Rheumatoid arthritis (RA) is a chronic disease with no known cause or cure that typically follows an unpredictable course. The present article provides a comprehensive review of the psychological literature related to etiology, effects, and treatment of RA. A brief summary of the relevant medical as

https://psycnet.apa.org/journals/bul/98/2/358.pdf

Rheumatoid arthritis: Review of psychological factors related to etiology, effects, and treatment.

Rheumatic diseases are a group of painful and often disabling systemic diseases that usually become chronic. The most frequent problems reported by those affected are complaints connected with the musculoskeletal system. From the wide range of rheumatic diseases, rheumatoid arthritis (RA), ankylosing spondylitis, fibromyalgia syndrome (FS), and psoriatric arthritis have the highest prevalence, with almost 1% to 2% of the total population affected by each of them. Because of the fact that these illnesses are usually chronic and disabling, they represent a major social and economic burden. RA, ankylosing spondylitis, and psoriatric arthritis are especially known to be immune-related diseases. Their etiology still remains unclear. Most commonly, multiple factors are suspected to be responsible for the initiation of these illnesses. Lack of knowledge as to the causes of most rheumatic diseases meant that a wide range of different approaches evolved. One of them is the field of stress and personality research. As early as 1909, the first article suggesting an association between factors in everyday life like anxiety and worry and the provocation of RA was published. 63 Some years later, the personality of the RA patient was also taken into consideration as a possible risk factor for increased susceptibility to RA. 18 In 1939, Cobb et al 25 summarized speculations dating back to 1880 that there is a relation between environmental or emotional factors on the one hand and the onset and exacerbation of RA on the other hand. Alexander 10 classified RA as one of the seven classic psychosomatic diseases. Since the beginning of this field of research, a large number of articles focusing on stress and personality traits as provoking, predisposing, or modulating factors have been published. The results were often equivocal and caused considerable controversy. This article reviews the role of psychologic stress as a factor that may precipitate or exacerbate rheumatic diseases. The most common and effective strategies for coping employed by patients with rheumatic diseases and the value of stress-reducing therapies are discussed.

Stress and rheumatic diseases

In the past ten years, a number of studies have reported data linking psychological statuses to the etiology and pathogenesis of neoplastic disease. Reviews of this literature include those of Kowal.’ LeShan and Worthington,’ Tromp,:3 Petschke4 and LeShan.j It is far too early to come to any definitive conclusions in this area and much further material is needed before the potential of this type of research can be evaluated. It is in terms of this need that this paper is presented. It is a report of a research project carried out over the past 12 years during which the emotional life histories of 450 adult cancer patients were evaluated. The patients were studied by means of three techniques. All 450 were given a projective device, the Worthington Personal History Test. In addition, 150 patients were seen in short series of interviews ranging from 2 to 8 hours and averaging 4 hours. Further, 45 patients were evaluated by means of intensive individual psychotherapy for a total of over 5000 hours of psychotherapy. The research consisted of two phases. In the first, a “back-and-forth” method of developing hypotheses was used. Tentative insights, arising from the interviews and the therapy, were tested against the protocols of the projective tests. Hypotheses arising from the study of these tests were evaluated, expanded and refined by use of the material from the interviews and the therapy. In the second phase, an attempt was made to reformulate the hypotheses arising from the clinical study of cancer patients in such a way that they could be tested statistically. In this phase, the goal was to put each clinical insight into such a form that it could be evaluated by means of classical scientific methodology. Each of these two phases is described separately below.

An emotional life-history pattern associated with neoplastic disease*

Since at least 1913 reports have suggested there are personality traits and behaviors that are found premorbidly in those who go on to develop Parkinson’s disease (PD). This premorbid personality consists of traits such as industriousness, punctuality, inflexibility, cautiousness, and lack of novelty seeking and persists after the onset of the motor illness. The existence of this personality remains controversial but is supported by case-based anecdotes, twin studies, and comparison of patients with PD with medical control patients on standardized instruments. In addition a large number of epidemiologic studies show that people who develop PD have low lifetime risks for cigarette smoking, coffee drinking, and alcohol consumption, again suggesting that there is a behavior pattern that predates PD. Despite the retrospective nature of much of these data, the use of nonstandardized instruments, and diffuse concepts of personality, the great majority of studies show striking similarity in identifying these traits. An integrating hypothesis, involving damage to dopaminergic systems, known to predate the onset of the motor illness, is discussed.

The personality associated with Parkinson's disease.

Projective Methods for the Study of Personality

Personality and chronic arthritis

The Rorschach records of two groups, each consisting of 60 patients, were compared. One group, designated as V group, was picked for the common feature of arterial hypertension. The other group, designated as L group, was composed of 30 cases of chronic arthritis and 30 cases of parkinsonism. The two groups showed specific preferences for certain types of responses which made it possible to distinguish between an L type and a V type of response. The critical responses could be subsumed under 4 general categories. In all 120 patients the number of responses of their own type exceeded the number of responses of the other type in at least 2 categories. The 4 categories and the differences between the two groups are as follows: 1. Vertical axis— (a) Location—Patients of the L group had a much greater tendency to center one-half or more than one-half of their responses in the axis than the V group. (b) Form—Patients of the V group saw the axial part as an opening about 5 times more often than the L group. (c) Content—Warm-blooded organisms and dynamic emphasis centered in the axis were observed more often in the L group than in the V group. The V group saw more anatomical structures, ritualistic objects, and water and fire than the L group. 2. Kinesthetic responses—Goal-directed activities were indicated more often by the L patients, while actions determined by convention or by efforts to maintain a certain position were indicated more often by the V patients. 3. Integration and disintegration—The tendency toward integration of the inkblots into a comprehensive interpretation was more pronounced in the L group, while the tendency toward disintegration was more pronounced in the V group. 4. Animals—Eagles and pigs were most frequently seen by the L group, while cows, sheep and beasts of prey were most frequently seen in the V group. The psychological interpretation of the findings suggested that arthritic and parkinsonian patients are dominated by an urge for individualistic, independent action. Obstacles are liable to provoke aggressiveness in excess of the chances for success. Patients suffering from arterial hypertension have a tendency toward dependent relationships in form of identification with their social environment. Action is determined by material needs and by social standards. Obstacles easily provoke conflicts between dependent and aggressive impulses, resulting in restriction of the range of action and of perception. Specific correlations between organ dominance, disease liability and form of perception were discussed. They gave added insight into the physiological basis of the Rorschach method, and of physiognomical understanding. The discovery of two gestalt tendencies associated with individualistic and with collectivistic personality types suggested the possibility of making current personality and aptitude tests more reliable, and the possibility of further extending the use of the Rorschach method.

Organ function and form perception; use of the Rorschach method with cases of chronic arthritis, parkinsonism and arterial hypertension.

Irrational complications of the cancer problem.

Ancient medical science based its diagnosis mostly on the observation of the patient under the conditions of life to which he happened to be subjected. During the last half century an enormous advance in the precision of medical diagnosis has been achieved by subjecting the various functions of the body to relatively invariable standard tests. For example, the condition of the pyramidal tracts is determined no longer entirely by the character of the patient's conscious muscular efforts but, in addition, by the nature of the plantar response to stimulus applied to the sole and by the tendon reflex as elicited by the percussion hammer. THE NEED FOR OBJECTIVE PERSONALITY DIAGNOSIS While the field of organic functions of the body has been increasingly well covered, medicine has been forced to recognize that the physical facts do not tell the whole story about the condition of the patient. It was by following

Objective technics in personality testing

Disease as a message

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