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Are You a Type D Personality?

You’re probably aware of whether you tend toward a type A or type B personality, since those labels are part of our lexicon. What you may not know, however, is that there is a third type -- type D -- and it’s not a great category to find yourself in. The D stands for distress, and a growing body of research links this personality type with a variety of health risks and even early death -- so it may be especially important for these inhibited and gloomy folks to do everything they can to lighten up.

Remember Eeyore -- the sad, self-conscious donkey character in Winnie-the-Pooh? To my mind, he is a perfect illustration of the type D personality. He always expected the worst and therefore, that’s what he usually got. Traits associated with this personality type include social inhibition, a negative self-image, depressed mood, hostility, tension, chronic anger and a tendency to overreact to stressful events.

Type D & Death Risk

It’s already known that having this type D personality elevates risk for people who have had heart attacks, cardiac bypass surgery and/or stent implants. In new research from the University of Tilburg in the Netherlands, scientists set out to determine the impact of these characteristics on people with a common condition called peripheral artery disease (PAD), a circulatory problem in which narrowed arteries reduce blood flow to the limbs. People who have PAD have four to five times greater risk for heart attack and stroke.

Researchers asked 184 patients (average age 65) diagnosed with PAD to fill out a 14-item personality questionnaire to assess character traits, such as negativity and social inhibition. They rated statements such as "I would rather keep people at a distance" and "I often find myself worrying about something" as false or true on a scale of zero to four. During the next four years, 16 patients (9%) died -- six of cardiovascular disease, seven of cancer and one each from emphysema, pneumonia and acute pancreatitis. After factoring in other variables such as age, gender, diabetes and kidney disease, investigators learned that those with type D personalities were more than three times as likely to have died as those who were Type A or B.

How Distress Raises Risk

There are numerous pathways linking this particular personality type with poor health outcomes, I learned from study coauthor Johan Denollet, PhD, a professor of medical psychology at Tilburg University. Some are physical, other behavioral. For instance, Type D individuals tend to...
  • Experience chronic anxiety and negativity. Living in such a state has a variety of physical effects on your body, none beneficial. Chronic stress drives up levels of inflammatory proteins called cytokines, which leads to increased oxidative stress and contributes to disease. The adrenal glands respond to stress by pumping out cortisol, the hormone that helps us meet perceived threats. Having high and prolonged levels of cortisol in the bloodstream causes serious problems, including blood sugar imbalances, reduced immunity, slower wound healing and increased abdominal fat.
  • Have poor health habits. Research has shown that people with type D personalities often neglect their health by eating improperly, not having medical checkups and being sedentary.
  • Are unlikely to be proactive in seeking medical care. Perhaps because they are unable to express their emotions and are tense, insecure and uncomfortable in social situations, type D individuals are often slow to seek the medical help they need. In one study, type D patients with chronic heart failure experienced more cardiac symptoms and worried more about them than other people but, paradoxically, were less likely to discuss them with ealth-care professionals. Other research demonstrates that heart failure patients with "inadequate consultation behavior" face a six-fold increased risk for impaired health.

What Can Help

Generally speaking, you can’t change your personality -- but if you recognize these traits in yourself or a loved one, there are plenty of things you can do to address the issues and minimize the impact on your health. For example, Dr. Denollet notes that type D personalities are more likely to experience anxiety and depression -- and points out that these can be managed to a significant degree with counseling and/or medication. Other strategies include...

  • Adopting healthier lifestyle behaviors, such as better diet and regular exercise.
  • Participating in programs or counseling to conquer addictions, such as smoking or alcohol abuse, or to improve social skills and learn to relax.
  • Using techniques such as guided imagery, breathing exercises, meditation, tai chi and yoga to help manage stress and mood and learn to control anger and hostility.

While you can’t change who you are, if you have a type D personality, you can take these concrete steps to make yourself healthier and, I’llbet, happier.

Johan Denollet, PhD, professor of medical psychology, Tilburg University, Tilburg, The Netherlands.

March 10, 2010

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