Internal-external control, defensiveness, and anxiety in hypertensive patients

Abstract

PROBLEM Previous research has suggested that beliefs in internal-external control (19) may be related to the degree of an individual's emotional adjustment and the kinds of defenses used to cope with stressful events. Externally oriented individuals have been found to report more anxiety and endorse more deviant or pathological items on a variety of stlf-report personality measure^ (^^ 12, 17) than internals, who tend to report less anxiety but rely more heavily on the defenses of denial and repression@* 12). Internal scores also have been associated with a tendency to give socially desirable responses (9, lS). On a theoretical basis, individuals at either extreme of the internal-external continuum might be expected to exhibit some form of maladjustment because both extremes may present unrealistic control expectancies for most individuals(19). The present study was designed to investigate the locus of control expectancies and defensive styles of a group of Ss who might be expected to be overly internal, i.e., individuals with psychosomatic disorders. Relatively little research has been done to examine the locus of control expectancies of individuals with psychosomatic problems. Three general findings from past research have suggested that locus of control may be related to the development of certain psychophysiological disorders. First, individuals who develop psychophysiological disorders have been described as showing an overcompensatory facade of selfsufficiency, independence, and self-control. Such individuals tend to rely on the defenses of denial and repression and often appear emotionally stable, conscientious, striving, and competitive (5). Excessive concern about controlling hostile-aggressive impulses and behaving in socially desirable ways long has been considered to be related t o certain psychosomatic disorders, such as essential hypertension (l).Second, Houston (16) found that externals in experimentally induced stress situations reported increased anxiety, whereas internals showed greater physiological response. This suggests that internals may become highly aroused when threatened, but may be defensive about reporting anxiety. Similar findings were reported in Brady's (2) study of the "executive monkey." Brady found that monkeys in the role of executive (able to control shock administered to themselves and another monkey) developed gastrointestinal lesions, whereas the monkeys in the "external" condition (no control over shock) did not develop lesions. Although it has not yet been shown that general beliefs about control are related to longterm patterns of physiological response, the findings of these studies suggest the possiblity that physiological responsivity may be influenced by the degree of control that the individual believes he has over events in his environment.Third, studies by Fotopoulos(*O) and Ray and Strupp(18) have found significant differences in patterns of heart-rate responses of internals and externals under biofeedback conditions. Fotopoulos found that internals were signifi...

Personality differences between hypertensive and normotensive individuals: influence of knowledge of hypertension status.

“…For example, aware hypertensives have not been found to differ from medical and surgical patients (4), ulcer patients and general illness patients (10), chronically ill outpatients (74), normotensive patients attending a general medical clinic (11,17,21), cardiovascular disease patients (12), or patients with secondary hypertension (13,15). The conclusion based upon these studies, taken together, may be that the influence of disease knowledge on personality parameters is a general phenomenon which is associated with many different medical conditions.…”

“…Reviews of the earlier empirical literature concluded that neuroticism (2), hostility, and difficulties in coping with anger were associated with hypertension (3). However, much of this work suffers from major methodological flaws, including inadequate methods to diagnose hypertension and the use of unvalidated measures of personality, and is confounded by the recruitment of subjects from hypertension treatment centers and the use of antihypertensive medications (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). Moreover, little attention has been given to the importance of differential exposure to medical attention and hypertension labeling as determinants of personality.…”

Physiological stress responses in defensive individuals: Age and sex matter

“…Elevated levels of defensiveness have been associated with cardiovascular‐related morbidity and mortality (Dimsdale & Hackett, 1982; Helmers et al, 1995; Jorgensen et al, 2001; Rutledge, Linden, & Davies, 2000), hypertension (Kidson, 1973; Linden & Feuerstein, 1983; Mann & James, 1998; Rutledge & Linden, 2000; Santonasto, Canton, Ambrosio, & Zamboni, 1984; Wennerholm & Zarle, 1976), and elevations in blood pressure (BP; Jamner, Shapiro, Goldstein, & Hug, 1991; Jorgensen, Johnson, Kolodziej, & Schreer, 1996; King, Taylor, Albright, & Haskell, 1990; Nyklicek, Vingerhoets, Van Heck, & Van Limpt, 1998; Rutledge & Linden, 2003), lipids (Niaura, Herbert, McMahon, & Sommerville, 1992), and glucose levels (Jamner, Schwartz, & Leigh, 1988). Older women who are elevated on defensiveness exhibit an increased metabolic burden, placing them at higher risk for disease development (Lévesque et al, 2009).…”

Psychosomatic Research in Hypertension: The Lack of Impact of Decades of Research and New Directions to Consider

“…Existing evidence suggests that this style of ''defensive'' or ''repressive'' coping is associated with hypertension. [35][36][37] Studies in which defensiveness was assessed by questionnaires such as the Marlowe-Crowne Scale of Social Desirability have reported a consistent relationship between defensiveness and hypertension. 9,18,35,38 In addition, in a study that was unique in including patients with severe hypertension, the condition was associated with defensiveness and not with perceived anger or anxiety.…”

“…Existing evidence suggests that this style of “defensive” or “repressive” coping is associated with hypertension 35–37 . Studies in which defensiveness was assessed by questionnaires such as the Marlowe‐Crowne Scale of Social Desirability have reported a consistent relationship between defensiveness and hypertension 9,18,35,38 .…”