Is Type D Personality Here to Stay? Emerging Evidence Across Cardiovascular Disease Patient Groups

Abstract

Abstract:The distressed personality (Type D) is an emerging risk factor in cardiovascular disease (CVD) that incurs a risk on par with left ventricular dysfunction in patients with ischemic heart disease. Type D is defined as the co-occurring tendencies to experience increased negative emotions and to inhibit self-expression in social interactions. Evidence is accumulating that Type D may also be a risk factor for adverse outcome across CVD patient groups, including patients undergoing revascularization with drug-eluting stent implantation or bypass surgery, patients with heart failure, peripheral arterial disease, and arrhythmia. In these patient groups, Type D personality has been associated with a 2-5 fold increased risk of adverse prognosis, impaired quality of life and symptoms of anxiety and depression independent of traditional biomedical risk factors, including disease severity. Although little is known about the pathways responsible for the detrimental effects of Type D on clinical outcome, the immune system and health-related behaviors, such as smoking and noncompliance, are likely candidates. Further research is warranted to investigate whether Type D personality is here to stay as a risk factor for CVD, but weighing current evidence on Type D against a set of external criteria shows that Type D personality fulfills the majority of these criteria. Importantly, Type D can easily be assessed in clinical research and practice with the standardized and validated DS14.

Type D personality and cardiovascular reactivity to an ecologically valid multitasking stressor

“…Heightened cardiovascular reactivity to stress, hyper-reactivity of the hypothalamicpituitary-adrenal (HPA) axis (including an elevated cortisol awakening response ;Whitehead et al, 2007), and the subsequent release of stress hormones have all been postulated as mechanisms by which Type D individuals are at risk for adverse clinical outcomes following coronary events (Pedersen & Denollet, 2006). To appropriately address this hypothesis, prospective research is needed to investigate whether a relationship exists between Type D personality and stress reactivity pre-clinically, and in turn, whether those Type D individuals who demonstrate greater psychobiological reactivity to stress develop clinically relevant coronary abnormalities.…”

Type D personality and illness perceptions in myocardial infarction patients

“…Type D personality has been identified as an independent predictor of morbidity and mortality in cardiac patients [1][2][3]. Type D personality refers to the conjoint effects of the two stable personality traits negative affectivity and social inhibition [4].…”

Type D personality in Poland: Validity and application of the Polish DS14

“…However as Pedersen and Denollet (2006) suggest that type of personality might be linked to disease outcome either directly through psychophysiological mechanism, such as silent myocardial ischemia or platelet release potentiated by mental stress or it might be related indirectly through poor health behaviors (smoking, alcohol overusing, overeating) or psychological factors, such as lack of social support. The association between unhealthy behaviors, related to smoking, excessive drinking, using drugs was yielded in a study of Ogińska-Bulik (2009).…”