Neuroticism: a non-informative marker of vulnerability to psychopathology



Neuroticism measures are very popular in psychopathological research, but it is unclear how useful neuroticism is in studies of the aetiology of psychopathology.


A conceptual examination was made of the literature on the association of neuroticism and psychopathology, the ontological status of neuroticism, the purport of neuroticism questionnaires, and causal issues.


The research on which neuroticism is built has historically been based solely on the factor analyses of the common adjectives used to describe usual behaviours. An abundance of studies have shown that neuroticism scores predict life stress, psychological distress, emotional disorders, psychotic symptoms, substance abuse, physical tension-related symptoms, medically unexplained physical symptoms, and health care utilisation. This evidence suggests that neuroticism scales index vulnerability to many forms of negative affect and psychiatric disorder. However, the associations do not clarify the nature of this vulnerability nor the underlying psychobiological mechanisms. We present evidence that neuroticism scores reflect a person’s characteristic (or mean) level of distress over a protracted period of time. In this perspective, even prospective associations of neuroticism with mental health outcomes are basically futile, and largely tautological since scores on any characteristic with substantial within-subject stability will predict, by definition, that characteristic and related variables at later points in time.


Neuroticism is not an explanatory concept in the aetiology of psychopathology, since it measures a person’s characteristic level of distress over a protracted period of time. This situation will not change until knowledge becomes available about: (i) the mechanisms that produce high neuroticism scores (and, therefore, also psychopathology) and (ii) its neurobiological substrate. Only then will we understand why neuroticism appears to ‘predict’ the outcomes it predicts.

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  1. 1.

    Aluja A, Garcia O, Garcia LF (2002) A comparative study of Zuckerman’s three structural models for personality through the NEO-PI-R, ZKPQ-III-R, EPQ-RS and Goldberg’s 50-bipolar adjectives. Pers Indiv Diff 33:713–726

    Article  Google Scholar 

  2. 2.

    Bolger N, Schilling EA (1991) Personality and the problems of everyday life: the role of neuroticism in exposure and reactivity to daily stressors. J Pers 59:355–386

    CAS  PubMed  Google Scholar 

  3. 3.

    Bolger N, Zuckerman A (1995) A framework for studying personality in the stress process. J Pers Soc Psychol 69:890–902

    Article  CAS  PubMed  Google Scholar 

  4. 4.

    Bolger N (1990) Coping as a personality process: a prospective study. J Pers Soc Psychol 59:525–537

    Article  CAS  PubMed  Google Scholar 

  5. 5.

    Cacioppo JT (1994) Social neuroscience: autonomic, neuroendocrine, and immune responses to stress. Psychophysiol 31:113–128

    CAS  Google Scholar 

  6. 6.

    Carney RM, Freedland KE, Stein PK (2000) Anxiety, depression, and heart rate variability. Psychosom Med 62:84–87

    CAS  PubMed  Google Scholar 

  7. 7.

    Carney RM, Freedland KE, Veith RC, Cryer PE, Skala JA, Lynch T, Jaffe AS (1999) Major depression, heart rate, and plasma norepinephrine in patients with coronary heart disease. Biol Psychiatry 45:458–463

    Article  CAS  PubMed  Google Scholar 

  8. 8.

    Claridge G, Davis C (2001) What’s the use of neuroticism? Pers Indiv Diff 31:383–400

    Article  Google Scholar 

  9. 9.

    Clark LA, Watons D, Mineka S (1994) Temperament, personality, and the mood and anxiety disorders. J Abn Psychol 103:103–116

    Article  CAS  Google Scholar 

  10. 10.

    Cloninger CR (1986) A unified biosocial theory of personality and its role in the development of anxiety states. Psychiatr Developm 4:167–226

    CAS  Google Scholar 

  11. 11.

    Cloninger CR, Przybeck TR, Svrakic DM, Wetzel RD (1994) The temperament and character inventory (TCI): a guide to its development and use. Center for Psychobiology of Personality, St. Louis

  12. 12.

    Conley JJ (1984) Longitudinal consistency of adult personality: self-reported psychological characteristics across 45 years. J Pers Soc Psychol 47:1325–1333

    Article  CAS  PubMed  Google Scholar 

  13. 13.

    Costa PT Jr, McCrae RR (1980) Influence of extraversion and neuroticism on subjective well-being: happy and unhappy people. J Pers Soc Psychol 38:668–678

    Article  PubMed  Google Scholar 

  14. 14.

    Costa PT Jr, McCrae RR, Arenberg D (1980) Enduring dispositions in adult males. J Pers Soc Psychol 38:793–800

    Article  Google Scholar 

  15. 15.

    Costa PT Jr, McCrae RR (1986) Personality stability and its implications for clinical psychology. Clin Psychol Rev 6:407–423

    Article  Google Scholar 

  16. 16.

    Costa PT Jr, McCrae RR (1987) Neuroticism, somatic complaints, and disease: is the bark worse than the bite? J Pers 55:299–316

    PubMed  Google Scholar 

  17. 17.

    Costa PT Jr, McCrae RR (1991) Trait psychology comes of age. Nebr Symp Motiv 39:169–204

    PubMed  Google Scholar 

  18. 18.

    Costa PT Jr, McCrae RR (1992a) Normal personality assessment in clinical practice: The NEO Personality Inventory. Psychol Ass 4:5–13

    Article  Google Scholar 

  19. 19.

    Costa PT Jr, McCrae RR (1992b) The five-factor model of personality and its relevance to personality disorders. J Pers Dis 6:343–359

    Google Scholar 

  20. 20.

    Duggan CF, Lee AS, Murray RM (1990) Does personality predict long-term outcome in depression? Br J Psychiatry 157:19–24

    CAS  PubMed  Google Scholar 

  21. 21.

    Eaves L, Heath A, Martin N, Maes H, Neale M, Kendler KS, Kirk K, Corey L (1999) Comparing the biological and cultural inheritance of personality and social attitudes in the Virginia 30,000 study of twins and their relatives. Twin Res 2:62–80

    Article  CAS  PubMed  Google Scholar 

  22. 22.

    Eysenck HJ, Eysenck SBG (1968) Manual for the Eysenck Personality Inventory. Educational and Testing Service: San Diego

    Google Scholar 

  23. 23.

    Eysenck HJ (1985) A genetic model of anxiety. Issues Ment Health Nurs 7:159–199

    CAS  PubMed  Google Scholar 

  24. 24.

    Farmer A, Harris T, Redman K, Sadler S, Mahmood A, McGuffin P (2000) Cardiff depression study. A sib-pair study of life events and familiality in major depression. Br J Psychiatry 176:150–155

    Article  CAS  PubMed  Google Scholar 

  25. 25.

    Farmer A, Redman K,Harris T, Mahmood A, Sadler S, Pickering A, McGuffin P (2002) Neuroticism, extraversion, life events and depression. The Cardiff Depression Study. Br J Psychiatry 181:118–122

    PubMed  Google Scholar 

  26. 26.

    Fergusson DM, Horwood LJ (1987) Vulnerability to life events exposure. Psychol Med 17:739–749

    CAS  PubMed  Google Scholar 

  27. 27.

    Finn SE (1986) Stability of personality self-ratings over 30 years: evidence for an age/cohort interaction. J Pers Soc Psychol 50:813–818

    Article  CAS  PubMed  Google Scholar 

  28. 28.

    Folkman S, Lazarus RS (1988) The relationship between coping and emotion: implications for theory and research. Soc Sc Med 26:309–317

    Article  CAS  Google Scholar 

  29. 29.

    Friedman HS (2000) Long-term relations of personality and health: Dynamism, mechanisms, tropisms. J Pers 68:1089–1107

    Article  CAS  PubMed  Google Scholar 

  30. 30.

    Goldsmith HH, Buss AH, Plomin R, Rothbart MK (1987) What is temperament? Four approaches. Child Dev 58:509–529

    Google Scholar 

  31. 31.

    Goodwin RD, Fergusson DM, Horwood LJ (2003) Neuroticism in adolescence and psychotic symptoms in adulthood. Psychol Med 33:1089–1097

    Article  CAS  PubMed  Google Scholar 

  32. 32.

    Gray JA (1981) Anxiety as a paradigm case of emotion. Br Med Bull 37:193–197

    CAS  PubMed  Google Scholar 

  33. 33.

    Groenink L, Pattij T, De Jongh R, Van der Gugten J, Oosting RS, Dirks A, Olivier B (2003) 5-HT1A receptor knockout mice and mice overexpressing corticotropin-releasing hormone in models of anxiety. Eur J Pharmacol 463:185–197

    Article  CAS  PubMed  Google Scholar 

  34. 34.

    Gurrera RJ, O’Donnell BF, Nestor PG, Gainski J, McCarley RW (2001) The P3 auditory event-related brain potential indexes major personality traits. Biol Psychiatry 49:922–929

    Article  CAS  PubMed  Google Scholar 

  35. 35.

    Hansenne M (1999) P300 and personality: an investigation with the Cloninger’s model. Biol Psychol 50:143–155

    Article  CAS  PubMed  Google Scholar 

  36. 36.

    Hariri AR, Mattay VS, Tessitore A, Kolachana B, Fera F, Goldman D, Egan MF, Weinberger DR (2002) Serotonin transporter genetic variation and the response of the human amygdala. Science 297:400–403

    Article  CAS  PubMed  Google Scholar 

  37. 37.

    ten Have M, Oldehinkel AJ, Vollebergh W, Ormel J (2004) Does neuroticism explain variations in care service use for mental health problems in the general population? Results from the Netherlands Mental Health Survey and Incidence Study (NEMESIS). in press, 2004

  38. 38.

    Heath AC, Martin NG (1990) Psychoticism as a dimension of personality: a multivariate genetic test of Eysenck and Eysenck’s psychoticism construct. J Pers Soc Psychol 58:111–121

    Article  CAS  PubMed  Google Scholar 

  39. 39.

    Heath AC, Neale MC, Kessler RC, Eaves LJ, Kendler KS (1992) Evidence for genetic influences on personality from self-reports and informant ratings. J Pers Soc Psychol 63:85–96

    Article  CAS  PubMed  Google Scholar 

  40. 40.

    Heim C, Nemeroff CB (2002) Neurobiology of early life stress: clinical studies. Semin Clin Neuropsychiatry 7:147–159

    Article  PubMed  Google Scholar 

  41. 41.

    Holsboer F (2001) Stress, hypercortisolism and corticosteroid receptors in depression: implications for therapy. J Affect Disord 62:77–91

    Article  CAS  PubMed  Google Scholar 

  42. 42.

    Jorm AF, Christensen H, Henderson S, Korten AE, Mackinnon AJ, Scott R (1993) Neuroticism and self-reported health in an elderly community sample. Pers Indiv Diff 15:515–521

    Article  Google Scholar 

  43. 43.

    Kagan J, Reznick JS, Snidman N (1987) Temperamental variation in response to the unfamiliar. In: Krasnegor NA, Blass EM (eds) Perinatal development: A psychobiological perspective. Academic Press, San Diego. Behav Biol, pp 421–440

  44. 44.

    Katon W, Russo J, Frank E, Barrett JA, Williams JW, Oxman T, Sullivan MD, Cornell JE (2002) Predictors of nonresponse to treatment in primary care patients with dysthymia. Gen Hosp Psychiatry 24:20–27

    Article  PubMed  Google Scholar 

  45. 45.

    Kendler KS, Kessler RC, Neale MC, Heath AC, Eaves LJ (1993) The prediction of major depression in women: toward an integrated etiologic model. Am J Psychiatry 150:1139–1148

    CAS  PubMed  Google Scholar 

  46. 46.

    Kendler KS, Gardner CO, Prescott CA (2003) Personality and the experience of environmental adversity. Psychol Med 33:1193–1202

    Article  CAS  PubMed  Google Scholar 

  47. 47.

    Kirschbaum C, Hellhammer DH (1989) Salivary cortisol in psychobiological research: an overview. Neuropsychobiol 22:150–169

    CAS  Google Scholar 

  48. 48.

    Krabbendam L, Janssen I, Bak M, Bijl RV, de Graaf R, van Os J (2002) Neuroticism and low self-esteem as risk factors for psychosis. Soc Psychiatry Psychiatr Epid 37:1–6

    Article  Google Scholar 

  49. 49.

    Loehlin JC (1992) Genes and environment in personality development. Sage Publications, Thousand Oaks

  50. 50.

    Lucas RE, Fujita F (2000) Factors influencing the relation between extraversion and pleasant affect. J Pers Soc Psychol 79:1039–1056

    Article  CAS  PubMed  Google Scholar 

  51. 51.

    MacLeod C, Hagan R (1992) Individual differences in the selective processing of threatening information, and emotional responses to a stressful life event. Behav Res Ther 30:151–161

    Article  CAS  PubMed  Google Scholar 

  52. 52.

    McCrae RR, Costa PT Jr (1997) Personality trait structure as a human universal. Am Psychol 52:509–516

    Article  CAS  PubMed  Google Scholar 

  53. 53.

    Neeleman J, Sytema S, Wadsworth M (2002) Propensity to psychiatric and somatic ill-health: evidence from a birth cohort. Psychol Med 32:793–803

    Article  CAS  PubMed  Google Scholar 

  54. 54.

    Neeleman J, Bijl R, Ormel J (2004) Neuroticism, a central link between somatic and psychiatric morbidity: path analysis of prospective data. Psychol Med 34:521–531

    Article  CAS  PubMed  Google Scholar 

  55. 55.

    Oldehinkel AJ, Ormel J, Neeleman J (2000) Predictors of time to remission from depression in primary care patients: do some patients benefit more from positive life change than others. J Abn Psychol 109:299–307

    Article  CAS  Google Scholar 

  56. 56.

    Ormel J (1983) Neuroticism and well-being inventories: measuring traits or states? Psychol Med 13:165–176

    CAS  PubMed  Google Scholar 

  57. 57.

    Ormel J, Wohlfarth TD (1991) How neuroticism, long-term difficulties, and life situation change influence psychological distress: a longitudinal model. J Pers Soc Psychol 60:744–755

    Article  CAS  PubMed  Google Scholar 

  58. 58.

    Ormel J, Rijsdijk FV (2000) Continuing change in neuroticism during adulthood-structural modelling of a 16-year, 5-wave community study. Pers Indiv Diff 28:461–478

    Article  Google Scholar 

  59. 59.

    Ormel J, Oldehinkel AJ, Brilman EI (2001) The interplay and etiological continuity of neuroticism, difficulties and life events in the etiology of major and subsyndromal, first and recurrent depressive episodes in later life. Am J Psychiatry 158:885–891

    CAS  PubMed  Google Scholar 

  60. 60.

    Ormel J, Oldehinkel AJ, Nolen WA, Vollebergh W (2004) Vulnerability before, during, and after a major depressive episode. A three-wave population-based study of state, scar and trait effects. Arch Gen Psychiatry 61:387–392

    Article  PubMed  Google Scholar 

  61. 61.

    van Os J, Jones PB (1999) Early risk factors an adult person-environment relationships in affective disorder. Psychol Med 29:1055–1067

    Article  CAS  PubMed  Google Scholar 

  62. 62.

    van Os J, Jones PB (2001) Neuroticism as a risk factor for schizophrenia. Psychol Med 31:1129–1134

    Article  CAS  PubMed  Google Scholar 

  63. 63.

    Plomin R, Owen MJ, McGuffin P (1994) The genetic basis of complex human behaviors. Science 264:1733–1739

    CAS  PubMed  Google Scholar 

  64. 64.

    Poulton RG, Andrews G (1992) Personality as a cause of adverse life events. Acta Psychiatr Scand 85:35–38

    CAS  PubMed  Google Scholar 

  65. 65.

    Rutter M (1987) Temperament, personality and personality disorder. Br J Psychiatry 150:443–458

    CAS  PubMed  Google Scholar 

  66. 66.

    Schinka JA, Busch RM, Robichaux-Keene N (2004) A meta-analysis of the association between the serotonin transporter gene polymorphism (5-HTTLPR) and trait anxiety. Mol Psychiatry 9:197–202

    Article  CAS  PubMed  Google Scholar 

  67. 67.

    Sullivan PF, Kendler KS (1998) Genetic epidemiology of ‘neurotic’ disorder. Curr Opin Psychiatry 11:143–147

    Article  Google Scholar 

  68. 68.

    Surtees PG, Wainwright NWJ (1996) Fragile states of mind: neuroticism, vulnerability and the long-term outcome of depression. Br J Psychiatry 169:338–347

    CAS  PubMed  Google Scholar 

  69. 69.

    Tambs K, Sundet JM, Eaves L, Solaas MH, Berg K (1991) Pedigree analysis of Eysenck Personality Questionnaire (EPQ) scores in monozygotic (MZ) twin families. Behav Genet 21:369–382

    CAS  PubMed  Google Scholar 

  70. 70.

    Tellegen A (1985) Structures of mood and personality and their relevance to assessing anxiety, with an emphasis on self-report. In: Hussain Tuma A, Maser J (eds) Anxiety and the anxiety disorders. Erlbaum, Hillsdale, pp 681–706

  71. 71.

    Viken RJ, Rose RJ, Kaprio J, Koskenvuo M (1994) A developmental genetic analysis of adult personality: extraversion and neuroticism from 18 to 59 years of age. J Pers Soc Psychol 66:722–730

    Article  CAS  PubMed  Google Scholar 

  72. 72.

    Watson D, Clark LA (1984) Negative affectivity: the disposition to experience aversive emotional states. Psychol Bull 96:465–490

    Article  CAS  PubMed  Google Scholar 

  73. 73.

    Watson D, Walker LM (1996) The long-term stability and predictive validity of trait measures of affect. J Pers Soc Psychol 70:567–577

    Article  CAS  PubMed  Google Scholar 

  74. 74.

    Widiger TA, Hurt SW, Frances A, Clarkin JF, Gilmore M (1984) Diagnostic efficiency and DSM-III. Arch Gen Psychiatry 41:1005–1012

    CAS  PubMed  Google Scholar 

  75. 75.

    Widiger TA, Trull TJ (1992) Personality and psychopathology: an application of the five-factor model. J Pers 60:363–393

    CAS  Google Scholar 

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Correspondence to Prof. Dr. Johan Ormel.

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Ormel, J., Rosmalen, J. & Farmer, A. Neuroticism: a non-informative marker of vulnerability to psychopathology. Soc Psychiatry Psychiatr Epidemiol 39, 906–912 (2004).

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Key words

  • neuroticism
  • negative affectivity
  • psychopathology
  • physical health
  • explanatory power
  • causality