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The prevalence of coronary–prone behaviour, Type A, was investigated in a representative sample of all Finnish adults comprising 1941 men and 2168 women aged 30–64 years. The behaviour pattern was assessed by the Jenkins Activity Survey. The mean of the Type A scores was –5.7 for men and –5.8 for women. Among men, 28.2%, and among women 26.8% had scores greater than or equal to 0. Type A was positively associated with the level of education. The prevalence of Type A in Finnish men and women seems to be lower than that found in most other surveys.

During the last 50 years, many studies have analysed the correlations between personality factors, behavioural pattern, personality type, psychiatric disorders and coronary artery disease (CAD). Although consistent evidence of causal association between CAD and major depressive disorders does exist, the role and importance of personality factors and character traits in CAD development and manifestations are still debatable. We reported the most important studies from the literature on type A behaviour pattern (TABP), the first correlated to CAD. After the initial enthusiasms, large clinical trials raised doubts about the role of TABP as CAD risk factor. We reported subsequent researches aimed at extracting from TABP components predisposing to atherosclerosis, such as hostility and anger. Finally, we analysed a recent personality type (type D) introduced in 1995 and identified as a negative prognostic factor in CAD patients.

To examine the relationship between type A behavior pattern and hypercholesterolemia, we recruited 109 primary hypercholesterolemic patients without treatment for hyperlipidemia (30 males and 79 females) and then classified them according to Maeda's questionnaire into two groups; type A group (16 males and 35 females, aged 73.1 +/- 8.7) and type B group (14 males and 44 females, aged 71.3 +/- 8.7). We studied serum total cholesterol, serum triglyceride and BMI. Serum total cholesterol was shown significantly higher in type A group than that in type B (233.0 +/- 22.8 vs 223.9 +/- 14.2 p < 0.01) and BMI lower (24.0 +/- 3.9 vs 25.4 +/- 3.9 p < 0.05), however, there was no significant difference in serum triglyceride between two groups (148.96 +/- 8.2 vs 134.0 +/- 48.8). Although there was no significant difference in BMI, serum total cholesterol was significantly higher in the women's group and in the 60s. This study suggests that type A behavior pattern is related to lipid metabolism, however we should take gender and age into consideration to study the relationship between type A behavior pattern and lipid metabolism.

The present study assessed the prevalence of the Type A behaviour pattern in a rural and an urban sample of men in Norway. The study was carried through on data collected for other purposes, reported earlier in 1998 and 1999, to evaluate whether there were differences in Type A behaviour pattern between the two environmental settings. The Type A behaviour pattern was assessed in both studies using the Jenkins Activity Survey. Analysis of the data on the Global Type A scale indicated that, on average, participants in both environments reported as Type Bs as opposed to Type As. However, the distribution of scores on the subscales of the Jenkins Activity Survey showed that mean scores on the Type A behaviour attributes were higher in the urban sample than those in the rural sample. The results concerning the expression of the Global Type A from these samples supported expectations about differences in challenges of a competitive environment such as an urban setting, expressed in the literature.

Background: Studies of type A behaviour pattern suggest that it can be promoted as a whole by certain parental rearing styles. However, the association of the different components of the type A behaviour with specific rearing practices has not been clarified. Method: The relationship between parents' rearing style and the different type A behaviour components of their children was analysed in a sample of 312 university students. Parental rearing style was assessed with the EMBU, a Swedish measure originally designed to assess one's recollections concerning one's parents rearing behaviour. Type A pattern was measured by the JAS, a self-administered questionnaire that gives the global type A score and three of its components. Results: Hard Driving was related to Rejection and Favouring Subject in males. Speed-Impatience was related to Rejection and Control in both sexes, and Job Involvement was related to Control and Favouring Subject in females. In a discriminant factor analysis in males, Rejection, Control and Favouring Subject on the part of fathers classified correctly 80% of the subjects identified as having high or low Speed-Impatience and the variables of Rejection and Favouring Subject (also by fathers) classified correctly 69.23% of the subjects identified as high or low Hard Driving. In females, Control and Favouring Subject on the part of mothers and low Rejection by fathers classified correctly 70.37% of the subjects with high or low Job Involvement. Conclusion: These results suggest that different rearing characteristics are related to the various components of the type A behaviour pattern.

The Type A behaviour pattern is a well‐documented, if controversial, risk factor for coronary heart disease. Surprisingly, relatively little work has been reported on ways of modifying this behaviour pattern. Aerobic exercise, with its demonstrated benefits for both cardiovascular reactivity and psychological ‘well‐being’, is a promising treatment. The literature is reviewed and recommendations are made for practical applications and future research.

A comparison of Type A behaviour pattern, hostility and Typus Melancholicus (TM) was examined in a sample of 228 Japanese and 121 American college students. It was found that: the Japanese students expressed Type A, especially hostility, less strongly than American ones; TM was seen to the same degree in both Japanese and American students; Type A was related to hostility and TM in both groups of students; and compared with American students, the Japanese students displayed the defensiveness more frequently, and there appeared to be a strong relationship between defensiveness and hostility. These results suggest the possibility that hostility, a component element of Type A, is manifested under the influence of defensiveness, which is partially related to a variety of different sociocultural contexts.

40 adult subjects completed three measures of the Protestant Work Ethic and a multidimensional measure of the Type A behaviour pattern. The only consistent pattern of correlations was between the “hard-driving” subscale of the Type A measure and all three total PWE scores for Protestant Work Ethic. Results are discussed in terms of the constituent parts of both concepts.

Fifteen boys and eleven girls between three and six years of age were examined at a day-care center and at home as regards their catecholamine and cortisol excretion. Behaviour pattern was assessed by the MYTH-scale, which measures the competitiveness, impatience-anger and aggression components of the type A behaviour pattern in children (Matthews and Angulo, 1980). The boys obtained higher type A scores and excreted more adrenaline and noradrenaline than the girls, while cortisol excretion did not differ between the sexes. In view of previous findings, the results suggest that sex differences in catecholamine excretion in children are induced by sex related differences in behaviour. This relationship in childhood could be of relevance for sex differences in catecholamine responses observed in adulthood. In both sexes, adrenaline excretion was significantly elevated at the day-care center compared with the at-home levels, indicating that mental arousal was greater at the center. In a separate part of the study, eleven new children were tested while they were adjusting to the day-care situation; it was found that only noradrenaline levels during the first week at the center were significantly elevated.

Three studies are reported, in which subjects were exposed for a period of three minutes to a threat of possible shock. On average subjects showed higher heart rates before the trial than after the trial, and higher rate during the first minute of the trial than the final minute. Results are reported here which show that Type A behaviour pattern and internal locus of control are consistently related to less decline in heart rate.

The Type A behaviour pattern has been associated with the onset of myocardial infarction (MI). So too, though independently, has the presence of stressful life-events in the period preceding illness. The present paper examines the notion that persons characterized by the Type A behaviour pattern organize life-styles in such a way as to increase the probability of encountering stressful life-events. Significant correlations were indeed found between a measure of Type A behaviour and both reported frequency of life-events and estimates of the emotional impact of these, for a sample of 120 survivors of MI. While such retrospective data do not provide casual evidence that Type A behaviour influences MI by way of stressful life-events, they point the way to a future prospective test of this hypothesis.

A questionnaire consisting of a subset of questions from the Jenkins Activity Survey was given to 135 male military personnel aged between 18 and 25, together with the EPQ and the AI3, an obsessionality scale. A factor analysis of the answers revealed a four-factor structure - impatience, hard-driving competitiveness, speed and emotional unrepression. Neuroticism was found to correlate positively with impatience and speed, but negatively with hard-driving competitiveness, which together with emotional unrepression correlated positively with extraversion. Impatience, speed and emotional unrepression also correlated positively with obsessionality. Obsessionality was the only personality measure to correlate significantly with the total Type A score. The nature of the relationships between the Type A behaviour pattern and the Eysenckian personality measures are discussed.

Recent research has shown that psychological risk factors play an important role in the pathogenesis of cardiovascular diseases. The so-called ‘coronary prone behaviour pattern’ predominates, an important part of which is the ‘Type A behaviour pattern’. This is characterized by a marked ambition, a constant feeling of being under pressure, due to latent aggression and to a striving to dominate. For cerebrovascular diseases the so-called ‘pressured pattern’ as a risk factor has been found to be typical which is comparable to the Type A behaviour. Psychological risk factors and their components are not equally important for different vascular diseases. Besides the explanation of the question as to how far psychological processes really are involved in the development of vascular diseases, the research on psychological risk factors serves as a foundation for psychosomatic theories.

This study examines the possibility that Type A behaviour is related to physique, and thus, is secondary to physique as a risk factor for coronary heart disease (CHD). Scores on a modified version of the 1966 Jenkins Activity Survey were correlated with a number of physical parameters. Age was found to have the highest correlation of -0.177. When the effects of age were adjusted for, only 7.1% of variation in JAS scores was explained by the body measurements used to define physique. In addition, when high and low scorers on the JAS were compared, no significant differences were found between the groups on any of the body measurements. Since this study found no significant relationship between JAS scores and physique, the results do not controvert the supposition that Type A behaviour is an independent risk factor for CHD.

Early views of the Type A behaviour pattern (TABP) sought to disengage it from either neuroticism or emotional distress. Recent evidence challenging these views has, however, recommended a reevaluation of the area. Data arising from the present study indicate the TABP to be statistically related to measures of both neuroticism and emotional distress, though whether this association extends to a conceptional similarity, particularly with the former, is a matter for further discussion.

Sixty male subjects, all under age 60, taken consecutively from a cardiologist's referral practice were studied in terms of A Behaviour pattern using the Rosenman-Friedman Stress Interview. Subsequently they all underwent personality, temperament and life stress assessment by questionnaire using the MMPI, Thurstone Temperament Schedule, Holmes-Rahe Schedule of Recent Experience, Rosenman Life Satisfaction Questionnaire and a number of demographic measures. They were examined medically and divided into coronary heart disease (CHD) and non-coronary heart disease (NCHD) groups. There were many more A Behaviour subjects reflecting the sampling bias from the cardiologist's practice. There were significantly more A subjects found in the group with CHD than in the NCHD group. A Behaviour subjects were more dissatisfied with their marriages and attainment of life goals and preferred respect and recognition to love and affection. The A Behaviour subjects were considered more open, self-critical, dissatisfied and passive than the non-A cohorts as interpreted from the L, K and Mf scales of the MMPI. The finding of an association between A Behaviour and CHD validates the research of others. The greater dissatisfaction in certain areas of the A subjects’ lives fits in with other research evidence and is discussed in this vein. The passive, aesthetic interests of A subjects although difficult to explain in the light of the contrasting behaviour style, is discussed with reference to earlier psychoanalytic theories. The lack of psychopathology and personality differences in A subjects points up the difficulty of recognizing the A pattern using personality tests and points to the need of improved behavioural measures.

People who exhibit the type A behaviour pattern have different approaches to problems compared with their non-type A counterparts. On the basis of published work on such differences, a number of predictions were tested in 85 outpatients with type I diabetes. Contrary to expectations, no differences were observed in glycaemic control between type A and non-type A diabetics of either sex. However, dividing type A diabetics according to their health locus of control beliefs yielded significantly different groups in terms of glycaemic control.

Summary. A sample of 104 medical students was tested for the Type A behaviour pattern, using the Jenkins Activity Survey (Form N fully weighted and Form C Glass Student scores) at four points over a 6-year period during the medical course. Fully weighted Type A scores showed a significant increase over the first 3 years of the course, followed by a drop—to approximately second-year levels—by the end of the 6-year period. A similar but non-significant pattern was observed for the Glass scores. It was suggested that the decrease in the scores was related to lesser usefulness of the Type A pattern during the clinical years of the medical course. A significant difference was found for the final written examination, with those who scored above the median on the Glass Student Type A scale doing better than low scorers. This result was not replicated for the fully weighted Type A scores. It may be that there is some specific usefulness of Type A responding for performance on written examinations, although no equivalent performance difference was found for the final clinical examination.

SynopsisEvidence is summarized suggesting that existing self-report questionnaires for the assessment of Type A behaviour pattern suffer from major methodological shortcomings. Type A individuals may be unwilling or unable to accurately self-report. The female spouse of the male patient can potentially provide a more objective, accurate ‘trait’ description less contaminated by ‘state’ variables such as diagnosis of illness or medication. The development of a spouse-report questionnaire is described and pilot data from 41 couples are presented, including comparison of the self-report and spouse-report responses on 46 questionnaire items and five scales. Unexpectedly high levels of agreement were found between self and spouse reports. Possible explanations of such agreement are critically examined.

SynopsisNearly one hundred subjects completed two Type A behaviour questionnaires twice. First, they were asked to complete them honestly, reporting accurately on their behaviour patterns. Half of the subjects were then asked to fake good, presenting themselves in a positive light, and half to fake bad, presenting themselves in a negative light. There was only a marginal difference on one questionnaire's total score, with fake good subjects having lower Type A (i.e. higher Type B scores) yet nearly every individual question revealed large significant differences. The subjects' own A/B classification did not effect the way in which they faked the questionnaires. The results are discussed in terms of the literature on faking, lay concepts of psychological phenomena and the multidimensionality of the Type A concept.

Some of the major nervous and psychological factors affecting the functioning of the heart are briefly reviewed. Emphasis is placed on the autonomic nervous system and its response to stressful situations. Possible pathways by which mental processes and behaviour might influence cardiovascular pathology and sudden death are outlined. Differences observed in the pattern of response are emphasized, as are the factors upon which these differences depend. The Type A behaviour pattern is considered and the importance of marital and social support is also discussed.

Two questionnaire measures of the Type A behaviour pattern, the Jenkins Activity Survey and the Bortner Questionnaire were completed by a sample of 151 middle-aged male civil servants on three occasions, up to 34 weeks apart. The reliability of both measures was satisfactory. The reliability coefficient of the JAS Type A measure did not fall below 0.79 while the Bortner achieved a reliability of 0.71 over the longest time interval studied. The intercorrelation of the two tests on two occasions was approximately 0.7. In addition it was shown that both tests were largely independent of a number of standard cardiovascular risk factors. It was concluded that in the population studied both tests had satisfactory psychometric properties and that they were measuring a very similar behavioural characteristic.

Both the Type A Behaviour Pattern (TABP) and the presence of stressful life-events have been independently established as precursors to the onset of coronary heart disease (CHD). The thematic character of the TABP suggests, however, that the two phenomena might be linked, to the extent that features of the TABP may place an individual in social, occupational and personal circumstances which enhance the probability of encountering stressful life-events. Evidence from survivors of clinical CHD gives some support to this idea. The present study extends the hypothesis to a large sample of healthy males, screened for CHD risk factors. These results, too, support the idea that the TABP and encounters with stressful life-events are not entirely independent phenomena. Associations between the TABP and a range of measures of life-events were most evident in the occupational aspects of the latter, though not exclusively so. The data do point to the need, in future epidemiological studies of CHD risk, to treat the TABP and stressful life-events as related measures of CHD risk.

Thirty-three subjects were allowed to choose between actively monitoring a visual channel for warning of a possible aversive event, or passively watching a distracting visual channel. Subjects could switch between channels as little or as often as they wished. Heart-rate was recorded throughout the experiment. In accordance with hypothesis, Type A subjects, as measured by the Framingham Scale, chose the active coping strategy more consistently than Type B subjects. Type A subjects also exhibited higher heart-rate while anticipating the start of the experiment. The results are discussed with reference to the literature on Type A and controllability and on active coping and cardiovascular activity.

Current research into ‘coronary proneness’ is considered particularly in relation to attempts to extend the idea of the Type A Behaviour Pattern. A generalised critique is made of research aiming at an explanation of ‘coronary-proneness’ through the association of empirical categories or through predictive investigations, which lead in the one case to a plethora of conceptually indistinct findings and in the other away from the elaboration of theory. By reference to the cross-disciplinary nature of work on this problem it is argued that the designation of people as ‘Type A’ is a categorical description rather than an explanation in terms of conceptually integrated theory. The assumptions underlying this issue are sought in the relation between medical and social scientific approaches to CHD, and a summary statement offered on this problem.

This paper is concerned with how Type A and B subjects perceive themselves. Subjects first completed a unidimensional A type measure, then rated themselves and their ideal selves on various personality traits. As expected, Type A was associated with negative self-ratings and high actual-ideal self-discrepancy scores. However, it is argued that self-evaluation in negative terms by Type As is not necessarily synonymous with low self-esteem. Negative self-ratings may be an important factor in the aetiology and maintenance of the Type A behaviour pattern.

The demonstration of modest statistical associations between measures of the Type A behaviour pattern (TABP) and some measures of authoritarianism has given rise to a view that the TABP represents little more than an attempt by some individuals to exercise the personality attribute of dominance. The present study examined this view with regard to a wide selection of measures of the authoritarian personality and found that measures of the TABP related only to measures of authoritarianism reflecting authoritarian behaviours. While such correlations indicate a facet of the TABP resembles the attribute of dominance, they do not amount to conceptual equivalence of the TABP and authoritarianism. The conceptual complexity of the TABP demands a more multidimensional view of this explanatory notion in medical psychology.

Controversy has arisen over the usefulness and reliability of the Jenkins Activity Survey (JAS) as a measure of Type A behaviour. Ray & Bozek (1980), Jenkins & Zyzanski (1982) and Ray (1984) have exchanged contrasting views. Our data show low internal consistency scores for the four components of the JAS: i.e. the Type A scale itself and factors speed and impatience (S), job involvement (J), and hard-driving competitiveness (H); and a low test-retest reliability result for the Type A scale. Further, the weighted scoring scheme of the JAS is questioned. Recommendations are made to eliminate the weighted scoring scheme, delete factors S, J, and H, and revise specific items in the JAS.

This paper reports on two studies of how Type A and B subjects perceive themselves. Both studies investigated differences in self-ratings of personality by Type As and Bs, and differences in the recall of positive and negative personality information. As predicted, a modest significant positive correlation was found in both studies between Type A scores and number of positive traits remembered, suggesting that Type A behaviours are associated with a tendency to process information about the self in such a way as to bolster self-esteem. Self-ratings of positive and negative personality traits showed that Type As tended to rate themselves much more negatively than Type Bs. This provides support for a self-evaluative model of Type A behaviour. The results are discussed in terms of the paradoxical nature of the Type A behaviour pattern.

Twenty-eight subjects completed 2 Type A questionnaires. Just under half the patients were considered Type A. Painful episodes of myocardial ischaemia occurred more frequently in Type A patients during a stressful period of ambulatory Holter monitoring compared to a later date. This difference could not be explained in terms of severity of disease or length of myocardial ischaemia. Rather it seemed to reflect increased reporting of somatic symptoms on the background of a greater sensitivity to environmental stress. Type A patients may thus present themselves earlier than their Type B peers.

The “coronary prone” or Type A behaviour pattern, characterized by e.g., hard-driving competitiveness, impatience and aggressiveness, is associated with elevated systolic blood pressure and catecholamine secretion during challenge. In experiments at our laboratory, elevated psychophysiological arousal was found in Type A subjects during understimulation, but not during active performance on a self-paced reaction time task. Results suggest that differences in cardiovascular and behavioural reactivity between Type A and B persons tend to be related to the pace of the environment to which they are exposed. Studies of antecedents of Type A behaviour in children show that “Type A children” respond to challenge with a greater increase in sympathetic arousal than “non-Type As”. This suggests the possibility that genetic dispositions and/or conditioned sympathetic reactivity play an important role in the development of the Type A behaviour pattern.

A series of research developments is described which together consider the problem of the relationships between behavioural, physiological and pathophysiological processes. Arguments are advanced for the measurement of challenge–induced changes in haemodynamic responses for use in the understanding, prediction and control of coronary heart disease (CHD), hypertension and sudden cardiac death. A methodology is presented as a possible tool for accomplishing this latter goal and preliminary data are reported in support of the feasibility of these methods. Finally, basic pathophysiological mechanisms in cardiovascular disorders are examined in relation to potentially damaging haemodynamic activity.