Elevated prevalence of Type D (distressed) personality in moderate to severe psoriasis is associated with mood status and quality of life impairment: a comparative pilot study

Abstract

Background: Psoriasis may imply a remarkable psychological impairment, which can influence patient's personality. The Type D personality is defined by the combination of social inhibition and negative affectivity. Furthermore, Type D personality has been associated with impaired health-related quality of life (HRQOL) and increased cardiovascular risk, both facts being associated with moderate to severe psoriasis.

Objectives: To explore the prevalence of Type D personality in moderate to severe psoriasis patients; To analyse the relationship between Type D personality and the most common physical and psychological comorbidities in moderate to severe psoriasis and To explore the impact of Type D personality on HRQOL.

Methods: A prospective comparative study matched to age and sex. Eighty patients with moderate to severe psoriasis and 80 healthy volunteers were included in the study. The participants completed the DS14 test, the Massachusetts General Hospital-Sexual Functioning Questionnaire, the Hospital Anxiety and Depression Scale, the SF-36 and the Psoriasis Disability Index.

Results: The prevalence of Type D personality was higher in patients with moderate to severe psoriasis as compared to healthy volunteers: 38.7% vs. 23.7%, P < 0.001. Psoriasis patients with Type D personality had a 3.2-fold risk of anxiety when compared to patients without Type D personality; odds ratio 3.2 (1.3-8.83 P = 0.01). Type D personality was significantly associated with an impaired general, sexual and psoriasis-related HRQOL (P < 0.01).

Conclusion: Because Type D personality could represent a frequent type of personality among individuals with moderate to severe psoriasis, it could serve as a 'marker' of more psychologically vulnerable patients, probably related to dysfunctional coping strategies. The Type D personality could represent a profile more frequently encountered among patients with psoriasis, and might therefore help identify subjects physiologically more vulnerable to disease, most likely due to inadequate adaptation mechanisms.