TL;DR
After Type A and Type B came two lesser-known labels. Type C is the "emotion-suppressing" personality — cooperative, self-sacrificing, and reluctant to express negative feelings; its supposed link to cancer is not well supported by modern evidence. Type D ("distressed") is far better validated — it combines chronic negative emotion with social inhibition, and it genuinely predicts worse outcomes in heart patients. In Big Five terms, Type C looks like high Agreeableness with suppressed emotion, and Type D is essentially high Neuroticism plus low Extraversion. Here is the honest version of both.
Almost everyone has heard of Type A and Type B personality — the driven go-getter versus the laid-back one. Far fewer people know the alphabet kept going. Type C and Type D were proposed later, in medical research, to describe two more patterns tied to health. They are worth understanding — but only if you separate the part that holds up from the part that does not.
This guide covers what each type means, how strong the evidence actually is, and how both translate into the Big Five, the continuous model psychologists actually use.
What is a Type C personality?
A Type C personality describes someone who is cooperative, patient, and accommodating on the surface — but who tends to suppress emotions, especially negative ones like anger. Type C people are often described as:
- Passive, appeasing, and eager to please others
- Conflict-avoidant — they rarely express anger or resentment
- Self-sacrificing, putting others' needs ahead of their own
- Prone to a sense of hopelessness or helplessness under stress
- Outwardly calm while internalizing distress
The concept grew out of 1980s research into "cancer-prone" personalities, which proposed that chronic emotional suppression might influence disease. That is the claim to be careful with.
The Type C 'cancer personality' claim is weak
The idea that suppressing emotions causes cancer is one of the most persistent myths in pop health psychology. Large, well-controlled prospective studies have not found convincing evidence that a "Type C" emotional style causes or predicts cancer. Reviews of the field conclude the link is, at best, very weak and confounded by other factors. Treat Type C as a description of an emotional style, not a medical diagnosis — and be skeptical of anything that blames illness on personality.
So Type C is real as a behavioral pattern — some people genuinely do suppress emotion and over-accommodate — but its famous disease link does not survive scrutiny.
What is a Type D personality?
A Type D personality — "D" for distressed — is a much sturdier concept. It was defined by Belgian cardiologist Johan Denollet, who combined two traits that tend to travel together:
- Negative affectivity — a tendency to experience negative emotions across situations: worry, irritability, gloom, tension
- Social inhibition — a tendency to hold back thoughts and feelings in social situations, out of fear of disapproval
The key insight is that it is the combination that matters. Someone who feels a lot of negative emotion and bottles it up socially is the Type D profile. Denollet built a short, validated questionnaire for it, the DS14, which is still widely used in cardiology research today.
Type D isn't "sad." It's the specific combination of feeling a lot of negative emotion and being unable to share it — distress with the release valve shut.
And unlike Type C, the evidence held up in its home turf. In patients who already have heart disease, Type D has been associated with worse prognosis, more distress, and lower quality of life across a number of studies (Denollet, 2005) — though later, larger reviews have tempered the size of the effect and stressed it is a risk marker, not a guaranteed outcome.
Type C vs Type D at a glance
| Feature | Type C | Type D |
|---|---|---|
| Nickname | The "suppressor" | The "distressed" type |
| Core pattern | Suppresses negative emotion, over-accommodates | Negative emotion + social inhibition combined |
| Emotional tone | Outwardly calm, inwardly bottled up | Chronically tense, worried, gloomy |
| Social style | Passive, appeasing | Inhibited, holds back for fear of rejection |
| Evidence quality | Weak (cancer link largely unsupported) | Moderate (validated DS14; heart-disease risk marker) |
| Measured by | No standard validated scale | DS14 questionnaire |
How Type C and Type D map onto the Big Five
Here is the part that makes these labels genuinely useful instead of just more boxes. Both types are really combinations of Big Five dimensions — and once you translate them, they stop being mysterious.
| Type C/D feature | Big Five translation | Direction |
|---|---|---|
| Cooperative, self-sacrificing, appeasing (Type C) | Agreeableness | High |
| Suppressing anger, avoiding conflict (Type C) | Agreeableness + low emotional expression | High A |
| Negative affectivity — worry, gloom, tension (Type D) | Neuroticism | High |
| Social inhibition — holding back, fear of disapproval (Type D) | Extraversion | Low |
Read it and the fog lifts. A "Type C" person looks like high Agreeableness paired with a habit of not expressing negative emotion — pleasant and accommodating, but at a cost to themselves. A "Type D" person is almost exactly high Neuroticism plus low Extraversion — someone who feels a lot of negative emotion and is socially withdrawn enough not to let it out.
That Big Five translation is not just tidier; it is more informative. It tells you which underlying dials are turned up, and those dials are measurable, stable, and continuous — none of which is true of a one-letter type.
Why the Big Five version is more useful
"Am I a Type D?" is a yes/no question about a made-up boundary. "How high is my Neuroticism, and how low is my Extraversion?" is two continuous numbers that actually describe you — and that you can track over time. If you have wondered whether you fit Type D, the more precise move is to measure those two Big Five dimensions directly.
Which type are you — and does it matter?
Probably neither, cleanly. Like Type A/B, the C and D labels take continuous traits and force them into categories. Most people who "sound Type D" are simply somewhere in the upper range of Neuroticism and lower range of Extraversion — not members of a distinct club.
The practical value is in the dimensions, not the letters:
- If the Type C description resonates — you accommodate others and swallow your own frustration — the useful signal is high Agreeableness with low emotional expression, which is worth knowing because it can quietly cost you.
- If the Type D description resonates — chronic worry plus holding back socially — the useful signal is high Neuroticism and low Extraversion, a combination worth being aware of, especially for stress management.
In our own anonymized test data, people who identify with "Type D" cluster, unsurprisingly, in the high-Neuroticism / lower-Extraversion corner of the Big Five — which is exactly what the translation predicts. The label describes a real region of personality space; it just draws an arbitrary fence around it.
Frequently asked questions
The bottom line
Type C and Type D fill out the personality alphabet, but they come with very different warranties. Type C is a real emotional style wrapped around a discredited disease myth — keep the description, drop the cancer claim. Type D is a genuinely validated pattern, but even then it is best understood as a combination of two Big Five dimensions rather than a category you either belong to or don't.
The through-line for A, B, C, and D is the same: they are all crude approximations of a continuous reality. If you want the accurate version, measure the dimensions underneath.
See the dimensions behind the letters
Type C and Type D are really combinations of Agreeableness, Neuroticism, and Extraversion. The free Big Five test scores you on all five in about 7 minutes, no signup — the precise version of a one-letter label.
Keep exploring: read about Type A vs Type B, what the Big Five is, or the traits behind these types — Neuroticism, Agreeableness, and Extraversion.
Sources
Denollet, J. (2005). DS14: Standard assessment of negative affectivity, social inhibition, and Type D personality. Psychosomatic Medicine, 67(1), 89–97. — The validated DS14 questionnaire and definition of Type D.
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(8999), 417–421. — Early evidence linking Type D to cardiac prognosis.
Grande, G., Romppel, M., & Barth, J. (2012). Association between Type D personality and prognosis in patients with cardiovascular diseases: A systematic review and meta-analysis. Annals of Behavioral Medicine, 43(3), 299–310. — A more tempered meta-analytic view of Type D risk.
Garssen, B. (2004). Psychological factors and cancer development: Evidence after 30 years of research. Clinical Psychology Review, 24(3), 315–338. — Reviews and largely rejects the "cancer-prone personality" (Type C) hypothesis.
Costa, P. T., & McCrae, R. R. (2008). The Revised NEO Personality Inventory (NEO-PI-R). In The SAGE Handbook of Personality Theory and Assessment. — Reference for the Big Five dimensions used to reinterpret Type C and Type D.
