How the Arteries Are Damaged by Hostile Type A Behavior

How does Type A behavior, particularly the hostility component, produce its toxic effects on the heart and arteries? Strong feelings of hostility and aggression produce the fight-o -flight response. Part of this response is a increase in blood pressure, accompanied by a constriction of the arteries, plus an increase in heart rate and in the amount of blood pumped out with each heartbeat. In short, the person' s body suddenly pumps more blood through smaller arteries. These changes can produce wear and tear on the inside lining of the arteries, causing microscopic tears and abrasions. These abrasions then become sites at which cholesterol and fat can become attached. In addition to this mechanical wear and tear on the artery walls, stress hormones released into the blood during the fight-o -flight response may also lead to artery damage and subsequent buildu of fatty deposits on the artery walls. As these fat molecules build up on the inside of the arteries, the arteries become progressively narrower . This is called arteriosclerosis, or hardening or blocking of the arteries. When the arteries that feed the heart muscle itself become blocked, then the subsequent shortage of blood to the heart is called a heart attack.

In summary, research on the Type A personality has taken some interesting twists and turns. It all began with a couple of cardiologists noticing certain personality differences between heart attack patients and other medical patients. This led them to define the Type A personality as consisting of three characteristics: competitive achievement motivation, time ur gency, and hostility . After several decades of research, psychologists have found that hostility is the most toxic component of the Type A personality, and most research on cardiovascular disease and personality today is focusing on specific traits. Understanding how hostility devel ops and is maintained, how exactly it damages the arteries, how it is evoked by specific situations, and how it can be overcome or managed are all important ques tions for future personality researchers.

SUMMARY AND EVALUATION_

This chapter focused on the part of personality psychology related to physical adjustment and health. It began with several models of the personality and illness link. It then examined the concept of stress as the subjective reaction to extreme events, which often involve conflicting feelings, and over which one has little or no control The stress response comes in four distinct varieties; acute, episodic acute, chronic, and traumatic. Traumatic stress can evolve into a disorder , called posttraumatic stress disorder, in which the person experiences nightmares or flashbacks, di ficulties sleepin

A cross-section of a human coronary artery, the artery that feeds the heart muscle itself, showing extreme arteriosclerosis. Here the artery diameter has narrowed dramatically by the buildup of plaque on the inside artery wall.

and other somatic problems, and feelings of being detached from reality or estranged from other people. It is important to realize that stress is not in the event but, rather , in how one appraises the event. Primary appraisal concerns an evaluation of how threatening the event is with respect to a person' s goals and desires. Secondary appraisal concerns an evaluation of the person' s own resources for meeting the challenge of the threatening event. Both of these appraisals are important for understanding how events come to elicit the stress response. Research is exploring the role of positive emotions in coping with chronic stress.

Much of the work on personality and stress began with a focus on major life events, such as losing a loved one or getting fired from one s job. Although serious, such events are relatively rare. More insidious are daily hassles, the relatively minor but frequent frustrations and disappointments of daily life. Stress researchers have begun to focus on these daily stressors in terms of their impact on health.

Personality psychologists have been concerned with understanding why some people appear more resistant to stress than others. That is, some people appear to take frustration and disappointment more in stride and to not suf fer the deleterious health consequences often associated with chronic stress. One personality dimension in this regard is optimism, which has a wealth of findings associating it with stress resist ance, good health, competent immune functioning, and longer life expectancy . Psychologists are developing grade school programs to train people to be more optimistic. Some related personality characteristics associated with generally better health prognosis are emotional expressivity and personal disclosure.

This chapter also focused on a specific disease, cardiovascular disease, one o the most common serious diseases in the United States. The chapter covered the history of the search for a personality dimension that might be a risk factor for developing heart disease. Type A personality provides an interesting example of progressive research, in which findings are gradually refined until the field becomes more more certain about an ef fect. In the case of Type A personality, most researchers now agree that the hostility component is most associated with the tendency to develop heart disease. Fortunately , people can be competitive workaholics and strive to do more and more in less and less time, just as long as they do not have the hostile part of the Type A syndrome.

KEY TERMS

Health Psychology 588 Stress 589

Interactional Model 589 Transactional Model 589 Health Behavior Model 591 Predisposition Model 591 Illness Behavior Model 592 Stressors 594

General Adaptation Syndrome

(GAS) 594 Alarm Stage 594 Resistance Stage 594 Exhaustion Stage 595 Major Life Events 595

Daily Hassles 597 Acute Stress 598 Episodic Acute Stress 598 Traumatic Stress 598 Posttraumatic Stress Disorder

(PTSD) 599 Chronic Stress 599 Additive Effects 599 Primary Appraisal 599 Secondary Appraisal 599 Positive Reappraisal 602 Problem-Focused Coping 602 Creating Positive Events 603 Dispositional Optimism 603

Self-Efficac 603 Optimistic Bias 604 Emotional Inhibition 607 Disclosure 610 Type A Personality 612 Competitive Achievement

Motivation 613 Time Urgency 613 Hostility 613 Frustration 613 Leukocyte 616 Arteriosclerosis 618

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