on negative situations and stimuli. Scoring high on social inhibition means that these individuals tend to avoid the potential 'dangers' involved in social interactions, such as disapproval. Generally speaking, social situations tend to make type D individuals feel inhibited, tense, uncomfortable, and insecure. Health risks A wide variety of health risks are associated with type D personalities, primarily due to the fact that they seem to lead to a more highly activated immune system and therefore, more inflammation. This increase in inflammation can often lead to damaged blood vessels throughout the heart and body. Type D individuals have also been found to have higher blood pressure than normal, as well as an exaggerated response to stress, both physiological and psychological. Among the health issues commonly associated with this personality subtype are depressive and anxiety symptoms, as well as post-traumatic stress disorder. Additionally, type Ds are might have a predisposition to social phobia, panic disorder, and even the development of avoidant personality disorder. According to Dr. Denollet, what most likely links poor health outcomes to the type D personality subtype is the distinctly high level of stress associated with it. Unlike other personality types who like to vent, type Ds social inhibition leaves them with no such outlet for their stress. This pent-up stress causes high cortisol levels, which, in turn, can lead to high blood pressure as well as chronic, artery-damaging inflammation. It is worth noting that another possible explanation for this correlation is that type Ds likely also suffer from depression, anxiety, and poor social connections, each of which has been linked with poor health and heart disease. Cardiovascular complications Both type D dimensions (negative affectivity and social inhibition) are associated with a stress-induced increase in cortisol release. High levels of cortisol are thought to be the mediating factor in the association between this personality type and the increased risk for coronary heart disease. Additionally, the inhibition of emotions that characterizes type D personality types is strongly associated with higher cardiovascular reactivity, lower cardiovascular recovery, lower heart rate variability, carotid atherosclerosis, incidence of coronary heart disease, and cardiac mortality. The correlation between emotional suppression and cardiovascular complications has been observed in numerous different studies, including one that involved patients undergoing cardiac rehabilitation. In this study, deaths from cardiac causes were increased by a factor of four in those with type D personality, even after controlling for conventional risk factors.