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Maladaptive Personality Traits, Psychological Morbidity and Coping Strategies in Chronic Central Serous Chorioretinopathy

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Maladaptive Personality Traits, Psychological Morbidity and Coping Strategies in Chronic Central Serous Chorioretinopathy Acta Ophthalmologica 2018 Maladaptive personality traits, psychological morbidity and coping strategies in chronic central serous chorioretinopathy Femke M. van Haalen,1,† Elon H.C. van Dijk,2,† Cornelie D. Andela,1 Greet Dijkman,2 Nienke R. Biermasz,1 Alberto M. Pereira1 and Camiel J.F. Boon2,3 1Department of Medicine, Division of Endocrinology and Center for Endocrine Tumors, Leiden University Medical Center, Leiden, the Netherlands 2Department of Ophthalmology, Leiden University Medical Center, Leiden, the Netherlands 3Department of Ophthalmology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands ABSTRACT. Introduction Purpose: ‘Type A’ behavioural characteristics and psychosocial stress have traditionally been associated with chronic central serous chorioretinopathy Central serous chorioretinopathy (cCSC). However, a characteristical personality profile could not be identified in (CSC) is a specific and relatively com- these patients and the presumed association with stress is subject to controversy, mon chorioretinal disease in which due to a lack of convincing studies using validated measuring instruments. In this choroidal congestion, thickening and hyperpermeability damage the retinal study, we aimed to assess maladaptive personality traits, psychological morbidity pigment epithelium and subsequently and coping strategies in patients with cCSC, in order to identify potentially induce serous subretinal fluid accumu- modifiable psychosocial aspects which could be used in support to current lation and detachment of the neu- standard treatment. roretina. Methods: A cross-sectional study in a cohort of 86 patients with cCSC using The pathogenesis of CSC is cur- validated questionnaires. Findings were compared to both Dutch population rently unclear, but many studies indi- reference data and reference data from patients treated for Cushing’s disease. cate a pathophysiological association Results: Maladaptive personality traits were not more prevalent in patients with with stress pathways, due to the rela- cCSC than in the general population, and psychological morbidity was not tion with both exogenous and endoge- increased. Patients with cCSC were shown to make more use of passive coping, nous corticosteroid excess, as well as active coping and seeking social support. Interestingly, personality, psycholog- overactivity of the hypothalamus–pitu- ical morbidity and coping characteristics of patients with cCSC were more itary–adrenal (HPA) axis (Bouzas et al. comparable to features of patients treated for Cushing’s disease than to 2002; Carvalho-Recchia et al. 2002; population-based data. Jonas & Kamppeter 2005; Wang et al. Conclusion: Maladaptive personality traits such as type A behavioural 2008; Gemenetzi et al. 2010; Liew et al. 2013; Nicholson et al. 2013; van Dijk characteristics are not more prevalent in patients with cCSC. Patients with et al. 2016; van Haalen et al. 2018). cCSC make more use of certain coping strategies, which could be addressed Both acute and chronic psychosocial by psychosocial care to improve self-management. Further research is needed stress have been suggested to predis- establish whether the course of disease can be improved by altering coping pose to CSC (Conrad et al. 2000; and reducing ‘stress’. Spahn et al. 2004). It has also been suggested that people with a type A Key words: central serous chorioretinopathy – coping – cross-sectional study – irritability behaviour pattern have an increased personality – stress risk to develop CSC (Jenkins et al. 1967; Yannuzzi 1987; Baraki et al. Acta Ophthalmol. 2010; Chatziralli et al. 2017). The term ª 2018 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd ‘type A behaviour’ was introduced by Friedman & Rosenman (1959) and was doi: 10.1111/aos.13952 characterized as follows: an intense, sustained drive to achieve self-selected but usually poorly defined goals, 1 Acta Ophthalmologica 2018 profound inclination and eagerness to poor coping mechanisms (Conrad callousness, rejection, conduct prob- compete, persistent desire for recogni- et al. 2000; Spahn et al. 2004; Lahou- lems and narcissism. Furthermore, tion and advancement, continuous sen et al. 2016). However, coping considering the recently described involvement in multiple and diverse behaviour may be a valuable starting hyperactivity of the HPA axis in functions constantly subject to deadli- point for psycho-education or self- patients with cCSC (van Haalen et al. nes, habitual propensity to accelerate management training in order to 2018) and the previously described the rate of execution of many physical improve quality of life. Also psycho- maladaptive personality traits in and mental functions, and extraordi- logical morbidity such as apathy or patients exposed to hypercortisolism nary mental and physical alertness. The irritability may be a potential point of (i.e. Cushing’s disease) (Tiemensma concept of personality types has been engagement for self-management pro- et al. 2010a,b), we hypothesized that studied in medical psychology as a grammes. To date, these psychological patients with CSC would report more predictor of the cause, course and factors have not been evaluated in CSC maladaptive personality traits, more quality of life of somatic diseases such patients. psychological morbidity (i.e. apathy, as cancer, rheumatic diseases and coro- To the best of our knowledge, no irritability) and less effective coping nary artery disease (Dalton et al. 2002; previous systematic studies have been strategies compared to reference data Hausteiner et al. 2010; Donisan et al. published assessing personality traits from the general population. In accor- 2017). It has been hypothesized that in patients with CSC, and there are no dance with previous literature in type A behaviour might be linked to studies in a large cohort of patients patients with other chronic diseases CSC by increased levels of circulating with CSC that have systematically (Schouws et al. 2015; Vollmann et al. catecholamines and corticosteroids, evaluated coping strategies using a 2016; Keramat Kar et al. 2017; Yadav since these hormone levels are found specific coping-oriented validated et al. 2017; You et al. 2018), we to be higher in people with type A questionnaire. Since CSC seems to be hypothesized that more maladaptive behavioural characteristics compared related to stress (Bouzas et al. 2002; personality traits are associated with to those with type B behavioural char- Carvalho-Recchia et al. 2002; Jonas & less effective coping strategies in acteristics (more relaxed and less hur- Kamppeter 2005; Wang et al. 2008; patients with cCSC. ried) (Friedman et al. 1960, 1975; Gemenetzi et al. 2010; Liew et al. Rosenman et al. 1976; Williams et al. 2013; Nicholson et al. 2013; van Dijk Subjects and Methods 1982). A recent meta-analysis indeed et al. 2016; van Haalen et al. 2018), a concluded that patients with CSC detailed assessment of potential asso- Study design demonstrated significantly more type ciations with personality traits, psy- A behavioural characteristics than chological morbidity and coping We conducted a cross-sectional study healthy controls (odds ratio mechanisms is essential to identify in a cohort of patients with cCSC. (OR) = 2.53; confidence interval (CI) potentially psychosocial aspects that Patients were asked to complete a set of 1.08–5.96) (Liu et al. 2016). Despite could be modifiable with self-manage- validated questionnaires on personality this proposed association between CSC ment programmes. traits, psychological morbidity (i.e. and type A behavioural characteristics The primary aim of this study was to apathy and irritability) and coping (Yannuzzi 1987), a typical CSC per- assess maladaptive personality traits strategies at home, using an online sonality profile could not be identified (i.e. traits related to type A behavioural survey. In addition, a clinical evalua- in previous studies. Only type A pattern), in patients with cCSC. For tion took place during a single visit to behavioural characteristics have been this purpose, we compared personality the outpatient clinic of the Division of previously observed (Bahrke et al. traits of patients with cCSC to person- Endocrinology of the Leiden Univer- 2000). ality traits of Dutch population refer- sity Medical Center. It is well known that personality ence data, but also to personality traits affects coping behaviour (Friedman of patients treated for Cushing’s dis- Study population et al. 2006). Coping behaviour encom- ease (since these patients were exposed passes the way people react on a to excessive HPA - axis activity). In Eighty-six consecutive adult patients behavioural, cognitive and emotional addition, this study aimed to assess with cCSC, who were followed at the level to situations that require adjust- psychological morbidity (i.e. apathy Department of Ophthalmology of Lei- ments in dealing with possible adverse and irritability) and coping strategies den University Medical Center, a ter- events (Schreurs et al. 1993), which has in patients with cCSC by comparing tiary referral center for CSC, were an effect on the amount of stress these patients with the same reference invited to complete the questionnaires. experienced (Ersan et al. 2017). Speci- groups. Finally, we aimed to assess the The cCSC diagnosis had been con- fic coping styles (e.g. emotion-oriented association between personality and firmed by fundoscopy, digital colour coping) have even been reported to coping in patients
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