Type A Behavior: A reappraisal of its characteristics in cardiovascular disease

Aims: The role of type A behavior 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 behavior 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, 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 behavior. Results: A cardiac condition was present in 366 patients. There was a significant difference in the prevalence of type A behavior in cardiovascular disease (36.1%) compared to other medical disorders (10.8%). Type A behavior frequently occurred together with psychiatric and psychosomatic disturbances, particularly irritable mood, even though in the majority of cases it was not associated with DSM diagnoses. Among cardiac patients, those with type A behavior were less depressed, demoralized and worried about their illness. Conclusions: Type A behavior 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 behavior