The distressed (Type D) and Five-Factor Models of personality in young, healthy adults and their association with emotional inhibition and distress
Highlights
► This study examined the validity of Type D personality in young, healthy adults. ► The Type D subcomponents correspond well with the Five-Factor Model of personality. ► The presence of emotional inhibition in the social inhibition trait was confirmed. ► Type D personality was related to elevated anxiety, depression and stress scores.
Introduction
The distressed (Type D) personality is defined by the combination of two broad personality traits, negative affectivity (NA) and social inhibition (SI). It portrays individuals who frequently experience negative emotions in daily life (NA), and tend to be insecure in social interactions and refrain from sharing their emotions with others (SI). Type D personality was developed from existing personality theory (Denollet and Brutsaert, 1998, Denollet et al., 1995), in efforts to identify cardiovascular patients vulnerable for emotional difficulties (Denollet, 2000). Subsequently, Type D personality emerged as a marker for negative health outcomes in cardiovascular disease (Denollet, Schiffer, & Spek, 2010). Risk of coronary artery disease mortality or non-fatal myocardial infarctions is 2–3 times higher in Type D patients (Denollet, Schiffer, et al., 2010, Grande et al., 2012), independent of conventional risk factors, disease severity, medical treatment and other psychological factors (Denollet, Schiffer, et al., 2010). In the general population, Type D personality has been associated with poor health status and disease-promoting mechanisms (Mols & Denollet, 2010).
Only a few studies (De Fruyt and Denollet, 2002, Howard and Hughes, 2011, Svansdottir et al., 2011) have examined how Type D personality fits within the framework of more comprehensive models of personality, such as the Five-Factor Model of personality (FFM) (Costa & McCrae, 1989). The FFM describes the basic dimensions of personality, and encompasses the traits of neuroticism and extraversion, which bear strong similarities to NA and SI, respectively. Similarly, information has remained sparse regarding how the Type D personality subcomponents relate to emotional control, especially emotional regulation within the SI subcomponent (Grande, Glaesmer, & Roth, 2010). Validating the presence of such emotional inhibition within the Type D construct is vital, as the adverse effect of Type D personality on health-related outcomes is postulated to result from the chronic psychological distress of inhibiting expression of negative emotions (Denollet et al., 1995). Notably, emotional suppression, i.e. consciously inhibiting emotional expressive behavior while emotionally aroused, has been associated with an increased sympathetic activation in the cardiovascular system (Gross & Levenson, 1993). Initial evidence has linked Type D with emotional control (Svansdottir et al., 2011), and suppressed anger (Denollet, Gidron, Vrints, & Conraads, 2010), but more information concerning its construct validity is needed.
The aim of this study was threefold. First, to evaluate the Type D construct within the framework of the FFM of personality. Second, to assess the presence of emotional inhibition within SI. Third, to examine Type D as a potential marker of emotional distress in young, healthy individuals.
Section snippets
Participants
The participant sample consisted of 498 healthy individuals (mean age 28.9 ± 8.4 years, 393 women (79%)), from the University of Iceland. Participants were recruited in March 2006 by an email asking for volunteers to participate in the study. The email included a link to a webpage where students filled out the questionnaires. The study was conducted to conform to the ethical tenets of the World Medical Association, as espoused in the Declaration of Helsinki.
The DS14 scale
Type D personality was measured with the
Dimensional structure and prevalence of Type D personality
A confirmatory factor analysis (N = 498) of the two-factor structure of the Icelandic DS14 (representing NA and SI) indicated an adequate model fit for the unconstrained model (λ2 = 224.996; p = 0.001; CFI = 0.955 and RMSEA = 0.070, CI.90: 0.06–0.08). Standardized regression weights of items to factor ranged from 0.53 to 0.85 (Fig. 1). Average scores on DS14 were M = 11.0 ± 5.9 for NA and M = 11.5 ± 6.4 for SI. Prevalence of Type D personality was 40% (N = 199), and was similar across men (36%) and women (41%; p =
Discussion
The findings of this study confirmed the factor structure of the DS14 (Denollet, 2005, Svansdottir et al., 2011) and the validity of the Type D construct within the framework of the FFM of personality. The Type D subcomponents were well represented within the FFM framework. NA and neuroticism were closely related, and SI was negatively correlated with extraversion. A second-order factor analysis of scale scores corroborated these findings, by showing that NA/neuroticism and SI/extraversion
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