Type A behaviour: a reappraisal of its characteristics in cardiovascular disease

Abstract

Summary Aims: The role of type A behaviour in cardiovascular disease is controversial and most of the research is based on self‐rating scales. The aim of this study was to assess the prevalence of type A behaviour in cardiology and in other medical settings using reliable interview methods that reflect its original description. Methods: A sample of 1398 consecutive medical patients (198 with heart transplantation, 153 with a myocardial infarction, 190 with functional gastrointestinal disorders, 104 with cancer, 545 with skin disorders and 208 referred for psychiatric consultation) was administered the Structured Clinical Interview for the DSM‐IV and the Structured Interview for the Diagnostic Criteria for Psychosomatic Research (DCPR) which identifies 12 clusters, including type A behaviour. Results: A cardiac condition was present in 366 patients. There was a significant difference in the prevalence of type A behaviour in cardiovascular disease (36.1%) compared with other medical disorders (10.8%). Type A behaviour frequently occurred together with psychiatric and psychosomatic disturbances, particularly irritable mood, even though in the majority of cases it was not associated with DSM‐IV diagnoses. Among cardiac patients, those with type A behaviour were less depressed, demoralised and worried about their illness. Conclusions: Type A behaviour was found to occur in about a third of cases of patients with cardiovascular disease. Only in a limited number of cases was it associated with depression. It has a lifestyle connotation that may have important clinical consequences as to stress vulnerability and illness behaviour.

Is Depression the Wrong Treatment Target for Improving Outcome in Coronary Artery Disease?

“…On the basis of original descriptions and the most relevant studies on type A, in the Diagnostic Criteria for Psychosomatic Research (DCPR) [71,72,73] nine items were identified to diagnose type A behavior. According to the DCPR, patients with cardiac conditions who presented type A (up to one third of the population) tended to display minimization of psychological impact and possible life-threatening consequences of cardiac disease [74]. This finding is in line with previous studies documenting an overlap between type A behavior and both hypomania and hyperthymic temperament, which are subclinical manifestations of the bipolar spectrum [75,76,77].…”

Influences of the Big Five personality traits on the treatment response and longitudinal course of depression in patients with acute coronary syndrome: A randomised controlled trial

“…Next, it is possible that the participants of our study had some intensified personality characteristics compared to general populations, given longstanding suggestions of associations between personality traits and risk of coronary heart disease (Rosenman et al, 1976;Sirri et al, 2012). For example, type A behavior is more prevalent in patients with cardiovascular disease compared with other medical disorders (Sirri et al, 2012). Finally, the timing of the personality assessment could give rise to different results.…”

“…The vulnerable type may be associated with poor outcome because the FFM model of personality shares generic risk factors with depression (Kendler and Myers, 2010), which has a greater genetic overlap in men than women (Fanous et al, 2007). Next, it is possible that the participants of our study had some intensified personality characteristics compared to general populations, given longstanding suggestions of associations between personality traits and risk of coronary heart disease (Rosenman et al, 1976;Sirri et al, 2012). For example, type A behavior is more prevalent in patients with cardiovascular disease compared with other medical disorders (Sirri et al, 2012).…”

Psychosomatics: Past, Present and Future

“…In the case of cardiovascular disease, the impetus for this was the observations by both Osler [62] in 1912 and later Meyer Friedman [63] that a type A personality, characterized by worry over time, hostile cynicism, and work pressures, is a risk factor for cardiovascular disease. Sirri et al [64] have carefully reviewed the current conceptualization of this construct [65]. There is clear data that behavioral therapy as well as medication such as buspirone can change elements of type A personality but the long-term outcomes from such interventions are not known [66,67,68].…”