Personality represents a person’s unique pattern of behavior, emotionality, and way of cognition, in addition to specific body features that interact to determine individual’s adaptation to the environment [
The traditional Korean Medicine adopted such perspectives and proposes a systematic medical typology (Table
Characteristics of the Sasang typology (modified from the previous studies of Chae et al. [
Type (prevalence) | Tae-Yang ( | So-Yang ( | Tae-Eum ( | So-Eum ( |
---|---|---|---|---|
Natural temperament | Sorrow ( | Anger ( | Gladness ( | Enjoyment ( |
Organ system | Developed lung and undeveloped liver | Developed spleen and undeveloped kidney | Developed liver and undeveloped lung | Developed kidney and undeveloped spleen |
Developed consumption and catabolism | Developed intake and digestion | Developed accumulation and anabolism | Developed waste discharge | |
Representative features | Masculine, forward moved, and originative | Active, external-oriented, talented for business, short, and small | Feminine, stay retracted, conservative, tall, and big | Still, internal-oriented, self-directed, short, and small |
Character | Creative, positive, progressive, charismatic, heroic, and rash mind | Unstable, easily get bored, sacrificing, righteous, easily acceptable, hot-tempered, and anxious mind | Gentle, commercial, endurable, humorous, look foolish, coward, and fearful mind | Neat, mild, negative, intelligent, organized, selfish, jealous, persistent, and nervous mind |
High extraversion and low neuroticism (NEO-PI)high novelty seeking and low harm avoidance (TCI) | Low extraversion and high neuroticism, low novelty seeking, and high harm avoidance | |||
Body shape | Developed nape of the neck and slender waist | Developed chest and small hips | Thick waist, weak nape of the neck | Developed hip and weak chest |
Low BMI and waist-hip ratio, low width-height ratio of face, and smaller neck circumference | High BMI and waist-hip ratio. High width-height ratio of face. Bigger neck circumference | Same as So-Yang type, but more smaller and slimmer | ||
Sign for healthy and unhealthy condition | Good urination, | Good bowel movement | Good perspiration | Good digestion |
bubbles in mouth, and emesis | Constipation | No perspiration | Indigestion | |
Prone to diabetes and high-insulin resistance. More perspiration than others | Frequent indigestion and upper respiratory infection | |||
Type-specific useful medical herbs | Chaenomelis Fructus, Acanthopanacis Cortex, and Phragmitis Rhizoma | Rehmanniae Radix, Corni Fructus, Hoelen, Alismatis Rhizoma, Osterici Radix, and Angelicae Pubescentis Radix | Ephedrae Herba, Liriopis Tuber, Schisandrae Fructus, Dioscoreae Rhizoma, Platycodi Radix, Coicis Semen, and Puerariae Radix | Ginseng Radix, Atractylodis Rhizoma Alba, Glycyrrhizae Radix, Cinnamomi Cortex, Citri Pericarpium, Zingiberis, and Rhizoma Crudus |
Type-specific acupuncture use | Diagnosis with HT8 Treatment with LR3(+)/LU9(−) | Diagnosis with HT3 Treatment with KI3(+)/SP3(−) | Diagnosis with HT4 Treatment with LU9(+)/LR3(−) | Diagnosis with HT7 Treatment with SP3(+)/LI4(−) |
Examination of corresponding Western personality traits in Sasang typology began with the Minnesota Multiphasic Personality Inventory in 1992 and has evolved to the use of various objective tools such as the 16-Personality Factor (16-PF), Myers Briggs Type Indicator (MBTI), State Trait Anxiety Inventory (STAI), Beck Depression Inventory (BDI), Eysenck Personality Questionnaire (EPQ), NEO-Personality Inventory (NEO-PI), and Temperament and Character Inventory (TCI). The theoretical and descriptive similarity of Sasang typology with the Western tradition of personality including Hippocrates and Eysenck has been suggested from these results [
There have been several reports on the influence of personality traits on health [
Study participants were 245 students from the School of Korean Medicine at Pusan National University and the College of Oriental Medicine at Wonkwang University. This study was approved by the Institutional Review Board (IRB) of the Pusan National University School of Korean Medicine (KCRC IRB 2010-01). All participants gave written consent for the assessments. The mean age of the 245 participants (134 males and 111 females) was
Since 20 participants did not receive their Sasang type classification based on the Questionnaire for Sasang Constitution Classification II (QSCCII), SPQ was examined with the remaining 225 participants (121 males and 104 females; mean age
SPQ item selection using internal consistency, explorative factor analysis using parallel analysis, convergent validity using correlation analysis between SPQ and SPQ subscales, TCI, and NEO-PI were performed (
The QSCCII is a Sasang typology-based inventory, which is composed of 121 forced-choice items including typical diet habits, body shapes, temperaments, and common health problems of each Sasang type. This questionnaire was developed in 1993 and revised in 1996 and has been used as an objective diagnostic tool in many studies examining the biopsychological aspects of Sasang typology [
The Korean version of the Temperament and Character Inventory-Revised-Short (TCI-RS) [
The NEO-PI-R is a 60-item self-report inventory on a 5-point scale (1 = not at all to 5 = very true) based on factor analysis designed to assess a wide spectrum of individual differences, including the universal, stable, and consistent big five structures of neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness [
The questionnaire items for the internal consistency analysis were selected from the 42 items collected from the information database of the Sasang typology project (2006-2007) and an online questionnaire development project (2005–2007) of Korea Institute of Oriental Medicine. These questionnaire items were based on Sasang typology theory and descriptions of clinical characteristics of each Sasang type (Table
Each item consists of two opposite words describing a particular personality trait, and participants must respond on a 3-point scale. This response system follows the typical way in which Sasang-type classification is made in clinical practice. For example, the participant can respond as “delicate (= 1),” “average/middle (= 2),” or “tough (= 3)” to the question “Do you have a delicate or tough personality?” The So-Eum type was expected to have a lower score while the So-Yang type evidence higher score on this particular SPQ item based on the consideration of previously reported clinical descriptions of each Sasang type (Table
A review board composed of three traditional medical doctors with more than 5 years of clinical experience and one licensed medical specialist in Korean Sasang typology then selected 15 items that were judged to have a high association with Sasang typology and which may represent typical features of each Sasang type.
The internal consistency of the preliminary 15-item SPQ was examined, after which one item that revealed a low correlation and judged to have low clinical importance was deleted from the final version of the SPQ. That is, the 5th questionnaire item (Q5) was deleted following preliminary item analysis, since the Cronbach’s alpha was able to be increased up to 0.817 when deleted. Although the 11th questionnaire item (Q11) was found to increase questionnaire’s internal consistency to 0.816 if deleted, this item was decided to be included following panel discussion due to having clinically significant contribution to explaining emotionality of Sasang typology. Therefore, the final 14-item SPQ (Table
Extracted and rotated factor-loading matrix of SPQ subscales and questionnaire items.
Questionnaire items | Factor loading | |||
SPQ-behavior (passive/active) | Q3: do you consider yourself passive or proactive? | 0.177 | ||
Q6: is your personality relatively introverted or extroverted? | 0.234 | 0.289 | ||
Q7: do you consider yourself relatively lethargic or energetic? | 0.179 | 0.246 | ||
Q2: are you relatively slow or quick? | 0.013 | |||
Q13: do you tend to not express your opinions or express well? | 0.36 | 0.257 | ||
SPQ-emotionality (static/dynamic) | Q10: are you relatively patient or impatient? | 0.154 | ||
Q14: do you tend to be logical or do you sometimes get excited? | 0.082 | 0.049 | ||
Q11: do you tend to experience little emotional change or big emotional change? | 0.042 | |||
Q12: do you consider yourself as someone who expresses inner thoughts and feelings a little or a lot? | 0.37 | 0.094 | ||
SPQ-cognition (meticulous/easygoing) | Q1: do you have a delicate or tough personality? | 0.172 | ||
Q9: do you consider yourself feminine or masculine? | 0.26 | |||
Q15: do you tend to act meticulously or hastily? | 0.488 | |||
Q8: in general, do you make decisions with difficulty or with ease? | 0.346 | |||
Q4: do you tend to be relatively indirect or direct when expressing yourself? | 0.36 | 0.327 |
The 14 items were subjected to explorative factor analysis to examine the possible structure of the SPQ using principal axis extraction and Promax rotation with an eigenvalue over 1.0 as the criteria. We also performed parallel analysis to get the right factor numbers using Monte Carlo PCA for Parallel Analysis which estimates an average distribution of eigenvalues based on a random process that can be compared to the calculated distribution [
The test-retest data for the reliability examination over a period of one month was analyzed with correlational analysis. The reliability of SPQ and its subscales were determined with Pearson’s correlational coefficients. The criterion validity of the SPQ and its subscales were examined by comparing the relationship with the well-established TCI and NEO-PI. We used Spearman’s correlational coefficients exceeding the minimum acceptable value of 0.3.
The SPQ and its subscales (SPQ-B, SPQ-E, and SPQ-C) were subjected to analysis of variance (ANOVA) and profile analysis such as test of parallelism and flatness to examine its effectiveness in representing temperament differences between the Sasang-type groups based on “QSCC II classification”. Demographic differences between Sasang-type groups were tested using ANOVA for continuous variable (age) and Fisher’s exact tests for categorical variables (gender).
In addition, we compared the differences of each Sasang-type group on the TCI and NEO-PI to examine if the participants of this study have similar characteristics as in previous studies. ANOVA was conducted to test between group differences in TCI and NEO-PI scores, and Scheffé was used for post hoc analysis, and the profile analysis was performed to test the difference of the TCI and NEO-PI profiles for each Sasang-type group [
The data are presented as means and standard deviations or frequency with percentage. All analyses were conducted using PASW Statistics 18.0 for Windows (IBM, Armonk, NY, USA) and
Promax rotation procedure with SPQ 14 items (Table
Extraction of SPQ subfactors with explorative factor analysis using Promax rotation.
Factor | Extraction sumsof squared loadings | Rotation sums of squared loadings | ||||
Eigenvalue | percent of variance | Cumulative percent | Eigenvalue | percent of variance | Cumulative percent | |
1 | 4.410 | 31.501 | 31.501 | 2.904 | 20.744 | 20.744 |
2 | 2.086 | 14.904 | 46.405 | 2.503 | 17.882 | 38.625 |
3 | 1.311 | 9.362 | 55.767 | 2.400 | 17.141 | 55.767 |
The first factor, which accounted for 31.5% of the variance, included behavioral components of personality such as “do you consider yourself passive or proactive?” Factor 2, which accounted for 14.9% of the variance, included emotionality component of personality such as “are you relatively patient or impatient?” Factor 3, which accounted for 9.4% of the variance, included personality component related to cognition/decision-making, such as “do you have a delicate or a tough personality?”
The three factors were defined as follows. SPQ-behavior (SPQ-B) measures the behavioral component of personality (passive versus active); SPQ-emotionality (SPQ-E) measures the emotionality component of personality (static versus dynamic); finally, SPQ-cognition (SPQ-C) measures the cognition/decision-making or cognitive component of personality (meticulous versus easy-going). The items comprising each subscale are outlined in Table
The test-retest reliability of the SPQ and its subscales were analyzed with Pearson’s correlational analysis. Overall test-retest reliability was found to be 0.837, and reliabilities of the three subscales of SPQ-B, SPQ-E, and SPQ-C were 0.830, 0.748, and 0.798, respectively (Table
Test-retest reliability for the SPQ and its subscales.
Score of the test | Score of the retest | Pearson’s correlation coefficient | |
---|---|---|---|
SPQ | .837** | ||
SPQ-Behavior | .830** | ||
SPQ-Emotionality | .748** | ||
SPQ-Cognition | .798** |
The criterion validity of the SPQ was examined with the TCI and NEO-PI. SPQ and its subscales showed significant relations with the TCI and NEO-PI (Table
Correlation between SPQ, subscales of SPQ, TCI, and NEO-PI.
SPQ ( | TCI ( | NEO-PI ( | |||||||||||||
SPQ-B | SPQ-E | SPQ-C | NS | HA | RD | P | SD | C | ST | N | E | O | A | Co | |
SPQ | 0.225** | 0.148 | 0.026 | 0.135 | −0.168 | 0.182 | −0.171 | −0.183 | |||||||
SPQ-B | 0.114 | 0.190* | 0.192 | −0.081 | 0.108 | ||||||||||
SPQ-E | 0.265** | 0.137 | −0.099 | −0.226** | −0.043 | 0.061 | 0.288* | 0.094 | −0.036 | ||||||
SPQ-C | 0.012 | 0.167 | 0.153 | −0.023 | 0.049 | 0.129 | −0.263* | −0.236 |
SPQ: Sasang Personality Questionnaire, SPQ-B: SPQ-behavior, SPQ-E: SPQ-emotionality, SPQ-C: SPQ-cognition, TCI: temperament and character inventory, NS: novelty seeking, HA: harm avoidance, RD: reward dependence, P: persistence, SD: self directness, C: cooperativeness, ST: self transcendence, NEO-PI: NEO-personality inventory, N: neuroticism, E: extraversion, O: openness to experience, A: agreeableness, Co: conscientiousness.
The biopsychological characteristics of the participants in this study were analyzed to determine whether the SPQ demonstrates temperament differences between Sasang-type groups and to confirm whether the TCI and NEO-PI scores replicate findings of previous studies [
The SPQ subscales (SPQ-B, SPQ-E, and SPQ-C) of each Sasang type showed significantly different profiles (Figure
SPQ subscale, TCI and NEO-PI dimension profile of each Sasang type. (a) SPQ subscale score of each Sasang type. The SPQ subscale profile of the So-Yang, Tae-Eum, and So-Eum types was significantly different (flatness with Wilks Lambda test,
Significant differences on the SPQ (
The TCI temperament (novelty seeking, harm avoidance, reward dependence, and persistence) of each Sasang type exhibited significantly different profiles (Figure
The significant differences on the TCI novelty seeking (
The NEO-PI subscales did not show significant profile differences between Sasang types (Figure
Personalized medicine revolves around the use of safe and effective medical treatment best fit to specific patients, and this theme has been a major concern in both Western orthodox and traditional Eastern medicine. Sasang typology founded in Neo-Confucianism is a temperament-based personalized medicine using acupuncture and medical herbs [
Reliability and validity examination of the 14-item SPQ demonstrated that the SPQ shows the benefit of multifaceted structural analysis of Sasang typology across the domains of behavior, emotionality, and cognition with acceptable reliability and stability [
It was found that the SPQ measures three facets of personality associated with Sasang typology, namely, behavior, emotionality, and cognition. More specifically, the So-Eum type scored relatively lower on the SPQ such that its personality can be characterized as passive (behavior), static (emotionality), and meticulous (cognition). In contrast, the personality profile of the So-Yang type can be characterized as active (behavior), dynamic (emotionality), and easy-going (cognition) as indicated by a higher score on the SPQ. From the perspective of traditional Korean medicine, such characteristics of the SPQ subscales reflect the basic theoretical foundation of Eastern philosophy that the smaller change in behavior, emotionality, and cognitive characteristics of the SPQ mirror the Yin (So-Eum type), while greater change mirrors the Yang (So-Yang type).
If we sum up these results, SPQ is a reliable and objective psychological measurement of the So-Eum
The psychological structure of the SPQ subscales was compared with existing validated psychological instruments using correlational analysis. The results indicated that the SPQ and its subscales are generally in the same direction as the TCI. However, it was found that the SPQ-emotionality subscale demonstrated a positive correlation with NEO-PI neuroticism, but the SPQ-behavior and SPQ-cognition subscales showed negative correlations (Table
This disparity could be the reason why current and previous studies [
As for the behavioral, emotional, and cognitive facets of the Sasang personality in this study, the manner in which an individual will evaluate a particular situation or environment will be determined by the individual’s emotional state, which will in turn be expressed in various corresponding behavioral forms judged to be suitable to the situation or event. For example, the positive affect-negative affect dimension has emerged as an important dimension of an individual’s emotional experience, such that self-estimate of such affect results in expressions of mood that correspond to measures of personality and emotionality, in addition to making possible predictions of cognitive performance [
Since there are insufficient studies examining the biopsychological basis and its medical value in different medical typologies, more scrupulous and practical studies are needed. Current studies with conventional Western medicine have reported that specific temperaments make a person predisposed to certain disease and affect its prognosis. For example, although much disagreement still exists, the link between cancer and type C personality was suggested wherein a personality that suppresses emotions and shows difficulty in coping with stress [
The SPQ and its subscales (SPQ-behavior, SPQ-emotionality, and SPQ-cognition) showed three facets of Sasang personality and provide further rationale for how one’s personality may affect health in clinical health psychology studies [
The relationship between stress and anxiety (neuroticism) has gained much interest in recent days. Predisposition of the HPA axis related to the stress response, the functioning of the stress-related response by the interleukin and natural killer cell have also been proposed as potential mediators in the stress-response cycle [
This study has several limitations that may affect generalizability. First, this study should be repeated with a larger and more balanced sample size. Although the TCI and NEO-PI scores of each Sasang-type groups in this study were not significantly different compared to previous studies [
Second, SPQ-behavior, SPQ-emotionality, and SPQ-cognition were extracted as the subscales of SPQ, and these should be validated with diverse psychological instruments alongside with their stability. In particular, as the SPQ-emotionality correlated with NEO-PI neuroticism while, SPQ, SPQ-behavior, and SPQ-cognition negatively correlated with NEO-PI neuroticism, other assessments much are examined to see whether such patterns continue to hold. The reason for distinct differences in emotionality or neuroticism dimension between Western psychology and Sasang typology should be analyzed to determine if such differences result from cultural or philosophical disparities, clinical experience, personality construct, or other factors [
Third, the possibility of response bias, or the tendency of participants to provide socially acceptable responses, cannot be ruled out, especially as they must self-assess using the SPQ. However, this may have been minimized due to the forced-choice nature of the SPQ and the fact that participants were unaware of its scoring method. In addition, the relatively high test-retest reliability score of the SPQ and the replication of theory-driven association with the NEO-PI and TCI suggest that the likelihood of response bias may have been reduced in the present study.
Last but not least, the clinical usefulness of SPQ should be substantiated using clinical samples. Although the psychological and biometric profiles of each Sasang type in this study using the QSCCII are a replication of previous clinical studies [
In conclusion, the Sasang Personality Questionnaire which can objectively measure the psychological personality basis of Sasang typology was developed and validated with Western psychometric instruments in this study. With further clinical investigation, the SPQ may serve as a solid foundation for personalized medicine with medical herbs and acupuncture by providing a biopsychosocial typology perspective.
The authors declare that they have no conflict of interests.
Korea Science and Engineering Foundation (KOSEF) grant funded by the Korean government (MEST) (Grant no. 20110027739).