokines that are associated with non-influidylase. inflammatory and non-inflammatory. And from here, they took multiple regression analyses to determine relationship between personality traits and cytokine values. Yeah, I'm blown away by the IFN gamma.

The beta is 32.1. That seems very strong. Yeah. Wow. Yeah, and interestingly enough, none of the anti-inflammatory cytokines were associated just the inflammatory. Huh.

Well, that would be, you know, you have kind of chronic inflammatory cytokines going on. That would increase risk of things like heart disease, things like, you know, the other medical issues. So that would make sense of it a little bit. Let's get through some of these other studies quickly. So neuroticism has been shown to be associated with life, time, asthma diagnosis. Neuroticism scores have been shown to be significantly higher in

in diarrhea predominantly irritable bowel syndrome patients. And that's compared to patients with ulcerative colitis and general medical patients. That's very interesting to me. So now let's talk a little bit about causal pathways of health effects due to neuroticism. So more neurotic patients tend to report more somatic complaints and distorted cognition regarding symptoms, greater use of medical services. And this is something that makes this topic important to all physicians, I think, right? Because people are highly neurotic are going to be the ones that are persistently coming with concerns of medical issues.

I've seen a couple of these patients stick them on some LexiPro. three months later, they're not worried about 10 different cancers that they think's going on. Stick them in some therapy as well, right? Learn to combat those negative, intrusive thoughts. So tell me about this one study, 2004, Gubert. Yeah, so this study looked at the role that neuroticism played in pain catastrophizing, pain-related fear and personality dimensions and vigilance to pain and pain severity. So it's important to first define what pain catastrophizing is.

So what they define it is is a maladaptive, cognitive, affective response to pain that involves negative thinking regarding the pain experience, which by definition sounds like something a neurotic patient would go through. You know, I think because I run or help run a program that deals with patients with a lot of pain, they often say things like, oh, it's bone on bone, there's no hope for it. You know, there's nothing, the doctor looked at it, looked at it and showed it to me and said, this is why you hurt. It's bone on bone. Remember that for 20 years.

You know, it's never bone on bone, right? That's not like, that's not a thing. There's always muscle supporting it. There's always all this other stuff going on. but then they develop this catastrophizing, you know, and then they fear movement, right? Pain catastrophizing is 0.85 correlated with fear of movement. So then what do they do? They have increased vigilance to pain.

Then they, you know, don't move around as much. They don't exercise as much. Their muscles get weaker. And guess what happens when the muscles get weaker? Pain worsens. I've had a number of. close friends that once I get them squatting, get them deadlifting, their back pain

goes away. And their back pain, you know, these are people who've had surgeries before on their back even. Their back pain goes away because the muscles are stronger. And plus, I think there's something about lifting that teaches you how to not

catastrophize pain. When I first started lifting, I catastrophize pain all the time. So I'd get a little tweak and I would like freak out to I do something, blah, blah. you know people see you squatting they they freak out for you and they tell you you know you're gonna hurt yourself or something and then so you start to kind of like buy into this like narrative right oh no something's really bad happen and because of that your muscle spasm even more so like the last year with like just kind of understanding my body it's like I get a little spasm and I'm just

I'm able to just relax those muscles because I can tell myself it's not a big deal. So in summary, vigilance to pain was related to experience of more severe pain. Right? So when you have increased vigilance,

when you're checking out your pain, when you're, you know, observing your pain, you're vigilant to the pain, you have increased pain severity. You have an increased experience of pain. Only neuroticism was found to be consistent related to vigilance to pain,

catastrophizing and fear of re-injury. Pain catastrophizing and fear of re-injury mediated the relationships between pain severity and pain catastrophizing. Cool. I like that study. I really do. I think it's helpful. I think it's helpful because if you're in psychiatry and you're in psychotherapy, often you don't think that your work is going to decrease pain, but it will.

pain is something that we treat pain will improve and most patients when I tell them that they look at me funny like what therapy's going to out my pain yeah yeah therapy's going to help your chronic migraines I wouldn't be surprised if some people listening to this who are stressed out you know we know that there's an increased rate of depression of suicidal thoughts which with essential workers during this phase, I wouldn't be surprised if some of you are also experiencing increased pain and getting some treatment can be helpful. Okay, so neurotic people may be more likely to engage in health risk behaviors,

including alcohol or drug use, unsafe sexual practices, or violent, aggressive behavior. Tell me a little bit about this study. Alwer Bach 2007. Yeah, so this was a study of university students, actually. They examined whether neuroticism, emotional regulation, deficits, and or their interaction, increased engagement of risky behaviors at all. So what they did is they basically had patients fill out a questionnaire about their personality traits,

FFIN and a risky behavior questionnaire. And what they found was that participants who had high levels of neuroticism and low levels of emotional repair reported higher levels of risky behavior when experiencing, only when experiencing high levels of anxiety symptoms. You know, talking about like kind of substance use, how it changes maybe mortality even. There was one study that we found, Morocheck, that found that 40% of the effect of neuroticism on mortality was mediated by smoking behavior. So a lot of mortality increase from neuroticism can be attributed just from the increase in smoking. We're going to talk a little bit

about neuroticism and quality of life. We know that people who are higher in neuroticism, are associated with higher levels of burnout and emotional exhaustion. When I looked at the beta, the effect size of 0.21 on this study, the effect size between neuroticism was a positive predictor of global burnout. Point 21 is not that much, actually. It's not that much. So it's not like, why are so many medical students burned out? It's because of the high neuroticism, you know?

doesn't have anything to do with attendants who force you to work nonstop on projects. I don't know anything about that. Yeah. That probably isn't the cause of any burnout. You know, when I talk to medical students, one of the biggest thing that burns them out is interpersonal interactions with attendants and residents. Those are the most stressful things in medical school. and in life really.

Usually it's the interpersonal interactions. And when they go well, it's the biggest help to us. So neuroticism is also associated with decreased level of marital satisfaction over time. I don't think that should be a huge surprise. I like this study because they followed individuals for 18 years. It's one of the longest follow-up periods in relationship research. and the results showed that neuroticism was significantly negatively associated with satisfaction at all three time points. Extroversion and openness demonstrated small, but positive significant

associations with satisfaction. Conscientious and agreeableness were only significantly positive at two time points, but neuroticism negative at three time points. Neuroticism loses, once again, the other big five personality types. How big was the correlation? At time one for neuroticism, negative 0.22, at time 2 for neuroticism, negative 0.18, at time 3 for neuroticism, negative 0.16. So not huge associations, but they're there. They're present. They're all negative. They're all going in the same direction. recent meta-analysis, 2020, fresh off the press, found a negative relationship between neuroticism and marital quality. This was a systemic review of 18 correlation studies, and they found that,

get this, couples high in neuroticism experience significantly lower levels of marriage satisfaction. 0.439 was the association and while couples high in conscientiousness have high levels of marital satisfaction. 0.9. Wow. That's a big association. I think about the connection between early warmth from parents and conscientiousness and I wonder if that has. anything to do with the impact here. So next episode, first of all, congratulations on getting this far. I'm glad you're interested in neuroticism. We are interested in how to help people with neuroticism.

And so that's really what kind of where the rubber meets the road. So in part two, we'll go over the treatment of neuroticism. We'll talk about medications that influence neuroticism. We'll talk about psychotherapy. which psychotherapies have been studied for decreasing neuroticism. I'll give you a hint. Mindfulness-based CBT is one of them. And we'll also talk about exercise,

and how exercise influences neuroticism. And we'll also talk about some potential benefits of neuroticism, which I challenged future Dr. Zane to get. And he found some. Yep. Challenge except. So if you're listening to this, I would highly recommend go check out the PDF in our resource library. Say hi to me on the way in. I read all the responses. It's very encouraging, actually. And if you want to pay for one of my meals that I've taken Alex Zain out for the last couple weeks, how many meals have I taken you out for?

I counted three or four. Okay. I want to pay for some of those meals. Join the Patreon. on helps support the podcast. Part of that is our food fund and our coffee fund. Helps caffeinate me. You also get a one-of-a-kind psychiatry and psychotherapy mug, which is a very nice mug. It's the highest quality mug I could find.

It's very nice. So I'm looking forward to part two. I hope you are too. I'm hoping that by the time you listen to all of these episodes on the Big Five, you really have an idea, like kind of a framework for understanding this, a big picture. And I think that would be exciting. So thank you for listening. Have a great evening.