Type A Personality and Cardiovascular Disease

Cardiovascular disease is one of the most frequent causes of death and disability in the United States. Health professionals have been searching for the factors that put people at risk for this disease. Known risk factors for developing cardiovascular disease include high blood pressure, obesity, smoking, family history of heart disease, inactive lifestyle, and high cholesterol. In the 1970s, physicians began to consider a new risk factor , a specific personality trait. As mentioned in Chapter 13, this grew out of the observation by some physicians that the patients who had had heart attacks often behaved dif fer-ently, and they seemed to have different personalities, compared with other patients. The heart attack patients were often more competitive and aggressive, more active and energetic in their actions and speaking, and more ambitious and driven (Friedman & Rosenman, 1974). They called this collection of behaviors the Type A personality.

Chapter 13 focused on the Type A personality dimension and emotion. Here we focus on Type A personality and health. Before examining some of the research find ings on Type A, let us look at a few misconceptions. Although researchers often refer to Type A and Type B persons, it is not true that people come in these two distinct categories. Few variables are truly categorical, whereby people fall into distinct categories. Biological sex is an example of a categorical variable; blood type is another . However, very few personality traits are categorical. Instead, most are dimensional, ranging from one extreme to the other , with most people falling somewhere around the middle. The Type A/Type B distinction is like this, with Type As defining one end and Type Bs the other, and a large number of people in the middle, who are neither clearly A or B. Thus, the Type A personality variable is a trait, or disposition, as discussed in Chapter 3. It is distributed normally, as in Figure 18.4(a), not as a category variable. Psychologists describe normally distributed traits by reference to one end (e.g., Type A). However, by describing the characteristics of people at one end, e.g., Type A, it is implied that people at the low end (so-called Type B) have the opposite characteristics.

Another misconception is that Type A is a single trait; in actuality , Type A is a syndrome of several traits. More specificall , it is a collection of three subtraits, which together make up the Type A personality. One of these three subtraits is competitive achievement motivation. Type A persons like to work hard and achieve goals. They like recognition, power , and the defeat of obstacles. And they feel that they are at their best when competing with others. For example, a person who shows up at a charity bike-a-thon ready for the Tour de France bicycle race is exhibiting competitive achievement motivation. Time urgency is the second subtrait of the Type A behavior pattern. Type A persons hate wasting time. They are always in a hurry and feel under pressure to get the most done in the least amount of time. Often, they do two things at once, such as eat while reading a book. Red lights are their enemies, and they hate to wait in line for anything. The third subtrait of Type A is hostility. When blocked from attaining their goals, which is the definition of frustration, Type A persons can be hostile and aggressive. They get frustrated easily, and this frustration can make them act in an unfriendly or even malicious manner . The guy you see yelling at and pounding on a vending machine is perhaps displaying the hostile component of his Type A personality style.

Early studies of the Type A personality found that it was an independent risk factor for developing cardiovascular disease. An independent risk factor operates independently from other known risk factors, such as being overweight or smoking. Thus, for example, it is not true that Type A persons necessarily smoke more, and their smoking causes the heart disease. Instead, the Type A personality is independent of smoking, and someone who is Type A and smokes is at more of a risk for heart disease than someone who just smokes or who is just Type A. In fact, one study found that the Type A personality was a better predictor of heart disease than the person' s history of smoking or the person' s cholesterol level (Jenkins, Zyzanski, & Rosenman, 1976), although high cholesterol and smoking also contribute independently to heart disease.

Physicians conducted most of the early studies of Type A personality, and to measure this personality variable they developed a structured interview. Standard questions were asked, and the interviewer noted the participants' answers and how they reacted to the questions. In fact, the interviewer was very interested in the behavior of the participants. For example, what was the tempo of their speech? Did they frequently interrupt

Frequently doing two activities at once is a component of the Type A personality. Time urgency, however, is not the part of Type A that is most associated with heart disease.

Many people

Few people _

(b) Type B Average Type A

Figure 18.4

Type A and Type B are not really types at all and do not refer to categories of people. Rather, Type A refers to a normal distribution of people, anchored at one end by persons showing a lot of Type A behavior and at the other end by persons showing very little (a). Most people, however, are in the middle, or average, range. This is the case with almost all personality traits. A true type, or categorical variable, would be distributed as in (b), with most people at one end or the other and very few people in the middle. This is not the case with the Type A personality.

the interviewer or put words in the interveiwer' s mouth? Did they fidget during th interview? Did they make frequent and vigorous gestures with their hands and heads? In one part of the interview, the interviewer tries to aggravate the participants by talking very slowly . Type A people are especially aggravated when other people talk slowly, and they interrupt, talk out of turn, or finish sentences for people in order t speed them up.

As research on Type A personality gained momentum in the 1980s, researchers tried to devise a more ef ficient measure. Interviews are slow; they can measure onl one person at a time, and it takes one interviewer to measure each participant. In short, interviewing is a relatively expensive and time-consuming way to measure any personality variable. Questionnaires are much cheaper because they are generally faster, they can be given to whole groups of participants, and one person can assess 100 or more persons at a time. Thus, researchers in this area put some ef fort into developing a questionnaire measure for Type A personality. Subsequently, one of the most widely used questionnaire measures of Type A personality is the Jenkins Activity Survey. It contains questions that tap into each of the three components of the Type A syndrome—for example, "My work improves as the deadline approaches," "I have been told that I eat too fast," and "I enjoy a good competition."

Early researchers using the structured interview often found a relationship between Type A personality and risk for heart attack and cardiovascular disease. Later research, mostly using the Jenkins questionnaire, often failed to replicate this finding This puzzled researchers for several years. Some wondered if Type A personality was a risk factor for heart attacks at one time but then things changed so that it no longer was a risk factor. Other psychologists began to take a close look at the studies, searching for a reason that some found a relationship but others didn' t. Quickly the pattern emerged that the studies using the questionnaire measure were less likely to find relationship between Type A and heart disease than the studies using the structured interview (Suls & Wan, 1989; Suls, Wan, & Costa, 1996). Researchers have concluded that the questionnaire measure taps into different aspects of Type A behavior than does the structured interview measures. Apparently, the structured interview gets more at the lethal component of Type A. But what part of the Type A behavior pattern is the most lethal, the part that is most related to heart disease?

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