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Heart patients with distressed personalities face risk of cardiovascular issues

Like Eeyore, Type Ds are vulnerable to depressive mood states.

�Walt Disney Co./Courtesy Everett Collection

If you find yourself continually feeling distressed and negative, you may be a Type D personality - and at risk for a lot more than a bad mood.

In a new analysis of 49 studies about the Type D (distressed) personality - a relative newcomer to the alphabetic personality categories that started with hard-driving Type As - has found that heart patients with the "distressed" profile face a three-fold greater risk of long-term psychological distress and future cardiovascular issues such as heart failure and death.

For one thing, in the study of more than 6,000 patients, the Type Ds tended to do poorly after invasive surgeries.

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"If you look into people who have had coronary stenting of their arteries, you see that the prognosis in patients with Type D personality is+ worse than in patients who don't have this personality profile," says the lead author, Johan Denollet, a professor of medical psychology at Tilburg University in the Netherlands who is also the author of many of the studies in the analysis.

Heart transplant patients with this personality type fare no better, he found. The reason may be that those who already feel distressed and negative find little reason to alter their behaviour.

"They are less likely to comply with treatments and have a more passive stance," he says. "And they are less likely to have changed their lifestyle."

The drive to classify personality types for both psychological and medical research started in the 1950s with Type A, which was characterized by ambition, hostility and a sense of urgency. Type B was generally described as the absence of Type A trait.

Many researchers have explored the link between Type A and heart disease since then. Because the most significant finding about the increased risk of heart disease have come to focus on the Type A's propensity for hostility and anger, the personality type itself has been de-emphasized among researchers. In other words, it's really only a few aspects of Type A personality - the hostility and the anger - that puts them at risk, so there is little need to be concerned about the other traits. (For a brief period in the eighties and nineties, a Type C was coined as being more prone to cancer, but research has been limited.)

Type D was defined in the mid-1990s as being characterized by negative emotions paired with social inhibition. The category is not a catch-all for those with depression; Type D refers to a more chronic, covert kind of distress than depression. Dr. Denollet created a questionnaire in 2005 to identify Type Ds. He says the new findings mean that it's not personality types per se that should be out of favour, just Type A.

"We realized it was not about Type A … but more about a specific combination of negative emotions combined with a tendency to be closed to others and hold back negative emotions," he said.

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Armed with this emerging evidence, medical professionals may consider trying to identify heart patients who are Type D and offering them additional support, he says. They may schedule more follow-up visits and keep better track of how the patient is doing.

"Psychological factors do matter and if people are aware of the potential influence of these factors, they might help to increase quality of life and maybe the prognosis of a large majority of patients with cardiovascular disease."

Up next is figuring out whether a person who is Type D and still healthy has an elevated risk of heart disease.

Dr. Denollet says avenues of research include looking for heart rate differences, responses to stress and even immunological differences between Type Ds and others. Other research has found that in cases of multiple sclerosis, gastrointestinal disorders and Parkinson's disease, Type D patients have an impaired quality of life and more physical symptoms, and are vulnerable to anxiety and depressive mood states.

So Dr. Denollet suggests that anyone who may be a Type Ds should look at their other risk factors. In the case of heart disease, those include a family history, smoking and lack of exercise.

"There are more healthy Type Ds than unhealthy," he says. "But it's important for anyone at increased risk of getting a disease, because they have heart disease in their family, for instance, to take a close look at their lifestyle. And to consider talking to a doctor or behavioural therapist who can help them deal in a different way with the stressful events of their lives."

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The D-Scale 14

Below are a number of statements that people often use to describe themselves. Read each one and circle the appropriate number next to that statement to indicate your answer. There are no right or wrong answers: Your own impression is the only thing that matters.

0 = false

1 = rather false

2 = neutral

3 = rather true

4 = true

1) I make contact easily when I meet people.

0 1 2 3 4

2) I often make a fuss about unimportant things.

0 1 2 3 4

3) I often talk to strangers.

0 1 2 3 4

4) I often feel unhappy.

0 1 2 3 4

5) I am often irritated.

0 1 2 3 4

6) I often feel inhibited in social interactions.

0 1 2 3 4

7) I take a gloomy view of things.

0 1 2 3 4

8) I find it hard to start a conversation.

0 1 2 3 4

9) I am often in a bad mood.

0 1 2 3 4

10) I am a closed kind of person.

0 1 2 3 4

11) I would rather keep people at a distance.

0 1 2 3 4

12) I often find myself worrying about something.

0 1 2 3 4

13) I am often down in the dumps.

0 1 2 3 4

14) When socializing, I don't find the right things to talk about.

0 1 2 3 4

˝Negative affectivity˝ scale: Add scores for questions 2, 4, 5, 7, 9, 12, and 13

˝Social inhibition˝ scale: Add scores for questions 1*, 3*, 6, 8, 10, 11, and 14

(*For scoring questions 1 and 3, if you circled 0, enter 4; if 1, enter 3; if 2, enter 2; if 3, enter 1; if 4, enter 0.)

You qualify as a type D personality if you scored 10 or higher on both negative affectivity and social inhibition scales.

Source: J. Denollet, © 2005, American Psychosomatic Society.

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