Article Text

THU0585 Over Half of Patients with Fibromyalgia have a Type D Personality
  1. H. Van Middendorp1,2,
  2. M. B. Kool2,
  3. S. van Beugen1,
  4. A. W. Evers1,
  5. J. K. Denollet3,
  6. M. A. Lumley4,
  7. R. Geenen2,5
  1. 1Medical Psychology, Radboud University Nijmegen Medical Center, Nijmegen
  2. 2Clinical and Health Psychology, Utrecht University, Utrecht
  3. 3Medical Psychology and Neuropsychology, Tilburg University, Tilburg, Netherlands
  4. 4Psychology, Wayne State University, Detroit, United States
  5. 5Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands


Background Type D personality combines 2 stable traits: negative affectivity and social inhibition. It has been linked to poor health status and disease course and outcome in cardiovascular and other chronic conditions [1]. Patients with fibromyalgia experience high negative affect associated with symptoms such as pain and fatigue [2] and may be socially inhibited, e.g., due to earlier victimization or lack of understanding for their medically unexplained symptoms [3]. Therefore, we hypothesized that Type D personality would be prevalent in fibromyalgia and potentially relevant for functioning.

Objectives The aim of the current study was to examine the prevalence and correlates of Type D personality in fibromyalgia.

Methods As part of an online cross-sectional questionnaire study, 559 English-speaking patients with fibromyalgia (94% women, 21 to 77 (M=47, SD=11) years), filled out measures of Type D personality (DS14), illness invalidation from the social environment (3*I), physical and mental health (RAND SF-36), and pain, loneliness, and quality of life (visual analogue scales).

Results The internal consistency of the Type D questionnaire was high (α>.90). Using the standard cut-score, Type D personality was present in 56% of patients, which exceeds the prevalence estimates in the general (13-24%), cardiovascular (27-31%), and diverse chronic pain (43%) populations [1,4]. Compared to the general population, negative affectivity was high (Cohen’s d=1.28) and social inhibition was above average (Cohen’s d=0.35). Having Type D personality was associated with worse mental health (d=1.02), more loneliness (d=0.72), more role limitations due to emotional functioning (d=0.54), lower quality of life (d=0.52), less vitality (d=0.36), poorer social functioning (d=0.27), and a higher perceived lack of understanding (d=0.23) and more discounting (d=0.20) from the social environment. Regarding physical health, only associations between type D personality and a worse general health were found (d=0.48).

Conclusions Type D personality is highly prevalent in fibromyalgia and a potential risk factor for emotional and social adjustment in fibromyalgia. In contrast to the evidence in cardiovascular diseases, Type D is not associated with poorer physical health.


  1. Mols F, Denollet J. Type D personality among noncardiovascular patient populations: A systematic review. Gen Hosp Psychiatry 2010;32:66-72.

  2. Van Middendorp H, Lumley MA, Jacobs JW, et al. Emotions and emotional approach and avoidance strategies in fibromyalgia. J Psychosom Res 2008;64:159-67.

  3. Kool MB, Van Middendorp H, Lumley MA et al. Lack of understanding in fibromyalgia and rheumatoid arthritis: The Illness Invalidation Inventory (3*I). Ann Rheum Dis 2010;69:1990-5.

  4. Barnett MD, Ledoux T, Garcini LM et al. Type D personality and chronic pain: Construct and concurrent validity of the DS14. J Clin Psychol Med Settings 2009;16:194-9.

Acknowledgements This study was funded by the Dutch Arthritis Association.

Disclosure of Interest None Declared

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