Six personality coping patterns that influence how you handle medical crisis

by Carolyn Thomas  @HeartSisters

As regular readers already know, I like to include the work of cardiac psychologist Dr. Wayne Sotile on this site, mostly because what he writes about the psychological challenges of heart disease and recovery rings so true for me since my own heart attack.

His 1992 book Heart Illness and Intimacy: How Caring Relationships Aid Recovery looks at the profound emotional impact that the stresses of heart disease can have on patients, spouses and children.

I was especially intrigued by the chapter called The Personality Factor: Can We Change? which explores how our personalities and coping patterns can often determine how we’ll react to a life-changing cardiac event.

Based on the 1987 pioneering work of Stewart and Joines on Transactional Analysis, Dr. Sotile outlines in this chapter the six basic coping patterns that seem to drive our perceptions, our behavioural choices, and our corresponding emotional reactions to both everyday life and to a chronic and progressive diagnosis like heart disease. He explains:

“These six personality drivers become especially influential in shaping our reactions during stressful times like a serious illness.”

I was surprised to recognize myself in more than one pattern on this list. How many of these six personality coping patterns seem familiar to you?

1.  Being Strong: These personalities are taught to cope with life by being stoic and shouldering burdens without complaints or requests for help. Overwhelming or frightening situations (like having a heart attack) can fill them with shame and discomfort.

   Heart patients in this group are often in denial, and can suffer serious depression from the perception that others do not care, or they may focus on physical symptoms only as an indirect way to get support.

2.  Being Perfect: Since perfection is never attained, those who are stuck in its pursuit may feel anxious, guilty or never good enough, but may also believe that their internal anxiety will just go away if only they can just “do it perfectly”.

   Heart patients in this group exhibit “all or nothing” self-critical thinking like developing irritatingly rigid rules around their cardiac rehabilitation, and may worry obsessively about every details of the illness.

3.  Trying Hard: These personalities have learned to feel valued for their ability to try harder than the next guy, for struggling longer and more tenaciously than others. They may have great difficulty determining when they have worked hard enough to deserve a rest, and may even feel anxious when they do try to relax or play.

   ♥ Heart patients in this group may feel demoralized and frustrated (with themselves and others) because of an excessive work ethic that interferes with enjoyment of everyday life.

4.  Pleasing Others: These self-sacrificing folks think they’ve been put on earth to take care of others, not themselves. It’s hard for them to set appropriate limits for responding to the needs of others and expressing (or even identifying) their own important needs, so they often feel drained and martyred.  They like to give to others the kind of attention and care they’d like to receive, but rarely ask directly for these gifts of love or attention.

   Heart patients in this group may go through recovery and rehabilitation feeling lonely due to reluctance to express their emotional needs, and may also blame themselves excessively for the discomfort they cause in others, like “putting the family through all this”.

5.  Hurrying: These personalities may feel uncomfortable, agitated and frustrated with a reasonably-paced lifestyle. They have become accustomed to an internal sense of urgency, and fill their lives with more to do than time allows, as if hurrying is necessary to survive.

   Heart patients in this group are similar to Trying Hard copers in their sense of urgency but feel more frazzled or chaotic in response to the urgency, expressing frustration and irritability when they realize, for example,  that cardiac rehabilitation is a lifelong process, not an event that will soon be finished.  They may go for dangerous quick-fix cures, or just impatiently give up recommended heart health improvements.

6.  Being Careful: Some people believe that living is a frightening proposition at best, filled with obsessive worrying and distressing anxiety in reaction to changes, big or small. They may doubt their own and others’ abilities to cope with changes in the status quo, and have difficulty relaxing and enjoying themselves.

  Heart patients in this group sometimes suffer depression, questioning their own value as their self-esteem suffers during recovery and they become obsessive monitors, observers and worriers who withdraw from life instead of trying to improve their quality of life.

Finally, no matter which coping pattern seems to fit either the heart patient or the patient’s family members, Dr. Sotile suggests these four things required to help each other cope with a medical crisis:

  • 1.  a basic understanding of each others’ coping patterns
  • 2.  the courage to steer your own reactions in healthy directions
  • 3.  the perseverance to put up with discomfort until new coping patterns feel familiar
  • 4.  the loving support of family and friends while everybody learns new ways of reacting.

Dr. Sotile’s book is, sadly, now out of print, but may be available at your local used book shop or through Abe Books. 


NOTE FROM CAROLYN:  I wrote much more about adapting to a scary diagnosis in my book, A Woman’s Guide to Living with Heart Disease , at your favourite local bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order directly from my publisher, Johns Hopkins University Press (use their code HTWN to save 20% off the list price).

Q:  In your experience as a patient, did any of these personality patterns ring true for you?

See also:

Why hearing the diagnosis hurts worse than the heart attack

How we adapt after a heart attack may depend on what we believe this diagnosis means

Which one’s right? Eight ways that patients and families can view heart disease

Denial and its deadly role in surviving a heart attack

Surviving the crisis: the first stage of heart attack recovery

The new country called heart disease

‘After the Diagnosis’: two books, same title, one hope

A tale of two women: how we react to a heart attack diagnosis


17 thoughts on “Six personality coping patterns that influence how you handle medical crisis

  1. Ahhhh.. I fit all of them! Am I a freak? Wow a nurse since 17 with a perfect record for 38 years, lots of family issues, I am trying to recover. My church activities lure me back into the frenzy but I resist the temptation “making excuses” as others say, I just know once I start I cannot stop myself; with all the needs and all the lonely people, how can I not help? Need serious therapy don’t I?

    Liked by 1 person

    1. Christina,
      I totally understand your feelings and I don’t know about you but, I look in the mirror and wonder who is this person because I feel and think so differently. I used to be outgoing, fun, and had lots of friends, life was good. Then I had Alveolar Hemorrhage which led me to being on a vent then trying to recover at rehab facility, and then when I was strong enough, Open Heart Surgery to replace my Mitral Valve. Ever since this was done over a year ago, I have changed. I don’t want to leave the house, I am very anxious and depressed, and at this point wish there was a magic pill or a plan for assisted suicide for those with heart disease or heart problems. I thought that as a nurse I could handle this and be back on my feet and zip through it all but, I can’t anymore.

      I too find myself making excuses just to stay in my safe home, and even though I have a good church group I even hold back from friends, those I went out to dinner and game night you name it, and now I see how it is stressing my family and husband out and I am so afraid they will leave. I don’t know what to do anymore. I

      wish there were answers somewhere, and I wish that my family, friends and others would understand I don’t even know where I went nor who the women is looking back at me in the mirror. I hope you are recovering and if you have any tips for me please let me know.
      Thank you,

      Liked by 1 person

      1. Mellissa, if you had a close friend or family member who described to you exactly what you just did, I’m pretty sure you would advise her to immediately make an appointment for some professional counseling to help get through this depressive state. You need some help to make sense out of what makes no sense to you, to gain some perspective on what has happened, and to understand that these bleak feelings don’t last forever. Meanwhile, read this and pick at least one thing on the list to do today. Best of luck to you…


  2. I’m enjoying these “blasts from the past” as I missed so many before I knew you were out there. I did get a laugh when I got to # 4… Pleasing Others…..I did identify with several of these but as I read “These self-sacrificing folks,” my brain read “these self-sacrificing fools!”….

    I laughed and then realized how pervasive this has been in my (long) life but how I am finally learning to put myself & my needs first, to even ask for help, and most importantly, to allow others to help me instead of saying, “oh, that’s OK…..I can do this….”(when I know I can’t!)

    Liked by 1 person

    1. Hi Sunny – that IS pretty funny when our brains can read things our eyes cannot! Congrats on giving yourself credit where credit is due – how far you have managed to come in putting your own needs first. Sometimes it’s only in hindsight that such profound progress can be appreciated… Just this morning, I read this little gem: “Remember how far you’ve come, not just how far you have to go.”


  3. Carolyn,
    I am wondering how each of these fits into developmental stages or “life’s passages”?

    My heart “stuff”, fibromylagia/chronic fatigue have been ruthless task-masters, teachers in moving beyond the personality-coping mechanisms described to a meaningful place of surrender to what is, instead of what could/should be, and finding more meaning in life apart from the physical “me”.

    I do think my age plays a big part in my process. And I emphasize I am MOVING – I’ve not arrived as most of those mechanisms still are in operation . . .

    Liked by 1 person

    1. Such good points, Judy-Judith! It seems that Sotile’s personality-coping styles do apply mostly to the early post-diagnosis stages, specifically in heart disease anyway. Coincidentally, one of my readers (almost one year post-heart attack) wrote to me recently: “I am getting involved with (community volunteering) among other things, so am no longer spending my time obsessing about my heart health.”

      It may be that symptoms are no longer as acute or frightening or disruptive as they originally were at the beginning, or that as time goes by, we gradually adapt to living with our new reality and start trusting that each twinge doesn’t necessarily mean an urgent call to 911. And yes! – we get older, too! Thanks for your perspective here…

      PS. It just struck me that there’s nothing like thinking I’ve finally got some aspect of managing my cardiac condition pretty well figured out by now to bring on a whole new and improved pain crisis, by the way… 😉


    1. I felt a bit the same, Sharon – I could almost see myself in each category, depending on the situation or the kind of day I’m having! But as I went through Dr. Sotile’s list again, some categories reminded me instantly of other people I know. (Easier to see this in others than in ourselves?) Perhaps this is why he also stresses the importance of “a basic understanding of each others’ coping patterns”.


    1. Ha! This morning I actually slept in until 5:20! I pre-schedule publication of my blog posts so they go up at around 4:15 a.m. each Sunday (that’s so my East Coast readers can read them over breakfast, while we’re still asleep here on the West Coast!) See you soon, Kit…


  4. Carolyn, I found this book after you posted in 2010. It was very powerful and useful then. Thanks for the reminder. What I find very interesting being back in a “normal” life, is just how many people around me have been thrown into the medical abyss by serious heart issues. It has been eye opening to say the least!


    Liked by 1 person

    1. I too love Dr. Sotile’s book (and also his Thriving With Heart Disease). You are in such a unique position, JG – being healthy now but still able to empathize completely with those “thrown into the medical abyss”.


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