A disease personality?

By the late 1980s there had been much discussion of a kind of Heart Attack personality, the type A personality and a cancer personality, The Type C personality. The “true” Type As were hostile and fearful people and the Type Cs repressed their emotions. Milton Friedman, who had been in the thick of these developments, & a colleague, Professor Booth-Kewley reviewed a large number of research studies in 1987 that changed the direction of the discussions. They selected five diseases selected for study; asthma, headaches, ulcers, arthritis, and heart disease. They calculated correlations between the personality factors and these diseases. This is a score between 0 and 1, with a score approaching 1 indicating a very high relationship.

The relationships found with personality attributes were generally moderate or high compared to other risk factors such as cigarette smoking. For instance, the relationships between anxiety and Coronary Heart Disease(CHD), Asthma, Ulcers, Arthritis, and headaches, averaged a little over .20, and relationships between ill health and depression averaged a little over .16. This seems pretty small until you realize that in the Framingham and Western Collaborative Group Studies that looked at many thousands of people found relationships between CHD and cholesterol and CHD and smoking under .15. Thus the risks associated with the personality factors investigated in this review were of meaningful size and of the same order of magnitude as more well-established risk factors such as cigarette smoking in CHD.

Friedman and Booth-Kewley noted that the combined effect for anxiety, anger/hostility, anger/hostility/aggression, and depression were of similar magnitude to that observed between Type A behavior and CHD. In other words, other personality factors may be as important as Type A behavior in predicting heart disease.

Overall the degree of consistency across diseases is quite remarkable, weakening the idea that there may be narrowly defined disease-personality patterns. Rather the idea that there is a general disease-prone personality gains support. The strength of relationships found with depression in these studies is interesting since it has been neglected while attention has been given to the role of anger and hostility.

The following table shows the correlations between the various health problems and particular aspects of personality such as anxiety, depression and anger/hostility. The first column shows the disease and the personality that were compared; the second column shows the correlations between them; the third column shows how reliable the findings were (the more zeros, the higher the reliability, or statistical significance).

Table 1 Relationships (correlations) between personality and disease: comparison with smoking.

Disease/personality ..........Relationship(r) ............Strength of effect**

CHD: anxiety........................ .136 ..............................<.0000001

CHD: depression.................... .238..............................<.0000001

CHD: anger/hostil/aggress ..... .143............................. <.0000001

CHD: anger/hostility.............. .167 ............................ <.0000001

CHD: extraversion................. .078 ............................ <.0013

Asthma: anxiety.................... .362 ............................ <.0000001

Asthma: depression............... .167............................. <.00003

Asthma: anger/hostil/aggress.. .224 ............................ <.000004

Asthma: anger/hostility........... .258 ............................ <.0000001

Asthma: extraversion.............. .132 ............................. <.0297

Ulcer: anxiety....................... .186 ............................. <.000001

Ulcer: depression................... .079 ............................. <.0022

Ulcer: anger/hostil/aggress..... -.031 ............................. <.4623

Ulcer: anger/hostility............. -.014 ............................. <.4410

Ulcer: extraversion................ -.174 ............................. <.0044

Arthritis: anxiety.................... .200 .............................. <.0000001

Arthritis: depression............... .156 ............................. <.0000001

Arthritis: anger/hostil/aggress.. .147 ............................. <.0006

Arthritis: anger/hostility.......... .158 .............................. <.00008

Arthritis: extraversion............ -.175 .............................. <.0056

Headache: anxiety.................. .205 .............................. <.00005

Headache: depression............. .187 .............................. <.0000001

Headaches: anger/hostil/aggr... .052 .............................. <.3016

Headaches: anger/hostility...... -.013 .............................. <.4502

Headaches: extraversion.......... .089 .............................. <.0216

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CHD: Cholesterol.................. <.150 ...........Very strong relationship

CHD: Smoking...................... <.150 ............Very strong relationship

(data from the Framingham and Western Collaborative Group studies)

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Note: Correlations above .10 are considered meaningful for public health purposes.

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