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The Ayurveda concept of Prakti and the Western construct of personality: A

comparative pilot study

Article in European Journal of Integrative Medicine · November 2014

DOI: 10.1016/j.eujim.2014.09.133

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European Journal of Integrative Medicine 7 (2015) 396–408

Original article

The Ayurveda concept of Prakŗti and the Western construct of personality:

A comparative pilot study夽
Antonella Delle Fave a,∗ , Luca Negri a , P. Ram Manohar b , Antonio Morandi c , Marta Bassi d
a Department of Pathophysiology and Transplantation, University of Milano, Italy
b AVP Research Foundation, Coimbatore, India
c Ayurvedic Point, Milano, Italy
d Department of Biomedical and Clinical Sciences, University of Milano, Italy

Received 18 June 2014; received in revised form 27 September 2014; accepted 30 September 2014

Abstract
Introduction: In the Indian medical system of Ayurveda, health results from the balanced interplay between three functional principles or dos.a –
Vāta, Pitta, and Kapha – that regulate psychophysical functions. The relative proportion of the three dos.a in an individual determines the person’s
psychophysical constitution, Prakŗti. The aim of this pilot study was to jointly assess individuals’ Prakŗti and personality and emotional traits,
investigating convergences and divergences between the two classification approaches.
Method: Data were collected among 391 adult participants through the following self-assessment instruments: Questionnaire on Dos.a Prakŗti
AyurVeda (QDAV), specifically developed in this study to evaluate Prakŗti; Big Five Inventory (BFI) to assess personality; Positive Affect Negative
Affect Schedule (PANAS), to evaluate emotional profile; Short Form Health Survey (SF-36), to measure perceived health. Participants’ Prakŗti
profile was identified first through QDAV and subsequently through its implemented version QDAV-R. Individuals characterized by predominant
Vāta, Pitta, or Kapha Prakŗti (N = 173) were selected for subsequent analyses. Personality, emotional profile, and perceived health were compared
across these groups through nonparametric procedures.
Results: QDAV-R allowed for effectively classifying participants according to their Prakŗti. Personality, emotional and health features reported
by Vāta, Pitta, and Kapha participants were consistent with the corresponding descriptions provided in the Ayurveda literature.
Discussion: Findings suggest that Prakŗti classification can be fruitfully integrated into diagnostic and treatment protocols in healthcare and
psychotherapy. These results can inform future studies, aimed at combining psychophysical measures derived from different knowledge traditions
within an authentically integrated and person-centered approach to health and well-being.
© 2014 Elsevier GmbH. All rights reserved.

Keywords: Ayurveda; Prakŗti; Personality; Person-centered; Biopsychosocial; Integrative medicine; Psychotherapy

Introduction system of medicine. The concept of individual constitution –

Prakŗti – includes both physical and mental components, whose
The debate around health, well-being and their measure- conditions of balance or imbalance influence health preservation
ment is becoming increasingly popular worldwide. Recently, and disease onset. In the light of the current claims for a person-
the role of individuals’ subjective evaluations and psycholog- centered approach to prevention and treatment, the joint study of
ical features in health and disease management attracted the individual Prakŗti and the psychological constructs identified by
interest of researchers and practitioners. This topic represents western science, while highlighting their similarities and differ-
one of the basic pillars of Ayurveda, the traditional Indian ences, can foster a more integrated view of health, and contribute
to the development of personalized intervention strategies.

夽 This article belongs to the Special Issue on Diagnostic Techniques and

Health as complete well-being: problems and challenges
Outcome Measures for Integrated Health.
∗ Corresponding author. Tel.: +39 0250319704. According to the World Health Organization, health is “a
E-mail address: antonella.dellefave@unimi.it (A. Delle Fave). state of complete physical, mental and social well-being” [1].
http://dx.doi.org/10.1016/j.eujim.2014.09.133
1876-3820/© 2014 Elsevier GmbH. All rights reserved.
 A. Delle Fave et al. / European Journal of Integrative Medicine 7 (2015) 396–408 397

The potential embedded in this biopsychosocial definition [2] is is the harmonious balance of biological, physiological, mental
universally acknowledged, but seldom translated into practice, and spiritual functions (Suśruta Samh.itā, SūtraSthāna: 15, 38)
as highlighted by health and social scientists [3–5]. Western [27].
medicine is still dominated by the biomedical approach, and its Balance is considered as the natural state of the individual.
prominent goal is disease treatment rather than health promo- At the psychophysical level, it is described as the interplay of
tion. three principles known as dos.a–Vāta, Pitta, and Kapha. The
What is more, the WHO health definition entails two termi- dos.a regulate strategic life functions at the body and mind lev-
nology problems. The adjective “complete” equals health to a els [28]. Vāta governs movement, controlling blood circulation,
utopian goal of no practical use [6]. The unspecific term “well- elimination of waste, breathing, and the flow of perceptions
being” is de facto usually understood as health-related quality and thoughts. Pitta governs heat and transformation, controlling
of life, and measured through objective indicators such as physi- food digestion, elaboration of sensory inputs, and intellectual
cal conditions and demographic features. Subjective well-being discrimination. Kapha is responsible for the body structure,
indicators such as positive emotions, meaning and goal pursuit, promotes physical cohesion and immunity, supports memory
and self-actualization are instead neglected, despite growing evi- retention and mental stability.
dence of their importance for health [7–9]. Two persons with
the same degree of physical health may differ in their level of Prakŗti: the psychophysical constitution in Ayurveda
functioning based on psychological features [10,11]. Thus, the
claim for person-centered health care makes the assessment of According to their relative proportions, the three dos.a deter-
psychological dimensions a compelling need in both research mine the individual constitution, or Prakŗti (Ćaraka Samh.itā,
and practice [12–14]. SūtraSthāna: 30, 25) [26]. Individuals with different Prakŗti
differ in body structure, physiological functioning, and men-
Individual differences and personality tal characteristics. The pure Prakŗti types, characterized by the
predominance of one dos.a over the other two, were classified
Within western psychology, a scientific taxonomy of individ- with astonishing precision in Ćaraka Samh.itā (VimanaSthāna:
ual types was developed through studies using natural languages 8, 96–98) [26]. This classification is based on the qualities
as sources of human attributes [15]. These studies led to the characterizing each dos.a. In particular, Vāta individuals show
identification of a set of individual characteristics, that were vari- the qualities of roughness, lightness, mobility, swiftness, cold-
ously categorized [16] until a consensus was reached around five ness and coarseness, reflected in features such as rough skin,
recurrent factors, the “Big Five”: Extraversion, Agreeableness, fragile body structure, fast movements, intolerance to cold, emo-
Conscientiousness, Neuroticism, and Openness to experience tional and behavioral instability. The prominent qualities of
[17,18]. The Big Five represent personality traits at the broadest Pitta individuals are hotness, sharpness, pungency, sourness, and
level of abstraction. They include more specific characteristics liquidity, resulting into strong appetite, thirst and perspiration,
[19] and recur across different languages [20]. powerful and quick digestion, lax and soft joints, intolerance
The Big Five classification shows however some limitations. to heat, willpower and decisiveness. Finally, individuals with
First, it is atheoretical in nature [21]. Second, although it allows predominance of Kapha are characterized by unctuousness,
for efficient personality descriptions [22], each factor subsumes smoothness, sweetness, softness, dullness, heaviness, and solid-
different characteristics, whose aggregation results in a loss of ity. They show a compact body, strong joints, little hunger and
information [23]. Third, personality features are but a compo- thirst, slow movements and behaviors, emotional stability, and
nent of the complex psychological landscape. Therefore, in most trustfulness.
studies the analysis of personality is integrated with the investi- Regardless of its componential structure, the healthy Prakŗti
gation of other cognitive, affective and motivational dimensions relies upon a dynamic balance among physiological and psy-
[24]. chological dimensions. This balance can be easily disturbed by
changes in the relative proportions of dos.a. The onset of these
The Ayurvedic view: health as balance changes is influenced by three overarching qualities of the mind,
the Triguna: satva, rajas, and tamas, that represent the princi-
In Ayurveda health is conceptualized from a holistic per- ple of equilibrium, proneness to action and inertia respectively.
spective, and it comprises physiological, psychological, social People sharing the same Prakŗti type can differ according to
and spiritual dimensions. Ayurveda is rooted in a philosoph- guna preponderance. A sātvic person shows self-control and
ical view [25], according to which the manifestation of all serenity. A rājasic person is restless and driven by passion and
living entities stemmed from the interaction between the pas- desire. A tāmasic person is depressed, lethargic and negligent
sive and unchangeable consciousness principle, and the active (Ćaraka Samh.itā, Śarı̄raSthana: 4, 36) [26]. Therefore, a truly
and dynamic material principle. Within this view, the material exhaustive evaluation of an individual should include the joint
elements of reality derive from the spiritual and psychological investigation of dos.a and triguna, since the former do not show
ones, and the individual soul, or Self (Ātman) is ontologically spiritual implications, while the latter are not related to physi-
identical to the universal consciousness principle. Life – Ayus cal dimensions [29]. Moreover, although the evaluation of the
– is defined as the conjunction of body, sense organs, mind, individual Prakŗti plays a prominent role in Ayurveda, “col-
and self (Ćaraka Samh.itā, SūtraSthāna: 1, 46–47) [26]. Health lective” Prakŗti types are also described in the classical texts.
398 A. Delle Fave et al. / European Journal of Integrative Medicine 7 (2015) 396–408

Jatiprakrt.i is related to race, Kulaprakrt.i to genetic inheritance, Method

Deśānupātinı̄prakrt.i to society and culture features, Kālaprakrt.i
to ecosystem and climate, and Vayaprakrt.i to the aging process Procedures
(Ćaraka Samh.itā, IndriyaSthana: 1,5) [26]. Nevertheless, most
studies are focused on dos.a-Prakŗti only [30–32], and very few Data were collected among adult volunteers, with the aim
ones investigate triguna-related aspects, however ignoring dos.a to include people in the productive life stage, living in urban
components [33,34]. areas and balanced in number as concerns gender. After project
In spite of such simplifications, the effort to systemati- approval by the University of Milano ethical committee (no.
cally assess individual Prakŗti has brought forth important 34/11, December 2011), participants were recruited through the
advancements, highlighting convergences between traditional snowball technique. With the help of colleagues, a list of eligi-
and modern science. In the biomedical domain, researchers have ble persons matching inclusion criteria and working in different
recently paid attention to the relationships between individual domains was compiled. These people were invited to participate
Prakŗti types and biological functions and structures. Encourag- in the survey and to provide contacts of further potential partic-
ing consistencies between the two perspectives were specifically ipants. All participants received information about the project
detected at the genetic level [35,36]. and research instruments, and filled out informed consent forms.
They could complete the questionnaires immediately, or at a
convenient time and place within the subsequent two weeks. Par-
Prakŗti and personality: two comparable constructs?
ticipants were invited to return the questionnaires either directly
to researchers, or via mail. Their anonymity was guaranteed in
Despite sharing an empirical bottom-up approach, Prakŗti
both data coding and storing phases.
and personality differ in underlying conceptual frameworks and
components. Prakŗti classification is based on relatively sta-
Instruments
ble and panhuman bio-physiological and behavioral features,
while the Big Five classification relies on psychological fea-
Data were collected through a set of self-report question-
tures described through natural languages, and thus related to
naires.
values and traditions that may vary across cultures and time.
Questionnaire on Dos.aPrakŗti AyurVeda (QDAV). QDAV
Prakŗti was conceptualized within a well-defined philosoph-
(Appendix A) was designed to identify participants’ Prakŗti.
ical view, while personality is a descriptive and atheoretical
It represents an adaptation of a 60-item questionnaire devel-
construct. Prakŗti results from the interplay of morpho-
oped and used at the Milano School of Ayurveda “Ayurvedic
physiological, psychological and behavioral features, while
Point”. The original questionnaire comprised three sections,
personality includes psychological and behavioral dimensions,
each corresponding to one dos.a: Vāta, Pitta, and Kapha. Each
ignoring physical ones. Nevertheless, exploring their similarities
section included 20 items describing biological, psychologi-
and differences may help build connections between systems of
cal and behavioral features. Within each section, items were
thought that have been traditionally considered as substantially
formulated in order to fit a specific Prakŗti type. For exam-
incompatible.
ple, in the Vāta section body structure was described as “slim,
with tiny bones”, and in the Kapha section as “strong and
Aims of the study sturdy, with big bones”. Participants were asked to fill in all
the sections, reporting on a 4-point scale their level of agree-
This study aims to investigate the relationship between per- ment with each of the 60 statements. This way to assess
sonality as operationalized through the Big Five factors and Prakŗti is widely used in Ayurveda literature [31]. However
individual Prakŗti, with the purpose to detect consistencies and it takes much time, items may appear repetitive, and the
divergences between the two constructs. Since Prakŗti represents multiple agreement ratings on the same dimension across sec-
a unitary construct including biological, physiological, psycho- tions generate problems of comparability and interpretation of
logical, and behavioral components, it can be evaluated through findings.
a single assessment instrument. On the contrary, in western psy- In the attempt to avoid these problems, within QDAV each
chology the study of human functioning is compartmentalized dimension is rated through only one scaled item, thus collapsing
into multiple domains. Therefore, in order to maximize data the 60 questions into 20 items, 19 of them formulated as five-
comparability, the evaluation of personality will be integrated point scales and one requiring the selection of one answer among
with the assessment of emotional and physical dimensions. As three options. Eleven items investigate biological dimensions
concerns Prakŗti, only dos.a related features will be investi- (at either the morphological or physiological levels); five items
gated, without considering triguna components. This decision explore aspects of the psychological functioning (such as mem-
is again based on comparability reasons. While several facets of ory and decision-making style); three items refer to behavioral
the Big Five show substantial similarities with the psychologi- patterns (eating schedule, spending money, cultivating relation-
cal components of dos.a Prakŗti, neither the metacognitive and ships). In each scale, the lowest value (1) describes features
spiritual components nor the moral or value judgments present typical of Vāta Prakŗti; the central value (3) refers to Pitta fea-
in the triguna classification are included in the personality tures, and the highest value (5) to Kapha ones. Values 2 and
construct. 4 represent intermediate Vāta/Pitta and Pitta/Kapha features
 A. Delle Fave et al. / European Journal of Integrative Medicine 7 (2015) 396–408 399

respectively. Item 20 instead provides three brief descriptions not provide this information. Most participants (89%) were full-
of psychological features, each of them considered as typical time workers, prominently as office employees (35.3%), helping
for one Prakŗti type. Participants were invited to select the item professionals (23.5%), freelance or self-employed professionals
value (or the description, for item 20) that best represented them. (10.2%), and engineers/technicians (10%).
Big Five Inventory (BFI) [37]. The instrument consists of 44
items representing psychological attributes or behaviors. Par- Prakŗti classification
ticipants are invited to describe themselves rating their level of
agreement with each item on a five-point scale (1 = strongly dis- Participants’ Prakŗti was identified through QDAV. A
agree; 5 = strongly agree). Item grouping results in the Big Five methodological premise is here necessary. As previously high-
factors: Extraversion, Agreeableness, Conscientiousness, Emo- lighted, the classification of Prakŗti types is based on qualities
tional Instability/Neuroticism, and Openness to experience. The and related features, rather than quantitative measures. When
BFI showed adequate validity and reliability [21]. The validated translated into research instruments, such a qualitative approach
Italian version [38] was used in this study. inevitably implies the adoption of multiple assessment criteria:
Positive Affect and Negative Affect Schedule (PANAS) [39]. Some qualities are more easily quantifiable through an ordi-
This instrument is widely used to assess positive and negative nal scale (for example, body structure or memory strength),
affect. It consists of 20 five-point scaled items. The Positive while others are best represented through nominal categories (for
Affect (PA) scale includes 10 items describing positive emo- example, eye and skin features). Since this heterogeneity was
tions such as being enthusiastic and excited. The Negative Affect reflected in item formulation, only descriptive nonparametric
(NA) scale comprises 10 items describing aversive affects such procedures were used to analyze QDAV data.
as fear and nervousness. PA and NA are usually evaluated as The frequency of each value was first calculated across the
dispositional traits – participants are invited to rate the fre- 19 five-point items, and five new variables were created for
quency or intensity of each emotion reported on average during each participant: Vāta (value = 1 frequency across the 19 items);
an extended period. The Italian version used in this study showed intermediate Vāta/Pitta (value = 2 frequency); Pitta (value = 3
excellent reliability and validity [40]. frequency); intermediate Pitta/Kapha (value = 4 frequency); and
The Short Form Health Survey (SF-36, version 1) [41]. The Kapha (value = 5 frequency). An additional variable “Prakŗti”
instrument, designed to investigate individuals’ self-assessment was built based on the frequency pattern of the single dos.a (or
of health, comprises 36 items, grouped into eight dimensions: intermediate value): If a value predominated on the others (fre-
degree of limitation in performing physical activities (Phys- quency => 9) the participant was attributed the corresponding
ical Functioning); experienced problems with daily activities Prakŗti type. If more values showed a similar frequency across
as a result of physical health (Role Limitations due to Physi- items, thus making it difficult to identify a clear profile, the
cal Problems); interference with usual social activities due to participant was discarded from subsequent analyses. This strat-
physical and emotional problems (Social Functioning); experi- egy proved to be excessively conservative: only 5 participants
enced body pain and the resulting degree of interference with were identified as Vāta types, 4 as Kapha types, and 87 as Pitta
normal activities (Bodily Pain); perceived anxiety, depression, types. This remarkable imbalance, and the prominence of inter-
loss of behavioral and emotional control, and happiness (Gen- mediate types, could be related to different issues: rarity of pure
eral Mental Health); problems with daily activities as a results Prakŗti types; genetic characteristics of the population under
of emotional problems (Role Limitations due to Emotional investigation; participants’ tendency to avoid extreme scale val-
Problems); perceived energy, endurance and fatigue (Vitality), ues; intrinsic limitations of the assessment instrument. The first
and perceived level of health (General Health Perception). The issue is clarified in Ayurveda literature, showing that mixed or
standard version of the survey, employed in the present study, dual Prakŗti types are far more frequent than pure ones. The rel-
covers a four week recall period. Higher scores indicate a more atively high percentage of participants (22.5%) reporting Pitta
favorable health status. The value of each dimension can be cal- features is consistent with other studies involving European sam-
culated either as the mean of the single item ratings, or as their ples [27]. In the specific case of Italy, this finding may be also
sum, subsequently transformed in order to obtain a common related to the historically recurrent genetic mixture, possibly
range of values from 0 (worst health) to 100 (best health), com- favoring less extremely characterized genotypes. As concerns
parable across dimensions. The instrument was validated and the risk for response set, supported by the correspondence of
normed in Italy [42]. Pitta features with the central point of the scales, this problem
was not detected for the other questionnaires, thus making this
Results explanation less plausible.
As concerns the fourth issue – adequacy of QDAV for Prakŗti
Sample identification – conceptual and empirical aspects were con-
sidered. The conceptual adequacy of item formulation was
The sample comprised 391 adult volunteers (55.5% women), supported by a careful analysis of each Prakŗti type’s features,
aged 39 on average (range 20–60), and living in urban areas as described in the classical texts and in the assessment instru-
of Northern Italy. As concerns education, 38% of the partic- ments currently used. At the empirical level, it was necessary
ipants had a high school diploma, 21% a college graduation, to verify whether Prakŗti types could be differentiated through
and 37.4% a post-graduation degree; the remaining 3.6% did QDAV items. Since the number of extreme Vāta and Kapha
400 A. Delle Fave et al. / European Journal of Integrative Medicine 7 (2015) 396–408

Table 1
Mean rank scores of QDAV items across Prakŗti types.
VATA PITTA KAPHA χ2 , p
(N = 35) (N = 103) (N = 35)
M M M

1. Body structure 54.31 79.70 120.83 40.99*** (V < P < K)

2. Teeth structure 67.96 76.30 111.96 19.99*** (V,P < K)
3. Fingers 60.14 85.41 95.62 14.49*** (V < P,K)
4. Neck 49.88 87.71 105.31 37.49*** (V < P,K)
5. Weather sensitivity 65.88 77.07 104.55 13.42*** (V,P < K)
6. Lips 72.33 77.48 100.91 8.26* (P < K)
7. Eyes 73.61 76.93 100.51 8.08* (V,P < K)
8. Skin 54.31 83.87 101.65 21.81*** (V < P,K)
9. Fat distribution 74.04 74.98 93.83 4.55 ns
10. Body structure during childhood 48.79 83.60 120.41 47.55** (V < P < K)
11. Memory 62.96 83.04 98.59 12.39** (V < P,K)
12. Spending style 66.73 81.05 98.72 10.22** (V,P < K)
13. Decision making 61.09 82.68 102.85 15.61*** (V < P < K)
14. Learning 68.55 89.44 68.64 9.53**
15. Meal schedule 72.80 76.33 98.54 6.45*
16. Cognitive style 56.50 83.26 102.81 20.60*** (V < P < K)
17. Relationships 74.02 80.98 86.78 1.50 ns
18. Movements 61.38 82.15 104.11 16.48*** (V < P < K)
19. Daily planning 63.57 86.23 83.75 8.60* (V < P)
* p < 0.05.
** p < 0.01.
*** p < 0.001.

participants was extremely low, it was decided to pool together nonparametric ANOVA with pairwise comparison. Results are
values 1 and 2 (Vāta and Vāta/Pitta) and values 5 and 4 (Kapha illustrated in Table 2.
and Kapha/Pitta): Participants with a frequency of the pooled Overall, QDAV-R allowed for better distinguishing Prakŗti
values => 15 were classified as Vāta and Kapha respectively. features across groups. For most items, the global Chi-square
This strategy led to the classification of 45 Vāta participants, value was higher than in the original version of the instrument,
and 27 Kapha ones, that were added to the 87 Pitta participants and each group significantly differed from the other two in the
previously identified. A nonparametric ANOVA based on rank pairwise comparisons. Only for item 3 was no group difference
scores calculation and Kruskal–Wallis test was conducted, in detected. This categorization was thus deemed as acceptable,
order to evaluate whether the value selected by participants for and the subsample comprising these 173 participants was used
each of the 19 scales varied across groups. A post hoc pairwise, in the subsequent steps of the study to investigate the relationship
two-sided multiple comparison analysis using Dwass, Steel, and between Prakŗti type and personality, affect, and self-reported
Critchlow-Fligner Method (DSCF) was also performed. Results health.
are reported in Table 1.
This analysis provided information on two major issues: the
representativeness of each item in identifying Prakŗti features; Subsample demographic features
the effectiveness of each item in distinguishing between types.
As Table 1 shows, two items (fat distribution and relationship Demographic features were analyzed in the whole subsam-
pattern) did not vary significantly in ranking across groups; two ple and across Prakŗti types. The subsample was substantially
other items (learning style and meal schedule) showed overall similar to the original global sample as concerns gender
variation, but no significant differences in the pairwise com- (50.9% women), age (M = 39.9, range 20–60), education level
parisons. As for item 20, analyzed through a contingency table and job distribution. In particular, 40% of the participants
reporting the frequency of each description across Prakŗti types, had a high school diploma, 20.8% a college graduation, and
Chi-square statistics did not highlight group differences. These 35.8% a post-graduation degree; the remaining 3.4% did not
five items were therefore dropped, and Prakŗti was again cal- provide this information. Working participants (90%) were
culated for the whole sample (N = 391) on the 15-item version prominently office employees (37.6%), helping professionals
of the instrument, QDAV-R. The minimum frequency of value (21.4%), freelance or self-employed professionals (11%), and
1 + 2, 3, and 4 + 5 to assign an individual to the correspond- engineers/technicians (9.2%). Some differences were instead
ing typology (Vāta, Pitta, and Kapha respectively) was set to detected across Prakŗti types. As concerns gender distribution
8. This procedure led to the identification of 173 individuals as (χ2 = 8.02, p < 0.02), women predominated in the Vāta group
relatively pure Prakŗti types: 35 Vāta, 103 Pitta, and 35 Kapha. (71.4%, partial χ2 = 5.92). As concerns age (F = 5.15, p < 0.006),
Their answers to QDAV-R items were analyzed again through a Tukey post hoc comparison (t = 3.34, p < 0.05) showed that
 A. Delle Fave et al. / European Journal of Integrative Medicine 7 (2015) 396–408 401

Table 2
Mean rank scores of QDAV-R items across Prakŗti types.
VATA PITTA KAPHA χ2 , pa
(N = 35) (N = 103) (N = 35)
M M M

1. Body structure 48.32 85.65 127.14 50.73*** (V < P < K)

2. Teeth structure 64.63 84.60 116.44 24.69*** (V < P < K)
3. Fingers 74.17 88.11 96.54 4.25 ns
4. Neck 46.30 92.19 112.43 44.27*** (V < P < K)
5. Weather sensitivity 63.53 83.61 116.31 13.42*** (V < P < K)
6. Lips 61.83 85.35 117.03 25.54*** (V < P < K)
7. Eyes 79.14 80.20 114.85 16.70*** (V,P < K)
8. Skin 54.25 87.40 111.04 21.81*** (V < P < K)
9. Body structure during childhood 47.38 89.39 119.57 47.55*** (V < P < K)
10. Memory 57.20 90.03 107.88 21.23*** (V < P,K)
11. Spending style 60.14 89.12 107.60 20.64*** (V < P < K)
12. Decision making 67.46 86.96 106.66 11.67*** (V < P,K)
13. Cognitive style 53.37 90.05 108.24 24.73*** (V < P < K)
14. Movements 65.24 85.41 113.43 18.22*** (V,P < K)
15. Daily planning 58.32 91.49 99.19 16.42*** (V < P,K)
*** p < 0.001.

Vāta participants were significantly younger that Kapha ones experiences” differed significantly among groups, while a
(M = 35.6 and M = 43.7 respectively). general tendency toward significance emerged for “active imagi-
nation”, “inventive” and “plays with ideas”. Finally, even though
the groups did not differ for Agreeableness at the factor level,
Prakŗti and personality Vāta participants scored significantly higher for the item “I am
usually trusting”, and Kapha participants for “I can be cold and
BFI mean values were compared across Prakŗti groups both aloof”. ANOVA also highlighted a significant group difference
at the general factor level and at the item level, using a nonpara- for the item “I am considerate and kind” that however could
metric ANOVA followed by a post hoc pairwise comparison not be further specified at the pairwise comparison level, even
through Tukey test. In order to control for individual differences though Pitta participants – as expected – reported lower scores
in acquiescent responding, before factor calculation item values than the other two groups.
were centered on each participant’s set of responses.
As Table 3 shows, several group differences were detected. At Prakŗti and affect
the factor level, Vāta participants reported significantly higher
values of Emotional Instability and Openness to Experience than Table 4 shows the mean values of the PANAS variables
Kapha participants, and significantly lower values of Conscien- across Prakŗti types, as well as the results of the nonparametric
tiousness than participants in the other groups. ANOVA and Tukey post hoc comparisons. Significant differ-
A more fine-grained analysis at the item level further ences emerged for the variables “alert” and “attentive”, with
supported these differences. Conscientiousness provided the Vāta participants reporting lower scores than the other groups
clearest characterization of the three groups. Pitta individuals in both cases. As concerns the aggregated dimensions, Positive
reported being significantly more careful, organized and able to Affect significantly differed across groups, but the post hoc pair-
do a thorough job than Vāta participants; moreover, they shared wise comparison did not provide additional information, even
with Kapha individuals higher values of perseverance and lower though Vāta participants reported lower values than Pitta and
tendency to get distracted compared with Vāta ones. A signif- Kapha ones.
icant group difference was also detected for the item “makes
plans and follows them through”, and a tendency to significance Prakŗti and self-reported health
for “reliable worker”. In both cases, however, pairwise com-
parisons did not provide further information, even though Pitta Table 5 shows the mean transformed values of SF-36 dimen-
participants reported higher values than the other groups. As sions across groups, as well as the results of ANOVA and post
concerns Emotional Instability, Vāta participants scored signif- hoc comparisons. Regardless of their Prakŗti type, participants
icantly lower than the other groups for the items “emotionally reported good health – as expected from the criteria guiding the
stable” and “calm in tense situations”. A tendency toward sig- original sample selection. Across groups, values were aligned
nificance in the expected direction (with Kapha participants with the national normative ones. However, Vāta participants
scoring highest) was detected for “relaxed, handles stress well”. reported the highest role limitations due to emotional problems,
Within Openness to experience Vāta participants reported higher differing significantly from Pitta participants.
values than the other groups in most items, while Kapha indi- It is worth noting that, even though the number of participants
viduals scored lowest. However, only the item “values artistic in the three groups differed, the within-group score variability
402 A. Delle Fave et al. / European Journal of Integrative Medicine 7 (2015) 396–408

Table 3
Mean values of the Big Five factors and their components across Prakŗti types.
Variables VATA PITTA KAPHA F, p
(N = 35) (N = 103) (N = 35)
M (sd) M (sd) M (sd)

Extraversion 3.1 (0.7) 3.2 (0.8) 3.2 (0.7) 0.57 ns

Talkative 3.4 (1.3) 3.6 (1.3) 3.5 (1.4) 0.20 ns
Reserved (R) 4.1 (0.8) 3.9 (1.1) 3.9 (1.2) 0.76 ns
Full of energy 3.7 (0.9) 3.7 (0.9) 3.7 (0.9) 0.14 ns
Generates enthusiasm 3.3 (0.8) 3.2 (1.0) 3.2 (1.1) 0.30 ns
Quiet (R) 3.3 (1.2) 3.1 (1.3) 3.3 (1.2) 0.63 ns
Assertive personality 3.4 (1.0) 3.7 (1.0) 3.6 (0.9) 1.29 ns
Shy, inhibited (R) 3.5 (1.2) 3.2 (1.2) 3.4 (1.3) 0.84 ns
Outgoing, sociable 3.6 (1.1) 3.7 (1.1) 3.8 (1.1) 0.50 ns
Agreeableness 3.9 (0.5) 3.8 (0.6) 3.7 (0.5) 1.51 ns
Finds fault with others (R) 2.8 (1.0) 2.9 (1.2) 3.2 (1.3) 0.30 ns
Helpful and unselfish 4.1 (0.7) 4.1 (0.7) 4.3 (0.7) 0.92 ns
Starts quarrels (R) 1.6 (1.0) 1.6 (0.9) 1.5 (0.9) 0.10 ns
Forgiving nature 3.6 (2.3) 3.7 (1.1) 3.6 (1.3) 0.14 ns
Trusting 4.0 (0.8) 3.3 (1.1) 3.2 (1.2) 5.61** V > P,K
Cold and aloof (R) 2.5 (1.2) 2.8 (1.2) 3.4 (1.2) 4.86** K > P,V
Considerate and kind 4.1 (0.8) 3.7 (0.9) 4.0 (0.7) 3.37*
Rude to others (R) 1.7 (0.9) 1.6 (0.9) 1.6 (1.0) 0.05 ns
Cooperates with others 4.1 (0.8) 4.1 (0.9) 3.9 (1.0) 1.02 ns
Conscientiousness 3.8 (0.6) 4.1 (0.5) 4.1 (0.5) 6.67** V < P,K
Does a thorough job 4.1 (0.8) 4.5 (0.6) 4.4 (0.8) 5.04** V < P
Somewhat careless (R) 2.3 (1.4) 1.7 (1.0) 2.0 (1.2) 3.84* V > P
Reliable worker 4.5 (0.6) 4.7 (0.5) 4.5 (0.6) 2.49+
Disorganized (R) 2.5 (1.1) 2.0 (1.1) 2.1 (1.3) 2.88+ V > P
Lazy (R) 2.5 (1.2) 2.5 (1.2) 2.9 (1.3) 1.51 ns
Perseverant 3.9 (0.9) 4.4 (0.7) 4.6 (0.7) 8.80*** V < P,K
Does things efficiently 3.9 (0.6) 4.1 (0.7) 4.1 (0.6) 1.37 ns
Makes and follows plans 3.7 (0.9) 4.1 (0.7) 3.9 (0.9) 3.10*
Easily distracted (R) 2.9 (1.3) 2.3 (1.0) 2.0 (1.0) 5.77** V > P,K
Emotional instability 3.1 (0.7) 2.9 (0.6) 2.7 (0.8) 3.42* V > K
Depressed, blue 1.9 (1.1) 2.0 (1.0) 1.8 (1.0) 0.18 ns
Relaxed, handles stress well (R) 2.8 (1.1) 3.0 (1.0) 3.3 (1.1) 2.37+
Tense 3.9 (1.0) 3.6 (1.0) 3.6 (0.9) 1.72 ns
Emotionally stable (R) 2.8 (1.0) 3.5 (0.9) 3.6 (1.3) 7.81*** V < P,K
Moody 3.4 (1.2) 3.3 (1.2) 3.1 (1.2) 0.58 ns
Calm in tense situations (R) 3.1 (1.1) 3.7 (0.8) 3.8 (0.8) 7.13** V < P,K
Worries a lot 3.7 (1.1) 3.4 (1.0) 3.3 (1.2) 1.49 ns
Gets nervous easily 2.6 (1.2) 2.8 (1.1) 2.6 (1.2) 0.90 ns
Openness to experience 3.8 (0.6) 3.7 (0.7) 3.4 (0.7) 3.54* V > K
Curious 4.0 (1.0) 3.9 (1.0) 3.8 (1.0) 0.18 ns
Original, new ideas 3.8 (1.1) 3.6 (1.0) 3.3 (1.1) 0.14 ns
Ingenious 3.7 (1.0) 3.8 (1.0) 3.6 (1.1) 0.45 ns
Active imagination 4.2 (0.8) 3.8 (1.0) 3.7 (1.2) 2.73+
Inventive 3.7 (0.8) 3.5 (1.0) 3.2 (1.1) 2.72+
Values artistic experiences 4.3 (1.0) 3.9 (1.1) 3.5 (1.2) 4.00* V > K
Prefers routine work (R) 2.3 (1.3) 2.3 (1.0) 2.7 (1.4) 1.86 ns
Plays with ideas 4.1 (0.8) 3.9 (0.9) 3.6 (1.2) 2.37+
Few artistic interests (R) 2.3 (1.4) 2.6 (1.3) 2.7 (1.4) 0.86 ns
Sophisticated in art 3.1 (1.2) 3.1 (1.1) 2.8 (1.3) 1.12 ns

Note. (R) reversed score.

+ p < 0.10.
* p < 0.05.
** p < 0.01.
*** p < 0.001.

was highly homogeneous across the three profiles for all the Discussion
variables examined. This is highlighted by the substantial simi-
larity in the standard deviation values across groups, as reported This work provided a descriptive analysis of the relation-
in Tables 3–5. ships between Prakŗti – the individual constitution formalized by
 A. Delle Fave et al. / European Journal of Integrative Medicine 7 (2015) 396–408 403

Table 4
Mean values of PANAS variables and global affect dimensions across Prakŗti types.
VATA PITTA KAPHA F, p
(N = 35) (N = 103) (N = 35)
M (ds) M (ds) M (ds)

Interested 3.8 (0.7) 4.0 (0.7) 3.9 (0.6) 0.70 ns

Distressed 2.4 (1.2) 2.4 (1.0) 2.3 (1.1) 0.34 ns
Excited 3.0 (0.9) 3.1 (0.9) 3.5 (0.8) 2.98 ns
Upset 2.4 (1.2) 2.5 (1.0) 2.2 (0.9) 1.32 ns
Strong 3.2 (0.8) 3.4 (0.8) 3.5 (0.8) 1.75 ns
Guilty 2.2 (1.3) 2.0 (1.0) 1.9 (1.0) 0.84 ns
Scared 2.2 (1.0) 2.1 (1.0) 2.0 (1.2) 0.20 ns
Hostile 1.8 (1.1) 1.9 (0.9) 2.1 (1.1) 0.38 ns
Enthusiastic 3.5 (1.2) 3.7 (0.9) 3.5 (1.1) 0.93 ns
Proud 3.5 (1.0) 3.7 (1.0) 3.9 (1.1) 1.35 ns
Irritable 2.9 (1.3) 2.9 (1.0) 3.1 (1.2) 0.80 ns
Alert 3.3 (0.8) 3.8 (0.8) 4.0 (1.0) 6.45** V < P,K
Ashamed 2.1 (1.3) 1.7 (0.8) 1.9 (1.3) 1.99 ns
Inspired 3.0 (0.9) 3.2 (1.0) 3.2 (1.1) 0.42 ns
Nervous 3.2 (1.1) 3.0 (1.0) 3.1 (1.2) 0.86 ns
Determined 3.7 (0.9) 4.0 (0.8) 4.1 (0.9) 2.02 ns
Attentive 3.6 (0.8) 4.1 (0.7) 4.0 (1.0) 5.23** V < P,K
Jittery 2.7 (1.2) 2.5 (1.1) 2.7 (1.0) 0.66 ns
Active 4.1 (0.8) 4.0 (0.8) 3.9 (1.1) 0.47 ns
Afraid 2.0 (1.0) 1.9 (1.0) 1.9 (0.8) 0.81 ns
Positive affect 3.5 (0.4) 3.7 (0.5) 3.7 (0.6) 3.15*
Negative affect 2.4 (0.9) 2.3 (0.7) 2.3 (0.6) 0.26 ns
* p < 0.05.
** p < 0.01.

Table 5
Mean transformed scores of the SF-36 dimensions across Prakŗti types.
VATA PITTA KAPHA
(N = 35) (N = 103) (N = 35)
M (sd) M (sd) M (sd)

Physical functioning 93.5 (12.4) 93.6 (12.9) 94.4 (10.8) 0.07 ns

Role limitation/physical 82.9 (27.0) 89.2 (24.0) 90.7 (21.1) 1.14 ns
Bodily pain 71.9 (22.3) 78.9 (21.4) 80.4 (23.7) 1.63 ns
Social functioning 69.3 (25.4) 75.2 (19.7) 74.6 (20.0) 1.07 ns
Mental health 68.0 (19.5) 68.9 (13.9) 71.6 (16.0) 0.55 ns
Role limitation/emotional 68.6 (36.1) 85.6 (28.0) 81.9 (29.5) 4.19** V < P
Vitality 57.4 (15.6) 60.1 (14.6) 57.0 (18.5) 0.70 ns
General health 67.4 (17.5) 68.4 (16.6) 72.1 (14.0) 0.85 ns
** p < 0.01.
Ayurveda – and personality traits, affect and perceived health, as level of education. As concerns fat distribution, other factors
operationalized by western psychology. These dimensions were besides physical constitution can influence it, such as gender
assessed through self-report instruments in a sample of Italian and age (in particular, menopause in women), lifestyle, diet
adult participants. and physical exercise. As concerns relationships, the item for-
To the best of our knowledge, no study has yet been con- mulation could elicit socially desirable answers; moreover, this
ducted on this topic using this comparative approach. This work dimension may be sensitive to culture-specific values and norms.
is thus exploratory in nature, and the findings represent a first Sociocultural aspects can also influence the self-assessment
step toward the development of a new research avenue. of meal schedule: All participants worked full-time following
structured daily routines. Finally, the formulation of the last
QDAV and Prakŗti assessment item was inadequate: The three brief descriptions were very
specific and not mutually exclusive. After removal of these
A specific questionnaire – QDAV – was developed to assess items, QDAV-R allowed for a reasonably good differentiation
Prakŗti. The first version showed structural weaknesses. Five between participants characterized by a relatively pure Prakŗti.
items did not allow for distinguishing between Prakŗti types: The Prakŗti type distribution was consistent with findings
learning pattern, fat distribution, quality of relationships, meal obtained from other European samples, with a higher percentage
schedule, and a synthetic description of mental features. Homo- of participants classified as Pitta. While no relevant demo-
geneity in learning pattern could be related to participants’ high graphic variations were detected across Prakŗti types, significant
404 A. Delle Fave et al. / European Journal of Integrative Medicine 7 (2015) 396–408

differences emerged for most QDAV-R items, concerning both prominent among Vāta participants, in line with the findings
physical and psychological functioning. These differences were obtained through BFI and Ayurveda assumptions.
in line with the Ayurveda literature on dos.a Prakŗti. Overall, for the majority of variables findings highlighted a
clear distinction of the participants with predominance of Vāta
Prakŗti, psychological features and perceived health features from the other two groups, in particular referring to
stability and persistence at both behavioral and psychological
Relevant consistencies were detected between Prakŗti fea- levels. The most evident differences emerged for dimensions
tures and psychological dimensions. As concerns personality, such as emotional instability, low perseverance in completing
Vāta participants reported being less conscientious than Pitta tasks, and the tendency to get distracted and upset. This result
and Kapha ones, less emotionally stable than Kapha partici- is conceptually grounded in the Ayurveda definition of the three
pants but more open to experience than the other groups. The profiles, in terms of both physiological features and patholog-
differences highlighted for these three factors were further con- ical aspects. The three dos.a are conceived as entities whose
firmed at the item level, and they are substantially consistent with material substrata are represented by the five basic elements,
the description of these Prakŗti types in Ayurveda. Instead, the or mahābhūta – earth, water, fire, air, and ether. Vāta is made
significant group differences detected in two items of the Agree- by air and ether, Pitta by fire and water, and Kapha by water
ableness factor require further clarification, as they apparently and earth (Ćaraka Samh.itā, SūtraSthāna: 1, 57) [26]. Within
contradict Ayurveda assumptions. Kapha participants reported this view, Vāta is thus structurally different from the other two
significantly higher values than the other two groups for “I can dos.a, that share water as a common element. Moreover, both
be cold and aloof”, while in the Ayurveda evaluation they are Vāta constituents are characterized by lightness and low density,
described as warm and affectionate. Vata participants scored thus being structurally unstable. These features are consistent
significantly higher than Pitta and Kapha ones for “I am usu- with the physiological role of Vāta as the principle of mental
ally trusting”, while Ayurveda describes them as distrustful and and physical movement. At the pathological level, this intrinsic
unreliable individuals with few close relations. These discrepan- instability of Vāta is related to the tendency toward imbalance
cies can be explained taking into account the cultural context and and thus disease. The classical texts ascribe to Vāta imbalance
demographic features of the participants. According to Ayurveda the origin of most pathologies, listing 80 diseases originated by
the healthiest and best constitution is Kapha: Its calmness, sta- Vāta alterations, 40 by Pitta and only 20 by Kapha imbalance
bility, and low activation are considered as positive traits in an (Ćaraka Samh.itā, SūtraSthāna: 20, 10) [26].
Asian culture like the Indian one, that praises equipoise, self-
control and detachment from passions. In today’s Italian context Strengths and limitations
– as in most western countries – the Vata features of improvi-
sation, creativity, high activation and originality are encouraged The original contribution of this study consists of three
and praised over stability and reliability. For this reason, Kapha aspects. The first one is the attempt to investigate, for the first
participants in this study may perceive themselves as being time in the psychological and medical literature, the relationship
sometimes cold and aloof (as stability and equipoise are inter- between Prakŗti – the psychophysical constitution described in
preted in western terms). Similarly, the tendency to seek help Ayurveda – and personality, its most similar western psycho-
from others to complete tasks and release ceaselessly fluctuat- logical construct, integrated by the assessment of emotional and
ing emotions may lead Vata participants to define themselves as physical health components in order to make the comparison as
trusting. As described in the previous pages, possible cultural complete as possible. The second strength is the involvement
variations in persons with the same Prakrt.i are not ignored by of a reasonably large group of healthy adult participants, whose
Ayurveda, that classifies them as Deśānupātinı̄ Prakrt.i, individ- socio-demographic features were rather homogeneous. The third
ual traits derived from the sociocultural context. original aspect of this work is represented by the development
The analysis of PANAS highlighted significant group dif- of QDAV-R to assess Prakŗti. This instrument differs from most
ferences for the variables alert and attentive, in which Vāta measures designed to this purpose, in that it is structured as a
participants scored lower than the other two groups. This find- scaled questionnaire, in which each item assesses one specific
ing is consistent with Ayurveda literature, if we consider that feature across different Prakŗti types.
PANAS variables are assessed as dispositional traits, rather than This pilot study also has several limitations. At the mea-
temporary states. According to Ayurveda, in Vāta individuals surement level, QDAV-R requires further refinement through
mental functioning shows high activation features in the short the inclusion of additional dimensions. Physiological processes
term, but its instability and fluctuations preclude sustained atten- such as digestion, sleep, metabolism, vulnerability to disease,
tion and alertness for prolonged periods. Also the significant and resistance to physical effort should be investigated. Emo-
group variation in Positive Affect, even though not confirmed by tional and motivational dimensions should be added to the
the post hoc pairwise comparisons, was consistent with Prakŗti prominently cognitive items referring to psychological function-
profiles. Finally, participants across groups were substantially ing. Finally, since behavior-related items – such as cultivation
similar for the vast majority of self-reported health dimensions. of relationships and meal schedule – were confounding rather
This finding is not surprising, in that one of the original sample than helpful, a different set of behavioral variables should be
selection criteria was the enjoyment of good health conditions. identified. Another problem with QDAV-R is that items differed
Only one group difference emerged: Emotional problems were in structure and content – some were formulated as ordinal
 A. Delle Fave et al. / European Journal of Integrative Medicine 7 (2015) 396–408 405

scales, and others as nominal categories. The investigation of derived from traditional systems of medicine, such as the Korean
the global statistical properties of the instrument was thus not one [48,49]. In order to actualize these potentials, however, the
possible. Moreover, due to the exploratory nature of this study, biopsychosocial model must be translated into practice through
only participants with relatively pure Prakŗti were examined. theoretically grounded research and methodologically sound
Future studies should include individuals characterized by dual assessment. An authentically integrated intervention designed
Prakŗti, derived from the combined predominance of two dos.a on this basis should foster individuals’ psychological and social
(e.g. Vāta and Pitta). Although most studies on Prakŗti involve functioning, besides physical health [50–52].
single-dos.a types, the percentage of these individuals is rela- The need for an integrated approach to treatment is even
tively low in the general population, while dual Prakŗti types more relevant in psychotherapy, a domain that suffers from
are much more common [43]. model fragmentation, theoretical confusion, and lack of clear-cut
Another limitation related to measurement is the self-report evidence-based outcomes. The numerous theories and models
nature of QDAV-R. A recommendation for future studies is currently available in psychotherapy represent sealed-off com-
to combine participants’ self-assessment of Prakŗti with eval- partments, leading to multiple definitions of well-being, each
uations performed by expert Ayurveda clinicians, in order to one grounded into a specific framework, but none of them cap-
verify consistencies and discrepancies between the two mea- turing the complexity and multidimensionality of the concept
surement approaches. From a biopsychosocial perspective, such [53]. Moreover, most psychotherapeutic approaches substan-
a joint evaluation could provide a relevant contribution to our tially neglect the body. The few clinical frameworks that take
still limited understanding of the complex relationship between this into account – such as bioenergetics and psychosomatics
objective and subjective indicators of human functioning [44]. – have not provided satisfactory intervention models yet. The
Finally, future studies should take into account cultural aspects. availability of well-established knowledge traditions, grounded
Behavioral and psychological features, besides characterizing a into a unitary view of the body-mind system, can open new
single individual, are related to the cultural context and value sys- avenues for designing integrated psychotherapeutic protocols.
tem the person is raised and lives in. They do not necessarily have As specifically concerns the integration of Ayurveda in med-
the same meaning or value across cultures, and thus an invariant ical diagnosis and treatment, it requires the development of
relation to health or individual adjustment [45,46]. This issue more rigorous instruments for Prakrt.i evaluation, that take into
was indeed addressed in Ayurveda classical texts through the account both individual components and collective factors such
identification of collective Prakŗti types, including those related as race, genetics, natural and cultural environment – as recom-
to the cultural and natural environment. mended in the classical texts. Most of the currently available
textbooks address Prakrt.i only at the descriptive level, and do
Future directions for research and intervention not give practical diagnostic protocols or instruments, leaving
this arduous task to practitioners. A better understanding of
The convergence detected between individuals’ Prakŗti and the concepts and descriptions of human functioning provided
psychological features has promising implications for research in Ayurvedic texts and a more systematic study of the way clini-
and practice. At the research level, the Prakŗti classifica- cians actually apply them in day to day practice will substantially
tion subsumes general morpho-physiological and psychological improve our knowledge of this complex system of medicine and
dimensions that can be profitably matched with the evaluation of its integration in global healthcare.
more analytic constructs identified by psychology. The heuris-
tic potential of the Ayurveda conceptualization of Prakŗti was Conclusion
confirmed by genetic studies, as well as by applications in vet-
The complexity of human behavior can hardly be captured
erinary science, in the study of birds, insects and plants. Overall,
through simplified paradigms, and the current state of the art in
these studies showed its effectiveness in identifying properties of
western science does not allow for a unified perspective yet. The
organisms throughout the animal kingdom, and not just among
tendency to polarize knowledge by contrasting universalism and
humans [47]. For this reason, the integration of Ayurveda basic
relativism, objective data and self-reports, quality and quantity,
concepts into the general assessments of individual features can
holistic and reductionist frameworks cannot take researchers and
be scientifically fruitful.
practitioners very far in their attempts to provide an exhaustive
As concerns practical applications, this first attempt to clas-
description of human life and health [54]. However, the repeated
sify people according to both their Prakŗti and psychological
claims for a biopsychosocial approach to health, and the recent
features shed light on the potential of integrating Ayurveda
acquisitions in physics and epigenetics support the crucial role
in health promotion, psychological diagnosis, and treatment.
of the dynamic interaction with the environment in shaping the
The joint investigation of Prakŗti and personality could pave
structure of any system – be it an individual, a community, or
the way to the development of a more integrated view of
a culture [5,55,56]. A constructive exchange and integration of
human functioning, joining apparently distant traditions of
views with other knowledge and medical traditions can represent
conceptual and empirical knowledge within a truly biopsychoso-
a substantial step toward the achievement of this goal.
cial approach to healthcare. Researchers and practitioners are
becoming increasingly aware of the potentials of this integra- Conflict of interest statement
tion, as witnessed by studies investigating physiological and
psychological parameters together with measures of constitution The authors declare that there is no conflict of interest.
406 A. Delle Fave et al. / European Journal of Integrative Medicine 7 (2015) 396–408

Appendix A. QDAV

We invite you to provide a description of some of your physical and psychological features. Please, for each feature put an “X”
on the vertical mark that best corresponds to it.
 A. Delle Fave et al. / European Journal of Integrative Medicine 7 (2015) 396–408 407

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