Abstract
This study examined workplace aggression among a Dutch group of 174 prison workers at 10 penitentiaries in the Netherlands. The purpose of the study was to investigate the main and interaction effects of Type D personality and violence on posttraumatic stress disorder (PTSD). The results showed a significant interaction effect between the type of violence and Type D personality. Physically violated Type D individuals achieved the highest average score on the PTSD scale. Type D personality was found to have a strong main effect on PTSD.
Aggression at work is an important issue for its frequency and pathogenic potential (Chappell & Martino, 2006; Christian, Bradley, Wallace, & Burke, 2009). A hostile work environment in which insulting or offensive remarks, persistent criticism, personal abuse, or even physical abuse and threats prevail is a reality for many employees in public and private organizations. There is little information about the relationship between personality traits, the development of posttraumatic stress disorder (PTSD) and the risk of becoming a victim of workplace aggression. In this article, this relationship is examined among a group of prison workers in the Netherlands.
Literature Review
Workplace aggression can occur incidentally, repeatedly, and/or persistently, and can be defined as acts of aggression committed by internal (colleagues or staff members), external (strangers), or client-initiated (clients against professionals) violence that causes psychological, emotional, or physical harm (Aquino & Thau, 2009; Einarsena, 2000). Several theories suggest that individual (addiction, inadequate social skills, insufficient coping mechanisms, posttraumatic stress), familial and interpersonal (inadequate parental care, negative childhood experiences, intimate partner violence), and contextual factors (nature of the workplace, untrained employees) can increase the risk of workplace violence (Aquino & Bradfield, 2000; Bogaerts, Kunst, & Winkel, 2009; Felson & Steadman, 1983; Kaplan, Bradley, Luchman, & Haynes, 2009; Reed et al., 2009; Schaufeli & Peeters, 2000; Wassell, 2009; Wong, Chen, Goggins, Tang, & Leung, 2009).
Some victim-related characteristics are significant in understanding why some people, are more susceptible than others to be violated at work (victim precipitation theory). Some individuals themselves may initiate the violent act, passively or actively, consciously or unconsciously, intentionally or unintentionally, that ultimately can lead to stress, injury, or even death (Aquino, Grover, Bradfield, & Allen, 1999; Dupre & Barling, 2006; Galaway & Hudson, 1981; Kennedy & Sacco, 2007; Tepper, Duffy, Henle, & Lambert, 2006; Von Hentig, 1948).
Aggression at work has repeatedly been associated with the development of PTSD (Bogaerts et al., 2009; Lambert, Hogan, & Tucker, 2009; Stadnyk, 2004). In the general population, the prevalence of PTSD seems to be approximately 8% (Bogaerts, Daalder, Van der Knaap, Kunst, & Buschman, 2008; Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995; Leymann, 1990). Stadnyk (2004) found a prevalence of PTSD of 26% in a group of prison workers employed in the Canadian province of Saskatchewan. Stadnyk’s research also showed that prison workers who were part of the group with PTSD symptoms were absent from work more often than their colleagues who did not suffer from PTSD.
Three sets of PTSD clusters can be distinguished (Diagnostic and Statistical Manual of Mental Disorders [4th ed., text rev.]; DSM-IV-TR; American Psychiatric Association [APA], 2000). The first symptom cluster is reexperiencing the traumatic event, the second cluster is the avoidance cluster, and the third symptom cluster is characterized by increased arousal. The development of PTSD is not coincidental but associated with personality traits. People characterized by high Negative Affectivity (NA) are more likely to exhibit behaviour consistent with prototypical victim behaviour (Aquino et al., 1999) and are more likely to develop PTSD after experiencing a traumatic experience. NA can be defined as the frequency and intensity with which an individual experiences high levels of emotions like anxiety, anger, hostility, and fear. High-NA individuals have negative views of themselves and others and are less satisfied with their lives. They focus on the negative aspects of colleagues and work and are also much less liked by colleagues and leaders. Watson and Clark (1984) found that high-NA individuals are more independent and nonconformist than low-NA individuals. High-NA individuals are more often the target of aggression because they experience others as threatening relatively quickly and therefore they often respond aggressively. Also, high levels of emotional distress may lead them to be incompetent at work-related tasks (Aquino et al., 1999).
NA is one of two concepts of the personality trait, “Type D personality,” introduced by Denollet (2000, 2005). The second concept, Social Inhibition (SI) is described as the avoidance of potential dangers involved in social interactions, such as disapproval or nonreward by others. Individuals scoring high on SI frequently feel inhibited, uncomfortable, and insecure in comparison with others (Elwood & Williams, 2007). Type D individuals are characterized by the joint tendency to experience negative emotions (irritability, anxiety, anger, and hostile feelings) and to suppress these emotions while avoiding social contacts with others (Pedersen & Denollet, 2004). These individuals have a negative view of self, report more somatic symptoms, and have an attention bias toward adverse stimuli. Individuals who are high in NA and SI have a distressed or Type D personality, given their vulnerability to chronic distress (Denollet, 2000, 2005; Sher, 1999). To the best of the authors’ knowledge, Type D personality has not been studied among prison workers in comparison with PTSD and workplace violence.
NA and SI have repeatedly been linked to PTSD (Bramsen, Dirkzwager, & Van der Ploeg, 2000; Cox, MacPherson, Enns, & McWilliams, 2004; Engelhardt, Van den Hout, & Kindt, 2003; Hyer et al., 2003; Watson & Clark, 1992). The combination of NA and SI involves a heightened risk for the development of PTSD after a traumatic event (Pedersen & Denollet, 2004). Distress tolerance is relevant to a person’s perception of the ability to handle negative emotional states and individuals with high NA have lower tolerance of emotional distress and thus are more likely to develop posttraumatic stress symptoms (Vujanovic, Bonn-Miller, Potter, Marshall, & Zvolensky, 2011). In a group of Dutch soldiers, NA was a significant predictor of PTSD symptoms (Rademaker, van Zuiden, Vermetten, & Geuze, 2011).
In this study, Type D personality, PTSD, and violence (harassment [hands-off] and a combination of physical violence, harassment and/or unwanted sexual attention [hands-on]) will be examined. The main and interaction effects of Type D personality and violence on PTSD and the interaction effects between Type D personality and violence will be examined. A main effect of Type D personality on PTSD is posited and we predict that more Type D individuals will suffer from PTSD than non–Type D individuals or partial Type D individuals and those combined violated individuals (whether or not related to Type D personality) will have a greater risk of developing PTSD.
Method
Sample
The study was carried out between January and April 2006 at 10 penitentiaries in the Netherlands. The research group consisted of 174 prison workers. An independent process supervisor selected at random male and female penitentiary workers who had been victims of harassment, physical violence, or a combination of physical violence, harassment, and/or unwanted sexual attention during the previous 12 months. The control group was composed by matching the characteristics of gender, age, and years of employment. All participants were explicitly informed that they were under no obligation to take part in the study and that their privacy would be guaranteed. The participants’ average age was 43 years and 11 months (SD = 8.59; range = 22-59 years of age). Of this group, 122 were men and 52 were female. The participating men were significantly older than the women (M age ♂ = 45 years and 5 months, M age ♀ = 43 years and 2 months; p = .05). In all, 62% were married, 24% were single, 3% were divorced, and 10% lived together without being married (1% was unknown). Seven percent finished primary school, 9% finished the first level of secondary school, and 67% succeeded in the second level of secondary school. Sixteen percent attended college or university. The average duration of employment was 14 years and 4 months (SD = 8.84; range = 0.5-36 years) and almost equal in both groups. The average number of years of employment was significantly higher for the men than for the women (M ♂ = 15 years and 9 months, M ♀ = 13 years and 7 months; p = .05). There were no significant differences between the research and control group for age (t = −.142, p < .88) and years of employment (t = .292, p < .771). Matching was not successful for gender (t = 2.42, p < .05), so gender differences were controlled for.
Measures
Type D personality (DS14)
Type D personality (DS14; Denollet, 2005) contains the subscales Negative Affectivity and Social Inhibition. Both subscales consist of seven propositions. Each proposition of the DS14 is scored on a 5-point Likert-type scale ranging from 0 = false to 4 = true. To be diagnosed as Type D personality, a respondent has to score high on both subscales. Respondents score high for NA or SI when they have a total score of 10 or more on both subscales (Denollet, 2005). An example of an item on the subscale NA is, “I often get excited about matters which are unimportant.” An example of an item of the subscale SI is, “I easily make contact with others.” The separate subscales have an internal consistency with Cronbach’s α values of .88 and .86 for the subscales NA and SI, respectively, and 3-months test–retest reliability r = .72 and .82 for NA and SI subscales, respectively (Denollet, 2005). In this study, the Cronbach’s α for the subscale NA was .80 and for the subscale SI was .77. The seven items of the subscale NA had a loading ranging between .56 and .89 on the corresponding trait. Factor loading ranging for SI was between .53 and .86. The total explained variance for both subscales was 45.32%; 31.15% for NA and 14.15% for SI. In this study, to obtain more detailed analysis, we introduce the term partial Type D personality when a combination of low NA and high SI or high NA and low SI is present.
The Self-Rating Inventory for Posttraumatic Stress Disorder (SRIP)
The SRIP (Hovens, 2001; Hovens et al., 1994) is a self-report questionnaire with 22 items based on the DSM-IV-TR (APA, 2000) relating to symptoms of PTSD. The SRIP does not refer to a specific traumatic experience (Hovens, 2001; Hovens, Bramsen, & Van der Ploeg, 2000). Because of its independence of trauma, the SRIP is very suitable as a screening instrument to map out PTSD symptoms within the normal and clinical population. The propositions of the SRIP are scored on a 4-point scale, a score of 1 representing “not at all,” and a score of 4 representing “very much.” For each question, the respondent has to indicate whether he has been suffering from that particular symptom for more or less than a month. A clinical cutoff value of 39, previously identified in a community sample, was used to indicate probable PTSD caseness (range = 22-88; van Zelst et al., 2003). The symptoms of the SRIP can be distinguished into three symptom clusters: symptoms of reexperiencing, of avoidance, and of hyperarousal. The psychometric qualities of the SRIP have been reported for various groups of Dutch citizens, such as traumatised psychiatric patients, veterans, medical students, and elderly people. The three scales in different research studies have good consistencies, with Cronbach’s α values between .77 and .89 for the subscale Reexperiencing, between .80 and .89 for the subscale Avoidance, and between .76 and .89 for the subscale Hyperarousal. In this study, Cronbach’s α values of .79, .85, and .87 were found for Reexperience, Avoidance, and Hyperarousal, respectively. Furthermore, the questionnaire was found to have an acceptable test–retest reliability over a 7-day period (r = .92; Hovens, 2001). When for at least 1 item of the subscale Renewed Experiencing a score of 3 or higher, for at least 3 items of the subscale Avoidance a score of 3, and for at least 2 items of the subscale Hyperarousal a score of 3 is reported, this will be an indication that a PTSD diagnosis answers to the DSM criteria.
Two types of violence
At the beginning of 2007, Dutch prison workers were asked to report workplace aggression in the previous 12 months. In this study, we concentrate on two types of violence committed by a coworker or supervisor: harassment (hands-off) and a combination of physical violence with harassment and/or unwanted sexual attention (combined violence/hands-on). Data collection was done face to face by two interviewers. Information was asked about, successively, the prevalence of the violence involved and absence due to the violence.
Statistical Analysis
Frequencies were calculated to describe the significant variables in the research (e.g., Type D personality, PTSD, type of violence). An independent-samples t test was used to compare whether Type D personality and PTSD differ between the research and the control group. Univariate General Linear Model (GLM; two-way ANOVA) was tested to examine the main effect and interactions of Type D personality and the type of violence on PTSD (Bhandary & Dai, 2009; Sayago & Asuero, 2004). We used SPSS 17.0.
Results
Descriptive Analysis
Based on independent-samples t tests, no significant differences on Type D personality (NA/SI), PTSD, and types of violence were found between the violated (research) and the nonviolated (control) group.Table 1 shows data on violence characteristics, Type D personality, and PTSD. In the research group, 36 respondents reported hands-off (harassment) and 44 respondents reported hands-on (combined) violence in the previous 12 months. No significant differences were found on the DS14 (Type D) and the SRIP (PTSD) between the violated and nonviolated samples. The prevalence of Type D personality was higher in the violated (20%) than in the nonviolated group (12%). No differences were found for NA/SI low and NA/SI high. To further analyze the results, the combination of low NA/high SI and high NA/low SI were reduced to one group (named partial Type D). Regarding the SRIP, the average on the total score was higher in the violent group than in the nonviolent group (31.1/29.4, respectively). Ten respondents in the research group and 4 in the control group reached a clinical cutoff score of ≥ 39 ≤ 52, previously identified in a community sample as partial PTSD, and 5 respondents in the research group and 3 in the control group achieved a score of 52 and more, identified in a clinical population as clinical PTSD. Although not mentioned in the table, it is noted that work incapacity did not differ between the violent and nonviolent group (Table 2). Finally, the association between NA and the three PTSD symptom clusters were examined (NA and Reexperiencing: r = .39, p < .0001; NA and Avoidance: r = .48, p < .0001; NA and Hyperarousal: r = .50, p < .001).
Type of violence, Type D levels, and PTSD symptom levels.
Note: NA = negative affectivity; SI = social inhibition; PTSD = posttraumatic stress disorder.
Descriptive Statistics Regarding Type of Violence, Type D on Estimated Means of PTSD.
Note: PTSD = posttraumatic stress disorder. Dependent Variable = means of PTSD. 0 = no Type D; 1 = partial Type D; 2 = Type D.
Main and Interaction Effect Between PTSD, Type D, and Type of Violence
Univariate GLM two-way ANOVA was used to test main and interaction effects of Type D personality and violence on PTSD. Table 3 (see also Figure 1) presents between-subjects effect. We examined violence–Type D personality interaction before looking at any main effect. There is a significant interaction effect between violence and Type D personality (F = 4.20, p < .003). The type of violence among respondents who reported no Type D personality does not vary on the dependent variable PTSD. No Type D personality, regardless of the type of violence, results in the lowest score on PTSD compared with respondents with partial or Type D personality. Partial Type D individuals, irrespective of the type of violence, only results in a marginal effect on the average PTSD score.
Tests of Between-Subjects Effects.
Note: PTSD = posttraumatic stress disorder. Dependent Variable = means of PTSD.
R2 = .308 (Adjusted R2 = .271)

The averages chart (profile plot): PTSD, Type D, and workplace violence.
Type D individuals who have been victims of hands-on violence in the past 12 months compared with the no Type D and partial Type D individuals and the nonviolent and hands-off group achieved a very high average score on PTSD. Furthermore, the main effect of type of violence and Type D personality on the dependent variable PTSD was tested. Table 3 shows that Type D personality—taking into account the interaction effect—has a strong main effect on PTSD (F = 21.9, p < .0001). This means that the null hypothesis must be rejected. Type D personality (NA/SI high) does have influence on the development of PTSD.
A post hoc test was conducted to find which means are significantly different from one another. The Tukey method was chosen because of its conservative analysis when there are unequal sample sizes (Jaccard, Becker, & Wood, 1984). Mean difference (–.60) were found at the .05 level between Type D personality and no Type D personality on PTSD.
The partial eta squared (PES) is a measure of relevance used for ANOVA and is .102, which means that the interaction effect (between violence and Type D personality) explains 10% of the variance in PTSD. The main effects of Type D personality and type of violence on PTSD achieve a PES of .227 and .06, respectively, and explain together more than 27% of the variance in PTSD (Table 3).
Discussion
The purpose of the study was to examine the interactions of Type D personality (NA and SI) and violence on PTSD among a sample of prison workers in the Netherlands. Interactions and mean effects between Type D personality and the type of violence on the level of PTSD symptoms were examined because many studies have demonstrated a strong relationship between NA and PTSD (Bramsen et al., 2000; Cox et al., 2004; Watson & Clark, 1992). The results confirmed a significant interaction effect between the type of violence and Type D personality. The type of violence among “no Type D personalities” did not vary on the PTSD scale and obtained the lowest score on PTSD compared with the partial or Type D personalities (NA/SI high).
Hands-on violated Type D individuals achieved the highest average score on the PTSD scale. Type D was found to have a strong main effect on PTSD. These findings confirmed the results of Aquino et al. (1999) that high-NA persons focus more on the negative aspects of themselves and colleagues and were more often the target of aggression because others were often experienced as threatening and because higher levels of emotional distress could cause incompetence on work-related tasks. This could increase their chance to become a victim of workplace aggression.
More than 20% of the respondents in our study achieved a (partial) PTSD diagnosis that corresponds with the results of Stadnyk (2004), who found a PTSD diagnosis of 26% among a group of Canadian prison workers. An overlap of the concepts NA and PTSD and the assumption that PTSD often reflects in negative thoughts must be considered.
The findings corresponded with the results of Pedersen and Denollet (2004) who found that Type D personality increases the level of prediction of PTSD. In this study, NA and SI were not examined as two distinct traits because we were only interested in interactions between (partial) Type D, violence, and PTSD. Notwithstanding there is very little empirical evidence concerning Type D personality as a sensitive factor in workplace aggression and PTSD, Type D personality was associated with a greater risk for PTSD. These findings are important and in line with the study of Vujanovic et al. (2011) that high-NA individuals had a lower tolerance degree of emotional distress because of the negative feelings like fear and anger and therefore were more prone to develop PTSD.
The current study has some limitations. Because of the cross-sectional research design, interactions could not be translated in causes. A longitudinal design is preferable because causal relationships and posttraumatic growth can be examined across multiple measurements over time. Also, the present results can only be related to the investigated prison workers and cannot be extrapolated to all prison workers in the Netherlands and abroad.
Beside experiences of negative emotions, future research should also focus on strategies individuals develop to cope with negative emotions. Such research should also consider whether (the quality of) coping operates as a mediator between NA and PTSD. A second limitation concerns the data. Observations were based on self-report questionnaires. In fact, multieffect and multicomparisons measurements require a multimethod design (e.g., self-report combined with registered data). A third limitation was the small sample size (N = 174) and the number of missing values (almost 10%). The third criticism must be nuanced; social-psychological research often makes use of small samples and no response often occurs. Because of the specificity of the research group (especially clinical indications such as PTSD and Type D personality) it was not possible to collect large samples. These findings must be seen as indicative, although we argue that specific victim characteristics (unconsciously and unintentionally) can contribute to workplace violence.
These findings may be interesting for inclusion in prevention goals. It would be desirable, for example, to screen prison workers in advance to gain insights in personality traits and the presence or risk of PTSD. In this way, the likelihood of workplace aggression could be considered.
Footnotes
Acknowledgements
We thank Mr. Ron Scherf and Mr. Toon Molleman for supervising data collection at different penitentiaries in the Netherlands and for their support and expertises during the research process. We also thank the participants who gave their free time to participate in this study.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
