Emotional distress and social relationship dysfunction: The clinical implications of Type D?

Social inhibition and emotional distress in patients with coronary artery disease: The Type D personality construct

We examined the validity of the social inhibition component of Type D, its distinctiveness from negative affectivity, and value regarding emotional distress as measured with the DS14 in 173 coronary artery disease patients. In dimensional analysis, social inhibition and negative affectivity emerged as distinct traits. Analysis of continuous negative affectivity and social inhibition measures showed main effects for several emotional and inhibition markers and an interaction effect for social anxiety. Categorical analysis indicated that Type D patients reported more depression, negative mood, social anxiety, and less positive mood. Social inhibition is not a redundant trait, but has additional conceptual value.

The Type D Construct

The interaction of negative affectivity (NA) and social inhibition (SI), known as the Type D personality, is associated with a worse prognosis in cardiac patients. Until now, causal models have been speculative, and this is partly due to a lack of clarity related to the validity of SI, its role in emotion regulation, and the postulated independence of social and emotional functioning. To examine the construct validity of the Type D personality, we analyzed associations of NA and SI with different measures of affectivity, social anxiety, and social competencies in a German population-based representative sample (n = 2,495). Both NA and SI were associated with all other measures of social functioning and negative affect (all rs > .30) and showed considerable cross-loadings (NA: a 1 = .39, a 2 = .63; SI: a1 = .73 and a2 = .34) in a two-factor solution with the factors labeled as Social Functioning and Negative Affectivity. The SI subscale did not properly differentiate between social fears and social competencies, which emerged as rather different aspects of social functioning. Further studies should examine the effect of broader dimensions of social orientation and competencies and their interaction with NA on cardiac prognosis.