Religion and Spirituality in Psychiatry

178 Ralph L. Piedmontsolitary orientation. The positive correlation withneuroticism indicates that these individuals arealso anxious and distressed; they avoid groupsbecause they may fear negative evaluations byothers or making social blunders. Those with anavoidant PD possess a clear social phobia thatmay underlie their withdrawal. Next, considerthe correlations found with the schizoid PDscale. Here is another disorder that is characterizedby social withdrawal and isolation. Like theavoidant PD, the schizoid PD also scores low onextraversion, reflecting the desire for privacy andseclusion. However, the schizoid scale does notcorrelate with neuroticism, indicating that thosewith a schizoid PD, unlike the avoidant PD, donot systematically experience social phobia as acause of their withdrawal. Those diagnosed as aschizoid are not necessarily threatened by groupsnor do they fear social contact in the ways thatthose with an avoidant PD do. Given that thesetwo types of disorders may present in similarways, knowing individuals’ scores on these FFMdomains can be quite helpful in making a differentialdiagnosis.The FFM provides a useful empirical andinterpretive framework for understanding awide range of psychological functioning and canbe useful in highlighting motivational qualitiesrelevant in diagnosis and treatment. Miller, (13)drawing on information from his own clients,provided useful clinical information into howindividuals high and low on each of the five personalitydomains would present themselves intherapy. He also outlined some of the key problemsthese clients were likely to experience alongwith potential treatment opportunities and pitfalls.For example, individuals high on neuroticismpre sent themselves with a variety of negativeaffects. Their presenting problems span the fullspectrum of neurotic pains. Such individualsmay always experience personal pain regardlessof how much therapy they receive, although suchemotional distress can certainly motivate patientcompliance with treatment. Miller also noted thatthose low on neuroticism and high on conscientiousnesshad better ratings of treatment outcome.In a study of outpatient substance abusers, I notedthat those high on neuroticism benefited fromclient-centered therapy and systematic desensitization,while problem-solving advice was notseen as effective with these types of clients. Thosehigh on agreeableness responded well to the AAand NA programs, while those low on agreeablenessresponded well to relaxation sessions, arttherapy, and journaling.(11) The FFM has muchto offer our understanding of Axis II functioning(i.e., PD clinical presentations).The question that we come to now concernshow spirituality and religiousness fit into thismodel. A number of important issues will beraised in the following sections that concern whatadded value these constructs bring to our understandingof Axis II functioning over the FFM.But first, these constructs need to be defined inways that are amenable to scientific analysis.4. DEFINING AND MEASURINGSPIRITUALITY AND RELIGIOUSNESSBecause spirituality and religiousness are seen bymany as being conceptually overlapping, in thatboth involve a search for the sacred, (21) someresearchers prefer to interpret these two dimensionsas being redundant.(22) Musick, Traphagan,Koenig, and Larson (23) have noted that insamples of adults, these two terms are highlyrelated to one another. They questioned whetherthere is a meaningful distinction between thesetwo constructs or if any disparities are simplyan artifact of the wishes of researchers hopingto find such differences (p. 80). Nonetheless,there are those who emphasize the distinctivenessbetween these two constructs.(24, 25) Here,spirituality is viewed as an attribute of an individual(much like a personality trait) while religiosityis understood as encompassing more ofthe beliefs, rituals, and practices associated withan institution.(26) Religiosity is concerned withhow one’s experience of a transcendent being isshaped by, and expressed through, a communityor social organization. Spirituality, on theother hand, is most concerned with one’s personalrelationships to larger, transcendent realities,such as God or the universe. In an effort to