There are parts of a person’s personality that are static through the passage of time and others that can fluctuate. If you are Introverted, chances are, to some degree, you will always be introverted. Yet I wonder how chronic pain over time changes us outwardly and internally. Constant pain changes a person. Medications change a person. Until you find you are no longer who you were. Some of these changes are from the coping process. We do what we need to, behave as we need to and act as we need to in order to function in the outside world. From this we develop a façade of wellbeing to distance others and ourselves from our pain.

So how does personality affect how we cope with chronic pain?

The Big Five Personality- how we respond to stressors can depend on our personality type. The Big Five looks at Openness, Agreeableness, Neuroticism, Extroversion and Consciousness. People who are high on N (High scorers tend to be nervous, insecure, worry a lot whereas low scorers are more calm, relaxed and secure) tend not to cope well and choose ineffective coping strategies. They engage in a lot of self blame, have difficulty with problem solving, practice more avoidance when stressed. Perhaps it is their high level of emotional responses that hinder their ability to choose healthy coping strategies for the right situations. Those high on the E scale of things however, tend to be quite effective copers, perhaps because they use a variety of coping strategies. How a person rates on the Big Five can effect how they will choose to cope with stressors. For example someone low on E, would rather retreat, avoid and self blame. Someone low on O might have difficulties finding effective coping strategies and less inclined to try them. The fact is if we use negative coping strategies and have problems with problem solving it could easily lead to hopelessness and depression.

Therefore, if our personality inclination is maladaptive to our reality of living with chronic pain, then we must consciously think about our habitual reactions in order to consciously find a way to adapt. ‘To the extent that a chronic illness challenges core beliefs, integrating the illness experience into their pre-existing beliefs should promote psychological adjustment. Cognitive processing has been used as the phrase to define cognitive activities that help people view undesirable events in personally meaningful ways and find ways of understanding the negative aspects of the experience, and ultimately reach a state of acceptance. Attempts to find meaning or benefit in a negative experience are ways patients may be able to accept the losses they experience. Focusing on the positive implications of the illness or finding personal significance of a situation are two ways of finding meaning in the illness. When considering meaning-making coping, one must distinguish coping activities that help individuals to find redeeming features in an event from the successful outcome of these attempts.’ (http://pagerankstudio.com/Blog/2010/10/psychosocial-coping-with-chronic-illness/)

We may be inclined to avoid the problem, engage in wishful thinking, disengage and retreat, instead of actively engaging in the world using several coping strategies.

I am an INTP using MBTI (Carl Jung, Katharine C. Briggs, and Isabel Briggs Myers) and that reflects me perfectly, or it used to, or that is me on the inside. I am reserved, private, prefer my own company or a few friends, prefer deep conversations, philosophy, abstract theories, living in my head, am not very emotional and all together too rational. That is me on the inside. It is how I interpret the world and even how I interpret my illness. I think about pain, about the price I pay surviving it and the coping process itself, rather than allow myself to connect emotionally to the experience. Therefore, one way I cope is to distance myself emotionally from the pain. My façade of well being is one that is radically different from who I am on the inside, yet it developed as a defense mechanism to laugh off my pain to others so they would be unable to see the emotional price chronic pain costs me. Again, what coping strategies we develop based on our instinctual personality traits, can be beneficial or negative in coping with chronic pain. For example, by laughing off and minimizing my pain I get the benefit of distancing myself emotionally from the pain and not worrying others, or getting negative remarks from others, yet at the same time this façade makes it extremely difficult to express my pain and emotional impact honestly. Due to the rational vs. emotional nature of my personality I somehow view expressions of emotion either inappropriate, embarrassing or a weakness. So with the MBTI factors of thinking vs. feeling and introverted vs. extroverted play a role in the instinctive defense mechanisms we choose when coping. Someone more extroverted and high in feeling might feel free to express their emotions but feel overwhelmed by them, anxious more prone to finding some sort of external release to vent emotional tension.

So what can happen to our personality when coping with chronic pain?

A) The Pain Haze- one thing that happens when you are in acute pain is your ability to interact with others and your environment becomes severely limited. You are in survival mode. For example, if someone where to have broken every bone in their body I would not expect them to have an informed conversation with a priest about Nietzsche. Other people will literally see you shut down, your personality becoming dimmed and your awareness hindered. Loved ones will say they do not even recognize you, you become a completely different person. This is essentially a zombie shut down mode, where none of your personality shines through.

B) There are a few psychological disorders than can develop which then influence your personality and your worldview- Basically facets of your personality help people deal in different ways to stressors. With chronic pain, a constant stressor that then affects all aspects of your life, your defined, habitual responses kick in. However, few of us have the skills and coping mechanisms that enable is to deal with this long term stressor, as a result certain emotional issues develop. This can start off by bringing out the more negative personality traits in your existing personality. “Scientists believe that chronic pain often leads to chemical and structural changes in the brain triggering mood swings and even personality changes. The changes are often manifested in the form of depression or anxiety. The psychological changes also induce feeling that the original pain “hurts” worse.” (http://www.maysandschnapp.com/services_pain-depression-anxiety.html). What psychological issues that arise may have something to do with your innate personality.

1) Depression: This is a very common occurrence in some form when suffering from chronic pain. Beginning slowly with insomnia, fatigue and irritability. Because some mild depression signs may be seen as normal aggravations from dealing with pain it may be difficult to catch in ourselves or know when to seek additional treatment. When depression worsens there comes the sense of worthlessness, hopelessness, guilt and suicidal ideation.

2) Anxiety: may be just increased worry about work and loved ones to irrational fears. Perhaps you might not even realize that a racing heart and trembling can be signs of anxiety.

3) Panic disorders: “Symptoms often include feelings of shortness of breath or smothering, which may lead to hyperventilation resulting in dizziness, tingling of the hands, feet and lips and sometimes even fainting. It is also common to experience a racing heart, chest or abdominal pain and sensations of imminent death or impending doom. Patients can easily confuse these symptoms with heart attacks or strokes, and they often end up in the emergency room only to be told “nothing is wrong.” Panic attacks usually last 15 to 30 minutes and in severe cases may occur several times a day.” (http://www.maysandschnapp.com/services_pain-depression-anxiety.html)

The natural inclination is to say ‘I have a pain problem, not a mental problem’. Unfortunately, when coping you have both, because methods of coping may be maladaptive and the emotional toll of pain affects our personality. Simple as that.

“How can anyone with a significant degree of chronic pain only be affected physically? Pain makes you feel tired, mentally fuddled, irritable and often depressed. It affects you mentally and emotionally as well as physically. Many of the effects come into play quite quickly. If a family member changes from relaxed and easy-going, to irritable and worried by continued pain, how many weeks will pass before family relationships begin to change? Similarly, an employer who had confidence in a promising employee does not take too long to change his or her attitude to one who constantly looks tired and strained.” (http://pagerankstudio.com/Blog/2010/10/psychosocial-coping-with-chronic-illness/)

Therefore, chronic pain literally changes your personality to others because of the difficulties in coping. Others may begin to see you as someone that is always tired, frazzled, confused and absentminded. Or conversely they may see you as fidgety, nervous and high strung. You begin to define yourself that way and soon your habitual personality traits shift.  Most facets of our personality are not fixed and other traits while fixed over time change in intensity.

C) The external perceived behaviors: People are not defined solely on who they think they are, but how others perceive them by their behaviors. Others would describe me as; engaged, chatty, nervous, humorous, talk about anything and everything, absentminded, flighty, almost hypo-mantic and most definitely the goofy one. Because that is how I act, partly because part of my facade is to laugh and goof off and partly because that is what I have become… more charismatic and engaged, than introverted and reserved. The pain drives me to distraction and I get all shaky, fidgety with energy, chatty and emphatic. That is not to say this change is or that I do not like how I am now, just that it is profound how endless pain, coping methods and meds mix together to create a different person. Because people see me that way, they interact with me that way, and it is who I am. Yet, on the inside, I still feel like the person I was. I am, to a degree, the person I was when I am alone. In the end I have to wonder what is the illness and what is me?

D) Life view: That is not to say all personality shifts lead to mental and emotional problems. Not so at all. “For example, people who have a serious illness may report that as a result they have found a new appreciation for life or that they place greater value on relationships. Patients may also develop an explanation for the illness that is more benign (e.g., attributing it to God’s will). While cognitive processing theory constructs have been applied to adjustment to losses such as bereavement (e.g., Davis et al. 1998), these constructs have received relatively little attention from researchers examining coping with chronic illness.” (http://pagerankstudio.com/Blog/2010/10/psychosocial-coping-with-chronic-illness). The very fact that we must make so many sacrifices for our health can lead to appreciating all the things we can do. Certainly as we learn to develop positive coping strategies we learn to live a more fulfilling life that considers all our needs, instead of being driven towards a goal and ignoring all other considerations. Coping with a chronic illness makes us look deeper into ourselves than perhaps we ever would have before, which then leads to more sympathy and understanding of others. Therefore, some of our coping strategies enrich our lives and have very positive results.

One thing that cannot be denied is that pain affects our personality in the long run, just as when we are learning to cope our personality affects how we react to pain. Still, it is odd to think that our outward personality can be so fundamentally different from our inward one. And I am left thinking who the am I now? My core self has changed beyond recognition. If you took away all the medication would I be different? If you took away all the pain would I return to who I was? Does years of coping, different ways to deal with pain in the world, different facades, change a person’s personality fundamentally, more so than life would normally? One thing is for certain, the pain would have crippled me or killed me had I not changed the ways I did, but then it became less of a coping strategy and abruptly a personality change. It is bizarre. And I am neither of these personalities and both. Maybe pain just makes us all crazy in a way, changes us in unforeseen ways, some positive and some negative. Otherwise how would we survive it? We would not. I have lost the career I wanted, I will never have children, I have made so many compromises for my health, given up so many goals, dreams, desires… pain takes and takes and takes some more. The center does not hold, it cannot hold. And we cope and we change and hopefully we survive.

Resources:

http://psyclab1.psych.ubc.ca/~adlab/webupload/File/pdfs with pswd/Delongis___Holtzman_2005.PDF

http://pagerankstudio.com/Blog/2010/10/psychosocial-coping-with-chronic-illness

http://www.maysandschnapp.com/services_pain-depression-anxiety.html

http://www.4therapy.com/consumer/conditions/article/7282/489/I+Have+Chronic+Pain,+Why+Do+I+Need+a+Pain+Psychologist?

http://www.outofservice.com/bigfive/info/

See also:

Chronic Pain: A Philosophical Discussion

Chronic Pain: The Coping Process

Chronic Pain: The Facade of Wellbeing　

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