Personality and Cardiovascular Disease

Nearly two thousand years ago the physician Galen considered that a major proportion of one of the essential physical elements in the body would produce the dominant temperament or personality, and an excess would produce disease.

There are some dangers in linking personality and health. It can lead to “blaming the victim”. It can be comforting to believe that something that a person has done "wrong" has caused his or her problem, because it is easy to convince ourselves that we will be different.

Another problem is the danger of assuming that knowing the person's personality is enough to understand the disease. At one time tuberculosis was seen as having been caused by the character of those afflicted. Then the tubercle bacillus was discovered and the pendulum has swung in the opposite direction with the application of a medical model of disease and treatment that has excluded psychological factors.

One of the best known theories about personality and disease is the proposed link between Type A behaviours and coronary heart disease. It is said that the initial idea was raised by a furniture upholsterer. During the 1950s Meyer Friedman and Ray Rosenman, two American cardiologists were having their office furniture renovated when they were asked by the repair man why only the front edges of the chairs were worn out. He asked what kind of doctors they were since he wondered what kind of patients were especially likely to sit on the edge of their seats. It seemed like a link between persistent agitated behaviour and heart disease.

In the early theorising, type A people were defined as those involved in a constant struggle to do more and more things in less and less time. They were frequently quite hostile or aggressive in their efforts to achieve these things. They always seemed to be under time pressure, and always had deadlines to meet. They took life seriously, were very competitive, sought achievement and were impatient, impulsive and very tense.

Research through to the mid 1980s established that Type A behaviour was reliably associated with coronary heart disease(CHD). Some of this research looked back at the behaviours and experience of people who already had heart problems, and some of it involved long term studies trying to predict the occurrence of heart disease. The Western Collaborative Group Study in the U.S. lasted nearly ten years and studied thousands of people. It found that Type A behaviour predicted the initial occurrence of CHD, second and third heart attacks, as well as hardening of the arteries.

These findings were confirmed by other long term studies such as the Framingham Heart Study in the U.S. and the French-Belgium Collaborative Group study in Europe. Among previously healthy individuals Type A behaviour predicted the likelihood of heart disease independent of other risk factors such as smoking, high blood pressure, and genetic endowment. Furthermore the personality factor was at least as important, and sometimes more important in the prediction than these other well established factors. Think about that for a moment. Personality was seen to be more important than smoking or blood pressure.

An interesting development more recently is the increased sophistication of the psychological theory in this area. The simple split into Type A and Type B doesn’t seem to explain what we see in everyday life. It has been argued that some people who are "workaholics" might be healthy if they work in a context of committed and meaningful devotion. These people have a predominantly positive, though highly energised, life experience. It may be only those Type As experiencing hostility and other chronic negative emotional states who get sick.

So maybe we need to think in terms of a Type A who is hostile and negative in other ways, and a highly energised Type A who is simply dynamic and positive in life. Conversely, some of the Type B people who are supposedly relaxed, passive, quietly spoken and otherwise seemingly pretty laid back, may actually be repressing powerful, and dangerous, emotions such as hostility and frustrated ambition. Research has compared the "true" Type As (who are hostile), healthy dynamic Type As, “true” Type Bs (who are relaxed) and unhealthy Type Bs (who repress emotions). The findings indicate that the “true” Type As and the unhealthy Type Bs are most at risk of poor health.

Since coronary heart disease is the largest cause of death in the Western world, and we spend hundreds of billions of dollars annually in treatment of illness, it is interesting to consider whether any preventative action can be taken with regard to the effects of personality on health. In one American programme 800 victims of heart attack (myocardial infarction) were randomly assigned to receive or not to receive psychological therapy. The therapy was aimed at reducing the Type A characteristics. Over a period of several years those receiving this form of therapy had a significantly reduced rate of recurrence of nonfatal heart attacks.

Governments might be a bit slow to set up such interventions, but there’s nothing to stop you doing it for yourself.

More readings will be added to my blog from time to time. Have a quick look now to see the first posting on my blog PSYC1PLUS