Type A coronary-prone behaviour pattern exhibits many of the features of neurotic repetition compulsion. Thus, it is often maladaptive and tends to be compulsive, inflexible, irrational and ultimately non-satisfying. There is a notable similarity between the descriptions of Type A individuals in the behavioural literature and narcissistic individuals in the psychoanalytic literature. It is postulated that Type A individuals may have a deficient self-representation. This psychodynamic formulation of Type A as a variant of pathological narcissism has implications for assessment, prevention and management. In particular, it may help discriminate a sub-group of high achievers who are neurotically motivated and have abnormally high arousal. Only this sub-group may be at increased risk of coronary pathology.
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