Personality factors associated with juvenile rheumatoid arthritis

Many of the personality features linked by body-image theory with rheumatoid arthritis in adults and, to a lesser extent, with juvenile rheumatoid arthritis (JRA) were investigated systematically using the sibling-comparison method. Thirty-three chronic JRA outpatients of both sexes, ages six to 16, were selected. The control group consisted of each JRA S's nearest-aged healthy sibling (Sib) of the same sex. A dozen hypotheses based upon 1954-1965 statements of Fisher and/or Cleveland were tested by means of 11 Hostility-Aggression and nine Personality-Cognitive-Activity criterion measures. The Hostility-Aggression category tapped the anger experienced, anger acknowledged, and aggression expressed in social behavior by the S. No consistent JRA-Sib differences were revealed, indicating that the theorists' findings of anger repression among hospitalized adult arthritics do not apply to JRA outpatients. As expected, the degree of physical impairment within the JRA group was not significantly related to the amount of overt aggression. The Personality-Cognitive-Activity category incorporated assessments of the S's claimed fear and hurt feelings when aggressed against, psychopathology, Rorschach Barrier and Penetration scores, intellectual functioning, and activity level. The only significant difference associated with diagnosis was the substantial Penetration elevation of the Sibs, implying that they may have felt more vulnerable to environmental dangers than the JRA Ss. Given the well-documented sensitivity of the Penetration index to anxiety and maladjustment, it was speculated that the Sibs may have been seeking resolutions of important personality problems mitigated in the JRA Ss by the presence of the disease. Another possibility equally supported by the Penetration literature is that the Sibs were reacting adversely to the unfamiliar, frightening hospital surroundings. Age, sex, and family membership proved to be much more important than diagnosis in determining the measured response patterns. Hence, the stringent control of background variables engendered by the comparison of siblings may have obscured behavioral features relevant to the theory. In general, however, this study supported the idea that the original Fisher and Cleveland interior-exterior disease model was a convenient but tentative method of conceptualizing inpatient differences. Compatible with the present data is the substantial later evidence showing that the body-boundary indices, especially Barrier, are closely related to social ascendancy and adaptability to the environment.