Forget Type A: a woman’s heart disease risk is higher for Type D personalities

woman sunglasses angry

by Carolyn Thomas  @HeartSisters

According to the Harvard Heart Letter, if you are the kind of person who . . .

  • tends to sweat the small stuff
  • sees the glass as half empty
  • keeps your feelings bottled up inside

… then you might well be termed a Type D (distressed or distant) personality, and be at increased risk for heart disease.

Type D people tend to be anxious, irritable, and insecure. They keep an eye out for trouble rather than pleasure. They may experience high levels of stress, anger, worry, hostility, tension, rudeness and other negative and distressing emotions. Even if they lack a strong support network of friends or family, they go to great lengths to avoid saying or doing things that others don’t like. As a result of biting their tongues to keep their negativity to themselves, they often feel tense and inhibited around other people.

Does this sound like it might be you?

Not too many decades ago, researchers suspected that hard-driving, competitive, ambitious Type A people were more likely to develop cardiovascular disease than Type Bs (those relaxed, laid-back, wastin’-away-in-Margaritaville folks).

But current studies now suggest that only one components of the Type A personality – hostility – may actually be linked with increased heart disease risks. UPDATE: see also How two cardiologists discovered Type A (and the surprising reasons Big Tobacco helped fund those studies for decades)

In the past decade, the Type D personality has been newly identified as a likely cardiac risk factor.

Medical psychologist Dr. Johan Denollet of the University Hospital of Antwerp in the Netherlands has led ground-breaking research in this area(1). He suggests that the key role of emotional distress in the development of heart disease is under-acknowledged by physicians, and urges them to look for factors that are both acute (major depression) and chronic (certain personality features) in high risk patients.

He suspects that Type Ds have chronically higher levels of the stress hormone cortisol in reaction to day-to-day stress.  When experienced on an ongoing daily basis, these high levels can increase blood pressure, LDL (bad) cholesterol, heart rate, soft plaque buildup and blood clotting. In fact, he also blames elevated cortisol for impaired metabolism and immune system function that may cause other serious diseases, too.

Since the Dutch research was first published in the mid 1990s, Type D personality has been linked with:

  •      increased risk for developing cardiovascular problems after a heart attack
  •      poorer response to proven treatments for heart disease
  •      higher mortality rates
  •      increased chances of sudden cardiac arrest

Dr. Denollet adds:

“How people cope with negative emotions may be as important as the experience of negative emotions per se. There are two important chronic characteristics of the Type D personality:

  1. negative affectivity (the tendency to experience negative emotions) 
  2. social inhibition (the tendency to inhibit expressing these emotions)”
According to Dr. Denollet and his colleagues, this brief questionnaire accurately identifies type D individuals.
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.
1=rather false
3=rather 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.

this brief questionnaire can accurately identify Type D individuals.

Debbie Mandel, author of Addicted to Stress: A Woman’s 7-Step Program to Reclaim Joy and Spontaneity in Life, offers these tips for toning down some of these possibly damaging traits:

  • Accept responsibility for your life. Learn to rid yourself of the victim mentality.
  • Express yourself honestly, but practice a lot of listening, too.
  • Balance your needs with those of others. Good energy rebounds.
  • Learn from criticism. Avoid being right all the time.
  • Don’t let your need for emotional security run your life
  • Don’t let anger fuel your future.
(1)  Erla Svansdottir, Hrobjartur D. Karlsson, Johan Denollet. Validity of Type D personality: association with disease severity and risk markers in cardiac patients. Journal of Behavioral Medicine. Apr 2012;  Published online April 28, 2011. 35(2): 155–166. 10.1007/s10865-011-9337-5


Q: Have you found yourself keeping an eye out for trouble, not pleasure?
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