Written by Heather McGinley
Are you at Risk?
Discomfort connecting with others and insecurity may further hurt those with heart-related problems.
Ever feel like you’re not quite boisterous enough to have a Type A personality, but you’re not laidback enough to be Type B? You’re not alone.
In a study published in September 2010 and conducted by Johan Denollet, Ph.D., in the Netherlands, more than 25 percent of the population assessed—the general population and cardiac patients—demonstrated personality traits of social inhibition and negative affectivity or appearance, placing them within a third category identified by Denollet as Type D, for distressed.
Denollet discovered the personality type in the 1990s while studying cardiovascular patients—who shared traits of being socially inhibited and seemingly stressed or depressed—to determine if those qualities could be the cause of their cardiac ailments.
Prior to Denollet’s discovery, people were considered to have fallen within the personality constructs of Type A or Type B.
Type A personality is characterized by aggressive/assertive behavior, a competitive nature, a cynical attitude, a paranoid outlook, neuroticism and a demeanor that makes it difficult to let go or relax. Being Type A has been considered a risk for heart disease for years, says Serina Neumann, Ph.D., licensed clinical psychologist and associate professor of psychiatry and behavior sciences at Eastern Virginia Medical School in Norfolk.
People with Type B personality tend to be more laidback, easygoing, patient and better able to calmly deal with stressors in life.
Like those with Type A, people with Type D personality tend to be neurotic and have a difficult time letting go, yet they are not assertive or aggressive. They are anxious, have a negative view of self, tend to be insecure and inhibited, avoid social situations and avoid anything that may bring about disapproval. They tend to hold in all of their stress, withdraw from social situations and shy away from sharing their feelings with other people.
People with Type D personality may appear to be clinically depressed during times of stress, but despite their negative affectivity the person may not be depressed at all, explains Neumann.
For a person to be considered clinically depressed, they must demonstrate certain traits for a two-week period like changes in appetite, mood, sleep and attention as well as loss of interest in activities they enjoy, Neumann says.
For those with Type D personality, distress is something they’ve grown accustomed to and often won’t seek help for.
Unlike Type B, Type D has a difficult time letting go of stress. “Their biology is not as resistant anymore. They are less able to come back to a relaxed state,” Neumann says. “Their thinking is preventing them from recovering more quickly from the stressor.”
Studies indicate that people with Type D personality are far more likely than others to have heart disease. And of those Type D individuals who have had heart problems in the past, the likelihood of suffering from heart issues again is high, Neumann says. In fact, persons with Type D personalities are four times more likely to suffer fatal outcomes than patients with other personality types, she explains.
In studies currently being conducted by EVMS students in conjunction with Sentara Heart Hospital in Norfolk, students monitored patients’ response to open heart surgery. Patients identified with Type D personality tended to have the more difficulty in the second and third weeks of recovery than other patients, says Claire Kelley, a doctoral candidate in clinical psychology in the Virginia Consortium Program who is an investigator in the study. Kelley believes that this is because during those weeks patients are recovering at home and must ask loved ones for assistance, an uncomfortable request for those with Type D personality.
During this time Type D patients’ heart rate variability—its ability to go up and down to a relaxed state—was not where it should have been, Kelley says. “Type D traits accounted for differences in people’s ability to come down a couple of weeks after surgery.”
Kelley proposes that Type D patients having heart-related procedures be identified early and placed in group and individual counseling sessions during the rehabilitation that is already in place after surgery. This would provide patients with coping strategies, relaxation exercises and practice relating to others. They could discuss their feelings and receive cognitive behavioral therapy that would target negative and anxious thoughts and help patients think more realistically and rationally in stressful situations. “It would be an ideal setting because it’s already built in and they’re more likely to stick with that,” Kelley says.
Currently, the choice to identify and counsel patients is up to the hospital, but Kelley hopes as more research studies are done and more is written about the health risks of Type D personality that more hospitals will adopt the practice. This could help patients learn and practice the social skills that will ultimately save their lives, Kelley says.
What’s Your Type?
Type A
Traits: Aggressive, Assertive, Competitive, Ambitious, Driven, Strong sense of urgency, Time conscious, Impatient, Perfectionist, Difficulty relaxing, Difficulty letting go
Appears As: Cynical, Hostile, Paranoid, Neurotic
Health Risk: Stress-related illnesses, More apt to have a heart attack or heart disease
Type B
Traits: Laid back, Easy-going, Patient, Calm, Little sense of urgency, Easily relaxed, Adaptive, Puts things in perspective, Not reactive
Appears As: Rolls with the punches
Health Risks: Unknown
Type D
Traits: Anxious, Negative view of self, Insecure, Inhibited in social situations, Avoids social situations, Avoids disapproval, Holds in feelings, Withdrawn, Has difficulty discussing emotions, Has difficulty letting go
Appears As: Appears stressed out or depressed (though they may not be depressed), Neurotic
Health Risks: Stress-related illnesses, More apt to have a heart attack or heart disease