Hostile, negative and introverted? Beware peripheral artery disease

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In boardrooms, classrooms, bedrooms and the playing field, we all recognize the classic signs of a ‘Type A’ personality. And most of us know that these hard-chargers seem to be at higher risk of heart attacks and strokes. Their demanding, competitive, restless, short-fused behavior seems to make them more likely to work themselves ragged, blow a physiological gasket, drink hard and drive fast.

Clearly, not personality traits likely to promote well-being -- physical or emotional well-being, anyway.

But who has ever heard of the Type D personality? Depending on whom you ask, D stands for distressed. Or, that it follows sequentially from Type A (above); Type B (A’s opposite -- laid-back, cooperative, slow to anger); Type C (a martyr -- compliant, eager to please, and prone to hopelessness and depression; studies have shown Type Cs to be vulnerable to cancer and other malfunctions of the immune system).

In any event, Type Ds are notable for negative thinking, worrying, suppressed anger and a tendency to respond to stress by withdrawal and denial. They stew. They simmer. They blame themselves -- and others. And when it comes to feelings, they’re given to stoicism: They rarely give voice to strong emotions, such as anger, and are likely equally disinclined to acknowledge them, say, in daily journal entries.

Turns out, being a Type D isn’t a personality type given to robust health, either, a fact that a new study underscores. (Want to explore your personality type? Here‘s a bit more information.)

In an article in this week’s Archives of Surgery, Dutch researchers found that Type D personalities who suffer from peripheral artery disease -- a build-up of plaque in the lower body’s veins and arteries that causes cramping and pain in the legs and pelvis -- were more likely to die in the four years they were studied than fellow patients with peripheral artery disease who were not identified as Type Ds.

The study followed 184 patients diagnosed with peripheral artery disease and who had filled out questionnaires that identified their personality traits as Type D. Type Ds were strong on social avoidance and tended to fret a lot. They were mostly likely to agree strongly with statements such as ‘I often find myself worrying about something,’ or ‘I would rather keep people at a distance.’

By the end of the study period, 16 of the Type-D PAD patients had died -- three times the number expected among a group of their average age (64) and health status. That’s despite the fact that the Type Ds on the whole had no greater risk factors for death than did any of the PAD patients in a larger study. Most -- seven -- died of cancer, and six of cardiovascular disease.

What is it about Type Ds that might make them more vulnerable to succumbing to a wide range of illnesses? For starters, said the study’s authors -- led by Annalies E. Aquarius -- studies have shown that Type D personality types tend to respond to stress with a surge of stress hormones, and that their blood carries physiological markers of inflammation higher than those not identified as Type D. Inflammatory processes over time are widely believed to give rise to cancer and erode the function of arteries.

Beyond that, the researchers note, the types of behavior that emerge from Type Ds’ personalities might well lead to a reluctance to acknowledge unwellness, seek care and participate aggressively in one’s treatment. Rather, a Type D personality might choose instead to fret about, give up on, or deny measures to protect his or her health.

As physicians cope with epidemics of cardiovascular disease, diabetes and obesity, say the authors, the importance of personality types in influencing treatment decisions, quality of life and outcomes will be ever more important.

Even, judging from the article’s publication in the Archives of Surgery, to surgeons, who might otherwise be tempted to cut those personality traits out.

--Melissa Healy