Cluster analysis of insomniacs' MMPI profiles: Relation of subtypes to sleep history and treatment outcome
Psychology Service, Veterans Administration Medical Center, Durham, NC 27705. Psychosomatic Medicine
(Impact Factor: 3.47).
01/1988; 50(1):77-87. DOI: 10.1097/00006842-198801000-00010
The Minnesota Multiphasic Personality Inventory (MMPI) profiles of 100 insomniacs who presented for treatment at a university medical center were analyzed by a hierarchical clustering procedure. This analysis revealed two major personality types that accounted for 88% of the sample. The two types referred to as "Type 1" and "Type 2" insomniacs differed significantly in regard to sleep history questionnaire responses and responsivity to treatment. MMPI scales and sleep history questionnaire items suggested that Type 1 insomniacs were less defended, more aroused/activated, and had sleep histories characterized by more childhood sleep problems and greater difficulties with sleep-disruptive cognitions than did Type 2 patients. Further, Type 1 patients had a poorer response to behavioral treatment as measured by change in sleep-onset latency than did Type 2 patients. These results suggest that the MMPI may be useful in identifying distinctive personality subgroups among insomniacs. Treatment implications are discussed, and mechanisms underlying the group differences are considered.
Available from: Nicole Lovato
- "Both age and a variety of other factors related to insomnia severity and duration were assessed as potential predictors of treatment efficacy. Past research has indicated that older participants had a poorer treatment response relative to younger participants  , though insomnia severity and duration have not yet been consistently related to treatment outcome     . "
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ABSTRACT: Cognitive behavior therapy is an effective nonpharmacologic treatment for insomnia. However, individualized administration is costly and often results in substantial variability in treatment response across individual patients, particularly so for older adults. Group-based administration has demonstrated impressive potential for a brief and inexpensive answer to the effective treatment of insomnia in the older population. It is important to identify potential predictors of response to such a treatment format to guide clinicians when selecting the most suitable treatment for their patients. The aim of our study was to identify factors that predict subjective sleep quality of older adults following group-based administration of cognitive behavior therapy for insomnia (CBT-I).
Eighty-six adults (41 men; mean age, 64.10y; standard deviation [SD], 6.80) with sleep maintenance or early morning awakening insomnia were selected from a community-based sample to participate in a 4-week group-based treatment program of CBT-I. Participants were required to complete 7-day sleep diaries and a comprehensive battery of questionnaires related to sleep quality and daytime functioning. Hierarchical multiple regression analyses were used to identify factors predicting subjective sleep quality immediately following treatment and at 3-month follow-up. Sleep diaries reported average nightly sleep efficiency (SE), which was used as the outcome measure of sleep quality.
Participants with the greatest SE following treatment while controlling for pretreatment SE were relatively younger and had more confidence in their ability to sleep at pretreatment. These characteristics may be useful to guide clinicians when considering the use of a group-based CBT-I for sleep maintenance or early morning awakening insomnia in older adults.
Available from: Megan E Petrov
- "Probable risk factors for chronic insomnia with hypnotic dependence that have been identified are being older, female , having poor health, greater psychological distress and anxiety , and severe insomnia   , but less is known about personality traits and disorders. Links between personality traits and chronic insomnia without hypnotic dependence have been described such as neuroticism, depression, rumination, internalization of emotions, and perfectionism      . Personality disorders  are also prevalent in patients with chronic insomnia without hypnotic dependence   . "
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ABSTRACT: To determine the prevalence of personality disorders and their relation to insomnia parameters among persons with chronic insomnia with hypnotic dependence.
Eighty-four adults with chronic insomnia with hypnotic dependence completed the SCID-II personality questionnaire, two-weeks of sleep diaries, polysomnography, and measures of insomnia severity, impact, fatigue severity, depression, anxiety, and quality of life. Frequencies, between-subjects t-tests and hierarchical regression models were conducted.
Cluster C personality disorders were most prevalent (50%). Obsessive-Compulsive personality disorder (OCPD) was most common (n=39). These individuals compared to participants with no personality disorders did not differ in objective and subjective sleep parameters. Yet, they had poorer insomnia-related daytime functioning. OCPD and Avoidant personality disorders features were associated with poorer daytime functioning. OCPD features were related to greater fatigue severity, and overestimation of time awake was trending. Schizotypal and Schizoid features were positively associated with insomnia severity. Dependent personality disorder features were related to underestimating time awake.
Cluster C personality disorders were highly prevalent in patients with chronic insomnia with hypnotic dependence. Features of Cluster C and A personality disorders were variously associated with poorer insomnia-related daytime functioning, fatigue, and estimation of nightly wake-time. Future interventions may need to address these personality features.
Available from: Simon Beaulieu-Bonneau
- "Moreover, most studies that documented correlates of insomnia have relied on treatment-seeking individuals recruited from sleep clinics. Such studies, while valuable, are restricted to describing a single group of individuals with chronic insomnia   , or when a comparative group of good sleepers is included, it is typically based on a convenience sample not drawn from the same population [18,20–22]. In addition, there has been no systematic investigation of the characteristics (e.g., personality, depression, and anxiety symptoms) of individuals with insomnia symptoms only (i.e., who do not fulfill all the diagnostic criteria of insomnia, although they represent approximately 30% of the general population)  . "
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ABSTRACT: This study examined the relationship of psychological and health-related quality of life variables to insomnia in a population-based sample.
Data were derived from a longitudinal epidemiological study assessing the natural history of insomnia. The present results are based on the first of four postal evaluations conducted over a 2-year period. Participants (n=953) completed questionnaires assessing sleep, psychological and personality variables, and health-related factors. Participants were categorized into three sleep status subgroups using an algorithm based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision and International Classification of Diseases, 10th Edition diagnostic criteria for insomnia: (1) insomnia syndrome (n=147), (2) insomnia symptoms (n=308), and (3) good sleepers (n=493).
Compared to individuals with insomnia symptoms and good sleepers, individuals with insomnia syndrome presented lower quality of life and higher scores on measures of depression, anxiety, neuroticism, extraversion, arousal predisposition, stress perception, and emotion-oriented coping. The same pattern was observed for individuals with insomnia symptoms in comparison with good sleepers. An ordinal logistic regression analysis showed that the presence of a past episode of insomnia, higher depressive symptoms, and lower scores on the 12-item Short Form Health Survey vitality and role physical subscales were the most useful variables to predict subgroups membership.
The findings indicate that insomnia is associated with increased psychological symptomatology and perceived stress, higher predisposition to arousal, and more impairment of health quality. Longitudinal follow-ups are now being conducted to assess the relative contribution of those variables in the development and natural course of insomnia.
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