Personality

It is probable that the effects of genetic loading, adversity in childhood, and psychological factors such as negative thinking come together in forming a particular type of personality that has a higher risk than the average of developing depressive illness. People with such a personality type include the anxious or dependent, those who have long-term difficulties in coping with stress, and those with constitutional tendencies to gloom, sometimes referred to as dysthymia.

In younger people, mild depression tends to affect anxious or dependent personalities with poor tolerance of stress. Severe depressive illness in middle age tends to affect hard-working, conventional people with high standards and obsessional traits. Obsessional personalities can find it particularly difficult to adapt to stress or life changes, as in work or relationships, and this can 'come out' as depression.

There are frequent exceptions to these general impressions, and it is important to appreciate that patients in the throes of a depressive or manic episode may give distorted accounts of their previous personalities. Another postulated mechanism is that depression results from inability to express hostility and aggression, so that these emotions are directed inward to produce self-blame and guilt. The learned helplessness model postulates that depression results from repeated failure to overcome problems by personal effort. Bipolar disorder tends to develop in those of cyclothymic personality.

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