Type D Personality: Helping Hopeless Patients

By February 3, 2016Ideas, Insights

We all know every patient has a different personality type. There’s the Type A Personality Patient who is motivated, even driven to succeed while stressing to get things right. Then there’s the opposite, the Type D Personality Patient who may be in denial, depressed and pessimistic about their ability to deal with their illness and whose behaviors may indeed be self-sabotaging.
Most experienced physicians and healthcare providers know it is important to empower patients by tapping into their personal motivators. It gets tricky when dealing with the Type D Personality Patient because we often first encounter them in an acute treatment setting. But it is important to try, as they are overrepresented among patients with multiple morbidities, who make up more than 80% of Medicare health care costs (Anderson 2002).
When it comes to the long-term management of a chronic condition, it is critical to believe that one’s actions count. This belief in one’s own ability is labeled self efficacy. In essence, what you think shapes how you behave, and how you behave can determine your health outcomes.
The ultimate goal is to help patients achieve high self efficacy. We build self efficacy by mastering self-care behaviors.

The “Hopeless” Patient

But what if you have a patient who denies they have a problem? Or is already convinced the situation is hopeless when it is not? How can you support a patient so that they manage their chronic condition better over the long run? Building self efficacy is important if you are to prevent costly acute care.
Type D Personality Patient
People who struggle with a negative thoughts, introversion and poor self care have a Type D Personality (Denollet, 2000). Compared to other personality types, the Type D Personality Patient believes their illness is more serious and will last longer. They feel sicker and sadder. They feel more helpless and hopeless (F. Mols et al 2012).
They strongly identify with these statements that show low self efficacy:

  • “I give up things before completing them.”
  • “If something looks too complicated, I will not even bother to try it.”
  • “When unexpected problems occur, I don’t handle them well.”
  • “I give up easily.”

Recent research, just published in the Journal of Health Psychology suggests that when it comes to health, patients with Type D Personality may be their own worst enemies. Lorna Booth and Lynn Williams showed that Type D Personality Patients don’t cope well. They eat badly, consuming more fat and sugar and less fruit and vegetables.
This is because they demonstrate low self efficacy. Type D Personality Patients do a worse job of taking care of themselves and end up sicker than other patients. Their low self efficacy may be due to a long history of failure, or a short traumatic history, and because of their personality type, they can be have a more traumatized response to bad experiences.
The Type D Personality Patient may be clinically depressed and have other mental health and behavioral health co-morbidities.
The goal with a Type D Personality Patient is to get their stress down, their self-acceptance up. They need help finding good coping strategies and may benefit from Motivational Interviewing to establish the right first step in self care.
Type A Personality Patient
We easily picture a Type A Personality as someone motivated, even driven to succeed. They may have a tendency toward worry that successfully motivates them to seek help early. The Type A Personality Patient strongly identifies with these statements associated with high self efficacy:

  • “When I decide to do something, I go right to work on it.”
  • “I am a self-reliant person.”
  • “If I can’t do a job the first time, I keep trying until I can.”

They feel that what they do directly impacts their health outcomes and they are driven to change if necessary. With a Type A Personality Patient, they want to “solve the problem”. But their tendency toward perfectionism may not be a good fit with the messy business of managing chronic illness, causing them additional, unhealthy stress.
The goal with a Type A Personality Patient is to develop reasonable expectations and channel their progress to minimize stress.

What Do Type D and Type A Personality Patients Have in Common?

A trait that a subset of Type D Personality Patients share with the Type A Personality Patient is a struggle with perfectionism. According to a team of Canadian researchers some Type D Personality Patients’ negative self-talk may be the result of holding unrealistic and perfectionist views.
Relatedly, Professors Mols and Denollet, of Tilburg University suggest that Type D Personality Patients are not necessarily depressed. But their research shows that if you have a Type D Personality Patient profile, you are three times more likely to have additional heart problems. In this way, Type D personalities share some biological features with the high-risk Type A Personality Patient group because both personality types suffer from high levels of the stress hormone cortisol and inflammatory factors that can promote heart disease.

What’s the Connection Between Self Esteem and Self Efficacy?

While high self efficacy is associated with increased self-esteem, they are not the same. In fact we build our self-esteem by demonstrating competence, which also builds self efficacy. As Bandura (1977) asserted “past mastery determines self efficacy expectations.” In other words, taking successful actions in the past empowers us to believe our actions will lead to success in the future.
There is no one-size-fits all approach to helping patients build their self ffficacy.

Do you struggle to engage patients? Want tips on how to build self efficacy when your patients demonstrate two very different personality types? Learn how to build self efficacy with our Patient Engagement Tip Sheet.Tips for Engaging Type A and Type D Patients: A Personalized Approach to Building Self Efficacy

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