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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 newly coined personality type could signal
a higher risk 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 Netherlands
have been looking into a connection between what
they call type D personality and different aspects
of heart disease. If their findings hold up elsewhere,
type D could prove to be a significant contributor
to heart disease. Then again, if the hoopla around
Type A personality was any indication, it could
end up on the scrap heap of faded ideas.
The D stands for distressed, says psychologist
Johan Denollet, of Tilburg University in the
Netherlands, who has led research in this area.
Type D people tend to be anxious, 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. As a result,
they are often tense and inhibited around others.
To see how you stack up, try the type D questionnaire
below, which was published in the January–February
2005 issue of Psychosomatic Medicine.
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 1996,
included 286 men and women who had enrolled in
a cardiac rehabilitation program. Each filled
out a personality questionnaire at the start
of the three-month program. Almost one-third
fit the type D pattern.
Eight years later, the researchers tracked down
the participants to find out who had died and
who was still alive. Among those classified as
type D, 27% had died, compared with just 7% of
the non-Ds. Most of the deaths were due to heart
disease or stroke.
Since 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.
In another report, a different Dutch team followed
almost 900 men and women who had received a drug-releasing
stent to hold open a blocked coronary artery.
After just nine months, 5.6% of those with type
D personalities had a heart attack or died of
heart disease, compared with 1.3% of the others.
What’s the connection? No one really knows.
People 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 exaggerated blood
pressure and other reactions to stress.
Another possibility is that type D is a catchall
for depression, anxiety, 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. Remember type A, the hard-driving, competitive
type who couldn’t relax? Beginning in the
late 1950s, a flurry of reports indicated that
type A people were more likely to develop heart
disease than type Bs (those who were more relaxed
and less competitive). In 1981, a national panel
of experts concluded that type A 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 A personality and heart disease.
The research wasn’t a waste, though. It
got people thinking about how emotion, mood,
behavior, and social factors might affect the
heart. Later work helped identify elements of
type A 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 C — knocked around for a while, but
it, too, has been largely discredited.
More work to be done
It is still too early to tell if type D personality
will stand the test of time or follow types A,
B, and C into obscurity. Researchers 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. Instead of focusing on individual
elements such as depression, anxiety, hostility,
and social isolation, using broad personality
traits may be a faster or more efficient way
to identify people at higher-than-average 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. But as Dr.
Denollet says, this is just the beginning of
the research process, not the end.
The
D-Scale 14 |
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. |
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. |
(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.)
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