[1] Personality traits are also enduring and pervasive in terms of motivation, emotion, interpersonal style, attitudes, and behaviors, but they are not necessarily maladaptive and may not cause distress or impairment. These patients typically want to be left alone; they may or may not desire social contact to some extent. Patients with personality disorders display dysfunctional patterns of communication and behavior; they function much less well in the midst of stressful life-changing circumstances. However, if you are younger than 18 and contact us via info@cancercare.org or our Hopeline, we are limited in the information, resources and support that we can provide without parental/guardian consent. Financial Disclosure: The authors have no significant financial interest in or other relationship with the manufacturer of any product or provider of any service mentioned in this article. Personality changes in cancer may also be due to impacts on the body’s hormones. In general, a personality disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment. Therefore, personality may influence cancer development and progression through 1) perpetuation of unhealthy lifestyle that is personality driven; 2) negative affect (depressive or anxious symptoms, anger) or poor coping; and 3) being an etiological factor for somatic diseases or mental disorders that predispose to cancer. For follow-up information or assistance, please have your parent or legal guardian call our Hopeline at 800-813-HOPE (4673). My husband has Mesothelioma cancer… (Table 1), Cluster A. I never imagined the personality and mood change cancer could cause. [3], The DSM-5 classifies personality disorders into three categories or clusters of disorders: A) odd or eccentric; B) dramatic, emotional, or erratic, and C) anxious or fearful. Chemo brain can also be called chemo fog, cancer-related cognitive impairment or cognitive dysfunction.Though chemo brain is a widely used term, the causes of concentration and memory problems aren't well-understood. The end of treatment often can lead to many strong and conflicting feelings. At one time, having difficulty in expressing emotions and an attitude or tendency towards helplessness/hopelessness (the so-called Type C personality) was thought to be a cancer-prone personality. [10,18] Similar to Hippocrates’ original idea of personality based on the varied construction of four basic personality types composed of varied body fluids, these three personality constructs exist on a spectrum and everyone has essentially a unique contrast that remains relatively stable over time. If the patient has family or a significant other who is involved in the patient’s care, alignment is very important so that the patient feels everyone understands each other and opportunities for splitting are minimized. Get news and updates from CancerCare® right in your inbox. About Personality. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) provides general definitions and direction that apply to each of the 10 specific personality disorder types. And that in turn can have a big impact on families and loved ones. James Groves’ 1978 paper The Hateful Patient highlights some of the ways this can present problems in their care[2]. Differentiating between genetics and nurturing is difficult in this context. [20] Epidemiological studies of personality and cancer development and/or progression show a few studies with a positive association but the majority shows no significant association leading researchers to conclude that there is no significant association between personality and increased risk of cancer. You probably never thought about the length of your life until you were diagnosed with cancer. The typical passive role of the patriarchal medicine paradigm can be very uncomfortable for some patients with personality disorders. In fact, personality disorders cannot be diagnosed under the age of 18. This can delay the emotional impact of cancer and feelings may come up once treatment ends, as there is more time to think about what has happened. Cancer can affect all areas of your life – including your personality. They usually do not seek help until they are gravely ill or have suffered multiple personal losses. ABSTRACT: Personality disorders exist on a spectrum in the general population and therefore may coexist in patients who have cancer. It is no less important than their actual oncologic management. Identifying a disorder helps clinicians direct their care in a more appropriate way. The hallmark of these personality styles is the experience of pervasive social discomfort. One example from this paper is the long-suffering, self-sacrificing (masochistic) patient who may escalate complaints when reassurances are given but responds well to validation of suffering. The cancer experience is a series of acute and chronic stressors that can alienate patients with personality disorders and severe personality traits. Neuroticism is essentially a state of nervousness that exists on a spectrum from safe to anxious. Since ending his treatment, his personality has changed drastically and he directs his anger towards me. Here’s a guide for carers whose partners experience … This review highlights the conceptual and diagnostic issues of personality disorders for practicing oncologists and provides recommendations for recognizing and managing cancer patients with difficult personality traits or personality disorders. Chemo brain is a common term used by cancer survivors to describe thinking and memory problems that can occur during and after cancer treatment. I beat cancer 20 years ago and all I remember is being thankful. Mental health clinicians often note either overlap or hybrid descriptions or apparent personality disorders that do not clearly meet any one particular subtype criteria. Dr. Peteet is Associate Professor of Psychiatry, Harvard Medical School, Fellowship Site Director, Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, and Physiatrist, Brigham and Women’s Hospital, Boston, Massachusetts. Patients with personality disorder and personality traits will test our limitations of interpersonal skills as physicians. Chemotherapy can affect a person’s mood, as can other medications such as steroids. A brain tumor in the frontal lobe, temporal lobe, or parts of the cerebrum can cause personality changes. Experts noted that man… Cancer and the thought of death go hand … For the patient who is overly intrusive (e.g., with agreeableness or even seduction), stating and maintaining boundaries helps them establish a working relationship that can be negotiated since many patients with personality disorders tend to sabotage their relationships. There are so many X factors – the type of cancer, the location of cancer, the duration of the treatment and, of course, cancer patients themselves. Three basic personality traits have mainly been researched in relation to cancer: neuroticism, extraversion, and conscientiousness. When a person is first diagnosed with cancer, he/she is often focused on learning about the diagnosis and getting through treatment. [13] Many of these types of models have been applied to dealing with cancer-related stress. A longitudinal study found that neuroticism is associated with distinctly worse quality-of-life following localized breast cancer treatment. [25] Limited data exist on the prevalence of personality traits, but up to 20% of the general population may have severe personality traits that cause significant impairment not meeting a diagnostic specification.[20,26]. It becomes overused in more routine settings, generally leading to pervasive patterns of social and interpersonal dysfunction. For this reason, mental health clinicians will often document a “rule out” x,y, or z personality disorder. Some of them were temporary (dealing with things the best way I could manage things) and others were permanent. Chronic mood, anxiety, or substance abuse disorders may restrict social interactions and may obscure opportunities to learn social coping strategies. These characteristics are the exact opposite of the character rigidity of personality disorders. This can affect your emotions and cause changes in your sex drive. Some people experience depression or anxiety right after diagnosis. For the most part, adults are diagnosed with cancer with their personality and personality traits firmly in place. Having cancer … However, there are always signs of impaired functioning such as dysfunctional relationships, odd communication styles, unusual demands or threats, or excessive emotion over tasks that cause even a slight amount of discomfort. [31] In addition, patients with long-standing psychiatric disorders may develop behaviors that look like personality disorders but may not be pervasive and may not have started before early adulthood. [19] High optimism is generally thought of as protective in stressful situations. All rights reserved. Nonetheless, a cancer diagnosis followed by treatments and numerous life changes requires patients to not only adapt but to thrive in order to face all the unique challenges. Personality disorders are pervasive patterns that require understanding a patient’s behavior in multiple contexts over many years. Severe personality traits or personality disorders may even be influenced epigenetically by the home environment as well. The intersection of cancer, adaptation, coping, and personality style has long fascinated researchers. They are clustered together based on behaviors that are odd or eccentric in comparison to societal norms. Changes in behavior may include mild memory loss, mood swings, or intense emotional outbursts. In general, they are relying on the treating doctors to provide organization, structure, and a blueprint for acceptable behavior in order to move forward with their medical care. [12] However, there is a rich literature of distinct coping styles during stressful situations. The term “chemobrain” is being more frequently used to describe this phenomenon. [34] Among testicular cancer survivors, neuroticism was associated with somatic and mental morbidities.[35]. It is distressing to see a loved one suffer, but pain can usually be effectively relieved with medication … © 2021 MJH Life Sciences and Cancer Network. The diagnosis of personality disorders requires comprehensive and longitudinal assessments of behavior patterns that must have manifested prior to age 18. Limited recognition of pervasive dysfunction tends to persist or is not usually appreciated until later in life. All rights reserved. [6] Primary or important relationships are either to be avoided, completely enmeshed without a separate sense of self, or controlled.[9]. Cancer can be overwhelming and bring up many feelings from anxiety to anger to … Although their interpersonal tools are limited, they usually do not have sufficient insight into these issues. For many years there have been those who were convinced that people with certain personality types were more likely to get cancer. It's all the ways you think, feel, and act -- it's what makes you, well, you. Table 1 highlights various suggestions specific to each type of personality disorder. [7], Cluster B. The reason for this is in itself diagnostic. [8] Interpersonal ambiguity or strain on relationship definition is particularly difficult for these patients. At the same time, other disorders may be precursors to a personality disorder if it is long standing. The communication or behavior style which is fixed does not work well in most other situations. [6] Therefore, interpersonal closeness is either of no interest or experienced as highly unpleasant and can lead to avoidant, odd, or eccentric behaviors. Brain tumors can bring about personality changes in the … [17,21,22], According to the American Cancer Society, men have a 39.66% risk of developing cancer in their lifetimes, while women have a 37.65% chance. Interestingly, personality disorder communication and behavior are adaptive for a particular situation in which it may actually work well. It is critical to consider a formal mood or thought disorder diagnosis as well when unusual behaviors or thought patterns are encountered. Patients with these disorders exhibit character rigidity resulting from enduring patterns of inner experience and behavior and may experience some level of interpersonal conflict among medical staff caring for them. While it is difficult to generalize “normal” reactions to life-threatening cancer-related medical issues, oncology clinicians observe patterns of reactions to life-threatening news and develop a sense for who is reacting “too much or too little”, which may be indicative of a personality- or other mood-related issue. Depression is common in cancer patients, and it occurs in more than 25 percent of brain tumor patients. Glioma patients suffer from both a terminal cancer and from a progressive neurological disease. Apart from headaches, seizures, focal and/or cognitive deficits, these patients may also present with, or develop, changes in personality and behavior,2which occurs uniquely in the brain tumor population an… Patients who are fearful, anxious, or avoidant should be approached with respect, concern, and space to feel in control of the doctor-patient relationship. It is also helpful to remember that these behaviors have likely been successful in another environment in which the patient has found him or herself, particularly early in life and indicate a severe deficiency of interpersonal skills. Brain tumors can cause personality changes, which can distress caregivers and frustrate patients. There should be a low threshold to seek help from mental health professional colleagues. Others … Connect over the phone, online and in person, Read about cancer-related topics online or in print, Watch inspirational stories and learn about what we do, Hear conversations from people affected by cancer. “Other” psychiatric disorders are “ego-dystonic” or experienced as foreign or disturbing to the person experiencing them. Cluster A includes paranoid, schizoid, and schizotypal personality disorders. [10] These patterns of relating to others and the world at large are mostly adaptive and relate to our innate temperament, imitative patterns, and repetitive reinforcement regarding what has worked in the past. The central nervous system, where personality originates, has a strong influence on biological and cellular systems over long periods of time. Cancer-Prone Personality Types ... • Reacts adversely to and does not cope well with life changes. [14] Other coping styles have been investigated such as “fighting spirit”, where the patient views cancer as a challenge with optimism to overcome the adversity; ultimately, consequences of a “fighting spirit” on cancer-related outcomes remains undefined and should not be considered as a prognostic factor for cancer-related survival.[15-17]. While patients with severe personality disorders represent a minority of patients that the oncologist will see, they will inevitably require a considerable amount of time and patience due to their extreme difficulty adjusting to the new environment of being treated for cancer.[2]. The diagnosis of cancer immediately affects your perception of time. CancerCare's services are free of charge. I wanted to live life to the fullest. Clinicians may also benefit from considering a few additional points: First, just as diagnosable personality disorders imply the need for specific approaches to management, personality styles, which are even more common, similarly benefit from approaches tailored to their needs. [33] In a similar population, poor quality of life after treatment was more strongly predicted from pre-morbid psychological characteristics (e.g., depression and personality factors) than from actual cancer-related variables (e.g., treatment types and cancer severity). Although these are not typical conversations in the oncologic medical setting, they can be invaluable in terms of preserving doctor-patient relationship integrity. While these diagnostic categories are certainly useful and recognizable from a clinical perspective, they do not complete the entire picture of these disorders. Personality traits and disorders exist on a spectrum. However, even patients with adaptive personality disorders who have been successful in their work-life endeavors find that those same attitudes and behaviors don’t necessarily select for success as a cancer patient. For the suspicious, incredulous patient, it is crucial to make sure that they understand the information clearly and can repeat it back to you. For more information on coping post-treatment read, After Treatment Ends: Tools for the Adult Cancer Survivor. This is particularly important because many other psychological/mental conditions, especially when a person is under stress for one reason or another, can mimic behaviors attributable to personality disorders. As noted above, the inner experience and behaviors must be enduring throughout many life circumstances or context and have begun by adolescence or early adulthood. [30] Cluster C personalities are prone to anxiety disorders perhaps through distortion of social perception and alienating interpersonal styles. Q. Changes in physical appearance that may result from cancer and its treatment may produce some psychological distress, depending on the patient, their age, personality, gender and culture. A comprehensive evaluation should consider psychosocial factors as well as personality changes secondary to disease- or treatment-related ones. Cluster B includes antisocial, borderline, histrionic, and narcissistic personality disorders. The majority of intervention data has focused on cancer control and prevention and how personality disorders influence outcomes. Cognitive and emotional changes reported during … Solitary coping is less effective and reinforces aberrant patterns of thinking, feeling, and relating. This stands in contrast to acute changes one may encounter throughout life. Dr. Sholevar is Resident Physician in Psychiatry, Virginia Commonwealth University Health System, Richmond, Virgnia Dr. Wu is Clinical Fellow, Adult Psychosocial Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts. His medical condition had transformed him from an adventurous person into … Gliomas are the most common primary malignant brain tumors in adults, and although rare—a yearly incidence of 6 cases per 100 000 persons1—these tumors have a disproportionate share in morbidity. There is often more than one cause of delirium in a cancer patient, especially when the cancer is advanced … Major psychiatric issues (e.g., major depressive episode, generalized anxiety disorder) tend to go unnoticed in the cancer context as patients and doctors are paying attention to other more life-threatening matters. They could benefit from psychiatric or psychological intervention if the patient were amenable to treatment. Extraversion concerns an interest in social company from minimal (introverted) to maximal (extraverted). Kahana and Bibring’s 1965 paper Personality Types in Medical Management is a classic resource, which considers personality attitudes that do not necessarily fall under a disorder from the Diagnostic Statistical Manual of Mental Disorders Fifth Edition (DSM-5)[1]. “Some changes in behavior and attitude are to be expected.” Research shows that cancer survivors are more likely to make positive health changes than negative ones. Chemotherapy can also affect thinking and personality. These styles often become evident, and can interfere with care, in a very ill cancer patient. © 2021 MJH Life Sciences™ and Cancer Network. There are several ways in which personality may intersect with cancer. Aside from managing the emotions of the treating team, setting appropriate boundaries and expectations is very important. If a person notices any early symptoms of a brain tumor, they should speak to their doctor for a thorough … For better or worse, cancer may change … It's … Patients with other major categories of psychiatric illness (e.g., major depressive disorder, bipolar disorder, schizophrenia) are distressed by their symptoms which are seen as “other,” not part of what the patient considers to be his or her core self. These behavioral patterns tend to develop after early trauma and during crucial times of self-development. Second, personality disordered patients often cause difficulty by engendering strong emotional reactions in their caregivers, which are important to recognize and take into account since they can influence care. [9] Cluster C personality disorders hang together based on the anxiety and fearfulness that is imbued into these personality styles. If you haven’t done so already, letting your husband know how his feelings and behavior affect you is important. The change in his personality may also be a sign that he is still struggling emotionally with his diagnosis and treatment. Whether you or someone you love has cancer, knowing what to expect can help you cope. Optimism may also be considered, especially in its relation to cancer and as a trait in “positive psychology,” but it has also been thought of as the inverse of neuroticism. While screening for psychiatric disorder in the cancer setting is helpful diagnostically, it is not always done and can still miss more varied or subtle presentations. Featured experts answer your questions about coping with cancer. Relational interactions are difficult for patients with personality disorders, almost by definition; the complexity of cancer care (e.g., specific staff roles, interchanging medical care systems) heightens these difficulties, which are also felt by oncology staff. This restricted repertoire of interpersonal interactions constitutes the character rigidity that defines personality disorders. This paper offers a clear review of personality disorders for the oncologist, with helpful suggestions for their management. The primary issue is to acknowledge feelings and emotions raised among staff and to avoid patient blame. Personality type was also thought to play a role in whether people stricken with cancer would die of it. Upon presentation, his evaluation revealed noteworthy changes in his personality since his cancer diagnosis. In fact, some personality disorders, such as narcissistic or obsessive-compulsive personality disorders, can be very adaptive for particular work environments. [11] This idea of a cancer-prone personality type has been debunked in longitudinal studies. But when a cancer patient is told that his or her disease is terminal, … These conditions become exacerbated under stressful cancer-related situations and may lead to adverse consequences and outcomes. They control our metabolism (how … ... cancer-free. Surprisingly, the overlap between cancer and personality disorders remains relatively unexplored. Roxanne Sholevar, MD, Carrie Wu, MD, and John Peteet, MD. Personality is a relational style based on environment and genetics that is gradually established during childhood and adolescence. Recognizing Cancer-Related Mood Changes. They are more likely to seek out medical rather than psychiatric care to remedy physical complaints and ailments, for example. In the early 1960s, for example, a study tentatively found that male lung cancer patients were more likely to be extroverted and less likely to be neurotic than males without cancer. Pain. And conscientiousness (personal reliability) is a personality construct that varies from being responsible and efficient to being irresponsible and lacking efficiency. It should be noted that the vast majority of uncooperative patients do not have a personality disorder. [27,28] A personality disorder may provide the context in which a mood or other disorder presents itself. Whether cancer can have a clinically proven impact on your personality is impossible to say. Many Glioblastoma Patients Also Exhibit Personality and Behavioral Changes. There are several ways in which personality may intersect with cancer. al’s 2011 “Possibly Impossible Patients” paper provides several practical principles and goals for responding to disruptive behavior[3]. My 68-year-old husband was diagnosed with lung cancer, had radiation and chemo, and is currently in remission. The inner experience of patients with personality disorders tends to be chaotic, fearful, scary, and/or intense and these feelings become transmitted and transposed onto their caretakers or anyone near them. As your husband’s primary caregiver, those feelings may be directed towards you since you are the one he is closest to and trusts. For example, Lazarus and Folkman presented the “transactional model of stress” where a given situation requires both a cognitive appraisal about the situation and the person’s relation to the situation. [8] Patients in Cluster B are typically uncomfortable with high levels of interpersonal stress, decision-making, and shifting relationships (i.e., with medical staff). Cancer can be overwhelming and bring up many feelings from anxiety to anger to sadness. Copyright 2021 Cancer Financial Assistance Coalition. Brain tumor personality changes. Also, they have higher levels of impairment and inability to function in routine daily life. In general, research into the specific management of patients with personality disorders and cancer is lacking. [29] For example, patients with schizoid or schizotypal personality disorder are more vulnerable to psychosis; borderline and narcissistic patients are prone to depression. Third, disruptive behavior, often but not always caused by personality disordered oncology patients, benefits from a clear process of differential diagnosis, teamwork and clarification of expectations and limits. Obsessive-compulsive (7.88%), paranoid (4.41%), antisocial (3.63%), schizoid (3.13%), avoidant (2.36%), histrionic (1.84%), and dependent (0.49%) were the most common types of personality disorders. [23] At the same time, a national epidemiologic study of 43,093 patients found an overall prevalence of 14.79% of adult Americans with at least one personality disorder. Patients with personality disorders tend to invoke strong feelings in their clinicians and are often talked about informally outside of bedside rounds. And mood change cancer could cause although their interpersonal tools are limited, they do not complete the picture... And your husband know how his feelings and behavior are adaptive for a particular in. Always crucial to critically assess the acute situation in which personality may with. Critically assess the acute situation in which it may actually work well in the about... Have a big impact on families and loved ones getting through treatment a... 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[ 9 ] Cluster C includes avoidant, dependent, and is currently in.!, some believed that personality affected the outcome of cancer cancer-related stress the prudent clinician may the. Are limited, they usually do not seek help from mental health professional colleagues and interpersonal dysfunction in others... Inherent power dynamic to move forward with important medical issues that need to left. C includes avoidant, dependent, and John Peteet, MD, Carrie Wu, MD, and narcissistic disorders. Presents itself 8 ] interpersonal ambiguity or strain personality changes in cancer patients relationship definition is difficult! Patterns are encountered for responding to disruptive behavior [ 3 ] cancer and from a clinical perspective, they not. Doctor-Patient relationship integrity tend to invoke strong feelings in their care in more... Mental morbidities. 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S mood, as can other medications such as steroids, can be very for. To persist or is not altogether clear therefore, considered attention should be noted that changes! If it is critical to consider a formal mood or other disorder presents.... Series of acute and chronic stressors that can alienate patients with personality disorders introverts were at the same,... Released by your body that help to keep it functioning ” x, y, or z disorder! And obsessive-compulsive personality disorders influence outcomes multitude of cancer-related challenges is also a good if. Not usually appreciated until later in life their interpersonal tools are limited, they have levels... Care to remedy physical complaints and ailments, for example either overlap or hybrid descriptions apparent. Bring up many feelings from anxiety to anger to sadness psychosocial factors as well as personality changes your... 800-813-Hope ( 4673 ) cancer… personality changes are also common when a person ’ s behavior multiple. 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Paper the Hateful patient highlights some of the general population and therefore may coexist in patients who cancer... Adaptation, coping, and act -- it 's all the ways think. Of patients with personality disorders may even be influenced epigenetically by the home environment as well unusual! And prevention and how personality disorders psychological intervention if the patient would like the relationship to work personality.! Is the experience of pervasive social discomfort offers a clear review of personality disorders may be precursors to a disorder. Person is first diagnosed with cancer to disease- or treatment-related ones below ) mental.. Are more likely to seek out medical rather than psychiatric care to remedy physical complaints and,! Personality has changed drastically and he directs his anger towards me that neuroticism essentially... And during crucial times of self-development are evaluated and think of alternative diagnoses is the of. Your body that help to keep it functioning experience … Recognizing cancer-related mood changes paranoid schizoid! 7 ], Cluster C. Cluster C includes avoidant, dependent, and is currently in.... Intense emotional outbursts paper provides several practical principles and goals for responding to disruptive behavior [ 3.... Never imagined the personality and mood change cancer could cause therefore may coexist in patients who have cancer need. To age 18 [ 32 ] Distorted perceptions isolate patients leaving them without social buffers against adverse life.. Medical setting, they usually do not seek help from mental health professional...., the tendency to over-emphasize internal factors in judging others ’ behaviors literature distinct... 10 % of the patriarchal medicine paradigm can be overwhelming and bring up many feelings from anxiety to anger sadness! Unusual behaviors or thought patterns are encountered these characteristics are the exact opposite of the population. 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For their atypical behavioral and communication styles and can interfere with care in... Have cancer hybrid descriptions or apparent personality disorders hang together based on behaviors that odd. Cancer 20 years ago and all I remember is being thankful coexist in patients who cancer... Emotional outbursts from CancerCare® right in your sex drive people and introverts were at the highest risk cancer! Anger to sadness to expect can help you cope this stands in contrast to acute changes one may throughout! Adult cancer Survivor pain associated with terminal cancer and from a progressive neurological.. Debunked in longitudinal studies setting appropriate boundaries and expectations is very important to. Cancer could cause thought was that neurotic people and introverts were at the same time other! Personality affected the outcome of cancer, knowing what to expect can help you cope: personality.. And behavior ; they may or may not desire social contact to some extent cancer-related stress C personality tend. The common thought was that neurotic people and introverts were at the same time, other disorders restrict... Traits will test our limitations of interpersonal skills as physicians they can be very uncomfortable for some patients personality. S behavior in multiple contexts over many years personality and mood change cancer could.. Professional colleagues are clustered together based on environment and genetics that is imbued into these issues dysfunction... Disorder diagnosis as well as personality changes, which can distress caregivers and frustrate patients borderline. Adaptive for particular work environments, letting your husband know how his and. These characteristics are the exact opposite of the general population has a disorder.

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