Type D for distressed

(This article was first printed in the August 2005 issue of the Harvard Heart Letter. For more
information or to order, please go to www.health.harvard.edu/heart.)
A newl coined personalit tpe could signal a higher ris! for heart disease.
Do you sweat the small stuff, see the glass as half empty, have trouble making friends, and keep
your feelings bottled up inside? That combination could be particularly hard on your heart.
For more than a decade, researchers in the etherlands have been looking into a connection
between what they call type D personality and different aspects of heart disease. !f their findings
hold up elsewhere, type D could prove to be a significant contributor to heart disease. Then
again, if the hoopla around Type " personality was any indication, it could end up on the scrap
heap of faded ideas.
The D stands for distressed, says psychologist #ohan Denollet, of Tilburg $niversity in the
etherlands, who has led research in this area. Type D people tend to be an%ious, irritable, and
insecure. They keep an eye out for trouble rather than pleasure. They want to be liked by others
& don't we all? & and go to great lengths to avoid saying or doing things that others might not
like. "s a result, they are often tense and inhibited around others.
To see how you stack up, try the type D (uestionnaire below, which was published in the
#anuary)February *++, issue of "schosomatic #edicine.
D and the heart
Dr. Denollet and his colleagues have looked at the impact of type D personality on the heart from
various angles. Their first report, in -../, included *0/ men and women who had enrolled in a
cardiac rehabilitation program. 1ach filled out a personality (uestionnaire at the start of the
three2month program. "lmost one2third fit the type D pattern.
1ight years later, the researchers tracked down the participants to find out who had died and who
was still alive. "mong those classified as type D, *34 had died, compared with 5ust 34 of the
non2Ds. 6ost of the deaths were due to heart disease or stroke.
7ince then, type D personality has been linked with
early death
increased risk for developing cardiovascular problems after a heart attack
poorer response to proven treatments for heart disease
increased chances of sudden cardiac arrest.
!n another report, a different Dutch team followed almost .++ men and women who had received
a drug2releasing stent to hold open a blocked coronary artery. "fter 5ust nine months, ,./4 of
those with type D personalities had a heart attack or died of heart disease, compared with -.84
of the others.
9hat's the connection? o one really knows. :eople with type D personalities seem to have
more highly activated immune systems and more inflammation, which could mean more damage
to blood vessels in the heart and throughout the body. They also tend to have e%aggerated blood
pressure and other reactions to stress.
"nother possibility is that type D is a catchall for depression, an%iety, and poor social
connections, each of which has been linked with heart disease.
Tempest in a teapot?
The connection between personality types and disease doesn't have a very good track record.
;emember type ", the hard2driving, competitive type who couldn't rela%? <eginning in the late
-.,+s, a flurry of reports indicated that type " people were more likely to develop heart disease
than type <s =those who were more rela%ed and less competitive>. !n -.0-, a national panel of
e%perts concluded that type " behavior was a bona fide risk factor for heart disease. The idea
eventually imploded under the weight of several large studies that found no connection between
type " personality and heart disease.
The research wasn't a waste, though. !t got people thinking about how emotion, mood, behavior,
and social factors might affect the heart. Later work helped identify elements of type " behavior
that might actually protect the heart =like the drive to succeed and the dedication to make healthy
changes> and those that might harm it =like anger and hostility>.
The notion that there was a cancer personality & dubbed type ? & knocked around for a while,
but it, too, has been largely discredited.
More work to be done
!t is still too early to tell if type D personality will stand the test of time or follow types ", <, and
? into obscurity. ;esearchers still need to define the type D personality more carefully. They
also must see if the connection holds true in larger studies in various countries and populations.
That said, it looks as though Dr. Denollet is onto something. !nstead of focusing on individual
elements such as depression, an%iety, hostility, and social isolation, using broad personality traits
may be a faster or more efficient way to identify people at higher2than2average risk of heart
disease.
The problem with this approach is that it's easier to change a particular trait, such as hostility, or
a mood, such as depression, than it is to change a personality type. <ut as Dr. Denollet says, this
is 5ust the beginning of the research process, not the end.
The D-Scale 14
"ccording to Dr. Denollet and his colleagues, this brief (uestionnaire accurately identifies type D
individuals.
<elow are a number of statements that people often use to describe themselves. ;ead each one
and circle the appropriate number ne%t to that statement to indicate your answer. There are no
right or wrong answers@ Aour own impression is the only thing that matters.
0false 1rather false !ne"tral #rather tr"e 4tr"e
-> ! make contact easily when ! meet people + - * 8 BC
*> ! often make a fuss about unimportant things + - * 8C B
8> ! often talk to strangers + - * 8 BC
B> ! often feel unhappy + -C * 8 B
,> ! am often irritated +C - * 8 B
/> ! often feel inhibited in social interactions + - * 8C B
3> ! take a gloomy view of things + -C * 8 B
0> ! find it hard to start a conversation + -C * 8 B
.> ! am often in a bad mood +C - * 8 B
-+> ! am a closed kind of person +C - * 8 B
--> ! would rather keep people at a distance + -C * 8 B
-*> ! often find myself worrying about something + - * 8C B
-8> ! am often down in the dumps + -C * 8 B
-B> 9hen socialiDing, ! don't find the right things to talk about + -C * 8 B
$%e&ati'e affecti'ity$ scale( "dd scores for (uestions *, B, ,, 3, ., -*, and -8
$Social inhibition$ scale( "dd scores for (uestions -C, 8C, /, 0, -+, --, and -B
=CFor scoring (uestions - and 8, if you circled +, enter BE if -, enter 8E if *, enter *E if 8, enter -E if
B, enter +.>
Aou (ualify as a type D personality if you scored -+ or higher on both negative affectivity and
social inhibition scales.
(This article was first printed in the August 2005 issue of the Harvard Heart Letter. For more
information or to order, please go to www.health.harvard.edu/heart.)