'Type D' Personality: How Distress Affects Your Health

Research suggests this set of traits, characterized by negativity, comes with health risks.

Video: The Dangers of Heart Disease

If you're a socially awkward, glass-half-empty sort of person, take note: New research suggests having a "distressed" personality may jeopardize your health. A study published today in the journal Circulation: Cardiovascular Quality and Outcomes finds that those with this personality type, known as Type D, are at three times the risk for future heart problems, including peripheral artery disease, heart failure, and death, compared to more optimistic sorts.

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Type D personality, first defined in the '90s, is characterized by feelings of negativity, depression, anxiety, stress, anger, and loneliness. Type D personalities sweat the small stuff and often expect the worst. They have trouble making friends and often have low self-esteem. They are tense, chronically angry, and overreact to stressful situations; they also tend to conceal their feelings from others out of fear of rejection. About 20 percent of healthy Americans are Type D's, as are up to half of people being treated for heart problems, says study author Johan Denollet, a psychologist at Tilburg University in the Netherlands.

Denollet and his colleagues analyzed 49 previous studies involving more than 6,000 people and found that Type D spells trouble—especially for heart patients, who had a greater risk of dying if they had this personality type, compared to non-D's. "It really adds weight to the argument that this core, hostile personality is a concern—or ought to be a concern—for people who have it," says Barry Jacobs, a clinical psychologist and American Heart Association spokesman. "If you perceive things in a particularly skewed, negative way, your body will become more reactive over time, and there will be long-term health consequences." In previous research, Denollet studied nearly 300 heart patients in a cardiac rehabilitation program and found that 27 percent of those classified as Type D died within eight years (mostly of heart attacks and strokes), compared to 7 percent of the non-D’s.

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The link between Type D personality and poor health outcomes is most likely driven by its hallmark high stress levels, Denollet says. Unlike Type A's who vent, Type D's—who don't tend to speak up for themselves or express their emotions—have no outlet for their stress. Stress causes high cortisol levels, which, in turn, can elevate blood pressure and lead to chronic, artery-damaging inflammation. Behavior probably plays a role, too, says Denollet, since Type D's are less likely to exercise, quit smoking, and are rather bad at "complying with treatment programs." And because they're typically tense and insecure in social situations, Type D's may also shy away from seeking medical care or prefer not to discuss worrisome symptoms with their doctors.

A 14-question scale is used to determine whether folks have Type D. But you can ask yourself the following questions: Do you often feel unhappy? Is your view of the world gloomy? Are you often irritated, or in a bad mood? Do you make a big deal out of unimportant issues? Is it difficult for you to start conversations? Do you tend to keep people at a distance? Answering yes to several may clue you in that you need to make some changes.

While personality can be tough to change, psychotherapy and cognitive behavioral therapy may help those who find that their extreme pessimism or social withdrawal affects their daily functioning. For most Type D's, however, professional help isn't necessary. "People can work on changing their outlook. Sometimes they turn over a new leaf because of an experience they've had, and they learn to count their blessings," Jacobs says. "Having a good attitude about the world, avoiding negative thinking, and learning to relax [should] all become part of a heart-wellness program."

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