APA Citation
Kotov, R., Gamez, W., Schmidt, F., & Watson, D. (2010). Linking "Big" Personality Traits to Anxiety, Depressive, and Substance Use Disorders: A Meta-Analysis. *Psychological Bulletin*, 136(5), 768-821. https://doi.org/10.1037/a0020327
Summary
This comprehensive meta-analysis examined relationships between the "Big Five" personality traits (neuroticism, extraversion, openness, agreeableness, conscientiousness) and common mental disorders across 175 studies with over 75,000 participants. Key findings: high neuroticism strongly predicts anxiety and depressive disorders; low extraversion predicts depression; low conscientiousness predicts substance use disorders. The research establishes that personality traits and mental disorders share significant connections, with implications for understanding vulnerability and treatment.
Why This Matters for Survivors
Understanding personality-disorder connections illuminates both vulnerability to narcissistic abuse and its aftermath. Survivors high in agreeableness and conscientiousness may be particularly attractive to narcissists; high neuroticism increases vulnerability to post-abuse anxiety and depression. This research also contextualizes personality disorder diagnoses within normal personality dimensions, showing that disorders represent extremes rather than categorically different conditions.
What This Research Establishes
Neuroticism is strongly linked to internalizing disorders. High neuroticism robustly predicts anxiety and depression across many studies. This trait creates vulnerability to emotional distress and its disorders.
Low extraversion predicts depression. The withdrawal, reduced positive emotion, and social disengagement of low extraversion are associated with depressive disorders.
Low conscientiousness predicts externalizing problems. Substance use disorders and related problems are associated with low conscientiousness (poor impulse control, disorganization).
Personality disorders are dimensional extremes. This research supports understanding personality disorders as extreme positions on normal personality dimensions rather than categorically distinct conditions.
Why This Matters for Survivors
Understanding your vulnerability. If you’re high in agreeableness and conscientiousness, you may have been particularly vulnerable to narcissistic exploitation—these positive traits made you trusting and hardworking at the relationship. Understanding this reduces self-blame.
Understanding post-abuse distress. High neuroticism predicts anxiety and depression following stress. If you were already somewhat high in neuroticism, trauma may have intensified this. Understanding trait vulnerability contextualizes your response.
Your personality isn’t the problem. The traits that made you vulnerable—agreeableness, conscientiousness, perhaps higher neuroticism—are normal personality variations, not defects. They may have been exploited, but they’re not flaws.
Dimensionalizing the narcissist. Understanding NPD as extreme low agreeableness (plus other dimensions) demystifies it. The narcissist isn’t categorically different—they’re at an extreme of normal personality dimensions, specifically the antagonistic extreme of agreeableness.
Clinical Implications
Assess personality in treatment planning. Understanding patient personality predicts vulnerability, likely symptoms, and treatment response. High neuroticism suggests attention to anxiety/depression; low extraversion suggests behavioral activation.
Use dimensional understanding of personality disorders. Help patients understand personality disorders as extreme positions on normal dimensions. This reduces stigma while explaining the continuity between normal personality variation and disorder.
Consider personality in vulnerability assessment. High agreeableness combined with narcissistic partner creates specific vulnerability. Understanding these patterns helps predict risk and guide intervention.
Address personality in recovery. Recovery may involve understanding how personality traits affected relationship dynamics—not to blame oneself but to develop realistic self-understanding and appropriate boundaries.
How This Research Is Used in the Book
Kotov et al.’s personality-disorder connections appear in chapters on vulnerability and assessment:
“Meta-analytic research reveals that personality traits predict mental disorders: high neuroticism creates vulnerability to anxiety and depression; high agreeableness may create vulnerability to exploitation by narcissists. Understanding these connections helps contextualize both why certain people may be targeted by narcissists—their agreeable, conscientious traits made them attractive—and why they may struggle afterward—high neuroticism amplifies stress response. These are normal personality variations, not defects.”
Historical Context
This meta-analysis appeared amid growing interest in dimensional approaches to psychopathology. Traditional psychiatry treated personality disorders as categorically distinct from normal personality; research increasingly suggested they represent extremes of normal dimensions. This meta-analysis provided robust evidence for personality-psychopathology connections that supported dimensional models.
The findings influenced development of the DSM-5 Alternative Model for Personality Disorders, which conceptualizes personality disorders using dimensions rather than categories. This represents a significant shift in how personality pathology is understood—as extreme variation rather than qualitatively different conditions.
Further Reading
- Widiger, T.A., & Costa, P.T. (2013). Personality Disorders and the Five-Factor Model of Personality (3rd ed.). American Psychological Association.
- Miller, J.D., & Lynam, D.R. (2015). Structural models of personality and their relation to antisocial behavior. Criminology, 39(4), 765-798.
- Krueger, R.F., & Tackett, J.L. (2003). Personality and psychopathology: Working toward the bigger picture. Journal of Personality Disorders, 17(2), 109-128.
- McCrae, R.R., & Costa, P.T. (2008). The five-factor theory of personality. In O.P. John, R.W. Robins, & L.A. Pervin (Eds.), Handbook of Personality (3rd ed., pp. 159-181). Guilford Press.
About the Author
Roman Kotov, PhD is Professor of Psychiatry at Stony Brook University, specializing in the structure of psychopathology and personality-disorder relationships. David Watson, PhD is Professor of Psychology at the University of Notre Dame, known for research on emotion and personality.
This meta-analysis synthesized decades of research, establishing robust personality-psychopathology links that individual studies couldn't demonstrate alone.
Historical Context
This 2010 meta-analysis appeared amid growing interest in dimensional approaches to personality disorders and the relationship between normal personality and psychopathology. The findings contributed to movements toward integrating personality assessment into psychiatric diagnosis, later reflected in DSM-5's Alternative Model for Personality Disorders.
Frequently Asked Questions
The Big Five are: Neuroticism (tendency to experience negative emotions), Extraversion (sociability, positive emotion), Openness (curiosity, creativity), Agreeableness (cooperation, trust), and Conscientiousness (organization, responsibility). These dimensions capture major personality variation.
High neuroticism strongly predicts anxiety and depressive disorders. People high in neuroticism experience more intense negative emotions and are more reactive to stress. This creates vulnerability to internalizing disorders, especially when combined with stressful life events.
Low extraversion predicts depression, possibly because of reduced positive emotion and social engagement. The link is less strong than neuroticism but consistent. Social withdrawal characteristic of low extraversion may maintain depression.
Narcissistic personality disorder involves low agreeableness (callousness, antagonism), variable neuroticism (depending on subtype), and often inflated self-reported extraversion. Understanding narcissism dimensionally shows it as extreme disagreeable personality, not a categorically different condition.
High agreeableness (trusting, cooperative) may make people attractive targets for narcissists and slow to recognize exploitation. High conscientiousness may lead to trying harder to make the relationship work. These are positive traits that can create vulnerability in specific contexts.
Trauma can affect personality scores, particularly increasing neuroticism. Whether this represents actual personality change or state effects (current distress affecting responses) is debated. Recovery typically involves returning toward baseline personality.
Some research suggests personality affects treatment response—high neuroticism may predict slower response, high conscientiousness better treatment adherence. Personality-informed treatment may improve outcomes.
This research supports dimensional views of personality disorders as extremes of normal personality dimensions rather than categorically distinct conditions. Someone with NPD has extreme scores on normal dimensions (very low agreeableness), not a qualitatively different personality.