 37. Personality and Health 775
concept. It assumes that stress is bad, that 
challenging environments produce stress, 
and that some people are poor at coping 
with stress. The focus is usually on indi -
vidual cognitive strategies (e.g., emotion- 
focused coping, rumination) in response to 
the life changes (e.g., losing one’s job) that 
are presumably stressful. Sometimes, the ef -
fects of social support (generally protective 
or salutary) are included here (Taylor, 2011). 
Although it is now very clear that individu -
als who are well adjusted and well integrat -
ed into stable social systems are generally 
healthier, it is also clear that there are many 
exceptions to this general rule and that these 
relations often depend on the unlikely case 
of other relevant factors remaining constant. 
In actual fact, many people get married or 
divorced, move to a new city, and start a 
challenging new job (thus facing many major 
life change stressors) but thrive anyway.
Some approaches within this simple stress 
paradigm focus on psychophysiological 
models—  the mechanisms by which coping 
traits influence body systems that promote 
disease. These models typically spotlight the 
cell- damaging effects of stress, implicating 
body systems such as the hypothalamic– 
pituitary–  adrenal (HPA) axis, cardiovascu -
lar hyperreactivity, and impaired immune 
functioning. Prolonged states of arousal, 
disrupting the immune system, can result 
in disease (Kemeny, 2007). Yet few well- 
controlled studies document the full process 
in operation (i.e., life change, poor coping, 
immune dysfunction, and resultant serious 
disease), and such straightforward long-
term prospective studies are rarely feasible 
(Kern & Friedman, 2017).
Simple Genetic Models (and Perinatal 
Biological  Models)
Simple genetic and perinatal models of per -
sonality and disease propose that underly -
ing third variables, often seen as genetically 
based, influence certain traits or behavioral 
patterns and certain diseases. Although this 
is sometimes the case, for example, with 
genetic diseases causing mental retardation 
and personality quirks, as well as various 
health problems, it is rare that links are so 
simple. Shared underlying biology can in -
deed give rise to spurious associations be -tween personality and health, in which case 
changing personality traits or personality- 
driven behavior would have no effect on 
health. But simple genetic models are limited 
by the failure to consider the various envi -
ronmental circumstances relevant to both 
personality and health.
Overall, previous analyses of personality 
and health have sketched these basic models 
and variations (e.g., Carver & Miller, 2006; 
Contrada, Cather, & O’Leary, 1999; Fried -
man, 2007; Ouellette & DiPlacido, 2001; 
Smith & Gallo, 2001; Wiebe & Smith, 
1997). These models—  behavior, stress, 
genetics—  each have some significant sup -
port, which suggests that all have some va -
lidity. Yet the overall field lacks a unifying 
paradigm and sufficient replicability. New 
efforts need to further elaborate and inte -
grate the basic approaches in terms of new 
understandings about personality.
Modern  Replacements: 
More  Sophisticated  Models
Sophisticated models of personality and 
health develop from two considerations. 
First, the various causal mechanisms pre -
dicted by the simpler models are often si -
multaneously present, and they interact 
with each other. Second, personality and 
health are not static. Personality develops 
and changes over the lifespan, as does health 
(Roberts, Walton, & Viechtbauer, 2006; 
Specht et al., 2014). More sophisticated 
models of personality and health recognize 
the interplay among mechanisms and the dy -
namic nature of variables involved (Hamp -
son & Edmonds, 2018; Kern, Della Porta, 
& Friedman, 2014; Shanahan et al., 2014).
The idea of transactions is a key mecha -
nism of newer approaches linking personal -
ity to health, well exemplified by the selec -
tion and evocation of healthful or harmful 
environments. Personality traits influence 
situational choices, and they also have evoc -
ative effects, provoking typical patterns of 
responses in others (Bolger & Zuckerman, 
1995; Hampson et al., 2016; Hill, Edmonds, 
& Jackson, 2019; Moffitt et al., 2011; Scarr 
& McCartney, 1983). Selective exposure to 
certain types of situations (e.g., riskier ones) 
and selective evocation of certain patterns of 