Perhaps the most widely studied association
between a personality trait/behavior pattern and ill-
ness is that between Type A behavior andcoronary
heart disease. As mentioned previously, the notion of
a possible link between personality or coping style
and adverse health consequences, specifically coro-
nary heart disease, was proposed by two cardiolo-
gists (Friedman & Rosenman, 1974). They
identified a set of discriminating personality charac-
teristics and behaviors and proposed that these con-
stitute a Type A behavior pattern. Glass (1977)
describes Type A individuals as those who tend to
■ perceive time passing quickly,
■ show a deteriorating performance on tasks that
require delayed responding,
■ work near maximum capacity even when there
is no time deadline,
■ arrive early for appointments,
■ become aggressive and hostile when frustrated,
■ report less fatigue and fewer physical symp-
toms, and
■ are intensely motivated to master their physical
and social environments and to maintain
control.
Table 17-1 provides some examples of inter-
view questions that are used to identify Type A
individuals.
A number of early studies suggested a relation-
ship between Type A behavior and coronary heart
disease. However, more recent studies do not show
as strong a relationship between Type A behavior
and heart disease as was once thought (Smith &
Ruiz, 2002), and it is clear that the vast majority of
Type A individuals do not develop coronary heart
disease (CHD). However, Type A individuals are at
relatively greater risk for CHD. More recent studies
suggest that the anger-hostility component of
the Type A pattern does a better job of predicting
coronary heart disease than the more global Type A
categorization (Smith & MacKenzie, 2006).
In an important methodological and conceptual
analysis of the research examining hostility and health,
Smith (1992) presented several theoretical models that
might explain the link between them. Thepsychophys-
iological reactivity modelposits that hostile individuals
experience larger increases in heart rate, blood pres-
sure, and stress-related hormones in response to
potential stressors. Increased psychophysiological reac-
tivity is believed to encourage the development of
coronary artery disease and the symptoms of coronary
heart disease. Thepsychosocial vulnerability modelpro-
poses that hostile individuals are more likely to expe-
rience a more stressful psychosocial environment
because they have higher levels of mistrust and are
scanning their environments for possible future mis-
treatment. Atransactional model of stressreflects a com-
bination and integration of the psychophysiological
and psychosocial models. This integrative model pro-
poses that those high in hostility create potentially
stressful situations in their lives because of their general
mistrust and their subsequent actions.T A B L E 17-1 Selected Items from the
Behavior Pattern Interview- Does your job carry heavy responsibility?
a. Is there any time when you feel particularly
rushed or under pressure?
b. When you are under pressure, does it bother you? - When you get angry or upset, do people around you
know about it? How do you show it? - When you are in your automobile, and there is a car
in your lane going far too slowly for you, what do
you do about it? Would you mutter and complain to
yourself? Would anyone riding with you know that
you were annoyed? - If you make a date with someone for, oh, two
o’clock in the afternoon, for example, would you be
there on time?
a. If you are kept waiting, do you resent it?
b. Would you say anything about it? - Do you eat rapidly? Do you walk rapidly?
After you’ve finished eating, do you like to sit
around the table and chat, or do you like to get up
and get going? - How do you feel about waiting in lines: Bank lines,
or supermarket lines? Post office lines?
SOURCE: From“The Interview Methods of Assessment of the Coronary-
prone Behavior Pattern,”by R. H. Rosenman, pp. 68–69. In T. M. Dembroski,
S. M. Weiss, J. L. Shields, S. G. Haynes, and M. Feinleib (Eds.),Coronary-prone
Behavior, Copyright © 1978 by Springer-Verlag. Reprinted by permission.
HEALTH PSYCHOLOGY ANDBEHAVIORAL MEDICINE 493