To propose an answer to Medicine's confusion about what Type A Behavior is.
Method:
To critically review early writings about Type A as well as current literature with a focus on five key articles which are frequently mentioned in medical and lay literature as containing relevant data undermining the Type A hypothesis. These five are critically evaluated for their definition of Type A, method of diagnosing Type A, nature of the cohort studied, and logic of their conclusions.
Results:
There is a failure in the literature to distinguish between Axis I symptoms and Axis II personality traits; the same term, Type A, being applied to quite different phenomena.
Conclusions:
Type A should be defined as a Axis II Personality Disorder, and a new term, Stress Disorder (or Hostility Disorder) to the Axis I symptoms. This opens up endless possibilities in Medicine for Stress Disorder research, since Medicine can rightly argue that the research is to better treat the Stress Disorder disease, that precedes Coronary Artery disease.
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2.
American Psychiatric Association, DSM-III-R: Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association, Washington, 1987.
3.
FriedmanM.RosenmanR. H.Association of Specific Overt Behavior Pattern with Blood and Cardiovascular Findings, Journal of the American Medical Association, 96:1286–1295, 1959.
4.
RosenmanR. H.FriedmanM.StrausR.A Predictive Study of Coronary Heart Disease: The Western Collaborative Group Study, Journal of the American Medical Association, 189:15–22, 1964.
5.
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6.
FriedmanM.ThoresonC. E.GillJ. J., Type A Behavior: Its Possible Role, Detection, and Alteration in Patients with Ischemic Heart Disease, in The Heart; Update V, edited by HurstJ. W. (ed.), McGraw-Hill, New York, 81–100, 1981.
7.
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8.
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9.
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10.
FriedmanM.ThoresonC. E.GillJ.UlmerD.PowellL. H.PriceV. A.BrownB.ThompsonL.RabinD. D.BreallW. S.BourgW.LevyR.DixonT.Alteration of Type A Behavior and Its Effect on Cardiac Recurrences in Post Myocardial Infarction Patients: Summary Results of the Recurrent Coronary Prevention Project, American Heart Journal, 112:653–665, 1986.
11.
RubermanW.WeinblattA. B.GoldbergJ. D.ChaudharyB. S.Psychosocial Influences on Mortality after Myocardial Infarction, New England Journal of Medicine, 311:552–559, 1984.
12.
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13.
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14.
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15.
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18.
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19.
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20.
HaynesS. G.FeinleibM.EakerE. D., Type A Behavior and the Ten-year Incidence of Heart Disease in the Framingham Heart Study, in Psychosomatic Risk Factors and Coronary Heart Disease, RosenmanR. H. (ed.), Hans Huber, Berne, Switzerland, 80–92, 1983.
21.
FriedmanM.UlmerD., Treating Type A Behavior and Your Heart, Fawcett Crest, New York, 1984.
22.
FrancisA., DSM-III Personality Disorders: Practitioners Manual, BMA Audio Cassettes, New York, 1987.
23.
PriceV. A., Type A Behavior Pattern: A Model for Research and Practice, Academic Press, New York, 1982.
24.
BellahR. N.MadsenR.SullivanW.SwidlerA.TiptonS., Habits of the Heart: Individualism and Commitment in American Life, University of California Press, Berkeley, 1985.
25.
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26.
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27.
GillJ. S.PriceV. A.FriedmanM.ThoresenE. E.PowellL. H.UlmerD.BrownB.DrewsF. R.Reduction in Type A Behavior in Healthy Middle-aged American Military Officers, American Heart Journal, 110:503–514, 1985.
28.
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29.
MatthewsK. A.CHD and Type A Behaviors: Update On and Alternative to the Booth-Kewley and Friedman Quantitative Review, Psychological Review, 104: 373–380, 1988.
30.
GlassD. C., Behavior Patterns, Stress and Coronary Disease, Erlbaum, Hillsdale, New Jersey, 1977.
31.
StrubeM. J.A Self-appraisal Model of the Type A Behavior Pattern, Perspectives in Personality, 2:201–250, 1987.
32.
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