The Enneagram and Chronic Illness: How Eights, Nines, and Ones React to Being Sick

There are many emotional, physical, and spiritual struggles associated with chronic pain and illness. Lately, I’ve been wondering if my personality exacerbates certain issues, making me more susceptible to particular frustrations. Do I have a certain attitude towards my pain that is different from others? Are there things I can learn from my personality type that will help me manage my chronic illness better? 

This led me to a fascinating research project by Penny Whillans, a psychologist and the Director of the Canadian Institute for Enneagram Studies. Whillans conducted a study on how personality types react to chronic pain present in a clinical setting, and linked her findings to the Enneagram. I also researched and interviewed people who have typed themselves to understand, on a more personal level, the variety of experiences that come with pain and illness.

This week, I’m looking at Type Eights, Nines, and Ones. The Enneagram bases personality types around three centers of intelligence—the gut (or instinctive) center, the heart (or feeling) center, and the head (or thinking) center. Though everyone uses all three methods to process their environment, the Enneagram suggests that everyone has a dominant center of intelligence, a default response. Eights, Nines, and Ones are the gut centers, which mean they frequently listen to their instincts, and their instincts are often triggered, in some way, by anger. Their relationship to anger plays a direct role in how they react to being sick or in pain, and understanding why may help them process frustrations associated with their conditions.

Enneagram 8: I Have to Push Through the Pain to be Strong.

Type Eights (Challengers) believe, consciously or unconsciously, that the world is divided into the weak and the strong. Anger is the core emotion of Eights, Ones, and Nines. While Ones tend to repress their anger (because they want to appear perfect) and Nines deny their anger (because they don’t want to upset anyone), Eights overdo anger; they have no problem feeling or expressing it. When people tell them they’re intimidating, Eights may be surprised to hear this because they are just being themselves. Eights are generous, energetic powerhouses who are unafraid to confront the truth.

Type Eights focus on people who have power and how they are using that power. In the world of chronic illness, it is usually doctors who have power. They are the ones with the ability to prescribe medications, run tests, diagnose conditions, and validate pain. Eights may get especially frustrated when doctors misuse their authority. Doctors often don’t know what to do with patients who have chronic conditions; when you can’t figure out what’s wrong with someone or how to fix it (which is your job) you tend to get frustrated. This can affect their bedside manner and even their belief that the patient is telling the truth about their pain. Eights’ anger may come to the forefront when they feel like their doctor is not helping them.

In her study, “Applying the Enneagram to the World of Chronic Pain,” Whillans writes, “The Type #8s wanted to be believed and stated clearly that they did not think that others, especially their health care practitioners, believed the amount of pain they experienced, because ‘if they did, then they’d do something about it!’”

Whillans also notes that Eights would follow their doctors’ instructions, but would often ignore the wisdom behind their orders:

“For example, a Type #8 subject might use a neck brace and cane for support while climbing onto the garage roof to mend it,” Whillans writes. “The Type #8s did not see this kind of behavior as inconsistent. They typically saw themselves as following doc’s orders, saying things like, ‘I gotta move, don’t I?’ Such behaviors triggered frustration, confusion, and irritation in their health care practitioners.”

This type of behaviour does not necessarily occur because the Eights don’t understand the repercussions of their actions, but because Eights have a lot of energy to channel. They also don’t want to be controlled and want to be in control. Pushing through the pain comes naturally to Eights, because it feels like they are in control of their bodies that way, and letting the pain overwhelm them would be “weakness.”

“I just push through the pain like it isn’t there,” says Benjamin, an Eight with epilepsy. “I try to remain upbeat, but as many other people with chronic illness, it’s extremely difficult, and as time goes on, it eats away at you a bit… I research other conditions with similar treatment plans and similar symptoms to try to figure out a way to treat the illnesses myself. It has completely changed the way I interact with people, and because of the research I’ve done, I’m closer to being on the doctors’ understanding of the conditions I have, rather than the patient.”

When their condition means they have to rely on others for help, Eights may struggle. They want to take care of themselves. 

The chronically ill Eight may find peace in learning how to rest and redefining what strength means to them. Being vulnerable is not weakness, but in our culture it often feels like it. Perhaps there is strength to be found in the very illness they are fighting, in being vulnerable, in taking care of their bodies and minds. A chronic illness often isn’t an obstacle to overcome, but a lifestyle to manage, and this requires getting in touch with the body’s needs.

Enneagram 9: Advocating for Myself is Too Exhausting.

Type Nines (Peacemakers) tend to become numb to themselves and what is happening to them, especially when in conflict. Anger is the core emotion of Nines, Eights, and Ones. While Eights overdo anger (because they want control) and Ones repress it (because they want to appear perfect), Nines avoid anger at all costs, denying they feel it at all. They are often out of touch with their own emotions and desires, preferring to go along with what others want, even to the point of merging with someone else’s identity. Nines are easygoing, supportive, and optimistic people who excel at healing conflict.

Nines may have trouble advocating for themselves with their doctors (and others) when it comes to their pain. Stefanie, a Nine with chronic back and hip pain, says: 

“Likely my Nine personality is why I don’t like going to the doctor, because my default is to avoid what feels like conflict, and advocating for oneself, to me, often feels like conflict. And one thing I’ve learned with experience is that it’s necessary to advocate for oneself within the healthcare system.”

Advocating for yourself is tiring, and Nines feel that exhaustion more than most. Doctor appointments can be especially difficult when you are out of touch with your own emotions and experiences, because doctors are trying to gather data on your condition in order to diagnose you and provide treatment. Often, Nines won’t be able to accurately describe their pain and symptoms, and they will understate their pain, because they aren’t used to focusing on their own experiences. In her study, Whillans writes about the Nines she observed:

“These Type #9s presented in a pleasant and unassuming manner with no direct information volunteered about their pain. They were readily overwhelmed with their pain, and presented with an untouchable, vague quality if asked to describe their pain or inner experience. Vague verbalizations around their pain were common. When asked to describe his pain, one Type #9 said, ‘Something is wrong. I’m not the way I used to be. I’m waiting for it all to be over.’ They demonstrated difficulty describing their pain when they were experiencing it, presenting with an absent quality.”

Avoiding doctor appointments altogether and seeking out treatment on their own is a common response for a Nine, because they pick up on their doctors frustrations with their vagueness. Doctors might even view them as uncooperative, not understanding that the Nine isn’t trying to be vague. Nines may seem agreeable to their doctor’s orders but then look into alternate treatments without their doctor’s knowledge. Nines don’t want to argue with their doctors when they don’t think a treatment will work (or even if they know it won’t work because they’d already tried it).

Nines like blending in and being like everyone else, so they may be unlikely to share openly about their condition with others, even people close to them. They are afraid that by sharing this piece of themselves, others may see them as a burden. Nines stamp down emotions associated with having a chronic illness—feelings like anger, grief, and frustration—and bottling these things up can result in depression.

The chronically ill Nine may benefit from keeping a health journal and documenting their pain symptoms so they don’t feel overwhelmed trying to recall details in the doctor’s office. They also may find it comforting to bring a friend or family member to the doctor’s with them to help advocate for them and, on a related note, may find it valuable to express their own needs to the people who care about them. Sharing and being vulnerable can be a challenge, especially when the Nine is unused to voicing their own emotions and desires. But the people you want in your life are not the ones who are going to abandon you for being sick. They’re the ones who stick with you, even if your life isn’t as harmonious as you wish it was.

Enneagram 1: I Need to be Healed to be Perfect.

Type Ones (Perfectionists) want to control their environment and fix flaws, and they struggle with anger when they can’t. Anger is the core emotion of Ones, Eights, and Nines. While Eights overdo anger (because they want control) and Nines deny anger (because they want to avoid conflict), Ones relate to more repressed versions of anger, such as irritation, resentment, or annoyance. They try hard to do good and keep their feelings to themselves in order to behave the “right” way. Used consciously, their anger can be channeled into compassion and constructive energy. Ones get things done, are crusaders for good, and are not afraid to confront the truth.

Like their name suggests, Ones dislike imperfection. Their self-criticism can be a problem when they experience chronic pain and illness, because our culture idealizes health. It’s why “active and fit” are often people’s top requirements on dating apps, why actors are muscular and slim, why people struggle to understand the “chronic” part of chronic illness. Ones may find it incredibly frustrating when there’s nothing they can do to be healed. The pressure from strangers, acquaintances, friends or family to “get better” may be especially tough for Ones to deal with, because they are already experiencing that pressure from themselves.  

In her study, Whillans noted that Ones who struggled with chronic pain were focused on getting the “right” type of treatment: 

“They held a belief that if they were provided with the ‘right’ diagnosis, the ‘right help,’ they made the ‘right effort,’ and the practitioner listened and read the reports in the ‘right way,’ they would not have to feel the pain; they would not have pain,” she writes.

Ones like to avoid mistakes and do things perfectly the first time. The problem with chronic illness is that doctors often can’t figure out what’s wrong with you or, if they do know the problem, are not sure how to treat it. Plus, many medications work on some people but not on others. This means diagnosis and treatment involves a lot of trial and error, which can be especially frustrating for Ones. There is not necessarily a “right” way to treat them, or if there is, it takes a while to figure it out. There’s no manual for living with chronic illness, no concrete set of steps that will result in an A+ to healing.

Ones like to be in control, so it makes sense that the ability to control their condition and symptoms gives them some comfort:

“I strive to control my triggers and perfect my nutrition,” says Laura, a One with food sensitivities. “I have control issues with food and experience anxiety when I can’t be confident that the food meant to nourish my body may instead poison it.”

It is a comfort to have that level of control, but chronic conditions can mean bodies go haywire and there’s no apparent logic to their malfunctioning. Ones are often afraid of being “bad,” “wrong,” or “defective,” and a chronic illness can play into that fear. Ones may find some relief from just giving themselves permission to be sick, getting in touch with their anger and sadness, and allowing themselves to be emotional and in pain. That doesn’t mean you stop looking for treatment or searching for a cure, but that your worth doesn’t come from being perfect. An unhealthy body doesn’t mean you are bad, doesn’t mean you are unloveable, doesn’t mean you have failed. You may find peace by accepting yourself as a whole, valuable person just the way you are.


Stay tuned for the next post in this series, which will be about how Type Twos, Threes, and Fours (the heart or feeling centers of the Enneagram) react to chronic pain. Disclaimer: I am not a doctor or a medical professional. These posts are not intended as medical advice.


Chestnut, Beatrice, The Complete Enneagram: 27 Paths to Greater Self-Knowledge. Berkeley, CA: She Writes Press, 2013.

“Eneagram Centers of Intelligence.” Enneagram Explained, Jan 21, 2020,

Riso, Don Richard and Russ Hudson. The Enneagram Institute, 1997,

The New School at Commonweal. Beatrice Chestnut – Type 1 Enneagram Panel, YouTube, Feb 1, 2019,

The New School at Commonweal. Beatrice Chestnut – Type 8 Enneagram Panel, YouTube, Feb 1, 2019,

The New School at Commonweal. Beatrice Chestnut – Type 9 Enneagram Panel, YouTube, Feb 1, 2019,

Whillans, Penny. “Applying the Enneagram to the World of Chronic Pain,” The Enneagram Journal, July 2009,

4 thoughts on “The Enneagram and Chronic Illness: How Eights, Nines, and Ones React to Being Sick”

  1. Wow… I’ve never felt so understood as a person with a chronic disease. I think I finally figured out that I am indeed a 9, thank you so much for making me realize this and for making me feel understood.

  2. This piece made me tear up. Thank you to the author for crafting such a validating and approachable interpretation of the data. As a type 8 with some Type 1 traits and a chronic disease, I felt so seen.

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