www.ijellh.com 148 Type-D Personality and Adverse Health Outcomes- An Overview Dr. Jasbir Rishi Associate Professor HMV, Jalandhar India Abstract Type D personality, a concept used in the field of medical psychology, is defined as the joint tendency towards negative affectivity (egg. Worry, irritability, gloom) and social inhibition (e.g. reticence and a lack of self-assurance). The letter D stands ‗distressed‘. Type-D can be assessed with the standardized 14-item Type-D Scale (DS14) that measures negative affectivity and social inhibition (7 items for each domain) (Denollet, 2005). Several studies have demonstrated that Type D is associated with a four-fold increased risk of mortality in coronary heart disease (CHD) patients, independent of traditional biomedical risk factors (Denollet et al.,2000; Denollet et al., 2006).The studies included in this review showed that the presence of Type D characteristics had a negative impact on mental health status (more symptoms of depression, anxiety, post-traumatic stress disorder, mental distress, passive coping, and less social support) and physical health status (more somatic complaints, lower health status, more influenza-like illness reporting). Other studies reported on behavioural and biological mechanisms of disease in apparently healthy individuals with a Type D personality.
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www.ijellh.com 148
Type-D Personality and Adverse Health Outcomes- An Overview
Dr. Jasbir Rishi
Associate Professor
HMV, Jalandhar
India
Abstract
Type D personality, a concept used in the field of medical psychology, is defined as the joint
tendency towards negative affectivity (egg. Worry, irritability, gloom) and social inhibition
(e.g. reticence and a lack of self-assurance). The letter D stands ‗distressed‘. Type-D can be
assessed with the standardized 14-item Type-D Scale (DS14) that measures negative
affectivity and social inhibition (7 items for each domain) (Denollet, 2005). Several studies
have demonstrated that Type D is associated with a four-fold increased risk of mortality in
coronary heart disease (CHD) patients, independent of traditional biomedical risk factors
(Denollet et al.,2000; Denollet et al., 2006).The studies included in this review showed that
the presence of Type D characteristics had a negative impact on mental health status (more
symptoms of depression, anxiety, post-traumatic stress disorder, mental distress, passive
coping, and less social support) and physical health status (more somatic complaints, lower
health status, more influenza-like illness reporting). Other studies reported on behavioural
and biological mechanisms of disease in apparently healthy individuals with a Type D
personality.
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REVIEW OF STUDIES
Psychological factors such as health related belief social, coping styles and personality type
are important predictors of health and illness. Acute and chronic psychological distress has
been associated with the pathogenesis of coronary heart disease (CHD). People with
‗distressed‘ type D personality may face a higher risk of the future cardiovascular problems.
Medicine and Psychology have long been separate discipline, despite the lack of
interdisciplinary studies and research doctors are aware that psychological traits influence the
incidence as well response to the treatment. Psychological factors such as health related
belief, social support, coping styles and personality type are important predictors of health
and illness. The individuals with different personality characteristics have been found to
differ in the way they explain symptoms and seek medical assistance.
The personality classification system that identified ,‖Type A‖ decades ago, more recently
defined ―Type-D‖ as a personality marked by chronic negative emotions , pessimism and
social inhibition. The Type-D profile is relatively new, but the number of studies tracking
Type-D patients and future health is growing. Recent studies have uncovered biologica and
behavioural pathways that may explain the adverse effect of Type-D.
Individual with a Type D personality have the tendency to experience increased negative
emotions across time and situations and tend not to share these emotions with others, because
of fear of rejection or disapproval. John Denollet (1996) professor of medial psychology at
Tilburg university, Tilburg, The Netherlands, developed the construct based on clinical in
cardiac patients, empirical evidence, and existing theories of personality. The prevalence of
type D personality is 21% in the general population Denollet (2005) an ranges between 18 to
53% in cardiac patients Pedersen and Denollet (2006)
Type-D patients appear to respond differently to cardiovascular stress. Type-D is associated
with differences in cortisol , stress hormones that can temporarily increase blood pressure. It
also may be related to elevated levels of inflammation. In addition, heart patients with Type-
D personality may be less likely to get regular medical checkups or communicate effectively
with their physician ( Science daily 2010). Thus the research in the field shows the use of
Type-D personality construct in clinical practice is of practical value.
Type D is a personality construct that is used to describe individuals that experience high
levels of negative affect along with high levels of social inhibition (Denollet et al, 1996).
Research has examined the effect of Type D on patients with established cardiovascular
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disease (CVD),and has indicated that Type D individuals have a poorer clinical prognosis
than non-Type D individuals (e.g. Denollet at al. 2006).
Type-D personality, a concept used in the field of medical psychology, is defined as the joint
tendency towards negative affectivity (e.g. worry, irritability, gloom) and social inhibition
(e.g. reticence and a lack of self- assurance). Research has shown that CHD patients with a
Type-D personality have a worse prognosis following a myocardial infarction (MI) as
compared to patients without a Type-D personality. . Seven items refer to negative
affectivity, and seven items refer to social inhibition. People who score 10 points or more on
both dimensions are classified as Type D. There is increasing evidence that cardiac patients
with a distressed (Type-D) personality comprise high risk patient, and that Type-D is an
important determinant of patient centered and clinical outcome. People who are Type-D,
says J.Denollet, a professor of psychology at Tilburg university in Netherland, have a
negative outlook on life and tend to suppress these feelings and emotions A high score on
the two stable personality traits , negative affectivity and social inhibition defines patients
with the personality D Type (Denollet ,2005).In a study published in ―circulation‖ Denollet
and his colleagues pooled 19 studies involving more than 6000 patients with Type-D
personalities and measured their rates of recurrent heart events compared to non-Type-D
individuals. Type D has been associated with a 4-fold increased in morbidity and mortality in
patients with (CHD) independent of established biomedical ethic factors. Denollet et.al
(1996, 1998). Research on the Type A behaviour pattern suggested that psychological factors
were related to increased risk of heart attacks, but further investigations on Type A behavior
were inconclusive (Rozanski et al., 1999). Subsequently, researchers turned their focus
towards isolated factors such as hostility, depression, anxiety, social isolation, and chronic
stress (Matthews, 2005; Rozanski et al., 1999, 2005; Strike & Steptoe, 2004) to document a
relationship between psychological factors and poor cardiac prognosis (Rozanski et al.,
2005).
More recent studies have also demonstrated a similar relationship between Type D and
mortality in patients with chronic heart failure (CHF) (Schiffer et al., 2010), and peripheral
arterial disease (PAD) (Aquariuset al., 2009). Research has also found that Type D
personality is associated with maladaptive Health related behaviour Type-D patients appear
to respond differently to cardiovascular stress. Type-D is associated with differences in
cortisol stress hormone that can temporarily increase blood pressure. It also may be related to
elevated levels of inflammation. In addition, heart patients with Type-D personality may be
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less likely to get regular medical checkups or communicate effectively with their physician (
Science daily 2010).Thus the research in the field shows the use of Type-D personality
construct in clinical practice is of practical use in clinical and epidemiological research.
The DS14 scale has been validated in Belgian (Denollet, 2005), Chinese (Yu et al., 2008),
Danish (Pedersen &Denollet, 2004; Spindler et al., 2009), Dutch (Denollet, 2005), German
(Grande et al., 2004), Italian (Gremigni & Sommaruga, 2004) and Ukrainian (Pedersen et al.,
2009) cardiac patients and healthy controls. The individuals with different personality
characteristics have been found to differ in the way they explain symptoms and seek medical
assistance.
The personality classification system that identified ,‖Type A‖ decades ago, more recently
defined ―Type-D‖ as a personality marked by chronic negative emotions , pessimism and
social inhibition. The Type-D profile is relatively new, but the number of studies tracking
Type-D patients and future health is growing. Recent studies have uncovered biological and
behavioural pathways that may explain the adverse effect of Type-D
Type-D personality was studied on the populations included policemen, nurses, psychiatrists,
prison workers, employees at a manufacturing plant, female teachers, right-handed males,
university students, undergraduates, youngsters, twins, and respondents from the general
population. The most frequently used questionnaire to determine Type D personality was the
14-item DS14 scale.
Another study assessed Type D by a combination of the Amsterdam Biographical
Questionnaire, the Spielberger Trait Anxiety Inventory and the Young Adult Self-
Report after the combination of scales method, 20 items were selected and used to determine
Type D status.
Whereas the majority of publications on Type D personality among patients with
cardiovascular diseases originate from the Center of Research on Psychology in Somatic
diseases (CoRPS) at Tilburg University, the Netherlands, only 6 studies in the present review
originated from CoRPS and 13 studies on Type D in the general population were performed
by other research groups. The studies were conducted in populations from 8 different