Stress and Health 441The Framingham Heart Study found that the risk of coronary heart disease for
women who work and are also Type A is four times that of Type B working women
(Eaker & Castelli, 1988). Other research has narrowed the key factors in Type A person-
ality and heart disease to one characteristic: hostility* (Fredrickson et al., 2000; Matthews
et al., 2004; Williams, 1999; Williams et al., 1980). Williams and his colleagues used the
Minnesota Multiphasic Personality Inventory, a personality test that looks for certain
characteristics that include the level of hostility. to Learning Objective 13.14.
In this study, 424 patients who had undergone exploratory surgery for coronary heart
disease were examined, and the presence of heart disease was related both to being Type
A and to being hostile, with hostility being the more significant factor in the hardening of
the arteries to the heart (Williams, 2001; Williams et al., 1980).
Numerous studies support the link between hostility and increased risk of coro-
nary heart disease. A study of hostility levels and risk factors for heart disease in more
than 4,000 young adults found that increases in hostility over a 5-year follow-up study
were associated with a rise in high blood pressure, one of the major risk factors of heart
disease (Markovitz et al., 1997). Another study of anger in young men and their risk for
premature heart disease found that over a period of slightly more than three decades,
the young men who had exhibited high levels of hostility in their youth were far more
likely to develop premature cardiovascular disease, particularly heart attacks, than
were those men who had lower levels of anger and hostility (Chang et al., 2002). Similar
studies found that hostility in college-aged males and females was significantly related
to increased risk of heart disease, particularly if levels of hostility rose in middle age
( Brondolo et al., 2003; Siegler et al., 2003).
Even children may not escape the hostility–heart disease link. One study found
that children and adolescents who scored high on assessments of hostility were more
likely to show physical changes such as obesity, resistance to insulin, high blood pres-
sure, and elevated levels of triglycerides 3 years after the initial measurements of hostil-
ity had been made (Raikkonen et al., 2003).
What about people who don’t blow their top but try to
keep everything “in” instead? Wouldn’t that be bad for a person’s
health?TYPE C A third personality type was identified by researchers Temoshok and Dreher
(1992) as being associated with a higher incidence of cancer. Ty p e C people tend to be
very pleasant and try to keep the peace but find it difficult to express emotions, espe-
cially negative ones. They tend to internalize their anger and often experience a sense of
despair over the loss of a loved one or a loss of hope. They are often lonely. These per-
sonality characteristics are strongly associated with cancer, and people who have cancer
and this personality type often have thicker cancerous tumors as well (Eysenck, 1994;
Temoshok & Dreher, 1992). Just as the stress of hostility puts the cardiovascular systems
of Type A people at greater risk, the internalized negative emotions of the Type C person-
ality may increase the levels of harmful stress hormones, weaken the immune system,
and slow recovery.
A word of caution here: “personality type” theories have come under criticism in
recent years. Many consider them to be too simplistic—many people would not fall eas-
ily into one type or another. Nevertheless, many of the personality traits associated with
these types do seem to be associated with stress and longevity. Many of the character-
istics of the Type A personality, for example, fit the description of a major personality
trait called neuroticism, the tendency to worry, be moody, and be emotionally intense.
Type C personality
pleasant but repressed person, who
tends to internalize his or her anger
and anxiety and who finds expressing
emotions difficult.InteractiveFigure 11.5 Personality and Coronary
Heart Disease
The two bars on the left represent men with
Type A personalities. Notice that within the Type
A men, there are more than twice as many who
suffer from coronary heart disease as those
who are healthy. The two bars on the right
represent men with Type B personalities. Far
more Type B personalities are healthier than are
Type A personalities, and there are far fewer
Type B personalities with coronary heart disease
when compared to Type A personalities.
SOURCE: Miller et al. (1991, 1996).7550Percentage of subjects 25Type AType BMen with coronary
heart disease
Healthy men*hostility: feelings of conflict, anger, and ill will that are long lasting.