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Type D personality

Type D personality, also known as the "distressed" personality, refers to a stable psychological trait characterized by the simultaneous presence of high negative affectivity (NA)—a pervasive tendency to experience negative emotions such as dysphoria, worry, irritability, and tension—and high social inhibition (SI)—a tendency toward reticence, non-expression of emotions, and withdrawal in social interactions due to fear of rejection.^[1]^[2] This combination distinguishes Type D from other personality types, as it involves both internal emotional distress and external behavioral suppression, often leading to unexpressed chronic stress.^[1] The construct was developed by psychologist Johan Denollet in the context of cardiovascular research during the late 1990s, drawing from empirical cluster analyses of patient data and theoretical models of emotional inhibition, such as those linking anxiety with repression.^[1] Type D is typically assessed using the DS14 scale, a brief 14-item self-report questionnaire introduced in 2005, consisting of seven NA items (e.g., "I often feel unhappy") and seven SI items (e.g., "I am quiet when around people"), scored on a 0–4 Likert scale with a cutoff of ≥10 on both subscales for classification as Type D.^[2] The DS14 demonstrates strong psychometric properties, including internal consistency (Cronbach's α = 0.88 for NA, 0.82 for SI) and test-retest reliability (r = 0.72–0.82), making it suitable for clinical and epidemiological use.^[2] In the general population, Type D personality has a prevalence of approximately 16–38%, with estimates varying by sample (e.g., 29% in British adults and 27% in Dutch populations), and it shows moderate heritability of about 52%.^[3] Individuals with Type D traits often exhibit passive coping strategies, lower perceived social support, and heightened vulnerability to mental health issues like depression (correlation r = 0.42) and anxiety, as well as physical health risks including somatic complaints, poor sleep, and adverse cardiovascular outcomes such as increased mortality in coronary patients (27% vs. 7% in non-Type D over 5–10 years).^[3]^[1] These associations highlight Type D as a potential risk factor for broad psychosocial and somatic distress, influencing areas from occupational stress to disease progression.^[3]

Definition and Traits

Negative Affectivity

Negative affectivity (NA) is a core trait of Type D personality, characterized by a stable tendency to experience and report negative emotions such as dysphoria, worry, irritability, gloominess, and somatic complaints on a chronic basis.^[4] This emotional disposition reflects a pervasive pattern of negative mood states, where individuals are more prone to feelings of unhappiness and dissatisfaction compared to those low in NA. In the context of Type D personality, high NA combines with social inhibition to form the distressed profile, though NA itself operates as an independent emotional vulnerability factor.^[4] Manifestations of high NA include frequent experiences of tension, sadness, and pessimism, often accompanied by heightened sensitivity to everyday stressors. Individuals may engage in constant rumination over problems, amplifying minor setbacks into significant emotional burdens, or display irritability in response to routine challenges. These patterns contribute to a general sense of psychological distress, with NA correlating strongly with symptoms like anxiety and passive coping styles, independent of clinical diagnoses. High levels of NA (DS14 NA subscale score ≥10) are estimated to occur in approximately 40–50% of the general population, based on normative distributions.^[5] This trait distribution remains consistent regardless of clinical status, highlighting its role as a broad personality dimension rather than a pathological condition.^[4] Physiologically, high NA is associated with elevated cortisol levels in response to acute stress, reflecting heightened neuroendocrine reactivity.^[6] In the context of Type D personality, it also correlates with increased sympathetic nervous system activation during mental stress tasks, evidenced by elevated heart rate, respiratory rate, and strain indices.^[7] These responses indicate a dysregulated stress axis, where NA amplifies autonomic arousal and prolongs recovery post-stressor.^[7] Social inhibition, as the behavioral component of Type D personality, refers to the tendency to withhold the expression of emotions and behaviors during social interactions out of fear of rejection or disapproval by others.^[8] This trait is characterized by discomfort in social settings, reticence in communication, and a lack of social poise, leading individuals to monitor their actions closely to avoid negative judgment.^[2] In Type D personality, social inhibition combines with negative affectivity to form a distressed interpersonal style, amplifying emotional restraint in group contexts.^[2] Manifestations of social inhibition include avoidance of initiating conversations, non-assertiveness in expressing needs, and discomfort during group activities, often resulting in suppressed opinions or evasion of potential conflicts.^[9] For instance, individuals may hide their feelings when upset or hesitate to speak up in meetings to prevent disapproval, as reflected in self-report items like "I seldom show how I feel about things" or "I often feel inhibited when interacting with other people."^[9]^[10] This reluctance extends to seeking social support, fostering isolation despite a desire for connection. High levels of social inhibition (DS14 SI subscale score ≥10) are estimated to occur in approximately 40–50% of the general population, based on normative distributions.^[5] Unlike introversion, which reflects a preference for solitude and low need for external stimulation, social inhibition in Type D personality is primarily driven by anxiety and fear of negative evaluation rather than an inherent enjoyment of isolation.^[11] This fear-based restraint distinguishes it as a maladaptive response rather than a neutral energy orientation.^[12]

History and Development

Origins in Cardiac Research

During the 1990s, researchers in European cardiac clinics observed that a subset of coronary heart disease (CHD) patients displayed poor emotional adjustment, marked by chronic negative emotions and inhibited social expression, which correlated with elevated complication rates and mortality.^[13] These early findings, drawn from longitudinal studies of post-myocardial infarction patients, highlighted how such distressed profiles contributed to adverse outcomes independent of disease severity or traditional risk factors.^[13] For instance, in a cohort followed for nearly eight years, patients with this personality pattern faced a fourfold higher risk of long-term mortality compared to non-distressed counterparts.^[13] The concept of Type D personality received its first formal introduction in a 1997 publication examining personality, emotional distress, and CHD, where it was delineated as a distressed profile combining high negative affectivity and social inhibition, distinct from the outward hostility of the U.S.-centric Type A behavior pattern.^[14] This work built on prior observations by proposing Type D as a stable trait predisposing CHD patients to heightened depressive symptoms, reduced social support, and increased vulnerability to cardiac progression, offering a more nuanced alternative to Type A's focus on competitive urgency.^[14] Johan Denollet played a pivotal role in formalizing this construct through these initial empirical investigations.^[14] A key refinement occurred in 2000 with the publication "Type D personality: A potential risk factor refined," which validated negative affectivity and social inhibition as core predictors of adverse cardiac events in a large sample of 734 hypertensive patients across Dutch- and French-speaking European populations.^[15] The study demonstrated that Type D individuals clustered multiple psychosocial risks, amplifying long-term event rates beyond isolated emotional states, and contrasted this inward-focused distress with the externally driven Type A model dominant in American research.^[15] This European-originated framework emphasized stable personality traits over transient behaviors, laying the groundwork for targeted risk assessment in cardiac care.^[15]

Key Contributions by Johan Denollet

Johan Denollet (November 20, 1957 – October 2019) was a Belgian psychologist who served as Professor of Medical Psychology at Tilburg University in the Netherlands, where he focused on the interplay between personality traits and somatic diseases, particularly cardiovascular conditions.^[16]^[17]^[18] His academic career at Tilburg, beginning as an associate professor in 2000, centered on empirical investigations into psychological vulnerability factors in heart disease patients.^[19] Denollet's seminal 1998 publication introduced the Type D ("distressed") personality construct specifically in the context of coronary heart disease (CHD), defining it through the Type D Scale-16 (DS16) as a profile marked by elevated negative affectivity (NA)—the tendency to experience negative emotions—and social inhibition (SI)—the avoidance of social interactions due to fear of rejection.^[20]^[21] This work built on prior observations of emotional distress in cardiac populations but innovated by operationalizing Type D as a stable trait rather than transient states, enabling its use as a prognostic indicator.^[22] In a 2000 refinement, Denollet advanced an interaction model positing that vulnerability arises from the multiplicative effect of NA and SI (NA × SI), where the joint presence amplifies risk for adverse outcomes more than either trait independently, highlighting the role of suppressed distress in health deterioration.^[23]^[15]^[24] Through a series of longitudinal studies in the 1990s and 2000s, Denollet established an empirical foundation for Type D's clinical relevance, demonstrating its independent association with heightened cardiac risk. For example, in cohorts totaling over 600 CHD patients followed for up to five years, Type D individuals exhibited a 3- to 4-fold increased likelihood of major adverse cardiac events, such as myocardial infarction or mortality, even after adjusting for medical and demographic factors.^[25]^[26] These findings, drawn from prospective designs like the 1996 Lancet study (n=267) and subsequent validations, underscored Type D as a psychological predictor comparable in impact to traditional biomarkers.^[13] Denollet's legacy endures through the widespread adoption of Type D in international research on psychocardiology, influencing studies across diverse populations and conditions beyond CHD, with his publications garnering over 23,000 citations.^[16]^[25] A key element of this impact is his 2005 development of the DS14 scale, a concise 14-item instrument that standardized Type D assessment by measuring NA and SI subscales, facilitating its integration into clinical and epidemiological settings as a reliable, brief tool.^[2] His foundational efforts also led to the creation of the Center of Research on Psychology in Somatic Diseases (CoRPS) at Tilburg University, perpetuating interdisciplinary investigations into personality-health links.^[19]

Assessment Methods

DS14 Scale

The DS14 (Type D Scale-14) is a standardized 14-item self-report questionnaire developed in 2005 to assess Type D personality through its core components of negative affectivity (NA) and social inhibition (SI).^[2] It features seven items per subscale, designed to capture NA traits such as dysphoria, worry, and irritability, and SI traits such as reticence and discomfort in social interactions.^[2] Each item is rated on a 5-point Likert scale ranging from 0 (false) to 4 (true), allowing respondents to indicate the frequency or intensity of the described feelings or behaviors.^[2] Representative NA items include "I often feel unhappy" and "I am often irritated," while SI items include "I find it hard to start a conversation" and "I am a closed kind of person."^[2]^[8] Some SI items, such as "I make contact easily when I meet people," are reverse-scored to align with the inhibition construct.^[8] Scoring involves summing responses for each subscale separately, yielding totals from 0 to 28 per subscale.^[2] An individual is classified as Type D if both NA and SI scores are 10 or higher, reflecting the combined presence of both traits at clinically relevant levels.^[2] The DS14 demonstrates strong psychometric properties, with internal consistency reliabilities of Cronbach's α = 0.88 for NA and α = 0.86 for SI in initial validation samples.^[2] Test-retest reliability over three months is also robust, with correlations of r = 0.72 for NA and r = 0.82 for SI.^[2] The scale has been validated across diverse populations, including general community samples, cardiac patients, and hypertension patients, and translated into multiple languages such as French, Spanish, Persian, and Chinese, maintaining its factor structure and reliability.^[2]^[27]^[28]

Alternative Approaches

While the DS14 serves as the gold standard for assessing Type D personality, alternative approaches treat negative affectivity (NA) and social inhibition (SI) as continuous dimensions, enabling the modeling of their interaction effects through regression analyses rather than binary classification. This method captures the synergistic impact of NA and SI on outcomes more precisely, avoiding the information loss associated with categorization. A systematic review of 44 studies demonstrated that continuous operationalizations produce more consistent Type D effects, particularly in detecting subtle personality-health associations, compared to dichotomous methods.^[29] Personality group methods, such as median-split categorization, provide another supplementary technique by dividing participants into high and low groups on NA and SI scales, resulting in four distinct profiles: high NA and high SI (Type D), high NA and low SI, low NA and high SI, and low NA and low SI (non-Type D). This approach facilitates comparative analyses across groups and has been employed in early validations of the Type D construct. Bivariate median splits, in particular, have been evaluated for their performance in assessing Type D effects, though they may introduce bias in smaller samples.^[30]^[31] Other tools include the DS16, a 16-item precursor to the DS14 developed specifically for coronary heart disease patients, which similarly measures NA and SI to identify distressed personality traits. Integration with Big Five personality inventories, such as the NEO-FFI, offers an additional avenue by mapping Type D traits onto related dimensions like high neuroticism and low extraversion, allowing researchers to assess overlap without dedicated Type D scales. These methods are especially valuable in research involving non-clinical populations, where they support nuanced explorations of personality dynamics in diverse settings like general community samples.^[20]^[32]^[33]

Health Implications

Cardiovascular Disease

Type D personality has been identified as a prognostic factor in patients with coronary heart disease (CHD), associated with an increased risk of adverse outcomes such as myocardial infarction, arrhythmias, and mortality, with reported odds ratios ranging from approximately 1.1 to 4 in various studies, though a 2023 meta-analysis indicates a more modest effect (OR = 1.14 for major adverse cardiac events).^[25] Meta-analyses from the 2000s to the 2020s, encompassing prospective cohort studies in CHD and heart failure populations, demonstrate an elevated risk independent of traditional biomedical factors like disease severity, though effect sizes vary, with a 2023 individual patient-data meta-analysis reporting modest odds ratios (1.14-1.15) for adverse events in CHD and inconclusive evidence in heart failure.^[34]^[35] For instance, in a seminal cohort study by Denollet et al., Type D patients with CHD exhibited a 27% rate of cardiac events or death over 5 to 10 years of follow-up, compared to 7% in non-Type D individuals, highlighting the personality's role in long-term vulnerability.^[36]^[31] A 2025 systematic review and meta-analysis of 15 studies confirmed a significant association between Type D personality and adverse CVD outcomes, with a prevalence of approximately 36% among CVD patients.^[37] The mechanisms underlying this association involve both behavioral and physiological pathways. Behaviorally, individuals with Type D personality often exhibit delayed help-seeking during acute symptoms, such as in acute coronary syndrome, due to social inhibition, which exacerbates outcomes.^[38] They also demonstrate poorer adherence to medication and treatment regimens in CHD and post-myocardial infarction settings, further compounding risk.^[39] Physiologically, Type D is linked to heightened pro-inflammatory responses, including elevated levels of cytokines like tumor necrosis factor-α in heart failure patients, promoting atherosclerosis progression.^[40] Additionally, it correlates with endothelial dysfunction, evidenced by reduced flow-mediated dilation in brachial arteries among CHD patients, which impairs vascular health and increases thrombotic potential.^[41] Interventions targeting Type D traits show promise in mitigating these risks through tailored cardiac rehabilitation programs that incorporate emotional support. Such programs, which include psychological counseling to address negative affectivity and social inhibition, have been found to reduce anxiety, depression, and dropout rates while improving prognosis in CHD patients.^[42] By focusing on distress reduction, these approaches can lower the incidence of adverse cardiac events, as supported by evidence that alleviating emotional burden enhances overall treatment efficacy.^[43]

Other Medical Conditions

Type D personality has been associated with heightened psychological distress and poorer survival outcomes among patients with certain cancers. In colorectal cancer survivors, individuals with Type D personality exhibit an increased risk of all-cause mortality, with a hazard ratio of 1.7 (95% CI: 1.3-2.4), particularly among older men, where negative affectivity drives this adverse effect.^[44] Similarly, in breast cancer patients, Type D personality correlates with elevated distress levels, including anxiety, depression, and post-traumatic stress symptoms, persisting over 6-month follow-ups, and is linked to immune system dysregulation mediated by maladaptive defense mechanisms.^[45]^[46] These associations suggest that the chronic negative affectivity and social inhibition characteristic of Type D may contribute to immune suppression, exacerbating cancer progression. In chronic illnesses beyond cancer, Type D personality is linked to diminished quality of life and increased symptom severity. Patients with multiple sclerosis and Type D personality report lower overall quality of life scores, alongside greater fatigue, pain, and reduced physical functioning, as measured by standardized inventories like the Multiple Sclerosis Quality of Life-54.^[47] Among those with gout, Type D individuals experience higher pain perception (via numeric rating scales), elevated inflammatory markers such as C-reactive protein, and greater disease activity scores, with approximately 30-60% of gout patients exhibiting this personality type compared to lower rates in controls.^[48] In diabetes, particularly type 2, Type D personality predicts poorer glycemic control (higher HbA1c levels), reduced medication adherence, and indirect effects on health-related quality of life through heightened diabetes distress and social isolation.^[49]^[50] Broader somatic effects of Type D personality include elevated rates of hypertension, sleep disturbances, and vital exhaustion in general populations. Type D individuals show a twofold higher prevalence of essential hypertension compared to non-Type D counterparts, with negative affectivity contributing to sustained elevations in blood pressure and associated cognitive impairments like mild cognitive decline.^[51] Sleep disorders, such as insomnia and apnea, are more frequent among those with Type D personality, who report significantly higher insomnia symptom scores and fourfold increased risk in adolescents, often mediated by stress reactivity.^[52]^[53] Vital exhaustion, characterized by fatigue and emotional depletion, is consistently higher in Type D populations, overlapping with but distinct from cardiovascular risks by influencing overall physical health status.^[54] Systematic reviews confirm these patterns, indicating that Type D personality acts as a vulnerability factor for adverse physical health outcomes across noncardiovascular conditions, with 12 studies demonstrating consistent links to increased complaints, poor self-management, and reduced health behaviors in patient groups like those with chronic pain, tinnitus, and melanoma.^[55]

Mental Health Outcomes

Individuals with Type D personality exhibit an elevated risk for various mental health disorders, including depression, anxiety, and post-traumatic stress disorder (PTSD). A longitudinal study of patients with chronic somatic diseases, such as breast cancer, indicates moderate to strong associations between Type D traits and higher levels of depressive and anxiety symptoms, with correlation coefficients ranging from 0.47 to 0.54.^[45] In general population samples, Type D personality is linked to a substantially increased vulnerability to depressive disorders, with odds ratios as high as 13.20 independent of physiological factors like inflammation.^[56] For PTSD, prospective studies in high-risk groups such as military personnel show that Type D predicts elevated PTSD symptoms, including intrusion, avoidance, and hyperarousal, even prior to exposure.^[57] The mechanisms underlying these associations involve chronic emotional distress amplification due to the core Type D traits of negative affectivity and social inhibition. Negative affectivity fosters persistent negative emotions, while social inhibition leads to suppressed expression, exacerbating internal distress without external relief.^[58] This pattern promotes maladaptive coping strategies, such as avoidance and withdrawal, which perpetuate anxiety and PTSD by hindering adaptive processing of stressors.^[59] Additionally, rumination—repetitive negative thinking—is strongly tied to Type D's negative affectivity component, correlating most closely with depressive symptoms in clinical populations.^[60] Type D personality is consistently associated with diminished quality of life, particularly in emotional and psychological domains. Systematic reviews report lower scores on health-related quality of life measures like the SF-36 among Type D individuals, with impairments in mental health, vitality, and social functioning subscales.^[61] In high-stress occupational groups, such as emergency physicians, Type D traits predict a 7-fold increased likelihood of burnout, characterized by emotional exhaustion and disengagement.^[62] Longitudinal research supports Type D as a predictor of incident and persistent mood disturbances over time. In cohorts followed for up to 24 months, Type D independently forecasts poorer mental health-related quality of life and sustained anxiety or depressive symptoms, with effects persisting after adjusting for baseline distress.^[63] Prospective studies further demonstrate that Type D elevates the risk for developing PTSD symptoms following trauma exposure.^[64] Individuals with Type D personality, characterized by high negative affectivity and social inhibition, often face challenges in professional settings due to their tendency to experience chronic distress while suppressing emotional expression. Research indicates that Type D traits are associated with higher rates of absenteeism and sick leave in the workplace, with one study finding that Type D employees had significantly elevated absenteeism levels (β = 0.499, p < 0.01).^[33] Additionally, these individuals report greater vital exhaustion and lower job satisfaction, perceiving higher workplace stress and burnout compared to non-Type D counterparts.^[33] In social contexts, Type D personality contributes to strained interpersonal relationships through emotional withdrawal and avoidance of conflict, leading to increased isolation. Type D individuals are more likely to inhibit self-expression during interactions, resulting in reduced social contact and lower perceived social support (e.g., mean scores of 12.7 vs. 14.7, p < 0.001).^[65]^[33] This pattern fosters a cycle of loneliness and diminished relational quality, as they prioritize suppressing negative emotions over seeking connection. Beyond specific domains, Type D traits exert negative effects on broader daily functioning, with studies in general populations showing poorer overall adaptation and health status. Systematic reviews highlight that Type D individuals experience more work-related problems and reduced quality of life in everyday activities, independent of clinical conditions.^[33] Interventions targeting Type D traits, such as group-based cognitive-behavioral therapy, have demonstrated efficacy in improving social functioning by enhancing communication skills and reducing inhibition. In a randomized controlled trial, an 18-session cardiac integrated intervention program significantly lowered Type D scores (p < 0.001) and boosted social skills like active listening and assertiveness among participants.^[66]

Criticisms and Validity

Methodological Concerns

One major methodological concern in Type D personality research involves the assessment of interaction effects between negative affectivity (NA) and social inhibition (SI), which are central to the construct. Common approaches, such as median splits to classify individuals into Type D and non-Type D groups or conducting subgroup analyses, have been shown through Monte Carlo simulations to inflate false positive rates for detecting a synergistic "Type D effect." In a 2020 simulation study involving 324,000 datasets, these methods produced significant Type D effects even when only one trait (NA or SI) was related to the outcome, with false positive rates exceeding 20% under realistic conditions of correlated traits (r = 0.5), leading to spurious conclusions about the interaction.^[67] The binary classification inherent in Type D as a "type" has also drawn criticism for oversimplifying the underlying continuous traits of NA and SI, resulting in arbitrary cutoffs (e.g., scores ≥10 on the DS14 scale) that discard nuanced information and reduce statistical power. This categorical approach ignores the dimensional nature of personality traits, potentially misrepresenting the gradient of risk and exacerbating issues with interaction detection, as supported by simulation evidence showing higher bias and error rates compared to continuous models. Replication issues further undermine the robustness of Type D findings, with several independent studies failing to confirm the predicted health risks, such as increased cardiovascular mortality. For instance, a large prospective study of German cardiac patients (N ≈ 1,000) found no association between Type D and all-cause mortality after adjusting for confounders.^[68] Additionally, while cross-cultural validity has been examined in non-Western samples (e.g., Taiwanese and Japanese populations), with associations to adverse outcomes such as anxiety, depression, and poor health,^[69]^[70] highlighting limited generalizability and the need for more diverse, independent replications beyond predominantly Western European cohorts. To address these concerns, researchers recommend shifting to continuous modeling that includes main effects of NA and SI, their interaction term, and quadratic effects, which simulations demonstrate maintain false positive rates near 5% while preserving sensitivity to true effects. This approach enhances validity by treating traits dimensionally and avoiding information loss from categorization, though reanalysis of existing datasets is needed to clarify prior claims.

Relation to Broader Personality Models

Type D personality aligns closely with the Five-Factor Model (also known as the Big Five) of personality, primarily through its defining traits of negative affectivity (NA) and social inhibition (SI). NA strongly corresponds to high Neuroticism, reflecting a tendency toward emotional instability, anxiety, and distress, while SI maps onto low Extraversion, indicating reticence, avoidance of social situations, and discomfort in interpersonal interactions. Empirical investigations have confirmed these links, with NA showing a robust positive correlation with Neuroticism (r = 0.74) and SI exhibiting a strong negative correlation with Extraversion (r = -0.61), alongside a moderate positive link to Neuroticism (r = 0.50). Consequently, Type D is often conceptualized as a specific facet-level combination within the Big Five framework, capturing a profile of neurotic introversion rather than a wholly independent dimension.^[71] In comparison to other established personality types, Type D emphasizes chronic emotional distress and social withdrawal, distinguishing it from Type A and Type C profiles. Type A personality, characterized by intense competitiveness, time urgency, and hostility, drives health risks through aggressive, achievement-oriented behaviors and overt stress responses, whereas Type D's vulnerabilities stem from internalized negative emotions and inhibited expression, without the same emphasis on ambition or antagonism. Type C, by contrast, involves pronounced submissiveness, compliance, and suppression of negative emotions—particularly anger—leading to passive emotional restriction and self-sacrifice, but lacks the pervasive negativity central to Type D; thus, Type C focuses on repression amid harmony-seeking, while Type D combines high distress with social avoidance.^[72]^[73] Type D has shown incremental validity over the Big Five in predicting certain health outcomes, particularly in cardiovascular and psychological contexts, according to some meta-analyses and targeted studies. For instance, the interaction between NA and SI in Type D explains additional variance in adverse events like cardiac mortality and PTSD symptoms beyond the main effects of Neuroticism and Extraversion alone, with evidence of modest added predictive power (e.g., ΔR² ≈ 0.06 for symptom reporting). This suggests Type D captures a synergistic distress profile that enhances risk stratification for health behaviors and emotional outcomes in vulnerable populations.^[74]^[75] Theoretical debates persist regarding Type D's distinctiveness, questioning whether it is redundant with the Big Five or provides unique value through its interactive structure. Some researchers contend that Type D merely recapitulates high Neuroticism and low Extraversion, arguing for redundancy since dimensional Big Five scores often outperform the categorical Type D in broad predictive models for health and well-being. Others maintain that the multiplicative interaction of NA and SI offers explanatory power not fully accounted for by additive trait effects, as evidenced in superior predictions for social anxiety and specific morbidity risks, supporting Type D's role as a targeted vulnerability indicator.^[75]^[76]

References

[1]
https://doi.org/10.1016/S0022-3999(00)00177-X
[2]
DS14: standard assessment of negative affectivity, social inhibition ...
The DS14 is a brief, psychometrically sound measure of negative affectivity and social inhibition that could readily be incorporated in epidemiologic and ...
[3]
https://doi.org/10.1186/1477-7525-8-9
[4]
https://doi.org/10.1097/01.psy.0000149256.81953.49
[5]
https://doi.org/10.1016/j.paid.2010.02.026
[6]
Type D Personality (DS14) - PsyToolkit
Dec 3, 2024 · Type D Personality refers to a Distressed Personality. DS14 stands for Type D Scale-14 (i.e., 14 questions). Johan Denollet (1957-2019) was a ...
[7]
Social inhibition and emotional distress in patients with coronary ...
Jun 18, 2017 · This subscale includes items such as “I seldom show how I feel about things” and “When someone upsets me, I try to hide my feelings.” Items are ...
[8]
[PDF] Social inhibition, sense of belonging and vulnerability to ...
Aug 16, 2017 · An example of a social inhibition item is: “I often feel inhibited when interacting with other people”. Reliability was found acceptable in ...<|control11|><|separator|>
[9]
Familial Factors in the Development of Social Anxiety Disorder
Jul 1, 2021 · As early as infancy, negative parenting styles may influence the development of social anxiety. Lawrence et al. (2020) followed mothers with SAD ...
[10]
The Four Types of Introverts, Explained - Verywell Mind
Social introverts prefer small groups and deep conversations, while anxious introverts worry about social interactions. When you think of an introvert, a quiet ...
[11]
What Does It Mean to Have Type D Personality? - Verywell Mind
Sep 12, 2023 · Type D personality, or "distressed" personality, refers to a tendency to exhibit negative affect (such as gloominess and worry) along with social inhibition.Type D Personality Traits · How to Know If You're Type D · Physical Health
[12]
Personality, emotional distress and coronary heart disease
### Summary of Abstract and Key Points on Type D Personality in Cardiac Research
[13]
Type D personality: A potential risk factor refined - ScienceDirect.com
This article concludes with some observations about the role of type D personality in clinical research and practice. ... Type D personality, cardiac events, and ...Missing: origins | Show results with:origins
[14]
Johan DENOLLET | Professor of Medical Psychology - ResearchGate
Johan DENOLLET, Professor of Medical Psychology | Cited by 23404 | of Tilburg University, Tilburg (UVT) | Read 435 publications | Contact Johan DENOLLET.
[15]
In Memoriam: Johan Denollet (1957 - 2019) - LVMP
Nov 2, 2019 · In Memoriam: Johan Denollet (1957 – 2019). 2 november 2019. Bedroefd vernamen wij het veel te vroeg overlijden van Prof. dr Johan Denollet.
[16]
[PDF] Prof. dr. Johan Denollet November 20, 1957, Wilrijk, Belgium ...
Jun 24, 2015 · In 2000, at the age of 42, I made a major shift in my professional life and started my academic career as an associate professor at Tilburg ...Missing: biography | Show results with:biography
[17]
Staff CoRPs | Tilburg University
Staff CoRPs. CoRPS was founded by Johan Denollet † In Memoriam Johan Denollet (1957-2019). Director. prof. dr. Tom Smeets · prof. dr. Tom Smeets. Full Professor.Missing: biography | Show results with:biography
[18]
Personality and coronary heart disease: the type-D scale-16 (DS16)
CHD patients with a "distressed" personality (Type-D) report high levels of negative affectivity and social inhibition; accordingly, this self-report measure ...
[19]
Personality and coronary heart disease: The type-D scale-16 (DS16)
CHD patients with a “distressed” personality (Type-D) report high levels of negative affectivity and social inhibition; accordingly, this self-report measure ...Missing: observations | Show results with:observations
[20]
Personality and coronary heart disease: The Type-D Scale-16 (DS16)
Aug 7, 2025 · Type-D personality is characterized by a combination of two key traits: a tendency to experience negative emotions, known as negative ...
[21]
Type D personality. A potential risk factor refined - PubMed
Accumulating evidence suggests that the combination of high NA and high SI designates a personality subtype ("distressed" type or type D) of coronary patients.
[22]
Type D personality: A potential risk factor refined | Request PDF
Aug 7, 2025 · ... low ES emotion regulation strategy groups. View. Show abstract ... Approximately 65% of patients with very poor SRH deviated in personality ...
[23]
A General Propensity to Psychological Distress Affects ...
Sep 1, 2010 · Type D personality was associated with a more than 3-fold increased risk of adverse events (9 studies) and long-term psychological distress (11 studies).Missing: key | Show results with:key
[24]
Usefulness of type D personality in predicting five-year cardiac ...
Type D personality is a psychological factor that may optimize risk stratification in patients with CHD.
[25]
Type D personality: Application of DS14 French version in ... - PubMed
The aim of this study was to validate the French-language version of the Type D personality scale-14 among general and clinical populations.
[26]
Psychometric Properties of the Persian Version of Type D ... - NIH
The findings proved that the Persian version of the DS14 is a reliable and valid scale to detect Type D personality. Moreover, the present results confirmed ...
[27]
A systematic review comparing two popular methods to assess a ...
We conducted a systematic review including 44 published studies assessing a Type D effect with both a continuous and dichotomous operationalization.
[28]
A re-evaluation of the Type D personality effect - ScienceDirect.com
Dec 1, 2020 · Type D theory states that the combined influence of NA and SI is essential, because the combination of experiencing emotional distress and not ...
[29]
[PDF] Type D personality A potential risk factor refined
Denollet, J. K. L. (2000). Type D personality: A potential risk factor refined. Journal of Psychosomatic Research,. 49(4), 255-266. https://doi.org/10.1016 ...
[30]
Type D Personality: A Five-Factor Model Perspective - ResearchGate
Aug 7, 2025 · This study investigated the position of Type D (high Negative Affectivity and high Social Inhibition) within the Five-Factor Model (FFM) of personality.
[31]
Type D personality in the general population: a systematic review of ...
Type D personality has been described as the tendency to experience a high joint occurrence of negative affectivity and social inhibition [1]. People that score ...
[32]
Type D personality as a risk factor for adverse outcome in patients ...
Jan 16, 2023 · Across 19 prospective cohort studies, Type D predicts adverse events in CAD patients, while evidence in HF patients was inconclusive.
[33]
Type D Personality as a Risk Factor for Adverse Outcome in...
Several meta-analyses have indicated that type D personality is associated with an increased risk of adverse events in patients with coronary artery disease ( ...
[34]
Personality as independent predictor of long-term mortality in ...
We found that type-D personality was a significant predictor of long-term mortality in patients with established CHD, independently of biomedical risk factors.
[35]
Psychosocial markers of pre‐hospital decision delay and ...
Feb 17, 2020 · Type D personality may be a risk factor for more delayed help-seeking for an ACS and higher psychological distress after the cardiac event.
[36]
Type D Personality Predicts Poor Medication Adherence in Patients ...
Type D personality is associated with poor medication adherence in patients with coronary artery disease.Missing: delayed | Show results with:delayed
[37]
[PDF] Type D personality and vulnerability to adverse outcomes in heart ...
Type D has been associated with poor prognosis in patients with peripheral arterial disease,17 but evidence for the prognostic role of type. D in patients ...Missing: 1990s | Show results with:1990s
[38]
Predictive value of Type D personality for impaired endothelial ...
May 15, 2018 · Type D personality was associated with decreased flow-mediated dilation (FMD) of the brachial artery in patients with CAD.
[39]
Interventions for Cardiovascular Patients with Type D Personality: A ...
Mar 22, 2016 · The findings of this review indicated that cardiac rehabilitation can significantly reduce anxiety and depression, improve physical functioning, ...
[40]
Reducing Emotional Distress Improves Prognosis in Coronary Heart ...
We tested the hypothesis that treatment-related changes in emotional distress may explain the beneficial effect of rehabilitation on prognosis.
[41]
Is Type D personality a risk factor for all-cause mortality ... - PubMed
Is Type D personality a risk factor for all-cause mortality? A prospective population-based study among 2625 colorectal cancer survivors from the PROFILES ...
[42]
Association between Type-D Personality and Affective (Anxiety ... - NIH
The aim of the study was to analyze the role of Type-D personality in relation to anxiety, depression, post-traumatic stress symptoms, general distress, and ...
[43]
Predicting the status of the immune system based on personality ...
The particular status of type D personality traits among cancer patients can be used to design psychotherapy programs for them to prevent disease ...Missing: survival | Show results with:survival
[44]
The Effect of Type D Personality on Quality of Life in Patients with ...
The Effect of Type D Personality on Quality of Life in Patients with Multiple Sclerosis ... Keywords: Multiple sclerosis, personality, type D personality ...
[45]
The Relation of Disease Characteristics with Type D Personality and ...
Sep 19, 2024 · This study showed that approximately one third of individuals diagnosed with gout have type D personality, and type D personality is associated ...
[46]
The Clinical Link between Type D Personality and Diabetes - Frontiers
Jun 20, 2016 · Type D personality is a significant predictor of both poor medication adherence and unhealthy behaviors, by predicting negative mental health consequences.
[47]
Relationship between Type D personality and adverse health ...
Dec 28, 2022 · Type D personality indirectly affected both HbA1c and HRQOL via the mediators of diabetes distress and social isolation.
[48]
Type D Personality and Essential Hypertension in Primary Care
Type D personality in the hypertension group was twice as frequent as in the no hypertension group and hypertension was more frequent among type D than non-type ...
[49]
The relationship between Type D personality and insomnia - PubMed
Results: Individuals with the Type D personality trait reported significantly greater symptoms of insomnia relative to Non-Type Ds. Moreover, insomnia-symptoms ...
[50]
Personality Type D, Level of Perceived Stress, Insomnia ... - Frontiers
Sep 20, 2021 · Moreover, adolescents with type D personality showed a four times higher risk of sleep disorders than people with non-type D. The authors ...
[51]
Type D personality in the general population: a systematic review of ...
Jan 23, 2010 · Conclusions: Type D personality is a vulnerability factor for general psychological distress that affects mental and physical health status and ...
[52]
Type D personality among noncardiovascular patient populations
Type D personality among noncardiovascular patient populations: a systematic review. Gen Hosp Psychiatry. 2010 Jan-Feb;32(1):66-72. doi: 10.1016/j ...
[53]
Association of Type D personality with increased vulnerability to ...
Jan 1, 2016 · The MINI is a short diagnostic structured interview, used to assess the presence of minor and major depressive disorder in the preceding two ...Missing: qualitative | Show results with:qualitative
[54]
Type D Personality, Temperament, and Mental Health in Military ...
May 15, 2010 · Type D personality was associated with harm avoidance, low self-directedness, and increased symptoms of PTSD and hostility in men awaiting deployment.
[55]
The Association of Depression with Type D Personality and Coping ...
Patients with type D personality actually experience anxiety and distress (i.e. negative affectivity) and suppress emotional expression in social interactions ...Missing: rumination | Show results with:rumination
[56]
Distressed (Type D) personality is predicted by avoidance - NIH
Oct 27, 2022 · Type D personality is characterized by high levels of both negative affectivity (NA) and social inhibition (SI). Individuals classified as Type ...
[57]
Relationships between depression, anxiety, type D personality, and ...
Aug 7, 2025 · Worry was most strongly associated with anxiety, whereas rumination was most strongly associated with depression and negative affectivity. The ...
[58]
Type D Personality as a Marker of Poorer Quality of Life and Mood ...
Jan 10, 2023 · Type D personality was found to be associated with poorer quality of life and higher rates of psychological comorbidities in patients with skin diseases.
[59]
Burnout, stress and Type D personality amongst hospital/emergency ...
Oct 15, 2021 · Type D personality has been identified as a determining factor for mental health problems, long-lasting stress periods, and burnout (Denollet ...
[60]
Type D personality, mental distress, social support and health ...
Jan 22, 2015 · Type D personality has an independent significant effect on the HRQoL in CAD patients with heart failure, and this relation is mediated by anxiety and ...
[61]
Social isolation, perceived social support, and type D personality ...
Nov 9, 2024 · Individuals with type D personality are more inclined to inhibit self-expression in social interactions, which leads to less contact with others ...
[62]
[PDF] Evaluating the Effectiveness of Integrated Intervention Program in ...
Jan 16, 2019 · Objectives: Therefore, the aim of this study was to evaluate the efficiency of integrated intervention program in type D personality ... social ...
[63]
https://hqlo.biomedcentral.com/articles/10.1186/s12955-014-0204-2
[64]
https://doi.org/10.1037/a0021806
[65]
https://pmc.ncbi.nlm.nih.gov/articles/PMC11647483/
[66]
Health specific traits beyond the Five Factor Model, cognitive ...
There is also evidence demonstrating incremental validity of Type D over depression with respect to cardiac mortality (Martens, Mols, Burg, & Denollet, 2010).
[67]
https://doi.org/10.1016/j.paid.2020.110254
[68]
[PDF] Type D personality versus the Big Five personality traits and the ...
Previous studies regarding the relationship between the Big Five traits and the Type D personality have used versions of the NEO Personality Inventory as well.