Distressed personality type, or "type D" individuals, tend to suppress powerful negative emotions as a means of coping with stressful events or situations. These individuals suppress feelings of anger or sorrow even when they are in an environment that is supportive of emotional expression, such as suppressing anger when clearly justified, or refusing to cry at a funeral. The type D individual tends to be anxious, irritable, insecure, and uncomfortable with strangers. These types of people are constantly experiencing and anticipating negative emotions, which results in their being more tense and inhibited around others.
The type D personality was defined in the 1990s, describing individuals who experience feelings of negativity, depression, anxiety, stress, chronic anger, and loneliness. The distressed personality type is also prone to pessimism, low self-esteem, and difficulty making personal connections with others. It is thought that about 20% of otherwise-healthy Americans fall under this category. [1]
In 1996, Dr. Denollet reported a longitudinal study of 286 men and women who had enrolled in a cardiac rehabilitation program. At the beginning of the program, each participant filled out a questionnaire in order to determine whether they fell under the type D pattern. Eight years later, researchers tracked down the participants in order to find out who had died, and who was still alive. Among those who had been classified as type D, 27% had died; meanwhile only 7% of the non-Ds had died. The majority of these deaths were due to heart disease or stroke. Since this study, the type D personality subtype has been thought to be associated with early death, increased risk for developing cardiovascular problems, poorer response to proven treatments for heart disease, and increased chances of sudden cardiac arrest. [2]
A 14-question scale is used to determine whether an individual can be categorized as having a type D personality type. This scale, the D-Scale 14, aims to measure negativity as well as social inhibition. Each of the 14 items on the scale is rated according to a 5 point Likert scale, from 0 to 4 (false to true). Individuals who score high (above a 10) on both negativity and social inhibition can be classified as type D. [2]
This questionnaire was developed based on the idea that individuals who score high on negative affectivity are dysphoric and have a negative view of self. They are also prone to more somatic symptoms, and focus more on negative situations and stimuli. Scoring high on social inhibition means that these individuals tend to avoid the potential 'dangers' involved in social interactions, such as disapproval. Generally speaking, social situations tend to make type D individuals feel inhibited, tense, uncomfortable, and insecure.
A wide variety of health risks are associated with type D personalities, primarily due to the fact that they seem to lead to a more highly activated immune system and therefore, more inflammation. This increase in inflammation can often lead to damaged blood vessels throughout the heart and body. Type D individuals have also been found to have higher blood pressure than normal, as well as an exaggerated response to stress, both physiological and psychological. [2]
Among the health issues commonly associated with this personality subtype are depressive and anxiety symptoms, as well as post-traumatic stress disorder. Additionally, type Ds are might have a predisposition to social phobia, panic disorder, and even the development of avoidant personality disorder. [3]
According to Dr. Denollet, what most likely links poor health outcomes to the type D personality subtype is the distinctly high level of stress associated with it. Unlike other personality types who like to vent, type Ds social inhibition leaves them with no such outlet for their stress. This pent-up stress causes high cortisol levels, which, in turn, can lead to high blood pressure as well as chronic, artery-damaging inflammation. It is worth noting that another possible explanation for this correlation is that type Ds likely also suffer from depression, anxiety, and poor social connections, each of which has been linked with poor health and heart disease. [1]
Both type D dimensions (negative affectivity and social inhibition) are associated with a stress-induced increase in cortisol release. High levels of cortisol are thought to be the mediating factor in the association between this personality type and the increased risk for coronary heart disease.
Additionally, the inhibition of emotions that characterizes type D personality types is strongly associated with higher cardiovascular reactivity, lower cardiovascular recovery, lower heart rate variability, carotid atherosclerosis, incidence of coronary heart disease, and cardiac mortality. The correlation between emotional suppression and cardiovascular complications has been observed in numerous different studies, including one that involved patients undergoing cardiac rehabilitation. In this study, deaths from cardiac causes were increased by a factor of four in those with type D personality, even after controlling for conventional risk factors.
Another study, conducted by Appels et al, investigated the effect of type D behavior on sudden cardiac death. This study involved interviewing the next-of-kin of the sudden cardiac death victims to determine whether they were type D or not. Patients scoring high on negative affectivity and social inhibition (the two dimensions of the type D personality subtype) were found to be seven times more likely to suffer sudden cardiac death. [3]
Stress, either physiological, biological or psychological, is an organism's response to a stressor such as an environmental condition. Stress is the body's method of reacting to a condition such as a threat, challenge or physical and psychological barrier. There are two hormones that an individual produces during a stressful situation, these are well known as adrenaline and cortisol. There are two kinds of stress hormone levels. Resting (basal) cortisol levels are normal everyday quantities that are essential for standard functioning. Reactive cortisol levels are increases in cortisol in response to stressors. Stimuli that alter an organism's environment are responded to by multiple systems in the body. In humans and most mammals, the autonomic nervous system and hypothalamic-pituitary-adrenal (HPA) axis are the two major systems that respond to stress.
The hypothalamic–pituitary–adrenal axis is a complex set of direct influences and feedback interactions among three components: the hypothalamus, the pituitary gland, and the adrenal glands. These organs and their interactions constitute the HPA axis.
Type A and Type B personality hypothesis describes two contrasting personality types. In this hypothesis, personalities that are more competitive, highly organized, ambitious, impatient, highly aware of time management, or aggressive are labeled Type A, while more relaxed, "receptive", less "neurotic" and "frantic" personalities are labeled Type B.
Social inhibition is a conscious or subconscious avoidance of a situation or social interaction. With a high level of social inhibition, situations are avoided because of the possibility of others disapproving of their feelings or expressions. Social inhibition is related to behavior, appearance, social interactions, or a subject matter for discussion. Related processes that deal with social inhibition are social evaluation concerns, anxiety in social interaction, social avoidance, and withdrawal. Also related are components such as cognitive brain patterns, anxious apprehension during social interactions, and internalizing problems. It also describes those who suppress anger, restrict social behavior, withdraw in the face of novelty, and have a long latency to interact with strangers. Individuals can also have a low level of social inhibition, but certain situations may generally cause people to be more or less inhibited. Social inhibition can sometimes be reduced by the short-term use of drugs including alcohol or benzodiazepines. Major signs of social inhibition in children are cessation of play, long latencies to approaching the unfamiliar person, signs of fear and negative affect, and security seeking. Also in high level cases of social inhibition, other social disorders can emerge through development, such as social anxiety disorder and social phobia.
Loeffler endocarditis is a form of heart disease characterized by a stiffened, poorly-functioning heart caused by infiltration of the heart by white blood cells known as eosinophils. Restrictive cardiomyopathy is a disease of the heart muscle which results in impaired diastolic filling of the heart ventricles, i.e. the large heart chambers which pump blood into the pulmonary or systemic circulation. Diastole is the part of the cardiac contraction-relaxation cycle in which the heart fills with venous blood after the emptying done during its previous systole.
Allostatic load is "the wear and tear on the body" which accumulates as an individual is exposed to repeated or chronic stress. The term was coined by Bruce McEwen and Eliot Stellar in 1993. It represents the physiological consequences of chronic exposure to fluctuating or heightened neural or neuroendocrine response which results from repeated or prolonged chronic stress.
Social connection is the experience of feeling close and connected to others. It involves feeling loved, cared for, and valued, and forms the basis of interpersonal relationships.
"Connection is the energy that exists between people when they feel seen, heard and valued; when they can give and receive without judgement; and when they derive sustenance and strength from the relationship." —Brené Brown, Professor of social work at the University of Houston
Type D personality, a concept used in the field of medical psychology, is defined as the joint tendency towards negative affectivity and social inhibition. The letter D stands for "distressed".
Chronic stress is the physiological or psychological response induced by a long-term internal or external stressor. The stressor, either physically present or recollected, will produce the same effect and trigger a chronic stress response. There is a wide range of chronic stressors, but most entail relatively prolonged problems, conflicts and threats that people encounter on a daily basis. And several chronic stressors, including "neighbourhood environment, financial strain, interpersonal stress, work stress and caregiving.", have been identified as associated with disease and mortality.
Occupational health psychology (OHP) is an interdisciplinary area of psychology that is concerned with the health and safety of workers. OHP addresses a number of major topic areas including the impact of occupational stressors on physical and mental health, the impact of involuntary unemployment on physical and mental health, work-family balance, workplace violence and other forms of mistreatment, psychosocial workplace factors that affect accident risk and safety, and interventions designed to improve and/or protect worker health. Although OHP emerged from two distinct disciplines within applied psychology, namely, health psychology and industrial and organizational psychology, for a long time the psychology establishment, including leaders of industrial/organizational psychology, rarely dealt with occupational stress and employee health, creating a need for the emergence of OHP. OHP has also been informed by other disciplines, including occupational medicine, sociology, industrial engineering, and economics, as well as preventive medicine and public health. OHP is thus concerned with the relationship of psychosocial workplace factors to the development, maintenance, and promotion of workers' health and that of their families. The World Health Organization and the International Labour Organization estimate that exposure to long working hours causes an estimated 745,000 workers to die from ischemic heart disease and stroke in 2016, mediated by occupational stress.
The effects of stress on memory include interference with a person's capacity to encode memory and the ability to retrieve information. Stimuli, like stress, improved memory when it was related to learning the subject. During times of stress, the body reacts by secreting stress hormones into the bloodstream. Stress can cause acute and chronic changes in certain brain areas which can cause long-term damage. Over-secretion of stress hormones most frequently impairs long-term delayed recall memory, but can enhance short-term, immediate recall memory. This enhancement is particularly relative in emotional memory. In particular, the hippocampus, prefrontal cortex and the amygdala are affected. One class of stress hormone responsible for negatively affecting long-term, delayed recall memory is the glucocorticoids (GCs), the most notable of which is cortisol. Glucocorticoids facilitate and impair the actions of stress in the brain memory process. Cortisol is a known biomarker for stress. Under normal circumstances, the hippocampus regulates the production of cortisol through negative feedback because it has many receptors that are sensitive to these stress hormones. However, an excess of cortisol can impair the ability of the hippocampus to both encode and recall memories. These stress hormones are also hindering the hippocampus from receiving enough energy by diverting glucose levels to surrounding muscles.
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The Shift-and-persist model has emerged in order to account for unintuitive, positive health outcomes in some individuals of low socioeconomic status. A large body of research has previously linked low socioeconomic status to poor physical and mental health outcomes, including early mortality. Low socioeconomic status is hypothesized to get "under the skin" by producing chronic activation of the sympathetic nervous system and hypothalamic–pituitary–adrenal axis, which increases allostatic load, leading to the pathogenesis of chronic disease. However, some individuals of low socioeconomic status do not appear to experience the expected, negative health effects associated with growing up in poverty. To account for this, the Shift-and-Persist Model proposes that, as children, some individuals of low socioeconomic status learn adaptive strategies for regulating their emotions ("shifting") and focusing on their goals ("persisting") in the face of chronic adversity. According to this model, the use of shift-and-persist strategies diminishes the typical negative effects of adversity on health by leading to more adaptive biological, cognitive, and behavioral responses to daily stressors.