Personality factors linked to development and recovery from CHD

Personality factors, including personality predispositions and psychological states and traits, have been linked to development and recovery from CHD. Personality predispositions are considered more stable traits, whereas psychological states may be more transient and acute. Anger and hostility are usually considered personality traits, whereas depression and anxiety are usually considered psychological states.

Personality Traits
In the 1980s, much of the research focused on describing a coronary-prone personality or set of psychosocial behaviors that would lead to the development of CHD. Friedman and Rosenman described a set of observable behaviors that encompassed aspects of time urgency, hard-driving and competitive behaviors, and elements of free-floating hostility. This constellation of behaviors became known as type A behavior. Studies undertaken to assess the independent CHD risk associated with this behavior type showed mixed results. For example, the Western Collaborative Group Study showed that type A behavior conferred twice the risk for development of CHD, whereas the Multiple Risk Factor Intervention Trial (MRFIT) failed to establish an association of type A behavior and CHD death. Similarly, cross-sectional angiographic studies examining type A behavior and the presence and severity of CHD have not found a consistent relationship between angiographic extent of disease and type A behavior.

During the late 1980s, further investigations delineated hostility and anger expression as key dimensions of type A behavior. A meta-analysis of available early research studies found that measures of hostility had the greatest effect on subsequent development of CHD and the largest effect size across all studies, and the relationship was at least as strong in women as in men. Thus, these early studies found that personality characteristics, such as the type A behavior pattern, were inconsistently related to the development of CHD, perhaps in part because the personality components were not appropriately defined.