Five Factor Theory

The FFT is a theory of the functioning of the person, whose centre is the Five Factor Model of personality traits: Neuroticism (N), Extraversion (E), Openness (O), Agreeableness (O), and Conscientiousness (C). FFT consists of a number of components that interact via numerous dynamic processes as depicted in Figure 2. These components are, namely: Biological Bases, Basic Tendencies, Characteristic Adaptations, Self-Concept (which is part of Characteristic Adaptations), Objective Biography, and External Influences (Costa & McCrae, 1994; McCrae & Costa, 2008, 2013). All those factors in turn interact through dynamic processes, which are understood as universal cognitive, affective, and volitional mechanisms, and are differentially affected by an individual’s personality traits (McCrae & Costa, 2003).

The person “begins” with the Biological Bases, which can be understood as genetic, developmental, neuroanatomical, or psychophysiological mechanisms. In the case of PNES, these can be understood as any genetic predisposing vulnerability factors.

Biological Bases, even though not yet fully understood by medical sciences,

determine personality traits, i.e. the endogenous Basic Tendencies (McCrae & Costa, 2003). Basic Tendencies, in turn can be defined as the abstract psychological potentials, limitations and capacities of the individual as embodied by the five personality dimensions. In this case these would be the broad personality dimensions of Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness, as well as specific personality traits considered to belong to them, in this study measured via the NEO-FFI-3 (measuring only the broad dimensions). While FFT argues that the environment does not have any interaction with personality traits (Basic Tendencies) and hence cannot exhibit direct influence over them, there are instances in which environment, in FFT denoted by the External Influences component, can influence personality traits through the mediation of the Biological Bases, such as head trauma and similar instances (McCrae & Costa, 2008).

External Influences can be understood as social or physical situations or contexts the individual finds themselves in and the demands associated with them (Costa & McCrae, 1994; McCrae & Costa, 2008). Furthermore, individuals are considered to construe, react to, and in turn influence the environment in ways consistent with their personality traits (Basic Tendencies; McCrae & Costa, 2008). In the case of PNES development and maintenance, External Influences may be understood as traumatic events, or dysfunctional family environment.

When External Influences interact with Basic Tendencies they shape Characteristic Adaptations (McCrae & Costa, 2008). Characteristic Adaptations represent the concrete manifestations of personality traits (Basic Tendencies) via patterns, such as, attitudes, beliefs, skills, habits, social roles and typical ways of relating to others (McCrae & Costa, 2013). As McCrae and Costa put it: “They are characteristic because they reflect the enduring

psychological core of the individual, and they are adaptations because they help the individual fit into the ever- changing social environment” (2008, pp. 163–164). Within the Characteristic Adaptation component another component is contained, called the Self- Concept. The Self-Concept can simply be defined as the view the individual has of themselves (Costa & McCrae, 1994). This component can be understood in terms of self- schemas, or “cognitive–affective view of themselves that is accessible to consciousness” (McCrae & Costa, 2008, p. 165) and selective perception, which ensures that the information represented in the self-concept is consistent with the person’s personality traits and brings a

sense of coherence to the person (McCrae & Costa, 2008). However, while Basic Tendencies are considered to remain constant throughout a person’s life, Characteristic Adaptations can undergo considerable change in the face of changing External Influences (McCrae & Costa, 2008). Similarly, while Characteristic Adaptations may vary considerably across different cultures, families and even periods in a lifetime, Basic Tendencies (personality traits) do not (McCrae & Costa, 2008). Hence, in the case of PNES Characteristic Adaptations can be understood as ways of coping, tending to have an external locus of control or abnormal attitudes to one’s health. In the case of this particular study, I will be looking at illness beliefs which will be measured via the Illness Behaviour Questionnaire (Pilowsky & Spence, 1983).

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Figure 2. Five Factor Theory model of the person adapted for current study from McCrae and Costa (2008).

When the abovementioned (Figure 2) Characteristic Adaptations interact with the External Influences the output of this interaction is considered to be Objective Biography, Objective Biography can be understood as everything the person does, thinks or feels across their lifespan - the output of the person system. Hence, in the case of PNES, while the same event may have no significant effect on one individual, another individual’s Characteristic Adaptations (attitudes, beliefs, etc.) may predispose them to experience it as traumatic and in turn predispose someone for PNES. Similarly, certain attitudes, beliefs, and concepts of the self once interacting with the External Influences (environment) can lead to a development of a number of psychiatric disorders. In the case of the present study, these emotional reactions and behaviours that will be measured are PNES (via vEEG) and psychiatric comorbidity of PTSD, depression and anxiety (via BAI-PC).

3.3 Chapter Summary

The chapter presented the FFT of the person as a theoretical framework and a basis for the approach to diagnosis taken in the present study. It is considered that the FFT successfully explains the development and maintenance of PNES by incorporating the

aetiological and maintaining factors of PNES shown to be important by previous research and specifically the personality, abnormal illness behaviour and psychiatric comorbidity factors targeted in the present study.

Chapter 4 Methodology 4.1 Introduction

This chapter looks back at the research aims and questions outlined at the beginning of the study and discusses the research methodology and design considered to best target them. The chapter goes into detail into the study sample characteristics and size, the sampling strategy, measures used in the study, the approach to data collection and analysis, as well as the ethical considerations pertaining to this study.

4.2 Research Aims

In light of the research problem outlined earlier, this study aims to examine if South African individuals with PNES differ from individuals with ES and oNES in terms of

demographic and seizure characteristics, personality traits, illness behaviours and depression, anxiety and PTSD symptoms in statistically significant ways; and if so, to test if these

differences may be utilised in raising suspicion of PNES as the differential diagnosis to epilepsy and oNES.

4.3 Research Questions

With the research aims outlined above in mind, the present study seeks to answer the following questions:

 What NEO personality domains prevail among the South African patients of PNES;

 What illness behaviours South African patients of PNES demonstrate;  If the NEO-FFI-3, IBQ, or BAI-PC questionnaires can differentiate between

patients with PNES and those with ES or oNES. 4.4 Design

The study followed a quantitative double-blind (i.e. neither the researcher nor the participant were aware of the participant’s diagnosis during data collection) convenient sampling comparative design.