The Enneagram and Chronic Illness: How Twos, Threes, and Fours 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 Twos, Threes, and Fours. 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. Twos, Threes, and Fours are the heart centers, which mean they base their actions on what their feelings are telling them to do. Their personality also has a specific relationship with grief. Their relationship to grief 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 2: Others Matter More than My Pain.

Type Twos (Helpers) focus on being liked and pleasing people. Their name suggests selflessness, but they may (even without being aware of it) act supportive in order to get something, such as gaining approval or hoping others will take care of them in return. Grief is the core emotion of Twos, Threes, and Fours. While Threes underdo grief (because they dislike feelings) and Fours overdo it (wrapping themselves up in their emotions as a defense mechanism), Twos repress their emotions because they don’t want to be separated from others. They feel like they need to support others to be loved; feeling emotions and needing support themselves would be contrary to those goals. Twos are helpful, sensitive people who are driven to be close to others.

Twos may ignore their chronic pain or illness in order keep focusing on others. The Twos in Whillans’ study went out of their way to help others in order to feel better about themselves, even though it increased their own pain. They were also concerned about losing relationships due to their pain. After all, if being in pain hinders their ability to help others, then how are they supposed to connect with people? Twos may push past their boundaries, or not know how to set boundaries at all, because they are afraid of losing people. 

“These Type #2s operated on the premise that ‘no one understands me or my pain,’ and made statements like, ‘it’s not possible to be loved with this pain.’ They experienced shame and guilt because of their self-focus, and they felt paralyzed by confusion, acting ‘nice’ all the time, which did not allow for their experience of pain to be clearly expressed, delineated, or heard,” Whillan writes in her study of Twos with chronic pain.

Twos may find it difficult to follow doctors’ orders or stick with treatment plans if they interfere with their need to help others. It’s difficult for a Two to say no. Even though they may feel resentful when people continue to ask them for favours, they may still push through the pain and do the favours. Their pain may escalate as they demand their bodies work normally when what they really need is rest.

Joy Beth, a Two with chronic migraines and back pain, says: 

“Through the years, I’ve learned how to take better care of myself, but centering myself in that way is completely unnatural. I go to a neurologist now, I make sure I have all the meds I need, I advocate for myself with my doctors. [If] I think in terms of me vs. medical, I do pretty well. But when my pain (back or head) interferes with my relationships with others, I feel a lot of guilt. I feel bad that I can’t play with my nieces or come over for dinner or whatever.”

Twos with chronic conditions may also be hesitant to enter into new relationships because they’re afraid of being a burden. They’re afraid people won’t want to be around them if they complain or that their pain will make others uncomfortable. Twos are proud when they can take others’ needs, and chronic pain comes in the way of that pride. What may help is learning boundaries and allowing yourself to express feelings, trusting that the people closest to you will love you as you are. Give yourself permission to be “selfish,” taking care of yourself instead of focusing on others. Be honest with others about how you are feeling and what you can handle.

Enneagram 3: I’ll Keep Busy to Distract Myself from the Pain.

Type Threes (Achievers) want to be valued and are concerned with what people think of them. They want to gain social approval, are good at seeing what people want them to be and becoming that person. The core emotion of Twos, Threes, and Fours is grief. While Fours overdo grief (wrapping themselves up in their emotions as a defense mechanism) and Twos are in conflict with it (because they feel like emotions get in the way of relationships), Threes numb themselves to their emotions so their feelings don’t get in the way of their goals. Threes are competitive, ambitious, and goal-oriented, incredibly competent at what they do.

In her study of Threes with chronic pain, Whillans notes, “The Type #3s tended to be emotionally affected by their pain and to distract themselves from their emotions by increasing their activity levels. They attempted to avoid being deeply affected by their pain, by the responses of others, and their emotions.”

I am a Three, and distraction is indeed my main method of coping with chronic pain and illness. I don’t like lying awake in bed with nothing to think about but the pain. I would much rather play video games, read a book, watch TV, or do something that engages my mind. I am afraid of the pain and the emotions that come with it. The fear is both rational (because pain hurts) and irrational (because I’ve experienced it over and over again and have survived).

My tendency to become what I think others want me to be affects my illness in several ways. I spent most of my childhood hiding my illness because I was afraid others would find it inconvenient or disgusting (IBS is not a socially acceptable condition). I bottled up my frustration and sadness because I didn’t want to feel those things. Threes also tend to value themselves through what they do—their careers, their goals, their projects. If illness and pain gets in the way of getting things done, they can find it incredibly frustrating.

Whillans also notes, “The practitioners were often missing symptoms.” I suspect this is also related to the Threes’ desire to become what they think others want them to be. I don’t always express accurately to doctors how much pain I’m in. I don’t lie on purpose, but my descriptions are often impacted by the doctor’s body language, demeanor, and bedside manner. If my doctor seems rushed and wants to get me out the door, I’ll become the easy patient and get out the door. If the doctor is frustrated because she can’t figure out what to do with me, I internalize that frustration and go with whatever treatment she suggests even if I don’t think it’s a good idea. Sometimes I don’t even mention all my symptoms, because I don’t want to “burden” her with a bunch of things all at once, even though that’s her job.

Type Threes may find some relief by being honest about their emotions (with themselves and with others). Consider how you’re adjusting your words, attitude, and even thoughts to feel accepted. Let yourself feel the grief that comes with being sick—if you feel the sadness and process it rather than stamping it down, it actually becomes easier to let it go. Surround yourself with people who will love you, illness and all, and will remind you that you are loved regardless of your condition or accomplishments. Let yourself rest even when your brain is telling you to DO ALL THE THINGS!

Enneagram 4: Is My Pain Real?

Type Fours (Individualists) want to be seen as unique. They are very in touch with their emotions—so much so that they can get too attached to them and refuse to let them go. The core emotion of Threes, Twos, and Fours is grief. While Twos are in conflict with grief (because they feel like emotions get in the way of relationships) and Threes underdo grief (because they dislike feelings), Fours overdo grief because they use melancholy as a defense mechanism. Fours are emotionally sensitive, intuitive, and creative people who have the capacity to process painful experiences and channel their emotions into empathy.

In her study of Fours with chronic pain, Whillans notes, “The pressing question of these Type #4s was ‘how can I heal?’ ‘Healing’ was defined as feeling deeply satisfied and whole, ‘even if I have to have pain.’ Their goals were internally focused, and not necessarily focused on their pain… The Type #4s tended to focus on altering their emotions in an attempt to alter their pain experience.”

Fours tend to focus on what’s going on inside them, so it makes sense that they attempt to harness their emotions to overcome their chronic pain. Whillans writes that Fours sometimes doubt the reality of their own pain to the point where their doctors start to doubt it as well.

Vanessa, a Type Four, says “I tend to disbelieve my pain—like, am I making this up? Am I really in pain at all? Could I just stop hurting if I wanted to? Is my pain really bad enough to take meds? Am I in enough pain to justify asking my loved ones for help?”

This doubt likely comes from the power Fours attribute to their emotions. Difficult emotions—anger, hate, grief, fear—can hurt just as much as a physical wound, just in a different way, and Fours are deeply attuned to this fact. So perhaps they more readily confuse physical symptoms with emotional ones, wondering if they are making their pain up.

Fours may experience depression and envy, thinking everyone else is healthier and happier and desiring that for themselves. Chronic illness can compound their fears of being deficient. Depending on the Fours’ subtype, some will keep personal details about their health to themselves because they’re afraid others won’t understand them well enough, while others will share freely and relish in the intensification of their suffering; they want to be pitied. Fours stay in sadness or even anger because they are familiar with it; in a way, it’s become comfortable. If they move on, they might experience feelings that are more foreign or uncomfortable. Chronically ill Fours may stay in that space because, if they leave it, all that will be left is the pain.

What may help a chronically ill Four is focusing on the moment and looking at what’s good in the here and now. Illness sucks, and it’s okay to just sit with that and grieve for a while, but maybe there’s hope to found as well. Try not to get caught up in “if only I wasn’t sick,” give people the opportunity to understand you instead of pushing them away, and get in touch with your body’s needs.

Stay tuned for the next post in this series, which will be about how Type Fives, Sixes, and Sevens (the head or thinking 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.

Daniels, David, M.D. “Working with the Enneagram Harmony Triads.” Dr. David Daniels,

“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 2 Enneagram Panel, YouTube, Apr 17, 2019,–M

The New School at Commonweal. Beatrice Chestnut – Type 3 Enneagram Panel, YouTube, Apr 17, 2019,

The New School at Commonweal. Beatrice Chestnut – Type 4 Enneagram Panel, YouTube, Apr 17, 2019,

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

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