British Journal of Psychology (1998), 89, 405-416 0 1998 The British Psychological Society

Printed in Great Britain 405

DSM-111-R and ICD-10 personality disorder features among women experiencing two types of self-reported homesickness : An

exploratory study

Elisabeth H. M. Eurelings-Bontekoe*, Evelien Brouwers, Margot Verschuur and Inge Duijsens

Department of Clinical and Health Pychology, Universio of Leiden, Wassenaarsetveg 52, 2333 AK Leiden, The Netherlands

This study investigated the intensity of DSM-111-R and ICD-10 personality disorder features among females experiencing self-reported homesickness. Three groups were compared: (a) a group of women experiencing chronic feelings of homesickness (CHS); (6) a group of women experiencing episodic attacks of homesickness, each time they go on holidays (EHS); and (c) a group of healthy control females, recruited from the general population (HC). This study aimed to investigate whether the homesick participants showed stronger features of personality pathology than the controls and whether those who report experiencing chronic feelings of homesickness showed stronger features of personality pathology than those who at the moment of testing were not in an actual state of homesickness. Glass effect sizes revealed that the DSM-111-R avoidant and dependent and the ICD-10 anxious and dependent traits were most strongly associated with either type of homesickness. Finally, CHS was particularly associated with passive-aggressive traits and EHS with sadistic traits. Based on the stories of 21 homesick women, a link between adverse attachment experiences in childhood and certain personality features on the one hand and homesickness on the other is tentatively suggested.

Homesickness can be described as a depression-like reaction to leaving a familiar environment, characterized by ruminative thoughts about home and the desire to go back to the familiar environment (Eurelings-Bontekoe, Vingerhoets & Fontijn, 1994; Fisher, 1989). It is important to distinguish between a mild state of homesickness as a rather normal and highly prevalent emotional reaction to the stress of adaptation to a new environment and a more pathological form leading to a severe state of depression and dysfunctioning. Such a distinction is similar to the one that can be made between normal and pathological mourning. Because the state of homesickness may vary from a common emotional experience to a severe form of depression, it is difficult to provide exact prevalence figures. Fisher (1988) presents data on boarding school children indicating that, depending on the seriousness of the symptoms and whether or not the question is prompted, prevalence figures vary * Requests for reprints.

406 Elisabetb H. M. Ewelings-Bontekoe et al.

from 16 to 91 per cent. Prevalence figures for first-year university students range from 19 per cent (Carden & Feicht, 1991), to 95 per cent (Lu, 1990). Serious forms of homesickness are estimated to occur in 7 to 10 per cent of the population. Thijs (cited in Vingerhoets, van Heck, Gruijters, Thijs & Voolstra, 1993) found that in a sample of 206 adults, only 7 per cent indicated that they had never suffered from homesickness.

Fisher (1989) has pointed out that homesickness is a function of both personality features as well as characteristics of the new environment. One can presume that rigid people are prone to develop homesickness as a reaction to the stress of having to adapt to new environments because of their inflexibility, their strong attachment to familiar habits and to a highly predictable environment. In contrast, stable extraverts and people with an openness to novel experiences generally will be less susceptible to homesickness. In addition, it can be hypothesized that avoidant and socially inadequate people will experience more difficulties during the process of adaptation to new environments because of their deficient ability or reluctance to seek social support.

Until recently, personality factors have received little attention in studies on adjustment, adaptation difficulties, transition and homesickness. As described elsewhere (Eurelings-Bontekoe, 1997), the following personality features appear to be associated with homesickness.

A high level of dependency (Brewin, Furnham & Howes, 1989), especially upon the parents (Carden & Feicht, 1991). Eurelings-Bontekoe ef al. (1994) found a strong emotional tie to the parents to be characteristic of homesick military conscripts. A low level of extraversion (Eurelings-Bontekoe, Tolsma, Verschuur & Vingerhoets, 1996 b ; Eurelings-Bontekoe, Verschuur, Koudstaal, van der Sar & Duijsens, 1995; Eurelings-Bontekoe e t al., 1994; Tolsma, 1995; Van Heck, Vingerhoets, Voolstra, Gruijters, Thijs & van Tilburg, 1997). Also Fisher (1 989) found a negative correlation between homesickness and extraversion. A high level of rigidity (Eurelings-Bontekoe e t al., 1994, 1995, 1996 b). A low level of dominance. In contrast to homesick males, who are less dominant than their non-homesick counterparts, dominance does not play a role among homesick females (Eurelings-Bontekoe e t al., 1996 6). This might have been due to a kind of ‘floor-effect’: women in general tend to be less dominant than males, implying that any dominance related effects on homesickness should be stronger among males than among females. A lack of self-esteem and under-assertiveness (Carden & Feicht, 1991 ; Eurelings-Bontekoe e t al., 1994, 1995, 1996a, 6 ; Voolstra, 1992). This lack of self-confidence may underlie the strong tendency of homesick individuals to avoid social contacts. Bergsma (cited in Dijkstra & Hendrix, 1983) found that 81 per cent of homesick military conscripts had not made new friends during their stay in the army as compared with 11 per cent of the non-homesick soldiers. In addition, Bergsma found that 55 per cent of the homesick conscripts did not have any friends at home either, as opposed to 20 per cent of the non- homesick ones. Brewin et aL (1989) found that the depressed and anxious

Personalig disorder and homesickness 407

homesick students in particular tended to socially withdraw, unless the social interaction was related in some way to feelings of homesickness. A low level of expression of emotions and seeking social support. Tolsma (1995) found in a study among primary mental health care patients with and without homesickness that homesick participants were less inclined to use expression of their feelings and emotions as a way of coping than both psychiatric and a healthy control group. This reluctance to disclose emotionally might explain why Eurelings-Bontekoe e t al. (1994) found that homesick military conscripts received little social support although they strongly needed it. It seems that homesick people do feel a strong need for social support, but that they lack the skill or are reluctant to obtain it.

(vii) A high level of neuroticism (Eurelings-Bontekoe e t al., 1994; Gasselberger, 1982; Riimke, cited in Gruijters, 1992; Van Heck e t al., 1997).

(viii) Features of the dependent, avoidant/anxious and obsessivecompulsive/ anankastic personality disorders. A study on the prevalence of DSM-111-R and ICD-10 personality disorder features comparing a group of military conscripts experiencing homesickness with a group of conscripts experiencing other psychological problems and with a control group of healthy males recruited from the general population (Eurelings-Bontekoe, Duijsens & Verschuur, 1996 a) showed that homesickness was particularly associated with the DSM- 111-R/ICD-10 dependent, avoidant/anxious and obsessivecompulsive/ anankastic personality disorder traits and with low scores on the antisocial personality disorder. The high intensity of the obsessivecompulsive/ anankastic, dependent and avoidant/anxious personality disorder traits among homesick males was considered to be compatible with their high level of rigidity, under-assertiveness and introversion, their strong need for social support and their low level of dominance. In addition, some temperamental factors appear to be related to homesickness. Van Heck e t al. (1997) studied the association between homesickness and the Pavlovian temperamental factors such as strength of excitation, strength of inhibition and mobility (Strelau, 1983). Strength of excitation reflects the capacity to endure intense stress without emotional disturbances and to behave in highly efficient ways under conditions of severe emotional strain. Strength of inhibition reflects impulse control and frustration tolerance. Finally, mobility reflects the degree of flexibility. Homesickness appeared to be associated with a low level of strength of excitation and a low level of mobility among both males and females. With respect to strength of inhibition, negative correlations were only found among females. These results imply that both homesick males and females are easily disturbed in case of prolonged social and/or physical strain and have a limited capacity for responding flexibly and quickly to changes in environmental conditions. In addition, homesick females show difficulties in inhibiting their actions and are easily disturbed when a delay of performance is expected. Finally, a low level of openness to experience. Van Heck e t al. (1997) studied the association between the ' Big Five ' personality dimensions (extraversion, agreeableness, conscientiousness, neuroticism and openness to experience ;

(vi)

(ix)

(x)

408 Elisabetb H. M. Eurelings-Bontekoe et al.

Goldberg, 1993) and homesickness. In addition to significant negative correlations between extraversion and emotional stability on the one hand and homesickness on the other, they also found a negative correlation between homesickness and openness to experience. This implies that homesick persons tend to be closed to novel experiences.

The present study focuses on the association between personality disorder features and homesickness among homesick women since the results of the study among military conscripts may have been biased in at least three ways.

This study used the nine-item checklist to define the presence of homesickness. Since all the items of this checklist except the first one, assessing the desire to return to a former home situation and/or ruminations about home, describe symptoms of major depression, the association between homesickness and personality disorders found among the military conscripts might have been due to the fact that homesickness has been operationalized as a chronic form of major depression. It is well known that the comorbidity between major depression and personality disorders is high (Van den Brink, 1989).

In addition, the nine-item checklist appeared to have a low sensitivity: In a study among 171 employees of an international company in The Netherlands (Brouwers & Eurelings-Bontekoe, in preparation ; Eurelings-Bontekoe, 1997), the prevalence of homesickness, defined on the basis of the nine-item checklist was 10.6 per cent. When however homesickness was defined on the basis of a one-item question (‘Have you experienced homesickness during the past four weeks ? ’) the prevalence was 29.4 per cent, indicating that prevalence figures depend upon the way homesickness is operationalized. The specificity of the nine-item checklist appeared to be high (95 per cent) and the sensitivity low (25.5 per cent). That is, of all participants classified as non-homesick according to self-report, 95 per cent were classified as non-homesick by the nine-item checklist as well. The sensitivity of 25 per cent implies that only 25 per cent of those with self-reported homesickness were identified as such by the nine- item checklist. This may imply that the nine-item checklist taps particularly the more seriously distressed cases of homesickness and tends to miss the milder cases, which may have inflated the previously found personality disorder scores.

Second, as Eurelings-Bontekoe e t al. (1 994) have pointed out, military conscripts form a rather specific population, implying that one should take the possibility of population bias into consideration.

Finally, in the study among military conscripts, personality disorder traits have been assessed only among persons in a state of homesickness, which could imply that the self-report results may have reflected to some extent the person’s current disturbed state. In addition, by measuring personality features among people in a state of homesickness it remains unknown whether the observed personality features are the consequences rather than the antecedents of homesickness. Therefore, in the present study the relationship between homesickness and personality disorder features was studied using a group of females. Instead of using the nine-item checklist, we asked for the participation of females who either experienced chronic feelings of homesickness (which is an operationalization comparable to the nine- item checklist; it assesses homesickness as a state) or who only experienced homesickness during holidays and stay-overs. The intensity of DSM-III-R and ICD-

Personalig disorder and homesickness 409

10 personality disorder features among both groups of homesick females was compared with the intensity of these traits found among a control group of females, recruited from the general population. This study aimed to investigate whether (a) the homesick groups show more features of personality pathology than the healthy controls and (b) whether those who reported currently experiencing chronic feelings of homesickness show more signs of personality pathology than those who are at the moment of testing not in an actual state of homesickness and whose homesickness occurs only during holidays or stay-overs.

Method

Participants Participants were recruited through an announcement and an article about homesickness in a Dutch women’s magazine. We asked for the participation of females who are currently in a long-lasting state of homesickness and of females who experience homesickness during holidays only. This request resulted in the participation of two study groups : (a) A group of women who reported chronic feelings of homesickness due, for example, to a residential move (CHS; N = 46; mean age 40.9; range 19-80 years; SD 13.9). Educational level was low among 40.5 per cent of these women, middle among 38.1 per cent and high among 21.4 per cent; 76.2 per cent were married or were living together, 16.7 per cent were unmarried and 7.1 per cent were divorced or widowed. (6) A group of women who reported feeling homesick only when on holidays or stay-overs (EHS; N = 96; mean age 40.9; range 18-74 years; SD 12.0). Educational level was low among 48.1 per cent, middle among 23.5 per cent and high among 28.4 per cent; 80.2 per cent were married or lived together, 12.3 per cent were unmarried and 7.4 per cent were divorced or widowed.

The personality disorder data of the homesick females were compared with data from all females from the healthy control sample, used within the scope of a study on the psychometric properties of the Questionnaire on Personality Traits (Vragenlijst Kenmerken Persoonlijkheid (VKP); Duijsens, Eurelings-Bontekoe & Diekstra, 19966). This healthy control group (HC) consisted of 383 females with a mean age of 35.8 (range 18-80 years; SD 13.3). Education level was low among 24.2 per cent, middle among 49.6 per cent and high among 26.2 per cent; 58.8 per cent were married or living together, 32.4 per cent were unmarried and 8.8 per cent were divorced or widowed. Compared to the healthy controls the age of the homesick females is higher (t(523) = 3.93; p < .001), their educational level is lower ( ~ ~ ( 2 ) = 26.5; p < .001) and more homesick females than healthy control females are married ( ~ ~ ( 2 ) = 16.1 ; p < .01).

After the end of the study, all participating homesick females were offered the opportunity to talk as a group to the investigators and each other about their homesickness experiences. Thirty-nine women reacted to this invitation. Of these 21 women actually attended the group sessions and told us their stories, 5 of these experiencing chronic feelings of homesickness and 16 experiencing homesickness during holidays only. Mean age was 45.3 (SD 13.7). Educational level was low among 53 per cent, middle among 31.6 per cent and high among 15.8 per cent; 68.4 per cent were married or living together and 31.6 per cent were unmarried. No one was widowed. Compared to the remaining homesick participants involved in the study, educational level among the women who attended is somewhat lower, as is the percentage of women who are married. In addition the mean age of the women who attended is approximately five years higher. (The differences were not statistically tested, due to the large difference in size between the two groups.)

Measurements All three groups completed the Vragenlijst Kenmerken van de Persoonlijkheid (VKP) (Questionnaire on Personality Traits : Duijsens, Eurelings-Bontekoe, Diekstra & Ouwersloot, 1993a, b). The VKP is a self-report questionnaire, based on the International Personality Disorder Examination (World Health Organization, 1993), which assesses all 13 DSM-111-R (American Psychiatric Association, 1987) and

410 Elisabetb H. M. Eurelings-Bontekoe et al.

9 ICD-10 (World Health Organization, 1993) personality disorders. The VKP consists of 174 items with the options ‘true’ (2), ‘?’ (1) and ‘false’ (0), and in some cases ‘not applicable’. All items are positively formulated, increasing the risk of response bias. This was done deliberately, however, in order to maximize compatibility with the classification systems and the IPDE. The questions are arranged in a natural order, covering 7 topics : work, self, interpersonal relations, affects, reality testing, impulse control and behaviour before the age of 15. Some criteria are scored by summing and weighing more than one question, some questions only count for DSM-111-R disorders, some only for ICD-10 disorders and others count for both.

The VKP yields dimensional scores as well as diagnoses. For each personality disorder (PD) the dimensional score is calculated by counting the number of fully endorsed criteria. This study uses the dimensional scores only, because the use of continuous scores rather than dichotomous diagnoses is more appropriate for research purposes, since the range of variance of personality disorders can be used optimally. In addition, the VKP overestimates the prevalence of personality disorders : compared to the IPDE the VKP assigns 2.5 times (DSM) as many people one or more positive diagnoses and also finds more diagnoses per person. This overestimation corresponds with the findings from other research into self-report questionnaires (Hunt & Andrews, 1992; Hyler, Skodol, Kellman & Doidge, 1990; Soldz, Budman, Demby & Merry, 1993).

Due to this tendency to overestimate the prevalence of personality disorders, a self-report can never be used as a diagnostic tool. Hence the results of the VKP will consistently be interpreted as self- reported personality features or traits to avoid the tendency to over-pathologize.

Duijsens e t ai. (1996b) have described the construction and psychometric properties of this instrument. The reliability of this instrument in terms of internal consistency and temporal stability appears to be relatively modest, with alphas ranging between .59 for the narcissistic and the schizoid personality disorder scales to .78 for the antisocial personality disorder scale, with a mean of .66; for ICD-10 alphas range from .44 for the dis-social personality disorder scale to .75 for the borderline personality disorder scale, with a mean alpha of .64. Test-retest correlations ranged from .41 for the histrionic scale to .86 for the antisocial scale, with a mean of .62. For ICD-10, test-retest correlations ranged from .29 for the histrionic scale to .64 for the paranoid, anankastic and the anxious scales, with a mean test-retest correlation of S6 . The reliability figures are, however, comparable to those found with other criterion-based instruments (Duijsens e t a/., 1996 b). In addition, Duijsens, Bruinsma, Jansen, Eurelings-Bontekoe & Diekstra (1996~) compared the VKP with the IPDE and found the VKP scales to have good convergent and discriminant validity: although the VKP subscales were intercorrelated, the highest correlations were found with the corresponding IPDE scales ; correlations between scales measuring different concepts were low. In addition, the VKP appears to be an adequate screening instrument: if the prevalence of disorders found by the IPDE (semi-structured interview) was considered as the ‘golden standard’, 76 per cent of the positive disorders according to the IPDE was also found to be positive according to the VKP. If the probable diagnoses according to the VKP were included, the percentage of true positives increased to 87 per cent. This means that only 13 per cent of the positive diagnoses according to the IPDE are missed by the VKP, in case all positive and probable diagnoses according to the VKP are probed.

Results

Comparison between the three groups on the dimensional scores (intensity of traits)

Table 1 presents the mean dimensional scores and standard deviations of the three groups on the different disorder scales of DSM-111-R. MANOVA was used to compare the chronically homesick, the episodic homesick and the healthy controls on all scales. Highly significant F values were found (Wilks’ lambda, p < .OOl), except for the antisocial personality disorder. This finding was confirmed with one-way AN0VAs.l

Because the three groups were considerably different in size, Box M, Cochran’s C and Barlett-Box F were computed to test the assumption of homogeneity of the variance-covariance matrices. The results were highly

Personalig disorder and homesickness 41 1

Table 1. Mean dimensional scores and standard deviations of the chronic homesick group (CHS), the episodic homesick group (EHS) and the healthy control group (HC) on the different personality disorder scales of DSM-111-R. Differences between the three groups were tested by means of Tukey tests. Glass effect sizes (ES) were computed for the differences between each of the homesickness groups and the healthy controls

DSM-111-R

CHS EHS HC mean mean mean 1-3 2-3 (SD) (SD) (SD) 1-2 1-3 2-3 ES ES

Paranoid

Schizoid

Schizotypal

Antisocial

Borderline

Histrionic

Narcissistic

Avoidant

Dependent

Obsessivecompulsive

Passiveaggressive

Sadistic

Self-defeating

1.85 (1.75) 0.85

(1.07) 1.46

(1.59) 0.35

(0.85) 1.59

0.89 (1.27) 1.48

1.87 (1.78) 2.63

(2.04) 2.00

2.15 (2.13) 0.1 1

(0.38) 1.54

(1.64)

(1.75)

(1.47)

(1.49)

2.00 (1.62) 0.85

(1.14) 1.37

0.54 (1.29) 1.60

(1.50) 0.93

(1.23) 1.37

(1.29) 1.83

(1.71) 2.71

(1.98) 2.06

1.67 (1.64) 0.31

(0.65) 1.44

(1.63)

(1.39)

(1.47)

1.14 (1.31) 0.36

(0.75) 0.71

0.45 (0.83) 0.74

(1.14) 0.44

(0.88) 0.73

(1.03) 0.78

(1.19) 1.15

(1.42) 1.36

(1.42) 1.18

(1.33) 0.13

(0.37) 0.93

(1.11)

(1.22)

ns . * * 0.54 0.66

n.s. * * 0.65 0.65

n.s. * * 0.68 0.60

n.s. n.s. n.s. -0.12 0.11

n.s. * * 0.75 0.75

n s . * * 0.51 0.56

n.s. * * 0.73 0.62

n.s. * * 0.92 0.88

n.s. * * 1.04 1.10

n.s. * * 0.45 0.49

n.s. * * 0.73 0.37

* n.s. * -0.05 0.49

n.s. * * 0.50 0.42

* p < .05. Note. Glass effect sizes (ES) were computed using the following formula :

Mean homesick group - mean healthy controls

SD of healthy controls

Tukey tests were computed to compare the two groups of homesick individuals and each of the homesick groups with the healthy controls. The two homesick

significant ($ < .001), indicating a clear violation of the homogeneity assumption. For this reason, Kruskal-Wallis ANOVAs were performed, in addition to the conventional ANOVAs mentioned above. The results of all significance tests were identical in both cases.

41 2 Elisabeth H. M. Eurelings-Bontekoe et al.

Table 2. Mean dimensional scores and standard deviations on the ICD-10 personality disorder scales of the CHS group, the EHS group and the healthy controls. Differences between the groups were tested with Tukey tests. Glass effects sizes (ES) were computed for the differences between each of the homesick groups and the healthy controls

CHS EHS HC mean mean mean 1-3 2-3

ICD-10 (SD) (SD) (SD) 1-2 1-3 2-3 ES ES

Paranoid

Schizoid

Dis-social

Impulsive

Borderline

Histrionic

Anankastic

Anxious

Dependent

1.44 (1.29) 1 .oo

(1.32) 0.28

(0.54) 1.11

1.80 (1.88) 0.70

(0.84) 1.76

(1.45) 1.98

(1.87) 1.80

(1.38)

(1.20)

1.53 (1.31) 1.10

(1.42) 0.23

(0.47) 1.34

(1.26) 1.97

(1.80) 0.74

(0.87) 1.84

(1.36) 2.06

(1.84) 2.00

(1.54)

0.76 (1.05) 0.47

(0.90) 0.19

(0.50) 0.69

1.16

0.41 (0.72) 1.11

(1.18) 0.69

(1.09) 0.98

(1.24)

(1.01)

(1.53)

n s . * * 0.65 0.73

n.s. * * 0.59 0.70

n.s. n.s. n.s. 0.18 0.08

n.s. * * 0.42 0.64

n.s. * * 0.42 0.53

n.s. * * 0.40 0.46

n.s. * * 0.55 0.62

n.s. * * 1.18 1.26

n.s. * * 0.66 0.82

groups did not differ from each other with respect to all personality disorder scales, except for the sadistic personality disorder scale, the group with episodic homesickness scoring higher than the chronic homesick.

Both homesick groups scored significantly higher than the controls on all personality disorder scales except for the antisocial personality disorder scale, where no differences between the three groups were found, and the sadistic scale, where of the two HS groups, only the episodic homesick scored higher than the healthy controls.

In addition Glass effect sizes (Smith, Glass & Miller, 1980) were calculated to indicate the strength of the associations. This was done only for the comparison of each of the two homesick groups and the healthy controls, since both homesick groups scored very similarly.

For both comparisons, remarkably high Glass effect sizes were found for the avoidant and the dependent personality traits, indicating that these personality features were most strongly associated with homesickness in general. The largest differences between the two comparisons in Glass effect sizes were found for the

Personaiit5, disorder and homesickness 41 3

passiveaggressive and the sadistic features, indicating an association between chronic homesickness and passive aggressive traits on the one hand and episodic homesickness and sadistic traits on the other.

Table 2 presents the mean dimensional scores and standard deviations of the three groups on the ICD-10 personality disorder scales. Again, MANOVA was used to compare the three groups on all scales. Highly significant F values were found (Wilks’ lambda, p < .OOl) for all scales except for the dissocial personality disorder scale. One-way ANOVAs.were used to investigate the differences. For all personality disorder features, differences were found, except for the dissocial personality traits. Next, Tukey tests were performed to compare the two homesick groups and each of the homesick groups with the healthy controls. No significant differences were found between the two homesick groups, whereas both groups differed from the healthy controls, except for the dissocial personality disorder scale, where no significant differences for the three groups were found. Remarkably high Glass effect sizes were found in both comparisons (CHS-HC and EHS-HC) for the anxious personality traits. Although effect sizes for the dependent personality traits were second highest, they were not as high as when DSM-111-R was used. Interestingly, Glass effect sizes for the comparison between the EHS and the HC were higher for almost all ICD-10 disorders than for the comparison between the CHS and the HC, indicating a stronger association between episodic homesickness and ICD-10 personality disorder features than between chronic homesickness and ICD-10 personality disorder features.

Discussion

The aim of the present study was to investigate the link between homesickness and personality disorder traits in a group of females reporting either chronic or episodic homesickness. Both homesick groups showed in general markedly stronger personality disorder features than the healthy controls irrespective of whether they were in an actual state of homesickness or not. The relatively high level of personality disorder features among homesick females is consistent with results of the study on personality pathology among homesick males (Eurelings-Bontekoe e t ai., 1996 a), despite the fact that the latter study used a different population and operationalized homesickness by means of a nine-item checklist, covering both actual homesickness experiences and symptoms of major depression, which could have resulted in a bias towards more severe homesickness as well as towards more severe personality pathology (as was pointed out in the introduction). So the conclusion seems warranted that homesickness may be associated with personality disorder traits, irrespective of sex, age, severity of homesickness or whether one is in an actual state of homesickness or not.

When each of the two homesick groups were compared with healthy controls using Glass effect sizes it appeared that the DSM-111-R and ICD-10 avoidant/anxious and dependent personality traits were most strongly associated with homesickness irrespective of type. A strong association between avoidant and dependent personality traits and homesickness was also found in the study among homesick males (Eurelings-Bontekoe e t ai., 1996~) . As was the case among homesick males, homesickness appeared also among females to be incompatible with antisocial traits

41 4 Efisabeth H. M. Ewefings-Bontekoe et al.

and behaviour. This suggests that in general those who experience homesickness do not tend to antisocial acting out, but are rather prone to internalizing behaviour, as was found by Thurber (1995) in a study among homesick pre-adolescent and adolescent boys. The present study, however, also points to (at least among homesick females) the presence of manifest feelings of anger (which is compatible with results of Voolstra (1992), who found homesick females to be more angry than homesick males) and suggests that chronic homesickness may be differentiated from episodic homesickness by the way anger feelings are handled and displayed: subtly and insidiously in the case of chronic homesickness or in a more obvious way in the case of episodic homesickness.

What follows should be considered as an exploratory attempt to shed some light on the results (see also Eurelings-Bontekoe, 1997). As described earlier, we were able to talk to 21 homesick females. Fourteen (66 per cent) of the 21 women had experienced their early environment as neglecting ; the remaining 7 had experienced over-concern. In addition, 8 (38 per cent) had experienced the sudden death of a parent or a sibling during childhood. More than half of the women had been sent to boarding school. These women felt like being sent away, because they were not loved or wanted by their parents. All of the women were very ambivalent: on the one hand they felt very attached to and dependent upon others and very responsible for the well-being of their partners or parents and for the harmony in the family, whereas on the other hand they felt pressured, angry and dissatisfied with the situation and showed a strong desire to be more independent and individualistic. At the same time, however, they experienced difficulties in handling feelings of anger and dissatisfaction and in expressing these feelings in a moderate fashion. Perhaps episodic homesickness may particularly have a function in this respect. For example, a woman experiencing homesickness during holidays disliked going on holidays because she felt forced to spend every hour with her partner and family. Another woman realized particularly during holidays that her husband, who never had time to participate in housekeeping, did not want to assist her during holidays either. Because holidays confronted her with the fact that she had an inflexible, ‘unloving’ husband, she wanted to stay at home where she was not so much confronted with this fact. By staying at home she probably punished her husband indirectly.

Although these stories cannot of course be considered as representative of the entire study group and data from controls are lacking, the combination of these stories may point to the relevance of problematic attachment and separation experiences during childhood and, associated with this, problems in the regulation of anger feelings. It is well known from clinical practice that anger and separation difficulties frequently go together (Bures, Badaracco, Birnbaum & Goisman, 1996).

Future research is needed to provide an empirical underpinning of the proposed relationship between early attachment and separation experiences and personality disorder traits on the one hand and homesickness on the other. A comparison between homesick and non-homesick persons should be made regarding early attachment and separation experiences before any inferences about the possible etiological role of these early experiences can be made. Another important research issue concerns the role of variables that mediate between adverse attachment experiences and homesickness : given a history of adverse attachment experiences,

Personalig disorder and homesickness 41 5

what variables protect against the development of homesickness ? Temperamental factors such as harm avoidance, reward dependence and novelty seeking (Cloninger, Svaric & Przybeck, 1993) definitely need further consideration in this respect as psychobiological factors that may both influence the attachment process as well as the impact of attachment-disrupting experiences.

References American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders. DSM-

Brewin, C . R., Furnham, A. & Howes, M. (1989). Demographic and psychological determinants of

Brouwers, E. & Eurelings-Bontekoe, E. H. M. Homesickness and biographic variables. In preparation. Bures, J., Badaracco, M. A., Birnbaum, R. J. & Goisman, R. M. (1996). Multiple perspectives on mixed

anxiety and depression. Harvard Review of Psychiatry, 4, 208-214. Carden, A. I. & Feicht, R. (1991). Homesickness among American and Turkish college students. Journal

of Cross Cultural Psychology, 22, 41W28. Cloninger, C. R., Svaric, D. M. & Przybeck, T. R. (1993). A psychobiological Model of Temperament

and Character. Archives of General Psychiatry, 50, 977-991. Dijkstra, S. J. & Hendrix, M. J. J. L. (1983). Heimwee, een verkenning. (Homesickness: An

orientation). De Psycholoog, 18 (l), 3-10. Duijsens, I. J., Bruinsma, M., Jansen, S. J. T., Eurelings-Bontekoe, E. H. M. & Diekstra, R. F. W.

(1996 a). Agreement between self report and semi-structured interviewing in the assessment of personality disorders. Personality and Individual Dzfferences, 21, 261-270.

Duijsens, I. J., Eurelings-Bontekoe, E. H. M. & Diekstra, R. F. W. (19966). The VKP, a self report instrument for DSM-111-R and ICD-10 personality disorders : Construction and psychometric properties. Personality and Individual Difference, 20, 171-1 82.

Duijsens, I. J., Eurelings-Bontekoe, E. H. M., Diekstra, R. F. W. & Ouwersloot, G. (1993~). Vragenlgst voor Kenmerken van de Persoonlgkbeid. Lisse: Swets & Zeitlinger.

Duijsens, I. J., Eurelings-Bontekoe, E. H. M., Diekstra, R. F. W. & Ouwersloot, G. (1993b). V K P : Preliminary Manual. Lisse : Swets & Zeitlinger.

Eurelings-Bontekoe, E. H. M. (1997). Homesickness, personality and personality disorders : An overview and therapeutic considerations. In M. A. L. van Tilburg & A. J. J. M. Vingerhoets (Eds), Psychological Aspects of Geographical Moves: Homesickness and Acculturation Stress, pp. 197-212. Tilburg : Tilburg University Press.

Eurelings-Bontekoe, E. H. M., Duijsens, I. J. & Verschuur, M. J. (1996~). Prevalence of DSM-111-R and ICD-10 personality disorders among military conscripts suffering from homesickness. Personality and Individual Differences, 21, 431-440.

Eurelings-Bontekoe, E. H. M., Tolsma, A., Verschuur, M. J . & Vingerhoets, A. J. J. M. (19966). Construction of a Homesickness Questionnaire using a female population with two types of self reported homesickness. Preliminary results. Personality and Individual Differences, 20, 41 5421.

Eurelings-Bontekoe, E. H. M., Verschuur, M. J., Koudstaal, A., van der Sar, S. & Duijsens, I. J. (1995). Construction of a Homesickness Questionnaire: Preliminary results. Personality and Individual Differences, 19, 319-325.

Eurelings-Bontekoe, E. H. M., Vingerhoets, A. J. J . M. & Fontijn, A. (1994). Personality and behavioral antecedents of homesickness. Personality and Individual Dz'erences, 16, 229-235.

Fisher, S. (1988). Leaving home: Homesickness and the psychological effects of change and transition. In S. Fisher & J. Reason (Eds), Handbook of Lve Stress, Cognition and Health, New York: Wiley.

Fisher, S. (1989). Homesickness, Cognition and Health. London: Erlbaum. Gasselberger, K. (1 982). Depressionsfordernde soziale und territoriale Faktoren von Heimweh-

reaktionen (Social and territorial factors as a trigger for depression). Zeitschrgt fur Klinische Psychologie: Forschung und Praxis, 11, 186-200.

Goldberg, L. R. (1993). The structure of phenotypic personality traits. American Psychologist, 48,2634.

III-R, 3rd ed. rev. Washington, DC : American Psychiatric Association.

homesickness and confiding among students. British Journal of Psychology, 80, 467477.

41 6 Elisabetb H. M. Ewelings-Bontekoe et al.

Gruijters, I. (1992). Heimwee en situatiekenmerken. (Homesickness and situational characteristics.) University of Tilburg, unpublished doctoral thesis.

Eiunt, C. & Andrews, G. (1992). Measuring personality disorders: The use of self-report questionnaires. Journal of Personalig Disorders, 6, 125-133.

Hyler, S. E., Skodol, A. E., Kellman, H. D. & Doidge, N. (1990). Validity of the Personality Diagnostic Questionnaire-Revised : Comparison with two structured interviews. American Journal of Psychiatry, 147, 10451048.

Lu, L. (1990). Adaptation to British universities: Homesickness and mental health of Chinese students. Counseling Psychologr Quarterb, 3, 225-232.

Smith, M. L., Glass, G. V. & Miller, T. I. (1980). The Benefits of Psychotherapy. Baltimore, MD: Johns Hopkins University Press.

Soldz, S., Budman, S., Demby, A. & Merry, J. (1993). Diagnostic agreement between the Personality Disorder Examination and the MCMI-11. Journal of Personalig Assessment, 60, 486-499.

Strelau, J. (1983). Temperament-Personalit~Activig. New York : Academic Press. Thurber, C. A. (1995). The experience and expression of homesickness in preadolescent and adolescent

boys. Child Development, 66, 1162-1 178. Tolsma, A. (1995). Constructie van de Heimwee Vragenlijst. Een studie onder eerstelijnspatienten.

(Construction of a Homesickness Questionnaire using a primary mental health care population). Leiden University, unpublished doctoral thesis.

Van den Brink, W. (1 989). Meting van DSM-111-R persoonlijkheidspathologie. Betrouwbaarheid en validiteit van de SIDP-R en as I1 van de DSM-111. University of Groningen: PhD thesis.

Van Heck, G. L., Vingerhoets, A. J. J. M., Voolstra, A., Gruijters, I., Thijs, H. & van Tilburg, M. A. L. (1997). Personality, temperament and homesickness. In M. A. L. van Tilburg & A. J. J. M. Vingerhoets (Eds), Psychological Aspects of Geographical Moves: Homesickness and Acculturation Stress, pp. 181-196. Tilburg : Tilburg University Press.

Vingerhoets, A. J. J. M., van Heck, G. L., Gmijters, I., Thijs, H. & Voolstra, A. (1993). Heimwee. Een literatuuroverzicht. (Homesickness : A review of literature.) Gedrag en Gexondheid, 21, 227-237.

Voolstra, A. (1992). Heimwee en persoonlijkheid. (Homesickness and personality.) Tilburg University, unpublished doctoral thesis.

World Health Organization (1993). The ICD- 10 Classz~cation of Mental and Behavioural Disorders. Diagnostic Criteria for Research. Geneva : World Health Organization.

Received 4 November 1996; revised version received 26 September 1997