Type D Personality Associated With Health and Mental Health Problems: A Comment on Lussier and Loas (2015)

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1 Article Type D Personality Associated With Health and Mental Health Problems: A Comment on Lussier and Loas (2015) Psychological Reports 2016, Vol. 118(3) ! The Author(s) 2016 Reprints and permissions: sagepub.com/journalspermissions.nav DOI: / prx.sagepub.com Barbara Gawda Department of Psychology, Maria Curie Sklodowska University, Poland Abstract Lussier and Loas examined relationship between anhedonia, depression, and type D personality. The aim of this commentary is to extend the discussion to four aspects not considered in the original article: association of type D personality with problems other than those of cardiovascular health, inconsistent findings in these associations, data on association between type D personality and mental problems, and an attempt to interpret their main findings. The proposed interpretation refers to trait anxiety as is partially incorporated into the type D personality. Keywords type D personality, trait anxiety, social inhibition Introduction The purpose of the present commentary is to extend information on the associations of the type D personality and to propose an interpretation of the main finding that was not considered in the original article. The commentary touches on four aspects. First, the original article mentions that type D personality is associated with cardiovascular problems (Lussier & Loas, 2015, p. 857). This association was documented; however, it must be noted that this type of personality is linked to many health problems, not only to cardiovascular ones. The second aim of this commentary is to provide information with respect to the original article on the controversial associations between the type D personality and cardiovascular problems. Not all of the extant studies have confirmed Corresponding Author: Barbara Gawda, Department of Psychology, Maria Curie Sklodowska University, Plac Litewski 5, Lublin, Poland. bgawda@wp.pl

2 1040 Psychological Reports 118(3) these associations. Third, type D personality is also associated with many mental health problems (mentioned in the original article, pp ). Hence, the aim of this commentary is to extend information on the association between type D and other health and mental health problems. The last point of the commentary is an attempt to explain the psychological mechanisms of association between anhedonia and social inhibition (as a factor of type D personality), the main finding of Lussier and Loas. They explored the relationship between anhedonia, depression, and type D personality and found that anhedonia was positively correlated with social inhibition in men and women. They also confirmed that the relationship between anhedonia and depression was mediated by social inhibition (as a factor of type D personality), although it only partially mediated the relationship in women, but not at all in men. The type D personality is a large concept encompassing two factors: negative affectivity and social inhibition (Denollet, 2013). This type of personality was significantly associated with cardiovascular problems in many studies (e.g., Hausteiner, Klupsch, Emeny, Baumert, & Ladwig, 2010; Howard & Hughes, 2013; Kupper et al., 2013; Wu & Moser, 2014). Recent findings demonstrated that type D personality may be a predictor not only of cardiovascular problems but also of many other health problems such as chronic pain, asthma, tinnitus, and others (e.g., Denollet & Kupper, 2015; Kupper et al., 2013; Mols & Dennolet, 2009). Second, dimensional research on the relationship between type D personality and cardiovascular problems report some inconsistent findings, for example, type D personality was not associated with coronary heart disease (Larson, Barger, & Sydeman, 2013), type D personality was associated with decreased heart rate variability (Hoogwegt, Pedersen, Theuns, & Kupper, 2014), and with an increased risk for ventricular arrhythmias (Einviket al., 2014). Furthermore, no relationship was found for short-term measurements of heart rate variability in nonclinical patients with no definitive cardiovascular disease (Kang, Lim, Hwang, Joe, & Lee, 2015). Third, type D personality was not only associated with health problems but also with many mental disorders, such as depression, suicidal ideation, anxiety, and emotional distress. Former and recent research documented links between type D personality and mood disorders (e.g., Kupper et al., 2013; van Dooren et al., 2016), anxiety disorders (e.g., Versteeg, Roest, & Dennolet, 2015), personality disorders, and posttraumatic stress disorders (e.g., Denollet & Kupper, 2015; Mochal, Wiltink, Grande, Beutel, & Brahller, 2011). Taking into account the above-mentioned information, type D personality seems to be omnipresent in patients with health and mental problems; it can be found in about a quarter of the general population (Hausteiner et al., 2010). This may be because type D comprises two factors: personality tendency to experience negative feelings and tendency to react in an inhibited way. Type D overlaps with many emotional or personality traits comprising negative affectivity and aspects of social inhibition, such as trait anxiety and neuroticism. This may

3 Gawda 1041 help interpret the main findings of Lussier and Loas (2015), that anhedonia is positively correlated with social inhibition in men and women, and that a relationship between anhedonia and depression is mediated by social inhibition. The most adequate interpretation is that of trait anxiety, which is well established in psychology in terms of measurement and its psychological, behavioral, and neurobiological aspects. The mechanism underlying the observed relationship may have its basis in trait anxiety, a disposition to respond to stimuli with irritability and negative mood, and increased inhibition (Hartley & Phelps, 2012). Trait anxiety is a consistent personality disposition exhibiting anxiety-related behaviors (Hartley & Phelps, 2012) and is thought to be a result of interaction between stress in early life and dispositional emotional arousal (Kindt, 2014). Type D personality is also relatively consistent (Denollet, 2013). Both, as personality traits (or factors), are associated with many neurobiological and behavioral mechanisms. Type D involves autonomic and inflammatory dysregulation, increased oxidative stress, cortisol secretion, hypothalamic-pituitary-adrenal axis hyperactivity, and many other problems (Denollet, 2013; Howard & Hughes, 2013; Sher, 2005). Much research shows that neurobiological mechanisms of trait anxiety play an essential role for fear expression, vigilance, heightened reactivity, impaired emotional regulation, and cognitive functioning (Bar-Haim, Lamy, Pergamin, Bakermans-Kranenburg, & van Ijzendoorn, 2007; Hartley & Phelps, 2012). Neurobiological mechanisms of trait anxiety tend to regulate behavior in anxious people. Two principal characteristics of information processing in anxious people were highlighted: a bias to attend to threat-related information and a bias toward negative interpretation of ambiguous stimuli (Hartley & Phelps, 2012). This may explain both the increased expression of negative emotions in people with higher trait anxiety and the tendency to inhibit emotional or behavioral expression in social interactions, as anxious people tend to avoid social interactions. Given the observed links between type D and trait anxiety (e.g., Denollet, 2013; van Dooren et al., 2016; Versteeg et al., 2015), it should be expected that trait anxiety, which potentially overlaps with type D personality, would affect the relationship between anhedonia and depression. Thus, the main findings by Lussier and Loas (2015) may be interpreted in terms of trait anxiety mechanisms. To conclude, Type D personality is thought to be related to many health and mental health problems. It overlaps with many personality concepts (thus it is a controversial concept), and that is why data on associations with type D report a plethora of correlations with traits, symptoms, and disorders. Trait anxiety mechanisms seem to be closely related to type D personality and may help to interpret the relationship between anhedonia and depression mediated by social inhibition. However, irrespective of the name of a concept, all these cited results indicate the importance of personality traits in the treatment and prognosis of health and mental health problems.

4 1042 Psychological Reports 118(3) Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The author(s) received no financial support for the research, authorship, and/or publication of this article. References Bar-Haim, Y., Lamy, D., Persamin, L., Bakermans-Kranenburg, M. J., & van Ijzendoorn, M. H. (2007). Threat-related attentional biases in anxious and nonanxious individuals: A meta-analytic study. Psycholological Bulletin, 133, Denollet, J. (2013). Interpersonal sensitivity, social inhibition, and type D personality: How and when are they associated with health? Psychological Bulletin, 139(5), Denollet, J., & Kupper, N. (2015). Stress and the heart: The role of type D personality in personalized care. European Heart Journal: The Journal of the European Society of Cardiology, 36(28), Einvik, G., Dammen, T., Namtvedt, S. K., Hrubos-Strøm, H., Randby, A., Kristiansen, H. A.,... Omland, T. (2014). Type D personality is associated with increased prevalence of ventricular arrhythmias in community-residing persons without coronary heart disease. European Journal of Preventive Cardiology, 21(5), Hartley, C. A., & Phelps, E. A. (2012). Anxiety and decision making. Biological Psychiatry, 72, Hausteiner, C., Klupsch, D., Emeny, R., Baumert, J., & Ladwig, K. H. (2010). Clustering of negative affectivity and social inhibition in the community: Prevalence of type D personality as a cardiovascular risk marker. Psychosomatic Medicine, 72, Hoogwegt, M. T., Pedersen, S. S., Theuns, D. A., & Kupper, N. (2014). Relation between emotional distress and heart rate variability in patients with an implantable cardioverter defibrillator. Psychophysiology, 51(2), Howard, S., & Hughes, B. M. (2013). Type D personality is associated with a sensitized cardiovascular response to recurrent stress in men. Biological Psychology, 94(2), Kang, N., Lim, J. S., Hwang, T. G., Joe, S. H., & Lee, M. S. (2015). The relationship between type D personality and heart rate variability in community mental health centre users. Psychiatry Investigation, 12, Kindt, M. (2014). A behavioural neuroscience perspective on the aetiology and treatment of anxiety disorders. Behavioural Research and Therapy, 62, Kupper, N., Pedersen, S., Ho fer, S., Saner, H., Oldridge, N., & Denollet, J. (2013). Crosscultural analysis of type D personality (distressed) in 6222 patients with ischemic heart disease. International Journal of Cardiology, 166(2), Larson, N. C., Barger, S. D., & Sederman, S. J. (2013). Type D personality is not associated with coronary heart disease risk in a North American sample of retirement aged adults. International Journal of Behavioral Medicine, 20(2), Lussier, A., & Loas, G. (2015). Relationship between type D personality and anhedonia: A dimensional study of university students. Psychological Reports, 116(3),

5 Gawda 1043 Mochal, M., Wiltink, J., Grande, G., Beutel, M. E., & Bra hel, E. (2011). Type D personality is independently associated with major psychosocial stressors and increased health care utilization in the general population. Journal of Affective Disorders, 134(1 3), Mols, F., & Denollet, J. (2009). Type D personality among noncardiovascular patient populations: A systematic review. General Hospital Psychiatry, 32, Sher, L. (2005). Type D personality: The heart, stress, and cortisol. QJM. An International Journal of Medicine, 98, van Dooren, F. E. P., Verhey, F. R. J., Pouwer, F., Schalkwijk, C. G., Sep, S. J. S., Stehouver, C. D. A.,... Denollet, J. (2016). Association of type D personality with increased vulnerability to depression: Is there a role for inflammation or endothelial dysfunction? The Maastricht Study. Journal of Affective Disorders, 189, Versteeg, H., Roest, A. M., & Denollet, J. (2015). Persistent and fluctuating anxiety levels in the 18 months following acute myocardial infarction: The role of personality. General Hospital Psychiatry, 37(1), 1 6. Wu, J. R., & Moser, D. K. (2014). Type D personality predicts poor medication adherence in patients with heart failure in the USA. International Journal of Behavioral Medicine, 21(5), Author Biography Barbara Gawda is an associative professor in Psychology at the University of Maria Curie-Sklodowska in Lublin, Poland. She received her PhD in Psychology in 1998 from the University of Maria Curie-Sklodowska. Her publications are focused on personality, personality disorders, emotions and motivation, and psycholinguistics.