The notion that a singer’s voice is an expression of their personality serves as the catalyst for an examination of the relationship between the continuum of introversion and extraversion, and the pathologies of muscle tension dysphonia, vocal nodules, and performance anxiety. This paper begins with a brief introduction defining extraversion and introversion, followed by a review of personality studies identifying opera singers as primarily extraverted. Definitions of vocal nodules and muscle tension dysphonia are then given along with a list of recommended therapies. These elements tie in with two studies in speech pathology that suggest that behaviors of extraversion contribute to the development of vocal nodules, and behaviors of introversion contribute to muscle tension dysphonia and a higher laryngeal placement. Performance anxiety is shown to compound the behaviors that lead to vocal pathologies in singers. Additional therapies are recommended to address anxiety management in vocal lessons. Finally, since personality factors that contribute to vocal pathology are psychological, it is recommended that voice teachers refer their students to a psychotherapist for proper treatment.