Most people are familiar with the "Type A," intense, overachieving, perfectionistic and "Type B," noncompetitive, relaxed personality styles and the link between Type A personality and heart disease. But now, "Type D" personality seems to be an even stronger predictor of cardiovascular health.

Psychologist Johan Denollet, a professor of medical psychology in the Netherlands noticed a definite difference in the cardiac patients he treated following heart attacks. One group had positive, cheerful attitudes and readily engaged in cardiac rehab despite significant cardiac damage.

Another group was pessimistic, discouraged, tended to complain and didn't follow through with rehab even though they had milder heart attacks. Denollet determined there had to be a fundamental difference between these two types of patients, so he set out to identify what it was.

He developed a 14 question personality test, known as the DS14, which measures a person's overall level of distress based on two emotional states:

• "Negative Affectivity" which is the level of worry, irritability or dysphoria a person feels, and
  
• "Social Inhibition" or the level of social discomfort and lack of self-confidence a person has.
  

The research based on this test shows that high distress scores are strongly associated with hypertension and coronary heart disease. Type D personalities are typically more resistant to treatment, have a lower quality of life following a cardiac event and are more likely to die prematurely.

A recent study done in the Netherlands showed that of 875 patients who received stents to open coronary arteries, the Type D patients were more than four times as likely to have another heart attack or die within six to nine months of the procedure.

Do You Have Type D Personality?

Take the DS14 and find out. Read each statement and circle or write down the number to indicate your answer. There are no right or wrong answers. Your own impression is the only thing that matters.

False       Less False       Neutral       Less True      True

OR    0                1                2                 3              4

1. I make contact easily when I meet most people.  4 3 2 1 0
2. I often make a fuss about unimportant things. 0 1 2 3 4
3. I often talk to strangers. 4 3 2 1 0
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

Add your answers:

Add scores for questions 2, 4, 5, 7, 9, 12 and 13: ______________

Social Inhibition:

Add scores for questions 1, 3, 6, 8, 10, 11, and 14: ______________

Results:

If you scored at the high end of the scale, don't worry! Type D Personality is not a psychiatric disorder, but rather a grouping of personality characteristics that can be helped with psychotherapy.

Decreasing the distress that comes with social discomfort and/or worry and negativity can make a big difference in the quality of your life. Feeling better mentally will influence how you respond to heart disease, your ability to make the changes necessary to treat it and the length of your life.

Source: Denollet, J. (2005). DS14: Standard Assessment of Negative Affectivity, Social Inhibition and Type D Personality. Psychosomatic Medicine, 67: 89-97.