In medical research, personality traits are related to medial outcomes. For example, people with certain personality traits are more likely to suffer from heart and other cardiovascular illnesses.

Type D Personality refers to a Distressed Personality. DS14 stands for Type D Scale-14 (i.e., 14 questions).

Johan Denollet (1957-2019) was a well-known Belgian psychologist in the area of medical psychology. He published influential articles about the link between personality and coronary heart disease in the world-leading medical journal The Lancet (Denollet, 1996).

There are not many YouTube’s with the late Prof. Denollet, but this one is there (in Dutch)
For students: I highly recommend to read the article by Deary, Weiss, & Batty (2010) about how psychologists address the relation between personality, illness and death.

The mechanism

Personality can influence medical outcomes through different pathways (Denollet et al., 1996). 1: Mental stress can directly lead to pathophysiological states. 2: Personality can promote disease through health-related behaviors (e.g., not listening or adhering to health and medical advice). 3: There might be an underlying (third) genetic variable that causes both the personality and the cardiovascular problems.

What is important is that there are now many independent studies confirming the value of the type-D personality in the context of health outcomes; the 2005 article has been cited nearly 2000 times (link to Google scholar).

It should be noted that personality type D is mostly meaningful in medical research. Type D refers to a type, it is part of a typology and includes different psychological traits. The Type D personality has two major traits, namely Negative Affectivity and Social Inhibition.

Negative Affectivity (NA) refers to the tendency to experience negative emotions across time/situations. High-NA individuals experience more feelings of dysphoria, anxiety, and irritability; have a negative view of self; and scan the world for signs of impending trouble (definition literally quoted from Denollet, 2005).

Social Inhibition (SI) refers to the tendency to inhibit the expression of emotions/behaviors in social interactions to avoid disapproval by others. High-SI individuals tend to feel inhibited, tense, and insecure when with others.

Individuals who are high in both Negative Affectivity and Social Inhibition have a distressed or Type D personality, given their vulnerability to chronic distress. Type D patients are at increased risk for a wide range of adverse health outcomes (definition literally quoted from Denollet, 2005).

There is also research on Type A, Type B, and Type C personalities. For a review, check out this link on Simply Psychology.


The scale to measure Type D personality is called the DS14. It has 14 Likert-style questions. Each of these questions has a possible score between 0 and 4 points. The English questionnaire listed was translated from Dutch and seems to best fitting American English (the article was published with the questionnaire).

The DS14 has two subscales:

  1. Negative Affectivity (possible total score 0 to 28 based on 7 questions)

  2. Social Inibition (possible total score 0 to 28 based on 7 questions)

Interpretation of raw scores

The simple interpretation is that a person who scores equal or higher than 10 points on both scales can be classified as having a type D personality.

Further, slightly more detailed interpretations for men are given in the 2005 paper (in the article they report the scores for the men and women in their sample of 2,508 participants). Note that only for Negative Affectivity the interpretation for men and women is slightly different:

Negative Affectivity Mean (SD) Very low Low Below Average Average Above average High Very High


6.3 (5.3)









8.0 (5.6)








Social Inhibition

Mean (SD)

Very low


Below Average


Above average


Very High


10.2 (6.6)









9.7 (6.2)








Warning and advice

If you want to know more about heart disease or if you are worried, please note the following:

Run the demo

It seems that the DS14 can be used for research, but you need to acknowledge the authors and their research paper when writing about it (Denollet, 2005).


This is a simple scale question with some reverse coded items.

The survey code for PsyToolkit

Copy and paste this code to your PsyToolkit account if you want to use the scale in your own online research project
scale: falsetrue
- {score=0} FALSE
- {score=1} RATHER FALSE
- {score=2} NEUTRAL
- {score=3} RATHER TRUE
- {score=4} TRUE

l: ds14
t: scale falsetrue
o: boxes
q: Below are a number of statements that people often use to describe themselves.
Please read each statement and then select the appropriate answer under the statement.
There are no right or wrong answers: Your own impression is the only thing that matters.
- {reverse} I make contact easily when I meet people
- I often make a fuss about unimportant things
- {reverse} I often talk to strangers
- I often feel unhappy
- I am often irritated
- I often feel inhibited in social interactions
- I take a gloomy view of things
- I find it hard to start a conversation
- I am often in a bad mood
- I am closed kind of person
- I would rather keep other people at a distance
- I often find myself worrying about something
- I am often down in the dumps
- When socializing, I don't find the right things to talk about

l: ds14_negative_affectivity
t: set
- calc $ds14.2 + $ds14.4 + $ds14.5 + $ds14.7 + $ds14.9 + $ds14.12 + $ds14.13

l: ds14_social_inhibition
t: set
- calc $ds14.1 + $ds14.3 + $ds14.6 + $ds14.8 + $ds14.10 + $ds14.11 + $ds14.14

l: ds14_is_type_d
t: set
- if $ds14_negative_affectivity >= 10 and $ds14_social_inhibition >= 10 then 1
- if $ds14_negative_affectivity < 10  or  $ds14_social_inhibition < 10 then 0

l: selecttype
t: jump
- if $ds14_is_type_d == 1 then goto feedback_typeD
- if $ds14_is_type_d == 0 then goto feedback_not_typeD

l: feedback_typeD
t: info
q: You have a type D personality
Your Negative Affectivity score is {$ds14_negative_affectivity}
Your Social Inhibition score is {$ds14_social_inhibition}
Because both scores are equal or greater than 10 points (out of 28), you are classified as having type D personality.

j: end

l: feedback_not_typeD
t: info
q: You do <b>not</b> have a type D personality
Your Negative Affectivity score is {$ds14_negative_affectivity}
Your Social Inhibition score is {$ds14_social_inhibition}
Only if both scores are equal or greater than 10 points, you would be classified as having a type D personality.


  • Denollet, J., Sys, S.U., Stroobant, N., Rombouts, H., Gillebert, T.C., & Brutsaert, D.L. (1996). Personality as independent predictor of long-term mortality in patients with coronary heart disease. The Lancet, 347, 417-421. Free link to full text

  • Denollet, J. (2005). DS14: Standard Assessment of Negative Affectivity, Social Inhibition, and Type D Personality. Psychosomatic Medicine, 67, 89-97. Free link to PDF

  • Deary, I.J., Weiss, A., & Batty, G.D., 2010. Intelligence and Personality as Predictors of Illness and Death: How Researchers in Differential Psychology and Chronic Disease Epidemiology Are Collaborating to Understand and Address Health Inequalities. Psychological Science, 11(2), 53-79. Publisher link (behind paywall)