The Heart of a Hermit

We all know a Type A personality when we see one: aggressive, overbearing, impatient. But see the unlucky soul who happens to get in his way? Timid, insecure, and anxious, her personality is as different from his as can be--yet she may face a greater danger of heart disease than her Type A tormentor.

Call her Type D, a high-risk category recently recognized by heart-disease researchers in Belgium. Such people are tense and unhappy, "always looking for upcoming problems," says Johan Denollet, Ph.D., of the University of Antwerp.

They combine this tendency toward negative feelings with social inhibition, an uneasiness in their interactions with other people. Together, these traits quadruple their risk of a second heart attack.

Though scientists aren't sure how particular personalities create disease, they speculate that the reserved natures of Type Ds prevent them from seeking the support of others, which is known to be critical to continued health.

The chronic anxiety that these people experience, especially in social situations, may also be a direct culprit, because stress constricts arteries to the heart, increases platelet activity in the blood (making dangerous clots more likely), and keeps the heart beating at a constantly high rate, which eventually wears it down.

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The problem is that Type D describes a personality type that is usually stable over a lifetime (as opposed to Type A, which is simply a hodgepodge of behavioral signs). It's therefore very difficult to change--but Denollet says a personality overhaul isn't necessary anyway.

"Type D is not the condition we seek to change, but a marker that tells us which patients to pay special attention to," he says. Once patients are identified as Type D, says Denollet, they could be offered additional treatments--counseling, behavioral therapy, social skills coaching--designed to help wallflowers bloom.

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