In Search of Coronary-Prone Behavior: Beyond Type A

By Aron W. Siegman; Theodore M. Dembroski | Go to book overview

7
The Role of Emotional Expression in Coronary Heart Disease

Howard S. Friedman

University of California, Riverside

Understanding the relationship between psychological factors and heart disease has proven to be a chronic struggle against the weaknesses of vague constructs. After a century of speculation and three decades of intensive research, some even doubt that any reliable link at all exists between psychological factors and clogged arteries ( Angell, 1985). The search for a "coronary-prone personality" has been seriously hindered by insufficient attention to construct validity, especially regarding the issues surrounding emotional expression.

Most attention has been directed toward the Type A behavior pattern (TABP), a collection of behaviors and emotional expressions that seems predictive of clinically apparent coronary heart disease (CHD) ( Cooper, Detre, & Weiss, 1981; Dembroski, Weiss, Shields, Haynes, & Feinleib, 1978). There are, however, differing means of assessing the Type A pattern and different definitions of the key characteristics of a Type A person. Emotional expressions often are not adequately assessed or understood. Futhermore, the Type A construct is sometimes overextended: All unhealthy emotions are not necessarily part of the Type A pattern. It is important to recognize that "Type A behavior" is not synonymous with "coronary-prone behavior"; coronary-prone behavior leads to CHD by definition, but the effect of Type A behavior on health is an empirical matter.

Although commonly recognized, the Type A behavior pattern is ambiguously defined. A tense, driven, business executive who struggles for long hours at his desk, tappping his fingers and pencil, and talking rapidly into two telephones at once while grimacing hostilely at his dallying assistant would almost certainly be diagnosed "Type A." As defined by its discoverers ( M. Friedman & Rosenman , 1974), the TABP refers broadly to "any person who is aggressively involved in a chronic incessant struggle to achieve more and more in less and less time . . . the most significant trait of the Type A man is his habitual sense of

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