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Distressed Personality Type or "Type D" individuals, suppress powerful negative emotions as a means of coping with stressful events or situations. These individuals suppress feelings of anger or sorrow even when they are in an environment that is supportive of emotional expression, such as suppressing anger when clearly justified, or refusing to cry at a funeral. This chronic suppression of emotions is believed to produce a suppression of the immune system, which can cause an increased susceptibility to illness and diseases such as cancer. The initial discovery of Type D personality was made in the Netherlands, when a group of cardiac patients were being tested and analyzed for Neuroticism and Extraversion data. It was then characterized as high levels of Neuroticism combined with low levels of Extraversion, but was then later summarized as social inhibition and elevated negative emotions.

Study History
In 1996, Dr. Denollet did a study of 286 men and women to analyze the influence of type D personality on the heart. It is estimated that one-third of the participants had distressed personalities. After the initial recording of the evaluations there was a follow up after eight years.
 * Results After Eight Years

Following Dr. Denollets’ study was a Dutch team that followed proximity 900 men and women that had went through a procedure were they have a drug releasing stent to hold open a blocked coronary.


 * Results After Nine Months

Characteristics
Individuals with type D personality tend to show negative emotions, such as anger, depression, anxiety, and hostile feelings and sometimes may have a negative outlook on themselves. This personality type can be associated with depression and other anxiety symptoms and some people may avoid social behavior. A negative effect on type D personality was viewed through studies for people who have issues in the workplace, such as stress and higher absence-leave. Other studies show that type D personality also takes a toll on physical well-being as well as mental health. Physically, people tend to have influenza-like illness problems and poor health. Mentally, symptoms of depression and anxiety occur. There have also been links to post traumatic stress disorder to type D patients.

Negative Affectivity and Social Inhibition are two factors that define type “D” personality; as well the outcome of heart problems, also early death. Usually those with high social inhibition experience being tense, and don’t feel comfortable with other people. Negative emotions that is experienced releases cortisol, which inhibits the growth hormone and gonadal axes. The deficiency of the growth hormone is related to the risk of premature cardiovascular disease.

Mood relates to higher cortisol levels. Cortisol also increases during depression due to the impairment of the connections of the HPA axis. Those with type “D” personality often experience depression and stressful emotions causing the cortisol levels to reach a point where there is a chance that it is neurotoxic. Regulations of the cortisol levels will vary with each individual, though it is more likely for younger individuals to react to the drug treatment faster than those more aged.

Distressed personalities could lead to long time chronic conditions such as tinnitus; the auditory phantom sound. Tinnitus is influenced by assorted personality disorders. Type “D” was individually was found to experience a more prominent case then others. Having health problems, along with anxiety and depression can deepen type “D” personality.

Both distressed personalities and those with tinnitus are associated with hysteria and hypochondriasis. Hysteria and hypochondriasis increases distress in individuals.

Treatment
Treatment for type D individuals is required, because they are at risk for other mental or medical disorders. "Cognitive behavioural therapy, social skills training, emotional support, interpersonal psychotherapy, progressive muscle relaxation, autogenic training, diaphragmatic breathing, guided imagery, various forms of meditation, hypnosis, biofeedback, exercise, and other treatments may all reduce stress in type D persons." Any basic lifestyle change can help treat this distress, such as a better diet, physical activity, and participating in pleasing activities.