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Why ‘healthy neurotics’ can thrive in stressful times
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Anxiety can be damaging, but harnessing your neuroticism could bring benefits, including some unexpected advantages in the current climate.
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We all know the neurotic personality when we see it: think Monica from Friends, or George from Seinfeld. Neurotic people worry too much, and if they don’t have anything concrete to worry about, then they start worrying about not being worried. Perhaps you identify. 

On personality tests, participants rate their neuroticism with questions such as “I get irritated easily” and “I am much more anxious than most people” – and the more you agree with those statements, the more neurotic you are. These traits might make for an amusing sitcom character, but it hardly sounds like a recipe for health and happiness. If stress is truly bad for our health, as much research suggests, then you would expect neurotics to have shorter life expectancies. 

About two decades ago, however, Howard Friedman at University of California Riverside noticed that the evidence for this assumption was rather weak. “Some good studies showed neurotic people to be or become less healthy or die sooner,” he recalls, “while other good studies showed the opposite – that neurotic people tended to be or become healthier and live longer.” 

Given these mixed findings, Friedman began to wonder whether the personality trait could be something of a double-edged sword. While the anxiety by itself could be damaging in some circumstances, some people might use their worrying as motivation to improve their health. This would be especially true, Friedman suggested, for people with both high neuroticism and high conscientiousness (the tendency to be disciplined and organised), a personality type he described as the “healthy neurotic”. Imagine, for instance, that you have a health scare. A more laid-back personality might fail to respond to the risk, whereas the healthy neurotic would be more likely to get medical help. 

Untangling the various personality factors that might lead to different health outcomes, and explaining how they do it, is an extraordinarily difficult task. But various studies have outlined the benefits of being a healthy neurotic, including some unexpected advantages in the current pandemic. 

Inflamed feelings 

Let’s first consider an examination of chronic inflammation, by Nicholas Turiano at West Virginia University. Whenever we are ill or injured, the body sends out pro-inflammatory molecules. This leads to redness and swelling, but it helps to kill off microbes and to repair tissue – making inflammation an essential weapon in our bodies’ defences. Unfortunately, various behaviours – such as smoking, drinking, overeating and physical inactivity – can create lingering long-term inflammation. Over time, this can damage our tissues, leading to arthritis, diabetes, cancer, heart disease and perhaps even Alzheimer’s. Measuring the levels of the key pro-inflammatory molecules therefore provides a snapshot of someone’s current health and their risk of illness in the future. 

To discover whether someone’s personality might influence their risk of chronic inflammation, Turiano examined a survey of more than 1,000 middle-aged participants who had undergone regular health checks. Supporting the theory of the “healthy neurotic”, Turiano found that people with the combination of higher conscientiousness and higher neuroticism had reduced levels of inflammation, faring better than people who had scored highly on just one of the traits. 

Like Friedman, Turiano proposed that the reason for these differences lay in the ways they responded to their anxieties. Healthy neurotics tend to have a lower body mass index, for example, perhaps because they are more conscious of the health risks of obesity, and so make more effort to maintain a healthy weight.

It's possible that a dose of neuroticism may make you more likely to look after your health

It's possible that a dose of neuroticism may make you more likely to look after your health

Along these lines, Mirjam Stieger, a psychologist at Brandeis University near Boston, has recently shown that healthy neurotics are more likely to stick to a new exercise regime. The subjects were given a FitBit tracker and encouraged to increase the number of steps they took every day, using a process known as “implementation intentions” (in which you make a concrete plan of when and where you will exercise). As expected, people with high conscientiousness tended to show greater improvements than people who were low in conscientiousness. But people who were high in both conscientiousness and neuroticism performed better still. “Healthy neurotics may be better able to channel their health concerns into positive behaviours,” she concludes. 

A recent meta-analysis of 15 studies examining personality and health behaviours across the US, UK, Australia and Germany bolster this argument. The researchers found that people with high neuroticism and conscientiousness are less likely to smoke and more likely to take regular exercise

Constructive coping 

The events of 2020 have, of course, turned many of our assumptions on their head – and you may wonder if the additional stresses of the pandemic would overwhelm any of the benefits that might come from neuroticism. 

Yet the latest research suggests that some neurotic personalities have coped surprisingly well with the uncertainty of Covid-19. The study in question looked at American employees’ sense of powerlessness in the last two weeks of March this year – just after the US government had declared a state of national emergency. As you would expect, everyone started to feel helpless at the beginning of this period, but the researchers found that people scoring high on neuroticism tended to recover the feeling of autonomy and control more quickly than those who had more laidback personalities. Although this particular survey did not also examine conscientiousness, the authors argue that it fits with the general concept of healthy neuroticism, showing how a heightened vigilance to new threats could sometimes lead to constructive coping.

 Given the previous research, it’s possible that healthy neurotics will also be less likely to catch the virus itself – as their naturally anxious personalities will lead them to take more precautions, such as handwashing, mask wearing and social distancing.

Neuroticism may make you more likely to take suitable Covid-19 precautions

Neuroticism may make you more likely to take suitable Covid-19 precautions

Needless to say, Friedman welcomes these findings. “The studies clearly show that although depressive rumination and chronic hostility are unhealthy, the vigilance and worrying concern of healthy neuroticism – paired in the right circumstances with the prudence and responsibility of being conscientious – can produce very healthy patterns.” 

Harnessing your neuroticism 

The long-term benefits of neuroticism remain a matter of debate, however. Sara Weston, an assistant professor at the University of Oregon, is among the researchers who have shown that healthy neuroticism can reduce smoking, yet her analyses have found no evidence that healthy neurotics live longer than the average person. “People who are high in both neuroticism and conscientiousness may engage in healthier habits, but it doesn't seem like this has strong downstream consequences,” she says. The physiological effects of the stress itself – such as increased strain on the heart – could counteract the positive behavioural changes, she suspects, meaning that you see no overall increase in longevity. 

Even so, she hopes that an understanding of healthy neuroticism may still help to suggest ways to personalise interventions so that people can capitalise on their existing strengths. “You could harness those behavioural tendencies and use them as a way to push people to do things that would have an impact on their health.” 

If you are high in neuroticism but lower in conscientiousness, you might try to boost your self-discipline to make sure that you act on your anxieties. Stieger is currently testing this possibility with an app that educates people about the benefits of conscientiousness and guides them to make specific plans to increase their physical activity. (As we wait for those results, you could look to BBC Worklife’s archive for some immediate evidence-based ways to increase perseverance and discipline.) 

Those of us with a neurotic personality might also reconsider the ways we frame our worries. A swathe of recent research has shown that our attitudes to anxiety often determine how it affects our mental and physical health. If we believe anxiety to be damaging, then we tend to take longer to recover from stressful events and suffer more long-term consequences from the experience; if we see anxiety as a source of motivation and energy, however, we tend to perform better and recover more quickly after the stress has passed. Although the mechanisms are still being explored, it seems that this more positive view of anxiety stops us from descending into counter-productive rumination about our worries, and helps to bolster our confidence in our ability to cope. One study, which tracked a cohort of German doctors and teachers, found that this attitude completely buffered the detrimental effects of heightened anxiety over the course of a year. With further research, it may turn out that the shift to healthy neuroticism can be achieved through a simple change in mindset. 

Friedman certainly thinks it’s time to take a more nuanced understanding of our personalities and our feelings. “The current zeitgeist often equates the anxiety and moodiness aspects of neuroticism with ‘stress’, and sees this ‘stress’ as a cause of disease, even in light of considerable documentation that this is a dangerous over-simplification,” he argues. “Worrying can be OK, especially in situations like a pandemic.” In this new age of anxiety, there may be no better time to embrace the benefits of our fretful minds. 

David Robson is the author of The Intelligence Trap: Why Smart People Do Dumb Things (WW Norton/Hodder & Stoughton). He is @d_a_robson on Twitter.

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