Type A Behavior in Cardiovascular Disease
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.
The concept of type A behaviour was introduced by the cardiologists Meyer Friedman and Ray H. Rosenman in the late 1950s to describe a 'specific emotion-action complex' they frequently observed in their patients. Friedman and Rosenman identified six core features of type A behaviour: (i) an intense drive to achieve self-selected, but usually poorly defined goals, (ii) competitiveness, (iii) a persistent desire for recognition and advancement, (iv) involvement in several functions subjected to time restrictions, (v) an accelerated rate of execution of several physical and mental functions and (vi) an increased mental and physical alertness. Subsequently, Friedman specified that type A behaviour includes both covert and overt characteristics. The former are insecurity and inadequate self-esteem, whereas the main overt components are sense of time urgency (impatience) and free-floating hostility. They result in several specific behavioural and psychomotor manifestations, such as speed in walking and eating, intense discomfort when waiting in lines, involvement in different activities simultaneously, extreme punctuality, rapid speech, tense posture, chronic facial tension, loss of temper while driving, sleeplessness because of anger or frustration, disbelief in altruism and excessive irritability or discomfort when facing trivial errors by others.
Type A behaviour predicted both onset and worse outcome of coronary heart disease (CHD) in longitudinal studies. In 1981, the evidence for a significant association between type A behaviour and cardiovascular diseases led the National Heart, Lung & Blood Institute to include type A behaviour among the independent risk factors for CHD. Beginning from the mid-1980s, the emergence of some contradictory findings resulted in a reappraisal of the predictive role of type A behaviour on the onset and course of CHD. Afterwards, it was suggested that only some components of type A behaviour, in particular hostility, yield an adverse effect on the cardiovascular system. A major difficulty in interpreting the results is the fact that most studies assessed type A behaviour with self-administered questionnaires, even though semi-structured interviews seem to be more reliable for the recognition of the motor-expressive characteristics of type A behaviour.
In 1995, a structured research interview for the determination of type A behaviour, following Friedman and Rosenman's original characteristics, was developed and validated. It was included in the Diagnostic Criteria for Psychosomatic Research (DCPR), a set of 12 psychosomatic syndromes, including also other psychological variables, such as irritable mood and demoralisation.
While the role of type A behaviour in cardiac diseases has been the object of a large body of literature, its occurrence in the setting of other medical conditions has been virtually neglected. Few preliminary data suggested a possible involvement of type A behaviour in some non-cardiac diseases. However, the lack of a systematic comparison between type A behaviour as observed in cardiology settings and in other medical environments does not allow to infer whether such characteristics are specific or not to cardiovascular diseases.
The aim of this investigation was to compare the prevalence and characteristics of type A behaviour, as assessed by a structured interview (DCPR), in a highly heterogeneous group of medical patients, encompassing both cardiological and non-cardiological illness.
Abstract and Introduction
Abstract
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.
Introduction
The concept of type A behaviour was introduced by the cardiologists Meyer Friedman and Ray H. Rosenman in the late 1950s to describe a 'specific emotion-action complex' they frequently observed in their patients. Friedman and Rosenman identified six core features of type A behaviour: (i) an intense drive to achieve self-selected, but usually poorly defined goals, (ii) competitiveness, (iii) a persistent desire for recognition and advancement, (iv) involvement in several functions subjected to time restrictions, (v) an accelerated rate of execution of several physical and mental functions and (vi) an increased mental and physical alertness. Subsequently, Friedman specified that type A behaviour includes both covert and overt characteristics. The former are insecurity and inadequate self-esteem, whereas the main overt components are sense of time urgency (impatience) and free-floating hostility. They result in several specific behavioural and psychomotor manifestations, such as speed in walking and eating, intense discomfort when waiting in lines, involvement in different activities simultaneously, extreme punctuality, rapid speech, tense posture, chronic facial tension, loss of temper while driving, sleeplessness because of anger or frustration, disbelief in altruism and excessive irritability or discomfort when facing trivial errors by others.
Type A behaviour predicted both onset and worse outcome of coronary heart disease (CHD) in longitudinal studies. In 1981, the evidence for a significant association between type A behaviour and cardiovascular diseases led the National Heart, Lung & Blood Institute to include type A behaviour among the independent risk factors for CHD. Beginning from the mid-1980s, the emergence of some contradictory findings resulted in a reappraisal of the predictive role of type A behaviour on the onset and course of CHD. Afterwards, it was suggested that only some components of type A behaviour, in particular hostility, yield an adverse effect on the cardiovascular system. A major difficulty in interpreting the results is the fact that most studies assessed type A behaviour with self-administered questionnaires, even though semi-structured interviews seem to be more reliable for the recognition of the motor-expressive characteristics of type A behaviour.
In 1995, a structured research interview for the determination of type A behaviour, following Friedman and Rosenman's original characteristics, was developed and validated. It was included in the Diagnostic Criteria for Psychosomatic Research (DCPR), a set of 12 psychosomatic syndromes, including also other psychological variables, such as irritable mood and demoralisation.
While the role of type A behaviour in cardiac diseases has been the object of a large body of literature, its occurrence in the setting of other medical conditions has been virtually neglected. Few preliminary data suggested a possible involvement of type A behaviour in some non-cardiac diseases. However, the lack of a systematic comparison between type A behaviour as observed in cardiology settings and in other medical environments does not allow to infer whether such characteristics are specific or not to cardiovascular diseases.
The aim of this investigation was to compare the prevalence and characteristics of type A behaviour, as assessed by a structured interview (DCPR), in a highly heterogeneous group of medical patients, encompassing both cardiological and non-cardiological illness.