The distressed (Type D) and Five-Factor Models of personality in young,healthy adults and their association with emotional inhibition and distress

The distressed (Type D) personality (the combination of negative affectivity and social inhibition traits) has been associated with adverse health outcomes. This study investigated the validity of the Type D construct against the Five-Factor Model (FFM) of personality, and its association with emotional control and distress. In total 498 university students (mean age 28.9 ± 8.4 years) completed the Type D scale (DS14), and measurements for the FFM of personality, emotional control, anxiety, depression and stress. The construct validity of the Icelandic DS14 was confirmed. The Type D components negative affectivity and social inhibition were strongly associated with neuroticism and extraversion of the FFM (r = 0.82 and r = −0.67, respectively). Negative affectivity also correlated with rehearsal/rumination (r = 0.58) and social inhibition with emotional inhibition (r = 0.54), indicative of emotional control. Type D personality (40% of sample) was associated with higher levels of anxiety, depression and stress. The Type D personality components were associated with the FFM of personality, emotional control and emotional distress. Importantly, social and emotional inhibition were closely related, providing novel information about the presence of emotional inhibition within the social inhibition trait.     

Type D personality and the development of PTSD symptoms: a prospective study

Psychological trauma and prolonged stress may cause mental disorders such as posttraumatic stress disorder (PTSD). Pretrauma personality is an important determinant of posttraumatic adjustment. Specifically, trait neuroticism has been identified as a risk factor for PTSD. Additionally, the combination of high negative affectivity or neuroticism with marked social inhibition or introversion, also called Type D personality (Denollet, 2000), may compose a risk factor for PTSD. There is no research available that examined pretrauma Type D personality in relation to PTSD. The present study examined the predictive validity of the Type D personality construct in a sample of Dutch soldiers. Data were collected prior to and 6 months after military deployment to Afghanistan. Separate multiple regression analyses were performed to examine the predictive validity of Type D personality. First, Type D personality was defined as the interaction between negative affect and social inhibition (Na × Si). In a second analysis, Type D was defined following cutoff criteria recommended by Denollet (2000). Results showed that negative affectivity was a significant predictor of PTSD symptoms. Social inhibition and the interaction Na × Si did not add to the amount of explained variance in postdeployment PTSD scores over the effects of childhood abuse, negative affectivity, and prior psychological symptoms. A second analysis showed that Type D personality (dichotomous) did not add to the amount of explained variance in postdeployment PTSD scores over the effects of childhood abuse, and prior psychological symptoms. Therefore, Type D personality appears to be of limited value to explain development of combat-related PTSD symptoms.     

The distressed (Type D) personality mediates the relationship between remembered parenting and psychological distress in cardiac patients

Objective: Both the distressed (Type D) personality (i.e. the combination of negative affectivity and social inhibition traits) and dysfunctional parenting styles are associated with anxiety and depression. As parenting styles have been related to personality development, dysfunctional parenting styles may also be associated with Type D personality. We examined whether remembered parenting was associated with anxiety and depression in cardiac patients and whether Type D personality mediated this relationship.

Methods: Our sample comprised 435 patients treated with percutaneous coronary intervention (PCI) and 123 patients with congestive heart failure (CHF). Patients completed the Hospital Anxiety and Depression Scale, Type D Scale (DS14), and Remembered Relationship with Parents (RRP¹⁰) scale.

Results: Remembered parenting was significantly associated with higher anxiety and depression levels and Type D personality. In multivariable linear regression analyses, Type D personality accounted for 25–29% of the variance in anxiety and 23–46% of the variance in depression, while remembered parenting was no longer significantly associated with these domains. Sobel tests and bootstrapping indicated that Type D personality mediated the relationship between remembered parenting and anxiety and depression.

Conclusion: Type D personality mediated the relationship between remembered parenting and anxiety and depression in both PCI and CHF patients.     

Type D Personality and Chronic Pain: Construct and Concurrent Validity of the DS14

A body of research has demonstrated that the Type D personality is a risk factor among cardiac patients. Previous studies validating the Type D Scale (DS14) across other clinical groups have not included chronic pain patients in their samples. The purpose of this study was to investigate the construct and concurrent validity of the DS14 using the MMPI-2. The DS14 and its two component subscales demonstrated strong internal consistency among chronic pain patients. The two subscales of the DS14 were found to be related to similar clinical scales on the MMPI-2, and significant differences were found in the MMPI-2 profiles of individuals with and without the Type D personality. Considerations for clinical practice and research are discussed.     

Depression, anxiety, and the MCMI-III: construct validity and diagnostic efficiency

This study aimed to enhance knowledge of the construct validity and diagnostic efficiency of the depression- and anxiety-related scales of the MCMI-III (Millon, 1994). The MCMI-III, various concurrent depression and anxiety measures, and an Axis I structured diagnostic interview were administered in a total sample of 696 outpatients with depressive disorders, anxiety disorders, or both. Sound construct validity was found for the Dysthymia and Major Depression clinical syndrome scales and the Avoidant and Depressive personality disorder scales. The validity of the Anxiety scale was poor, showing moderate convergence with panic and worry-related anxiety measures, but problems discriminating from depression. Operating characteristics for discriminating depressed patients from anxious patients were fair for the Major Depression scale, but poor for the Anxiety and Dysthymia scales.     

Cardiac morbidity risk and depression and anxiety: a disorder, symptom and trait analysis among cardiac surgery patients

The aim of this study was to examine depression and anxiety disorders and their characteristic symptoms (anhedonia/low positive affect and anxious arousal, respectively), along with measures of state negative affect (NA) and Type D personality, in relation to cardiac surgery related morbidity. Patients awaiting elective coronary artery bypass graft surgery (n=158; 20.9% female; 11.4% concomitant valve surgery; age M=64.7, SD=10.6) underwent the structured MINI International Neuropsychiatric Interview to determine current affective disorders. Patients also completed the Mood and Anxiety Symptom Questionnaire and a measure of Type D personality traits. Postoperative cardiac morbidity was confirmed after surgery during the index hospitalization and included stroke,renal failure, ventilation>24 h, deep sternal wound infection, reoperation, arrhythmia and 30-day mortality at any location (n=59, 37.3% of total). After adjustment for age, recent myocardial infarction, heart failure, hypertension, urgency of surgery and time spent on cardiopulmonary bypass generalized anxiety disorder was associated with cardiac morbidity (odds ratio [OR]=3.26, 95% confidence interval [CI] 1.10-9.67, p=0.03). Adjusted analysis of personality traits revealed the NA component of Type D personality was associated with cardiac morbidity (OR=1.07, 95% CI 1.01-1.14, p=0.03). The Mood and Anxiety Symptom Questionnaire subscales were not associated with increased morbidity risk. Affective disorders, affective phenotypes, and personality traits were differentially associated with post-cardiac surgery morbidity outcomes independent of cardiac surgery morbidity risk factors. Concurrent investigation of depression and anxiety with respect to cardiac outcomes warrants further research.     

Facets of Emotion Regulation and Emotional Disorder Symptom Dimensions: Differential Associations and Incremental Validity in a Large Clinical Sample

A growing literature suggests robust associations between dimensions of emotion regulation and emotional disorder psychopathology. However, limited research has investigated associations of emotion regulation dimensions across several emotional disorders (transdiagnostic associations), or the incremental validity of emotion regulation versus the higher-order construct of neuroticism. The current study used exploratory structural equation modeling and a large clinical sample (N = 1,138) to: (a) develop a multidimensional emotion regulation measurement model, (b) evaluate the differential associations between latent emotion regulation dimensions and five latent emotional disorder symptom dimensions (social anxiety, depression, agoraphobia/panic, obsessions/compulsions, generalized worry), and (c) determine the incremental contribution of emotion regulation in predicting symptom dimensions beyond neuroticism. The best-fitting measurement model of emotion regulation included four dimensions: Problematic Responses, Poor Recognition/Clarity, Negative Thinking, and Emotional Inhibition/Suppression. Although many zero-order associations between the four latent emotion regulation dimensions and five latent symptom dimensions were significant, few associations remained significant in a structural regression model that included neuroticism. Specifically, Negative Thinking and Problematic Responses incrementally predicted depression symptoms, while Emotional Inhibition/Suppression predicted both social anxiety and depression symptoms. Associations between neuroticism and the emotional disorder dimensions were similar regardless of whether the emotion regulation dimensions were held constant. These results suggest that self-reported emotion regulation dimensions are associated with the severity and expression of a range of emotional disorder symptoms, but that some emotion regulation dimensions have limited incremental validity after accounting for general emotional reactivity. Studies of emotion regulation should assess neuroticism as a key covariate.     

Personality and mood correlates of avoidant personality disorder

Avoidant personality disorder (APD) has been recognized as prevalent and clinically important; however, it is not clear how APD maps onto established personality and mood dimensions. In this cross-sectional survey study, 365 college students completed questionnaires assessing APD features and theoretically relevant personality and mood dimensions. Based on these self-report data, 6.6% may meet DSM-IV criteria for APD. Hierarchical regression analyses showed that APD features were associated with introversion, neuroticism, low self-esteem, and pessimistic expectancies. Additionally, APD features were linked with self-reports of elevated emotional responsiveness to threats and reduced emotional responsiveness to incentives (the behavioral inhibition system and behavioral activation system scales). After controlling for the effects of other personality, temperament, and cognitive measures, affective distress (i.e., anger, anxiety, and depression) was no longer related to APD. Results are consistent with APD models that emphasize the joint influences of emotional vulnerability and social-cognitive triggering and sustaining factors.     

Personality in multiple sclerosis (MS): impact on health,psychological well-being,coping, and overall quality of life

Personality has long been considered a factor that can account for differences in health, well-being, and overall quality of life (QOL). A ‘Distressed or Type D Personality’ has been studied in medical populations as a predictor of several outcomes. The purpose of the present investigation was to determine the presence of Type D Personality in multiple sclerosis (MS) and its role on disease symptoms, disease management, health-related behaviors, coping, psychological well-being, and overall QOL and functioning. Two hundred and thirty (230) individuals with MS completed a survey assessing personality, disease symptoms, disease management, coping, self-efficacy, locus of control (LOC), psychological well-being, and QOL. Thirty-seven (16%) individuals were found to be ‘Type D+.’ Such individuals reported greater fatigue, pain, depression, and anxiety and worse disease management and adherence. They also reported engaging in maladaptive means of coping. Compared to ‘Type D?’ they reported lower self-efficacy, LOC, QOL and greater perceived stress. Finally, ‘Type D+’ individuals were more likely to be considering leaving the workforce. Findings suggest that ‘Type D’ Personality is associated with various negative outcomes in MS. Consideration of the routine assessment of personality in MS seems warranted and may better inform interventions and ward off poor outcomes.     

Type D personality and cardiovascular reactivity to an ecologically valid multitasking stressor

Previous research investigating the influence of Type D personality on cardiovascular reactivity to stress in healthy young adults is somewhat mixed. The present study sought to investigate this question using an ecologically valid laboratory stressor. Beat-to-beat blood pressure and heart rate were measured in 77 healthy young adults during exposure to multitasking stress. Mood and background stress were both associated with Type D personality when Type D was conceptualised as a dimensional construct, with less robust findings observed using the traditional dichotomous typological approach. However, the continuous Type D construct added limited predictive value of the self-report measures above that of its constituent components, negative affectivity (NA) and social inhibition (SI). Further, an inverse relationship between the continuous Type D construct and blood pressure reactivity to multitasking stress was observed. In summary, our findings suggest that Type D personality is predictive of blunted cardiovascular reactivity to stress in healthy individuals when Type D is considered as a dimensional construct and the independent influence of NA and SI is controlled for. Further, our findings suggest that Type D does not predict additional variance in mood and background stress above that of NA and SI when these constituent factors are considered independently.     

What role does neuroticism play in the association between negative job characteristics and anxiety and depression?

Many studies have established an association between job characteristics and anxiety and depression and noted that personality characteristics such as neuroticism likely play a role in creating or modifying these associations. Few studies, however, have explicitly tested or compared these possible alternative roles. In this study, we tested several specific hypotheses about neuroticism and its effects on job characteristics, anxiety and depression and their association in a series of structural equation models. Participants (N = 372) completed the Big Five Inventory, Job Contents Questionnaire and General Health Questionnaire. We tested (a) whether neuroticism is likely to be an important confounder of the association between job characteristics and anxiety and depression and (b) whether neuroticism moderates the association between job characteristics and anxiety and depression. Results indicated large attenuations by neuroticism of the association between job characteristics and anxiety and depression but there remained significant effects of psychological demands on anxiety, and social support on depression independent of neuroticism. Evidence was also found for interaction effects between neuroticism and decision latitude, with those lower in neuroticism being at higher risk for depression under conditions of low control.     

Anger and postcombat mental health: Validation of a brief anger measure with U.S. Soldiers postdeployed from Iraq and Afghanistan

The involvement of anger in the psychological adjustment of current war veterans, particularly in conjunction with combat-related posttraumatic stress disorder (PTSD), warrants greater research focus than it has received. The present study concerns a brief anger measure, Dimensions of Anger Reactions (DAR), intended for use in large sample studies and as a screening tool. The concurrent validity, discriminant validity, and incremental validity of the instrument were examined in conjunction with behavioral health data for 3,528 treatment-seeking soldiers who had been in combat in Iraq and Afghanistan. Criterion indices included multiple self-rated measures of psychological distress (including PTSD, depression, and anxiety), functional difficulties (relationships, daily activities, work problems, and substance use), and violence risk. Concurrent validity was established by strong correlations with single anger items on 4 other scales, and discriminant validity was found against anxiety and depression measures. Pertinent to the construct of anger, the DAR was significantly associated with psychosocial functional difficulties and with several indices of harm to self and to others. Hierarchical regression performed on a self/others harm index found incremental validity for the DAR, controlling for age, education, military component, officer rank, combat exposure, PTSD, and depression. The ability to efficiently assess anger in at-risk military populations can provide an indicator of many undesirable behavioral health outcomes. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Examination of the Association Among Personality Traits,Anxiety Sensitivity,and Cannabis Use Motives in a Community Sample

Personality factors, such as neuroticism, are important for understanding motives for cannabis use; however, few studies have examined the role of neuroticism in the context of other personality factors, or possible mechanisms accounting for an association between neuroticism and motives for use. The present study examined concurrent associations between personality traits (i.e., conscientiousness, extraversion, agreeableness, and neuroticism) and cannabis use motives, and the role of anxiety sensitivity (AS) in the association between neuroticism and coping cannabis use motives. Seventy young adults endorsing past-month cannabis use (58.6 % female, M _age = 20.91) completed self-report measures. Linear regressions were conducted to examine the concurrent associations between personality factors and cannabis use motives. Higher levels of neuroticism, but no other personality traits, were significantly associated with greater coping (β = 45, p < .01) and expansion (β = 0.29, p = <.05) motives. Bootstrap analysis (10,000 re-samples) revealed that a significant portion of the relationship between neuroticism and coping motives was explained by AS (point estimate = 0.029, PB 95 % CI: 0.0089 to 0.0615). Greater neuroticism may result in heightened sensitivity to arousal, which may then increase motivation to use cannabis to alleviate such arousal.     

Personality dimensions and emotional problems: The mediating role of irrational beliefs in Pakistani adult non‐clinical sample

This study presents the first examination of the relation between the Big Five personality traits, irrational beliefs and emotional problems in Pakistan, which is an understudied country in the psychological distress literature. A total of 195 participants (aged 25–60 years), employees at COMSATS University, completed a demographic information sheet, the Big Five Personality Questionnaire, the Irrational Belief Inventory and two subscales of the Brief Symptom Inventory including depression and anxiety. Direct effects of neuroticism, openness and conscientiousness were also observed for depression and anxiety. Structural Equation Modelling demonstrated that irrational beliefs played a significant mediating role in the relationship between neuroticism and anxiety and neuroticism and depression. The results highlight the importance of cognitive beliefs in functionally linking personality traits and emotional problems.     

The Coping Competence Questionnaire: A measure of resilience to helplessness and depression

Based on helplessness/hopelessness theories of depression, the 12-item Coping Competence Questionnaire (CCQ) was designed to assess resilience against helplessness and depression. Evidence from a study involving 2,224 participants indicates that the CCQ is highly reliable, stable over a 1-month period, unidimensional, and internally valid. The CCQ converged negatively with measures of depression, neuroticism, and stress reaction and showed discriminant validity with a variety of other personality constructs. Compared to a measure of attributional style, the CCQ proved to be a superior predictor of depressed mood. Path models support the assumption that the CCQ buffers the effects of stress and negative life events on depressed mood and that dysfunctional coping mediates the effects of coping competence deficits on depression.     

Psychometric evaluation of the behavioral inhibition/behavioral activation scales in a large sample of outpatients with anxiety and mood disorders

The latent structure, reliability, and validity of the Behavioral Inhibition/Behavioral Activation Scales (BIS/BAS; C. L. Carver and T. L. White, 1994) were examined in a large sample of outpatients (N = 1,825) with anxiety and mood disorders. Four subsamples were used for exploratory and confirmatory factor analyses. In addition to generally upholding a latent structure found previously in nonclinical samples, results indicated measurement invariance of the BIS/BAS between genders and a higher order structure of the BAS scales. Convergent and discriminant validity of the BIS/BAS were supported by findings that the subscales correlated most strongly with measures of neighboring personality constructs (e.g., BIS with neuroticism, BAS with positive affect) than with measures of current anxiety and depression symptoms. Overall, the results support the psychometric properties of the BIS/BAS in this clinical sample.     

Social relationships, personality, and anxiety during a major stressful event

Although it is commonly believed that social relationships buffer the effects of stress on mental health, these apparent buffering effects may be spurious reflections of personality or prior mental health. This possibility was investigated in a prospective study of a medical school entrance examination. Five weeks before the examination, Ss (N = 56) rated their personality (extraversion and neuroticism) and social relationships (number of social contacts and perceived support). They then rated their anxiety for 35 days surrounding the examination. Controlling for personality and prior anxiety, social contacts buffered against increases in anxiety, whereas perceived support did not. Further analyses revealed that discretionary social contacts were beneficial whereas obligatory contacts were not.     

Structure of the hypochondriacal and hysteroid personality

Hypochondriacal and hysteroid personalities are considered the extreme variants of defined emotional and motivational dimensions. The hysteroid personality is mainly characterized by a strong need for social attention and respect as well as by a lack of emotional genuiness. For the diagnosis of hypochondriacal and hysteroid personality tendencies, a Hypochondria-Hysteria Inventory was developed and employed in 13 different samples with a total of 1206 persons. The index scores of the individual degrees of hypochondriacal and hysteroid tendencies were demonstrated to be of sufficient reliability. There was no important relationship between the individual degrees of hypochondriacal and hysteroid tendencies. Hypochondriacal tendencies are significantly correlated with general anxiety, neuroticism, depression, inhibition and psychasthenia as well as with a general negative self-concept. There is only a weak and partial significant relationship to the degree of introversion. The intensity of hypochondriacal tendencies increases with age. Hysteroid personality tendencies are significantly associated with extraversion, a certain degree of aggressiveness as well as with unconcern and sociability. The intensity of hysteroid tendencies in older adults is lower than in adolescents and young adults.     

Adolescent Psychopathy and Personality Theory—the Interpersonal Circumplex: Expanding Evidence of a Nomological Net

The construct validity of psychopathy was examined in a sample of 114 male and female young offenders (M_age = 15.16) at a southeastern detention center. The interpersonal circumplex served as a framework of general personality from which to examine the construct of adolescent psychopathy. A supplementary analysis of the psychopathy measures and the Big 5 factors of personality was also conducted using a matrix approach. Measures included: (a) Antisocial Process Screening Device (P. J. Frick & R. D. Hare, 2001); (b) Child Psychopathy Scale (D. R. Lynam, 1996); (c) Psychopathy Checklist—Youth Version (A. E. Forth, D. S. Kosson, & R. D. Hare, 2003); and (d) Interpersonal Adjective Scales Revised—Big 5 Version (P. Trapnell & J. S. Wiggins, 1991; J. S. Wiggins, 1995). Results showed substantial convergence among the three psychopathy measures. In addition, meaningful associations between psychopathy and constructs within the interpersonal circumplex and broader domains of the Big 5 were obtained. Two psychopathy scales correlated to a higher degree than expected with neuroticism. These findings provide evidence linking personality theory to the concept of child and adolescent psychopathy, thereby adding to its construct validity. However, they do so with the caveat that youth may also be displaying some characteristics of neuroticism, suggesting that worry and anxiety may accompany psychopathic features in earlier developmental stages. The implications of the current study are discussed.     

Coping as a personality process: a prospective study

The study tested the proposition that coping is personality in action under stress. Using a stressful medical school entrance examination, the study examined (a) whether neuroticism emerged in coping patterns over time and (b) whether the influence of neuroticism on coping accounted for changes in anxiety and examination performance. Fifty premedical students reported their coping efforts at 35 days before, 10 days before, and 17 days after the examination. They provided daily reports of anxiety for 35 days surrounding the examination. Neuroticism influenced coping efforts and increases in daily anxiety under stress. Two types of coping, wishful thinking and self-blame, explained over half the relationship between neuroticism and increases in preexamination anxiety. Consistent with previous research, neither neuroticism nor specific coping efforts influenced examination performance.