Psychological Reports, 1991,68, 615-619. O Psychological Reports 1991
HEADACHE A N D SENSATION SEEKING ' N. GINSBURG AND S. POLLACK-FELS Lukehead Uniuersiiy Summary.-According to the cognitive theory of sensation seeking, headache sufferers were predicted to score lower than controls on Zuckerman's Sensation Seeking Scale. 26 subjects who experienced chronic headaches scored significantly lower than a group of 26 controls. The relationships between the Sensation Seeking Scale and a number of personality tests are described. Replication of the findings on h s scale with headache patients is encouraged as well as exploration of other personality dimensions which show significant relations with sensation seeking.
I t was recently reported by Ginsburg and Ksander (1987) that there is a s m d , but significant correlation (-.3O, p = .01) between scores on Zuckerman's Sensation Seeking Scale (1979) and estimation of numerosity. These authors developed a cognitive theory of sensation seeking, as opposed to the usual motivational view. According to this theory, those who score high on the scale do so not because of any greater need for stimulation, but because they tend to underestimate the amount of stimulation offered them by the environment. Such people tend to be tolerant of high stimulation, including pain. O n the other hand, low-scoring people overestimate stimulation and tend to be less tolerant of high intensities. Any clinical population characterized by complaints of stimuli that are too intense might, on the above view, be expected to score low on the scale. One such group are people with chronic headaches, who experience excessive pain. It was predicted that headache sufferers would score lower on the Sensation Seeking Scale than a comparable group who d o not experience headaches.
Subjects
A group of 26 persons who experience chronic headaches was selected by means of a questionnaire. To be included in the Headache group, a person had to answer "True" to the statement: "I suffer from four or more headaches per year." The Headache group included 2 1 women and 5 men, whose average age was 33.5 yr. (range 18 to 77 years). Another group of 26 persons was selected who answered "False" to the statement cited above. This group, the Nonheadache group, also included 2 1 women and 5 men; their average age was 32.2 yr. (range 1 9 to 52 years). Most subjects worked
'Request re rints from N. Ginsburg, Department of Psychology, Box 67, McMaster University, Hamilton, Bntario, Canada L8S 4K1.
616
N. GINSBURG
&
S. POLLACK-FELS
for Lakehead University; their participation in the study was voluntary, and informed consent was obtained after the nature of the procedure had been fdyexplained. Materials
All subjects were given Form V of the Sensation Seeking Scale. This contains the following subscales: Thrill and Adventure Seeking, Experience Seeking, Disinhibition, and Boredom Susceptibility. For further information on the subscales, the reader should consult Zuckerman (1979). Participation of Nonheadache group ended with the admirustration of the scale. The Headache group, however, was asked to keep a Headache diary for one month (February 1987).
RESULTS Headaches were recorded by time of day (four periods), trigger factors, severity, and symptoms. O n the basis of symptoms, headaches were classified (by the second author, who suffers from migraine herself) as follows. rnigraine (vascular) 43.5%, tension (muscle-contraction) 38.5%, mixed 10 5 % , undifferentiated 7.5%. An attempt was made to relate headache occurrences to climatic changes, but this issue is not dealt with in the present paper (Pollack-Fels, 1988). TABLE 1 SENSATION SEEKINGSCORES (nS = 26) Scale
Headache M
Thrill 3.5 Experience 4.2 Disinhibicion 2.7 1.5 Boredom Total Score 11.9 "Zuckerman (1979, p. 128). t p < .O1.
Nonheadache
SD
M
SD
2.4 1.8 1.9 1.5 5.3
6.5 5.8 4.3 3.9 20.5
2.4 1.7 2.1 2.0 2.0
Ft
Norms: M*
19.73 10.45 8.92 25.86 40.66
N = 1023 7.4 4.7 4.7 2.7 19.5
Table 1 gives scores of both groups on all four subscales. Scores of the Nonheadache group are similar (by inspection, see Table 1) to the norms provided by Zuckerman (1979). Scores of the Headache group are clearly lower on all four subscales, as well as the total. All differences between groups are significant at . O 1 on simple one-way analyses of variance (df = 1,50).
DISCUSSION The results for the 26 headache sufferers and 26 controls are clear. The headache group scored consistently lower. To appreciate better any significance this relation may hold, we raise two questions: (a) what is known about the personahties of people who experience headaches and (b) what are
HEADACHE AND SENSATION SEEKING
617
the traits which are associated with the scale? The bibliography of Martin, Marie, and Nathan (1987) has been very helpful in attempting to answer the first question. Four approaches have been taken to the assessment of personality characteristics of headache patients: (a) Summaries of psychiatric interviews have been given by a number of writers. For instance, according to Adams, Feuerstein, and Fowler, "migraine patients have been described by a constellation of excessive compulsive traits including perfectionism, orderliness, moralistic preoccupation, and rigidityv (1980, p. 224). Henryk-Gutt characterizes such a patient as "tense, driving, obsessional perfectionist, with an inflexible personality, who maintains a store of bottled-up resentments which can neither be expressed nor resolved" (cf. Henryk-Gutt & Rees, 1973, p. 142). Bakal reports that "migraine headache is most often assumed to result from repressed hostdity" (1975, p. 374). "Individuals with tension headaches," we are told by Blanchard, Andrasik, and Arena "have traditionally been characterized as worrisome, depressed, anxious, chronically tense, hostile, dependent, histrionic, and psychosexually conflicted" (1984, p. 314). (b) Seven studies using self-reports are reviewed by Harrison, who summarizes them as follows: "They [headache sufferers] describe themselves as neurotic . . . more anxious, overwrought, tense, vulnerable, and depressed than do controls. Two other traits appear in more than one of these studies: forgetfulness and moralistic perfectionism" (Bakal, 1975, p. 183). (c) After reviewing projective tests, Harrison concluded "there are no positive findings whlch replicate from one study to the next" (1975, p. 183). (d) The results reported by Blanchard, et al. (1984) include a large number of subjects (166 with headaches and 63 controls), and covered a wide range of standardized tests. This account is confined to those tests for which there were significant differences from the controls for both migraine and tension subjects, since these categories account for over 80% of our headache sample. O n the Minnesota Multiphasic Personality Inventory the following scales showed significantly higher scores: Hypochondria, Depression, Hysteria, and Psychasthenia. A number of previous studies (see Harrison, 1975) had also indicated hgher scores on Hypochondria and Hysteria. Two other tests which, according to Blanchard, et al. (1984) yielded higher values for headache subjects were the Beck Depression Index and the Psychosomatic Symptom Checklist. Many studies have been carried out to explore the relation between the Sensation Seeking Scale and other psychological tests. Several are summarized here. (a) Eysenck's Personality Questionnaire contains three scales: Extraversion, Psychoticism, and Neuroticism. Extraversion has shown significant positive correlation with the Sensation Seeking Scale (Farley & Farley, 1967; Eysenck & Zuckerman, 1978). There have also been significant posi-
618
N. GINSBURG & S. POLLACK-FELS
tive correlations for Psychoticism, but not for Neuroticism (Eysenck & Zuckerman, 1978). (b) Of the 10 MMPI scales, significant positive correlations were obtained with the Manic scale (Thorne, 1971; cf. R. J. Daitzman & T. N. Tumulty, 1974, cited by Zuckerman, 1979). A significant negative correlation was noted for the Depression scale (cf. R. J. Daitzman & T. N. Tumulty, 1974, cited by Zuckerman, 1979). (c) O n Cattell's 16 PF significant positive correlations were obtained for dominance, adventurousness, and radicalism, while the correlation with super-ego was significantly negative (Gorman, 1970; Jacobs, 1975; Zuckerman, Bone, Neary, Mangelsdorff, & Brustman, 1972). (d) O n Gough's California Psychological Inventory correlations were significantly positive for social presence, dominance, and self-acceptance, while they were significantly negative for self-control and socialization. Flexibhty showed a significant positive relation (Kish, 1971). (e) Shostrom's Personal Orientation Inventory yielded significant positive correlations for inner directedness, spontaneity, and capacity for intimacy (Zuckerman, 1979). (f) O n Taylor's Manifest Anxiety Scale no relation was found with the Sensation Seehng Scale (Bone, Montgomery, Sundstrom, Cowling, & Caleb, 1972; McReynolds, 1971); however, Zuckerman has suggested that "the type of general anxiety measured by these tests is really social anxiety or fear of evaluation rather than situations involving threats of pain or bodily harm" (Zuckerman, 1979, p. 166). With tests of responses to imagined physical risks (being on a mountain ledge or in a sailboat in a rough sea), correlations with sensation seeking were significantly negative (Segal, 1973). I t might be noted that correlations were consistently stronger for women. In summary, each of the six personality tests cited above shows some relation to the Sensation Seeking Scale. Since headache-sufferers, as we have demonstrated, score lower than average on the Sensation Seeking Scale, we suggest exploring the possible relation between headaches and these personality variables. Such research could conceivably help us understand the dynamics of headaches and perhaps contribute to therapy. REFERENCES ADAMS,H. E., FEWRSTEIN,M., & FOWLER,J. L. (1980) Migraine headache: review of parameters, etiology, and intervention. Psychological Bulletin, 87, 217-237. BAKU, D. A. (1975) Headache: a biological perspective. Psychological Bulletin, 82, 369-382. BLANCHARD, E. B., ANDRASM,F., & ARENA,J. G. (1984) Personality and chronic headache. Progress in Evperimental Personality Research, 13, 303-364. BONE,R. N., MONTGOMERY, D. D., SUNDSTROM, P. E., COWLING, L. W., & CALEB,R. S. (1972) Relationship of sensation seeking and anxiety. Psychological Reports, 30, 874. EYSENCK, S. B. G., & ZUCKERMAN, M. (1978) The relationship between sensation seeking and Eysenck's dimensions of personality. British Journal of Psychology, 69, 483-487. FARLEY,F. H., & FARLEY,S. V. (1967) Extroversion and stimulus seeking motivation. Journal of Consulting and Clinical Psychology, 31, 215-216. GINSBURG,N., & KSANDER,A. T. (1987) Sensation seeking and estimation of number. Perceptual and Motor Skills, 65, 8 1 1-815.
HEADACHE AND SENSATION SEEKING
619
GORMAN,B. S. (1970) 16 PF correlates of sensation seeking, Psychological Reports, 26, 741-742. HARRISON, R. H . (1975) Psychological testing in headache: a review. Headache, 14, 177-185. H E N R Y K - G mR., , & REES, W. L. (1973) Psychological aspects of migraine. Journal of Psychosomatic Research, 17, 141-153. JACOBS,K. W. (1975) 16 PF correlates of sensation seeking. Psychological Reports, 37, 12151218. KISH, G. B. (1971) CPI correlates of stimulus-seeking in male alcoholics. Journal of Clinical Psychology, 27, 251-253. MARTIN,P. R., MARIE,G . V., & NATHAN,P R. (1987) Behavioral research on headache: a coded bibliography. Headache, 27, 555-570. MCREYNOLDS, P. (1971) Behavioral choice as a function of novelty-seeking and anxiety-avoidance motivations. Psychological Reports, 29, 3-6. POLLACK-FELS, S. (1988) An investi ation of the effect of personality and climatic factors on d thesis, Lakehead Univer. migraine headaches. ~ n ~ u b l i s k eHonors SEGAL,B. (1973) Sensation seeking and anxiety: assessment of response to specific stimulus situations. Journal of Consulting and Clinical Psychology, 41, 135-138. THORNE,G. L. (1971) The Sensation-Seeking Scale with deviant populations. Journal of Consulting and Clinical Psychology, 37, 106-110. ZUCKERMAN, M. (1979) Sensation seeking: beyond the optimal leuel of arousal. Hillsdale, N J : Erlbaum. M., BONE,R. N., NEARY,R., MANGELSDORFF, D., & BRUSTMAN, B. (1972) What ZUCKERMAN, is the sensation seeker? Personality trait and experience correlates of the Sensation Seeking Scale. Journal of Consulting and Clinical Psychology, 39, 308-321.
Accepted April 2, 1771
HEADACHE A N D SENSATION SEEKING ' N. GINSBURG AND S. POLLACK-FELS Lukehead Uniuersiiy Summary.-According to the cognitive theory of sensation seeking, headache sufferers were predicted to score lower than controls on Zuckerman's Sensation Seeking Scale. 26 subjects who experienced chronic headaches scored significantly lower than a group of 26 controls. The relationships between the Sensation Seeking Scale and a number of personality tests are described. Replication of the findings on h s scale with headache patients is encouraged as well as exploration of other personality dimensions which show significant relations with sensation seeking.
I t was recently reported by Ginsburg and Ksander (1987) that there is a s m d , but significant correlation (-.3O, p = .01) between scores on Zuckerman's Sensation Seeking Scale (1979) and estimation of numerosity. These authors developed a cognitive theory of sensation seeking, as opposed to the usual motivational view. According to this theory, those who score high on the scale do so not because of any greater need for stimulation, but because they tend to underestimate the amount of stimulation offered them by the environment. Such people tend to be tolerant of high stimulation, including pain. O n the other hand, low-scoring people overestimate stimulation and tend to be less tolerant of high intensities. Any clinical population characterized by complaints of stimuli that are too intense might, on the above view, be expected to score low on the scale. One such group are people with chronic headaches, who experience excessive pain. It was predicted that headache sufferers would score lower on the Sensation Seeking Scale than a comparable group who d o not experience headaches.
Subjects
A group of 26 persons who experience chronic headaches was selected by means of a questionnaire. To be included in the Headache group, a person had to answer "True" to the statement: "I suffer from four or more headaches per year." The Headache group included 2 1 women and 5 men, whose average age was 33.5 yr. (range 18 to 77 years). Another group of 26 persons was selected who answered "False" to the statement cited above. This group, the Nonheadache group, also included 2 1 women and 5 men; their average age was 32.2 yr. (range 1 9 to 52 years). Most subjects worked
'Request re rints from N. Ginsburg, Department of Psychology, Box 67, McMaster University, Hamilton, Bntario, Canada L8S 4K1.
616
N. GINSBURG
&
S. POLLACK-FELS
for Lakehead University; their participation in the study was voluntary, and informed consent was obtained after the nature of the procedure had been fdyexplained. Materials
All subjects were given Form V of the Sensation Seeking Scale. This contains the following subscales: Thrill and Adventure Seeking, Experience Seeking, Disinhibition, and Boredom Susceptibility. For further information on the subscales, the reader should consult Zuckerman (1979). Participation of Nonheadache group ended with the admirustration of the scale. The Headache group, however, was asked to keep a Headache diary for one month (February 1987).
RESULTS Headaches were recorded by time of day (four periods), trigger factors, severity, and symptoms. O n the basis of symptoms, headaches were classified (by the second author, who suffers from migraine herself) as follows. rnigraine (vascular) 43.5%, tension (muscle-contraction) 38.5%, mixed 10 5 % , undifferentiated 7.5%. An attempt was made to relate headache occurrences to climatic changes, but this issue is not dealt with in the present paper (Pollack-Fels, 1988). TABLE 1 SENSATION SEEKINGSCORES (nS = 26) Scale
Headache M
Thrill 3.5 Experience 4.2 Disinhibicion 2.7 1.5 Boredom Total Score 11.9 "Zuckerman (1979, p. 128). t p < .O1.
Nonheadache
SD
M
SD
2.4 1.8 1.9 1.5 5.3
6.5 5.8 4.3 3.9 20.5
2.4 1.7 2.1 2.0 2.0
Ft
Norms: M*
19.73 10.45 8.92 25.86 40.66
N = 1023 7.4 4.7 4.7 2.7 19.5
Table 1 gives scores of both groups on all four subscales. Scores of the Nonheadache group are similar (by inspection, see Table 1) to the norms provided by Zuckerman (1979). Scores of the Headache group are clearly lower on all four subscales, as well as the total. All differences between groups are significant at . O 1 on simple one-way analyses of variance (df = 1,50).
DISCUSSION The results for the 26 headache sufferers and 26 controls are clear. The headache group scored consistently lower. To appreciate better any significance this relation may hold, we raise two questions: (a) what is known about the personahties of people who experience headaches and (b) what are
HEADACHE AND SENSATION SEEKING
617
the traits which are associated with the scale? The bibliography of Martin, Marie, and Nathan (1987) has been very helpful in attempting to answer the first question. Four approaches have been taken to the assessment of personality characteristics of headache patients: (a) Summaries of psychiatric interviews have been given by a number of writers. For instance, according to Adams, Feuerstein, and Fowler, "migraine patients have been described by a constellation of excessive compulsive traits including perfectionism, orderliness, moralistic preoccupation, and rigidityv (1980, p. 224). Henryk-Gutt characterizes such a patient as "tense, driving, obsessional perfectionist, with an inflexible personality, who maintains a store of bottled-up resentments which can neither be expressed nor resolved" (cf. Henryk-Gutt & Rees, 1973, p. 142). Bakal reports that "migraine headache is most often assumed to result from repressed hostdity" (1975, p. 374). "Individuals with tension headaches," we are told by Blanchard, Andrasik, and Arena "have traditionally been characterized as worrisome, depressed, anxious, chronically tense, hostile, dependent, histrionic, and psychosexually conflicted" (1984, p. 314). (b) Seven studies using self-reports are reviewed by Harrison, who summarizes them as follows: "They [headache sufferers] describe themselves as neurotic . . . more anxious, overwrought, tense, vulnerable, and depressed than do controls. Two other traits appear in more than one of these studies: forgetfulness and moralistic perfectionism" (Bakal, 1975, p. 183). (c) After reviewing projective tests, Harrison concluded "there are no positive findings whlch replicate from one study to the next" (1975, p. 183). (d) The results reported by Blanchard, et al. (1984) include a large number of subjects (166 with headaches and 63 controls), and covered a wide range of standardized tests. This account is confined to those tests for which there were significant differences from the controls for both migraine and tension subjects, since these categories account for over 80% of our headache sample. O n the Minnesota Multiphasic Personality Inventory the following scales showed significantly higher scores: Hypochondria, Depression, Hysteria, and Psychasthenia. A number of previous studies (see Harrison, 1975) had also indicated hgher scores on Hypochondria and Hysteria. Two other tests which, according to Blanchard, et al. (1984) yielded higher values for headache subjects were the Beck Depression Index and the Psychosomatic Symptom Checklist. Many studies have been carried out to explore the relation between the Sensation Seeking Scale and other psychological tests. Several are summarized here. (a) Eysenck's Personality Questionnaire contains three scales: Extraversion, Psychoticism, and Neuroticism. Extraversion has shown significant positive correlation with the Sensation Seeking Scale (Farley & Farley, 1967; Eysenck & Zuckerman, 1978). There have also been significant posi-
618
N. GINSBURG & S. POLLACK-FELS
tive correlations for Psychoticism, but not for Neuroticism (Eysenck & Zuckerman, 1978). (b) Of the 10 MMPI scales, significant positive correlations were obtained with the Manic scale (Thorne, 1971; cf. R. J. Daitzman & T. N. Tumulty, 1974, cited by Zuckerman, 1979). A significant negative correlation was noted for the Depression scale (cf. R. J. Daitzman & T. N. Tumulty, 1974, cited by Zuckerman, 1979). (c) O n Cattell's 16 PF significant positive correlations were obtained for dominance, adventurousness, and radicalism, while the correlation with super-ego was significantly negative (Gorman, 1970; Jacobs, 1975; Zuckerman, Bone, Neary, Mangelsdorff, & Brustman, 1972). (d) O n Gough's California Psychological Inventory correlations were significantly positive for social presence, dominance, and self-acceptance, while they were significantly negative for self-control and socialization. Flexibhty showed a significant positive relation (Kish, 1971). (e) Shostrom's Personal Orientation Inventory yielded significant positive correlations for inner directedness, spontaneity, and capacity for intimacy (Zuckerman, 1979). (f) O n Taylor's Manifest Anxiety Scale no relation was found with the Sensation Seehng Scale (Bone, Montgomery, Sundstrom, Cowling, & Caleb, 1972; McReynolds, 1971); however, Zuckerman has suggested that "the type of general anxiety measured by these tests is really social anxiety or fear of evaluation rather than situations involving threats of pain or bodily harm" (Zuckerman, 1979, p. 166). With tests of responses to imagined physical risks (being on a mountain ledge or in a sailboat in a rough sea), correlations with sensation seeking were significantly negative (Segal, 1973). I t might be noted that correlations were consistently stronger for women. In summary, each of the six personality tests cited above shows some relation to the Sensation Seeking Scale. Since headache-sufferers, as we have demonstrated, score lower than average on the Sensation Seeking Scale, we suggest exploring the possible relation between headaches and these personality variables. Such research could conceivably help us understand the dynamics of headaches and perhaps contribute to therapy. REFERENCES ADAMS,H. E., FEWRSTEIN,M., & FOWLER,J. L. (1980) Migraine headache: review of parameters, etiology, and intervention. Psychological Bulletin, 87, 217-237. BAKU, D. A. (1975) Headache: a biological perspective. Psychological Bulletin, 82, 369-382. BLANCHARD, E. B., ANDRASM,F., & ARENA,J. G. (1984) Personality and chronic headache. Progress in Evperimental Personality Research, 13, 303-364. BONE,R. N., MONTGOMERY, D. D., SUNDSTROM, P. E., COWLING, L. W., & CALEB,R. S. (1972) Relationship of sensation seeking and anxiety. Psychological Reports, 30, 874. EYSENCK, S. B. G., & ZUCKERMAN, M. (1978) The relationship between sensation seeking and Eysenck's dimensions of personality. British Journal of Psychology, 69, 483-487. FARLEY,F. H., & FARLEY,S. V. (1967) Extroversion and stimulus seeking motivation. Journal of Consulting and Clinical Psychology, 31, 215-216. GINSBURG,N., & KSANDER,A. T. (1987) Sensation seeking and estimation of number. Perceptual and Motor Skills, 65, 8 1 1-815.
HEADACHE AND SENSATION SEEKING
619
GORMAN,B. S. (1970) 16 PF correlates of sensation seeking, Psychological Reports, 26, 741-742. HARRISON, R. H . (1975) Psychological testing in headache: a review. Headache, 14, 177-185. H E N R Y K - G mR., , & REES, W. L. (1973) Psychological aspects of migraine. Journal of Psychosomatic Research, 17, 141-153. JACOBS,K. W. (1975) 16 PF correlates of sensation seeking. Psychological Reports, 37, 12151218. KISH, G. B. (1971) CPI correlates of stimulus-seeking in male alcoholics. Journal of Clinical Psychology, 27, 251-253. MARTIN,P. R., MARIE,G . V., & NATHAN,P R. (1987) Behavioral research on headache: a coded bibliography. Headache, 27, 555-570. MCREYNOLDS, P. (1971) Behavioral choice as a function of novelty-seeking and anxiety-avoidance motivations. Psychological Reports, 29, 3-6. POLLACK-FELS, S. (1988) An investi ation of the effect of personality and climatic factors on d thesis, Lakehead Univer. migraine headaches. ~ n ~ u b l i s k eHonors SEGAL,B. (1973) Sensation seeking and anxiety: assessment of response to specific stimulus situations. Journal of Consulting and Clinical Psychology, 41, 135-138. THORNE,G. L. (1971) The Sensation-Seeking Scale with deviant populations. Journal of Consulting and Clinical Psychology, 37, 106-110. ZUCKERMAN, M. (1979) Sensation seeking: beyond the optimal leuel of arousal. Hillsdale, N J : Erlbaum. M., BONE,R. N., NEARY,R., MANGELSDORFF, D., & BRUSTMAN, B. (1972) What ZUCKERMAN, is the sensation seeker? Personality trait and experience correlates of the Sensation Seeking Scale. Journal of Consulting and Clinical Psychology, 39, 308-321.
Accepted April 2, 1771
