Personality, Type A/Type B

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Personality, Type A/Type B

The roles that personality and behavior play in illness and disease can sometimes be difficult to determine. Because specific personality or lifestyle characteristics cannot be randomly assigned to people, researchers must rely on longitudinal and prospective studies. In these studies, factors that are suspected to be related to disease proneness must be shown to predict health outcomes, sometimes by following participants for a period of many years. In the late 1950s, two California cardiologists named Meyer Friedman (1910–2001) and Ray Rosenman proposed a specific personality type that, based on their clinical experiences, seemed to be associated with high frequencies of cardiovascular disease. In 1960, Friedman and Rosenman began the Western Collaborative Group Study. In this longitudinal study, the researchers followed over 3,000 healthy adult males aged 39 to 59 for more than eight years. Their goal was to determine the relationships among personality, behavior, and the development of heart disease.

At the start of their study, Friedman, Rosenman, and their colleagues conducted 15-minute structured interviews that focused on both verbal and nonverbal behaviors. Participants answered questions about everyday events, such as waiting in lines, driving in traffic, and dealing with problems at home. In addition, interviewers assessed how loud and fast participants spoke during the interview and how they reacted when they were deliberately interrupted during the interview. Based on these taped interviews, the researchers identified different patterns based on a combination of physical, emotional, psychological, and behavioral indicators. Among these patterns was what the researchers called the Type A pattern, the Type B pattern, and mixtures of the two types.

TYPE A AND TYPE B

Physical indicators of Type A Behavior Pattern (TABP) include excess perspiration; facial muscle tension and tics; high levels of alertness and hyperactivity; high levels of epinephrine and norepinephrine (hormones associated with stress); and increased heart rate and levels of diastolic and systolic blood pressure. Emotional indicators include high levels of stress, irritation, hostility, anger, and aggression (especially under provoking conditions). Psychological indicators include impatience; strictness, rigidity, and perfectionism; low tolerance for mistakes; low self-esteem; personal insecurity; compulsiveness; and a high need for control. Finally, examples of behavioral indicators include a general sense of time urgency; losing one’s temper while driving; speaking loudly and quickly; interrupting other people’s speech; teeth and tongue clicking; a chronic focus on success, ambition, competitiveness, and achievement; and workaholism.

Early proponents of TABP sometimes referred to it as the “hurry sickness,” in order to highlight those factors related to the perception of and use of time. Several TABP indicators are thought to be influenced by European and North American social, cultural, and economic values. For example, job promotions and social prestige may often be tied to how much Type A behavior a person shows. The work climate and demands of many kinds of jobs may also reinforce Type A behaviors.

In contrast to the Type A pattern, Type B behavior pattern is characterized by a more calm and even-tempered demeanor. With regard to physical indicators, Type B individuals show more muscle relaxation and lower levels of activity and alertness. Emotionally, such personality types show less frequent irritation, anger, hostility, and aggression than Type A individuals. Psychologically, Type B persons are methodical, tolerant of mistakes, and personally secure. Finally, Type B individuals are more cooperative and relaxed and less achievement-oriented than their Type A counterparts. In the Western Collaborative Group Study, the TABP proved to be a significant predictor of coronary heart disease (CHD), with Type A men showing almost twice the risk of developing CHD than Type B men. In that study, the TABP predicted increased incidence of CHD independent of other risk factors such as smoking, exercise frequency, and parental history of heart disease.

REFINEMENT OF THE TYPE A CONCEPT

As these findings were publicized and tested more fully, several concerns arose regarding the original conception of TABP. First, questions about the best way to assess the pattern emerged. In an effort to assess TABP more efficiently than through the time-consuming individual structured interviews, researchers developed several self-report measures. For example, the multiple-choice Jenkins Activity Survey (JAS), developed in 1979, assesses many of the attitudes and behaviors originally identified as comprising the TABP. However, concerns have arisen about how well the JAS and other measures capture the major dimensions of TABP. For instance, the JAS devotes less attention to the hostility component than seems to be warranted, and scores on the JAS are only weakly related to incidence of CHD. Nonetheless, this measure continues to be the most frequently used instrument in studies of the TABP. More recently, some researchers have utilized videotaped structured interview protocols.

Although the original formulation of TABP was intuitively appealing, one of the problems with such a broad and overly inclusive definition is that many (sometimes the majority) of participants in a study had been labeled as meeting the diagnostic criteria of TABP. As researchers continued to examine the links between personality and CHD, some studies were also unable to replicate the earlier findings of Friedman and Rosenman. In addition to facilitating the development of new and different measures, the concerns about diagnostic criteria led to a detailed examination of the major components of TABP. Given the large number of behaviors that can make up the Type A pattern, it is not surprising that some of these do not necessarily occur together with others. Researchers thus began to focus their attention on which components of the original multifaceted TABP were (and were not) associated with negative health outcomes.

With these more sophisticated studies, researchers discovered that hostility, especially antagonistic or angry hostility, appeared to be the TABP component that was most strongly related to CHD. In other words, people showing chronic levels of anger and hostility as well as negative affect (in particular depression and anxiety) are more likely to develop CHD. On the other hand, levels of achievement motivation, impatience, and workaholism failed to predict CHD. In addition, subsequent research showed that the perception and use of time turned out to be less predictive of negative health outcomes than other parts of TABP. A 2006 study showed that negative affectivity (i.e., the frequency of negative emotions) and a socially dominant interpersonal style can play a role in a variety of poor health outcomes.

Researchers have also attempted to determine how the psychological components of the TABP develop and how they contribute to the development of CHD. Along these lines, some research suggests that Type A children react more strongly to stress than do Type B children. Researchers have also demonstrated that hostility and aggression are related to cardiovascular response and future risk level in children. Other research suggests that Type A characteristics are likely to develop through a combination of children’s temperaments and parental behaviors. For example, children who show the competitiveness associated with the TABP may be encouraged by their parents to perform well in achievement settings, possibly making them more prone to anger and hostility.

In the last decade, researchers have examined how the TABP might be related to social behaviors that are not specifically related to illness or disease. Examples of these behaviors include marital dissatisfaction, driving behavior, group performance, and work-related stress. Some researchers have attempted to apply TABP to companies and organizations. In addition, research has examined how TABP might interact with situational factors, specific kinds of stressors, and various demographic variables (such as age and gender) in determining negative health outcomes. For example, Type A persons might be more likely than Type B persons to find themselves in situations or settings that create frustration, impatience, or irritation. Researchers have also begun to examine whether certain aspects of TABP might be caused by specific disease processes and to identify possible pathways through which personality might increase the likelihood of unhealthy behaviors that could contribute to disease frequency.

In other words, efforts to assess the relationships among personality, behavior, and disease have become more sophisticated and complex than the original TABP concept. As such, the interest, excitement, and promise relating to the original formulation TABP has waned considerably. This has led many modern day personality and health researchers and theorists to consider TABP concept to be no longer useful. Nonetheless, the initial study that identified Type A and Type B personalities, and the publicity it received, helped to energize the emerging fields of behavioral medicine and health psychology.

SEE ALSO Aggression; Behaviorism; Disease; Lifestyles; Medicine; Mental Health; Mental Illness; Overachievers; Personality; Psychology; Replicability, Statistical; Stress