23Personality and Mental HealthMohammad Ali SalehinezhadUniversity of Tehran, Tehran,Iran1. IntroductionThe importance of personality to mental health entails accurate definition of bothpersonality and mental health. According to World Health Organization (WHO) health isdefined as “a state of complete physical, mental and social well-being and not merely theabsence of disease or infirmity (WHO, 2001b, p.1). Mental health and mental well-being areincluded in the foregoing definition of health which emphasizes on considering mentalhealth as a construct interconnecting with other variables in a unified context. In addition of,this definition, psychologists deal with mental health in some terms. looking at the realm ofmental health, we meet terms such as mental health (WHO, 2001), “psychological health”(Rosenthal & Hooley, 2010), well-being (Josefsson et al., 2011), “subjective well-being” or“happiness” (Lucas & Diener, 2008; Ryan and Deci, 2001), “Psychological well-being” or“eudaimonia” (Cloninger & Zohar 2011; Wood, Joseph, & Maltby, 2011) “mental hygiene”(Barenbaum & Winter, 2008) and “psychological wealth” (Diener & Biswas-Diener, 2008)that need to be explained in order to illustrate a correct definition and understanding ofmental health. Thus, it is clear that, mental Health cannot be considered separately, and inorder to have a better understanding of mental health, its major components such asphysical, mental, and spiritual well-being should be considered together (Cloninger &Zohar, 2011).Personality, which is the main concentration of this chapter, is defined as an individual’scharacteristic style of behaving, thinking, and feeling”(Schacter, Gilbert, & Wegner, 2009).Although there has been much debate about the definition of personality, two major themeshave pervaded nearly all efforts at domain of personality theorizing: human nature andindividual differences (Buss, 2008). The way we think, feel and behave and our uniqueindividuality have significant contribution in our mental health as in our psychopathology.Some individuals are more prone to mental illness and psychopathology because of theircharacteristics and personality traits (Hampson & Friedman, 2008), whereas some othersexperience higher level of mental health because of their personality traits and characters(Cloninger, 1999, 2004; Seligman et al., 2005; Wood & Tarrier, 2010). Therefore, it seems thatsome individuals are more susceptible to mental illness, thereby threatening their mentalhealth.Another controversy in personality psychology addresses the nature and domain ofpersonality. Do personality traits locate as some separate constructs that are either presentor absent in individuals? Or they should be considered in a continuum? The answer to thisquestion has grave theoretical and practical implications not only in personality psychology,

462Essential Notes in Psychiatrybut also in mental health. The purpose of this chapter is to explain and debate importantrole of personality in mental health in a comprehensive context and finally accentuate andpropose prospective areas of personality regarding to both mental health and mental illness.2. Domain of personalityPersonality psychology seems to be the broadest and most integrative branch of thepsychological sciences (Buss, 2008). The recent calls for integration in psychology, entails usto have a more unified and integrative approach toward behavior and psychological processof individuals. This integration has also addressed personality psychology (e.g., Mayer,2005; Miscehl & Shoda, 2008). Integration in personality psychology is depicted in newframe work in personality suggested by Mayer (2005). In the field of personality, there usedto be a perspective-by-perspective framework that causes personality psychology getfragmented by theories; however, Mayer (2005) suggests the systems framework forpersonality which leads to the integration of personality that can naturally promoteintegration as well as a vision of the whole person.While, Mayer (2005) proposes integration of personality in a broad scale, encompassing allpsychology, Miscel and Shoda (2008) on the other hand, argue about unification withinpersonality theories and concepts. They point to the two main approaches in personality:dispositional approach and processing approach. Miscel and Shoda (2008), reconcile thesetwo approaches within a unifying framework at least in the abstract. They analyze both thedistinctive behavior patterns that characterize the exemplars of a disposition and thepsychological processes and mediating units that underlie those.On balance, Mayer’s new frame work in personality (2005) seems more successful in regardto mental health because of its broad inclusion of biological, psychological, and socialsystems. Understanding that personality connects the biological and social helps identify itslocation. The biological, psychological, and social systems are connected, in part, along acontinuum called the molecular–molar dimension (Mayer, 2005). In the figure 1 Mayer,illustrates the integration of personality psychology. The molecular end of the dimensionrefers to smaller systems of interest—at its extremes, subatomic particles. The molar endrefers to larger systems—at its extremes, the entire universe as a system (Henriques, 2003;Levy-Bruhl, 1903). The middle range of this dimension separates psychology from itsbiological neighbors below and its larger sociological and ecological systems above.Considering this approach to personality, the biological, psychological and social andcultural factors with regard to mental health are appreciated. Thus I believe that when weaddress mental health issues, personality as described above, can provide a broader as wellas a more realistic view toward mental health. Each perspective may address mental healthproblems with more emphasize on a specific set of variables, rather than in a multivariablecontext. Thus, personality should be considered as an integral part whenever we tackleeither mental health or mental illness. The role of personality in determining mental healthand mental illness is quiet prominent and can lead to theoretical implications in the realm ofresearch toward mental health and practical implications in community level.2.1 Personality traits vs personality processesI like to point briefly to a new developed approach in personality psychology that bringabout new implications for issues in models of personality structure, methods of

Personality and Mental Health463assessment, and identifying targets for personality interventions. As we know Reviews ofstudies documenting associations between personality traits and important life outcomesamply confirm the predictive power of personality. Personality traits predict consequentialOutcomes for individuals (e.g., happiness, longevity), couples (e.g., relationship quality),groups, and society (e.g., volunteerism, criminality). These reviews provide an extensivecatalogue of what personality predicts but do not examine how personality gives rise to theseassociations (Hampson, 2012). According to Hampson (2012) Understanding personalityprocesses or “how” of personality, goes beyond describing individual differences byexplaining the expression of Individual differences. Adopting this approach in personalityresearches allows us understanding the predictive power of personality in our life and howpersonality can mediate or moderate our mental states.Note. The horizontal lines represent levels of the molecular–molar continuum. The “Inside the Person”box shows personality and its emergence from major psychological subsystems and from the brain. The“Outside the Person” box shows the psychological situation and the setting from which it emerges. Bothpersonality and the situation are incorporated within larger social systems (shown above them).Adapted from Figure 1 in “Classifying Change Techniques According to the Areas of Personality TheyInfluence: A Systems Framework Integration,” by J. D. Mayer, 2004, Journal of Clinical Psychology, 60, p.1296.Fig. 1. Personality and its Neighboring

464Essential Notes in Psychiatry3. Relationship between personality and mental health: unidirectional orbidirectional?What is the nature of relationship between personality and mental health? It is clear thatpersonality traits and characters of individuals affect their mental health (Josefsson et al.,2011; Cloninger & Zohar, 2011). But the question is that how these personality traits andcharacters affect individuals in a way that promote mental health and wholesomebehaviours. Is this relationship unidirectional, in a way that personality as an independentstructure, determines mental states of individuals? Or personality can be affected by thepresence or absence of mental health too? To answer this question we should primarilydefine both personality and mental health.3.1 Definition of personalityYour intuitive understanding of personality is probably very similar to the way thatpsychologists define the concept. Personality is an individual’s characteristic style ofbehaving, thinking, and feeling (Schacter, Gilbert, & Wegner, 2009). Consider thisdefinition regarding the figure 1 in order to draw a more accurate concept of personality inyour mind. Besidess of personality, personality disorders are notable with regard to mentalillness. The conceptualization of personality disorders in DSM-IV-TR represents thecategorical perspective that personality disorders are qualitatively distinct clinicalsyndromes (American Psychiatric Association, 2000, p. 689), which are distinct from eachother and from general personality structures (Shedler & Westen, 2004; Skodol et al., 2006).This categorical classification is problematic from both theoretical and practical points ofview. It has been argued that the current personality disorder classification in DSM isneither theoretically sound nor empirically validated (Aboaja, Duggan, & Park, 2011). Thecategorical model of classification has become so problematic that a Research PlanningWork Group for DSM-V concluded that it will be “important that consideration be given toadvantages and disadvantages of basing part or all of DSM-V on dimensions rather thancategories” (Rounsaville et al., 2002).In contrast to DSM-IV-TR, Psychodynamic Diagnostic Manual (PDM) and recent evidences(Rounsaville et al., 2002) suggest a dimensional model for personality disorders and personalitytraits. Dimensional model for personality suggest a spectrum relationship in regard topersonality and personality disorders (Widiger & Smith, 2008). It would appear more likely thatpersonality disorders are on a spectrum with general personality structure. This spectrumrelationship may also exist for personality disorders and Axis I mental disorders. (Widiger &Smith, 2008). Adopting this view toward personality has some important implications withregard to mental health; Personality traits which affect mental health can be found in eachindividual. The intensity or weakness of these traits is different in individuals and thesedifferences are responsible for mental states to be healthy or unhealthy. In what follows, I willdiscuss more about the consequences of spectrum relationship in mental health.3.2 Definition of mental healthThe term ‘mental health literacy’ was first coined by Jorm etal. (1997) meaning ‘knowledgeand beliefs about mental disorders which aid their recognition, management or prevention’(p.182). As it is said earlier, WHO has included mental well-being in the definition of

Personality and Mental Health465WHO famously defines health as: a state of complete physical, mental and social well-beingand not merely the absence of disease or infirmity (WHO, 2001b, p.1). Three ideas central tothe improvement of health follow from this definition: mental health is an integral part ofhealth, mental health is more than the absence of mental illness, and mental health isintimately connected with physical health and behavior (WHO, 2001a). WHO has recentlyproposed that mental health is: a state of well-being in which the individual realizes his orher own abilities, can cope with the normal stresses of life, can work productively andfruitfully, and is able to make a contribution to his or her community (WHO, 2001b, p.1).Realizing abilities, coping with stresses, and working productivity are some behaviors andaccording to definition of personality, these style of behaving are determined by personality.When we notice to definition of other related terms to mental health, we find the relationshipbetween personality and mental health more vivid.“Subjective well-being“ has been defined asan individual’s evaluation of his/her life as a whole (Diener, 1984; ) this individual evaluationcan be affected by the way of thinking or feeling in which personality account for this. Well-beingis the other term in the realm of health and mental health. Well-being is a multidimensionalconcept that includes Various aspects of mental and physical health, supporting socialrelationships, and ability to cope with stressful situations (McDowell, 2010; Stokes, etal., 1982).Subjective well-being and subjective health are more highly correlated with each other thansubjective health and objective physician assessed health (Jossefsson et al, 2011). Subjective wellbeing which is an integral component of well-being thus, is related with personality.“Psychological health” (Rosenthal & Hooley, 2010), well-being (Josefsson et al., 2011),“subjective well-being” or “happiness” (Lucas & Diener, 2008; Ryan and Deci, 2001;Luhmann et al., 2012), “Psychological well-being” or “eudaimonia” (Cloninger & Zohar2011; Wood, Joseph, & Maltby, 2011) “mental hygiene” (Barenbaum & Winter, 2008) and“psychological wealth” (Diener & Biswas-Diener, 2008) are terms and concepts in the realmof mental health each one points to psychological functioning and determines styles ofbehaving leading to healthy state. Therefore, personality which directs our ways of thinking,feeling and behaving is an undeniable construct in determining these healthy states. Finallywe should appreciate the role of culture with its given values which can affect directly orindirectly health and mental health through beliefs, expectations, values and ingroupconcepts (Bagherian, Rocca, Thorngate, & Salehinezhad, 2011)3.3 Relationship between personality and mental healthWe realized definition of personality and mental health. The question is that how theirrelationship is shaped? Many studies have shown the effect of personality, personality traits,and personality dimensions in mental health (e.g., Josefsson et al., 2011; Cloninger & Zohar,2011; Cloninger, 1999; Cloninger, 2004; Cloninger, 2006; Diener & Biswas-Diener, 2008; Aboaja,Duggan, & Park, 2011; Chan & Joseph, 2000; Herero & Extremera, 2010; Wood & Tarrier, 2010;Joseph & Wood, 2010). A cumulating body of research suggests that there are variables such aspersonality traits that predispose individuals to experience specific life events (Luhmann et al.,2012). However, as we know, personality is conceptualised as an unchanging aspect of theperson (Chan & Joseph, 2000) at least according to dispositional approach (Miscehl & Shoda,2008). According to Widiger and Smith (2008) an Axis I disorder can alter the appearance orexpression of premorbid personality traits. Persons who are very anxious, depressed, angry, ordistraught will often fail to provide an accurate description of their general personality

466Essential Notes in Psychiatry(i.e., their usual way of thinking, feeling, behaving, and relating to others). Presence of amental disorder negatively affect individuals in realizing their abilities and coping with stressas well as making them dysfunctional in important areas of life and this is in opposition withmental health. Thus presence and absence of mental health can alter the appearance andexpression of personality traits. Finally recent evidence even suggest that the relation betweenlife events and subjective well-being may be bidirectional (Luhman et al., 2012)4. Personality and mental illnessMental illness or, in other word, “psychopathology” is a term that can facilitate ourconceptualization of mental health. This is more intelligible when we consider that mentalillness (MI) and mental health (MH) have been recently considered to be bipolar extremes ofthe same underlying dimension (Insel & Scolnick, 2006; Keyes, 2007; Pressman & Cohen,2005). By measuring psychopathology symptoms in mental health studies, we can set thefindings in a broader perspective of well-being and ill-health (Josefsson et al., 2011). Theconcept of mental health requires an understanding of abnormal behavior leading to mentalillness. Normality and abnormality cannot be differentiated objectively. They reside on acontinuum and slowly fade into the other (Millon et al. 2004). Mental health and mentalillness are the same. They cannot be considered separately. An individual with mentalillness does not experience the state of mental health. By recognizing and examining thepersonality factors related to psychopathology, the relationship between personality andmental health would be clear in turn.It is notable that we consider, although mental illness (MI) and mental health (MH) havebeen considered to be bipolar extremes of the same underlying dimension, this viewpointhas begun to be questioned. There are now some indications that positive and negativeaspects of psychological experience are mediated by different psychological systems (Keyes,2007, 2009; MacLeod & Moore, 2000; Pressman & Cohen, 2005). Thus, low levels of a mentalillness characteristic such as depression does not guarantee high levels of mental healthcharacteristic such as optimism. What we can claim with more certainty is that variouscombinations of both MI and MH are possible (Keyes, 2007). Thus, with regard topsychological treatment of clients and considering researches in the realm of mental healthwe need to take into account the level and characteristics of MH as well as those of MI(Alterman et al., 2010).Understanding the role of personality can help us understand mental health and that’s whyin this part, the relationship between personality and psychopathology is discussed. Theimportance of personality to psychopathology has been recognized since the beginnings ofmedicine (Widiger & Smith, 2008). Hippocrates (in the fourth century b.c.) distinguishedbetween four fundamental dispositions (i.e., sanguine, melancholic, phlegmatic, andcholeric) that were thought to provide a vulnerability to a variety of physical andpsychological disorders (Maher & Maher, 1994). Moreover, in recent years personality andmental health have been studied in large amount of researches (e.g., Akiskal, Hirschfeld, &Yerevanian, 1983; Clark, Watson, & Mineka, 1994; Eysenck, 1987; Krueger, McGue, &Iacono, 2001). Contemporary theoretical models directly link personality withpsychopathology ( Pincus, Lukowitsky, & Wright, 2010; Widiger & Smith, 2008), and crosssectional research finds links between personality and psychopathology of most types andPersonality disorders in particular (Wright, Pincus, & Lenzenweger, 2011)

Personality and Mental Health467Krueger, McGue, and Iacono (2001) provided interesting findings about relationshipbetween personality and psychopathology. They found a connection between the higherorder structure of common DSM mental disorders and personality. This higher orderstructure includes internalization and externalization. These two fundamental dimensionsof child psychopathology map well also onto the adult psychopathology and fundamentalpersonality temperaments (Widiger & Smith, 2008). Krueger et al (2001) point to personalityas a covariance, meaningfully account for comorbidity among mental disorders. They foundthat internalization was linked with higher negative emotionality and lower positiveemotionality and externalization was linked with lower constraint. In general, they foundthat comorbidity could be modelled by hypothesizing the existence of broad, continuousvariables underlying observed patterns of correlation among DSM constructs. These broadvariables, in turn were linked to broad variables from the personality literature. This refersto a vulnerability model of the relationship between personality and mental disorder; amodel in which personality contributes to the risk of experiencing mental disorder (Krugeret al, 2001).It is notable that in relationship between personality and psychopathology, we shouldinclude both maladaptive personality functioning - as described within the AmericanPsychiatric Association’s (2000) Diagnostic and Statistical Manual of Mental Disorders(DSM-IV-TR) - as well as normal personality traits, as described within dimensional modelsof general personality structure such as Big Five theory. In respect to this relationship thereare three important potential forms of interplay between personality and psychopathology:first, Personality and psychopathology can influence the presentation or appearance of oneanother (pathoplastic relationships); second, they can share a common, underlying etiology(spectrum relationships); and third, they can have a causal role in the development oretiology of one another (Widiger & Smith, 2008).4.1 Pathoplastic relationshipThe influence of personality and psychopathology on the presentation, appearance, orexpression of each is typically characterized as a “pathoplastic relationship” (Widiger &Smith, 2008). As it was pointed earlier about bidirectional the relationship betweenpersonality and mental health, the relationship between personality and psychopathology isbidirectional too. Consequently, personality traits can affect on appearance ofpsychopathology and the appearance or presentation of personality can similarly be affectedby the presence of a psychopathology.4.1.1 Pathoplastic effects of personality on psychopathologyMental disorders occur within the context of a premorbid personality structure that often has aprofound effect on their presentation, course, or treatment (Millon et al., 1996). This is betterintelligible when we know that mental disorders are clinically significant impairments in oneor more areas of psychological functioning including one’s thinking, feeling and behaving(American Psychiatric Association, 2000). Thus, a person’s characteristic manner of thinking,feeling and behaving that we call it as personality, can affect these significant impairments.As an example it can be refer to anorexia nervosa and bulimia nervosa (Widiger & Smith,2008). The primary distinction between persons with anorexia nervosa and those

468Essential Notes in Psychiatrybulimia nervosa is perhaps simply that the former are pathologically successful in the effortto maintain a low body weight (i.e., are grossly underweight), whereas persons with bulimianervosa are relatively unsuccessful, due partly to their binge eating and inadequate (but stillexcessive) compensatory behaviors. This fundamental distinction could be driven, in largepart, by premorbid personality differences. It is possible that those who go on to developanorexia are characterized in part by premorbid personality traits of very highconscientiousness (Widiger & Smith, 2008).Another example in regard to this pathoplastic relationship of personality andpsychopathology refers to depression. Studies about relationships between depression andTemperament and Character Inventory (TCI), usually show that depressed patients exhibithigher harm avoidance and self-transcendence scores as well as lower self-directedness andcooperativeness scores as compared to healthy controls (Hansenne et al, 1999; Marijnissen etal, 2002). Personality features may predispose an individual to depression; the personalitycan be modified after a depression; the personality can modify the clinical presentation of adepressive disorder; and finally the personality can be considered like a subclinicalmanifestation of a depressive disorder (e.g., Akiskal et al., 1983; Hirschfeld et al., 1997).4.1.2 Pathoplastic effects of psychopathology on personalityJust as premorbid personality traits can alter the appearance or expression of an Axis Idisorder, an Axis I disorder can alter the appearance or expression of premorbid personalitytraits (Widiger & Smith, 2008). Persons who are very anxious, depressed, angry, ordistraught will often fail to provide an accurate description of their general personality traits(i.e., their usual way of thinking, feeling, behaving, and relating to others). Distortion in selfimage is a well-established symptom of mood disorder (American Psychiatric Association,2000), and it should not be surprising to find that persons who are depressed provideinaccurate descriptions of their usual way of thinking, feeling, and relating to others. Oncetheir mood, anxiety, or other mental disorder is successfully treated, their self-descriptionchanges accordingly.Some may argue that personality is a relatively stable structure and psychopathology cannotchange or alter personality, however some well-documented studies reveal the existence ofsuch a relationship (e.g., Clark & Harrison, 2001; Farmer, 2000; Vitousek & Stumpf, 2005;Widiger & Samuel, 2005). According to processing approach, personality is an organizedsystem of mediating units (e.g., encodings, expectancies, goals, motives) and psychologicalprocesses or cognitive–affective dynamics, conscious and unconscious, that interact with thesituation the individual experience (Mischel & Shoda, 2008). Personality in this approach is adynamic construct which operates across social situations as well as it can be influence fromsocial behaviour.In sum, pathoplastic relationship between personality and psychopathology is a notion withpractical implications, which should be considered in mental health research. An importanttheoretical and practical implication implies that psychological problems can predisposeindividuals to develop morbid personality traits which in turn can intensify thepsychological problems. On the other hand there are some kinds of personality profileswhich can promote mental health (e.g., Josefsson et al, 2011; Herero & Extremera, 2010;Chan & Joseph, 2000; Unterrainer et al, 2010) which will be discussed in this

Personality and Mental Health4694.2 Spectrum relationshipIt used to be assumed that personality and psychopathology are distinct entities. Looking atDiagnostic and statistical manual of mental disorders, 4th edition (DSM-IV), show attemptsin order to provide a more accurate diagnostic criteria in mental disorders, includingpersonality disorders. The assumption of the diagnostic manual is that the categories refer todistinct clinical entities, each with its own distinguishable etiology, pathology, andtreatment (Widiger & Mullins-Sweatt, 2007). However, personality and psychopathologymay themselves fail, in some instances, to be distinct entities. They may instead exist along acommon spectrum of functioning. For example, rather than contributing to the etiology ofdepression, neuroticism may itself be a form of a depression (Widiger & Smith, 2008). Incontrast to DSM-IV-TR, Psychodynamic Diagnostic Manual (PDM) and recent evidences(Rounsaville et al., 2002) suggest a dimensional model for personality disorders andpersonality traits.This spectrum relationship exists in some ways such as: Personality on a Spectrum withPersonality Disorders, Personality Disorders on a Spectrum with Axis I Mental Disorders,and Axis I on a Spectrum with Personality (Widiger & Smith, 2008). This dimensionalapproach to personality, personality disorders and mental disorders accompanies withbeneficial implication in the realm of mental health. The first and most important oneinvolves our attitude toward mental health research; identification and differentiation ofetiological relationships of personality and psychopathology cannot be considered withsimplicity. Actually it is more complicated because of observable overlapping andcomorbidity that exists among mental health problems specially. This approach affects theway clinicians meet mental disorders, as well as research guidelines we adopt towardpsychopathology and mental illness problems. That is why the American PsychiatricAssociation (APA) subsequently cosponsored a series of international conferences devotedto further enriching the empirical database in preparation for the eventual development ofDSM-V (Widiger & Smith, 2008).The other important theoretical and practical implication refers to inclusion of mentalhealth. Mental health is a pervasive issue which can be endangered and this can happen toeveryone, rather than a specific group of afflicted people suffering from mental problems. Infact mental health issues can afflict each individual based on styles of thinking, feeling andbehaving. By adopting this approach, community psychologist and researchers in the areasof mental health will have better conceptualization of mental health problems.4.3 Causual relationshipThe third form of interplay between personality and psychopathology refers that they canhave a causal role in the development or etiology of one another. This causal relationship isagain bidirectional: One’s characteristic way of thinking, feeling, behaving, and relating toothers can result in, or contribute to, the development of a mental disorder, just as a severeor chronic mental disorder can itself contribute to fundamental changes in personality(Widiger & Smith, 2008). Personality can change for the better or worse. The ICD-10 (WorldHealth Organization, 1992) contains a number of mental disorder diagnoses that concernmaladaptive changes to personality functioning occurring wit

Personality psychology seems to be the broadest and most integrative branch of the psychological sciences (Buss, 2008). The recent ca lls for integration in psychology, entails us to have a more unified and integrativ