The Amazing Facts Behind the Type A Personality
A link to poor health outcomes has come under fire.
Posted March 26, 2016
Like many of psychology’s most appealing ideas, the Type A personality, or Type A Behavior Pattern (TABP) has penetrated popular consciousness. “Don’t be so Type A,” your sister shouts when you, yet again, insist on being the first person to arrive at a family gathering. Or, as you tap your foot impatiently while waiting in line for a slow check-out clerk to finish with the person in front of you, a complete stranger urges you not to be so “Type A.”
It’s used so frequently that we hardly give any thought to its validity, or even where the term came from.
The story of the discovery of the TABP is that a pair of cardiologists became aware of the impatient nature of some of their patients. Sitting on the edges of their seats in the waiting room, these people seeking help with heart disease seemed to be the very personification of stress. The physicians, Meyer Friedman and R.H. Rosenman, were later to find that this combination of personality traits could be linked to health, and they quite randomly decided to name this particular phenomenon “Type A” (the “A” doesn’t really stand for anything). The discovery was a revolutionary idea at the time, and the pair's work, along with that of other stress researchers such as Hans Selye, became the bedrock of health psychology.
The charge that correlation does not equal causation was almost immediately leveled at the TABP research enterprise. Sure, someone’s hard-driving, competitive, impatient, and pressured behavior could cause heart disease, but it was also possible that heart disease led people’s personalities to change in response to a set of internal, physiological changes. And there was always the possibility that a third factor was really the culprit, causing both heart disease and personality to appear linked.
Eventually, researchers at Duke University believed that they had discovered exactly what that third factor was—it was the personality trait of hostility. If you’re impatient, hard-driving, concerned about being on time, and competitive plus hostile, this would become the kiss of death. Indeed, one particularly compelling study showed that college men high on hostility were the ones who, years later, developed heart disease.
The evidence from longitudinal studies did seem compelling. A correlation between your personality as a college student and your health as an alum must go in the direction of college personality to adult health. You can’t have time’s arrow go in a reverse direction and have your adult health status retroactively affect your personality as a young person. Even if there is a third factor causing both to be related, there seems to be an order of precedence established in these findings.
Researchers who study statistical models of causality over time have learned, however, not to be fooled by the appearance of relationships defined across the passage of time. University of Tsukuba’s Satoshi Usami and colleagues (2015) were able to show that although it makes no sense, it is possible to "demonstrate" statistically that changes in weight in later life cause changes in height. Obviously, you can’t cause someone’s height to change by tinkering with their weight; it must be the other way around. However, a ridiculous conclusion like this will emerge unless you control for the fact that height at one age is correlated with height at a later age, and that weight at Time 1 correlates with weight at Time 2. Once you perform this correction, you’re no longer led to make silly conclusions.
We can see this with the example of height and weight, but it’s not so clear with the example of personality and health. So add problems with autocorrelation to the mix when questioning the results of TABP research. Further, not all of the results on the TABP/health link were supportive, leading many scientists to question its validity on empirical grounds.
However, the TABP research enterprise may have an even more serious, darker, flaw. The funding for much of this research—Rosenman’s in particular—came from the tobacco industry. Why, you might wonder, would the tobacco industry care about the personality-health link? Consider: If it could be proven that people’s behavior patterns, and not smoking, cause heart disease, then the tobacco industry is off the hook.
The role of the tobacco industry in funding TABP research came to light in a 2012 journal article published by London’s School of Hygiene and Tropical Medicine’s Mark Petticrew and colleagues. Referring to the Type A research as tobacco company Philip Morris’ “crown jewel,” Petticrew and his team revealed that in 1976, Rosenman appeared in a film produced by the Tobacco Institute in which he comments on the fast pace of modern life, noting, "You become more frustrated—or you hurry” (p. 2020). Both Rosenman and Selye, along with other recipients of tobacco industry grants, endorsed the view that “Smokers tend to be more aggressive, out-going, extroverted people, hard-driving, full of tension....I would sum up what we have found here that smoking does not seem to cause heart disease....It’s not likely.” (p. 2020). Indeed, part of the defense used by the tobacco industry in litigation brought against them was that “TABP is a factor leading smokers to indulge in risky behaviors that may increase CHD risk” (p. 2022).
Petticrew and his collaborators consider TAPB research to be “zombie science: Research that continues to be published despite repeatedly negative findings” (p. 2022). Reinforcing this point is a study recently published by a team of Lithuanian and Finnish psychologists headed by Kastytis Šmigelskas of the Lithuanian University of Health Sciences (2015). The team re-evaluated the findings for and against the TABP-heart disease link by examining the long-term association between Type A personality measures and cardiovascular disease (CVD) deaths over an 11-year period. The 2,682 Finnish men in the study (ages 42-60 in the 1980s) were tracked through the end of 2011 using data from the Finnish National Death Registry. Most of the associations between TABP and CVD deaths were non-significant. Even more surprising, some associations suggested a protective effect of Type A personality traits on long-term outcomes. There were even fewer associations between non-CVD deaths and baseline personality.
As the group concluded:
“The years from 1970 to 1980, when the evidence about untoward health effects of TABP emerged, may be regarded as a publication bias decade, because later decades did not provide such strong evidence about the ‘toxicity’ of TABP” (p. 167).
The paper goes on to discuss the role of other factors that could influence CVD-related deaths, including other personality traits—hostility, for one, along with the social environment and stress in general. Whether TABP manifests itself as a higher risk factor for heart disease may depend, as they suggest, on one's interactions with the environment. Smoking, of course, could be considered one of those additional triggers.
It is also true that much of the TABP research is conducted exclusively on male populations. Associated closely with the stereotype of being bossy, aggressive, and domineering, it might not seem to be quite such a "female problem.” Thus, women get left out of the research, leaving us to question even further its universality.
To sum up: Having "a Type A personality" may make you less pleasant to be around and, as such, further increase your risk for negative health outcomes given that social support and health are strongly linked. But the TABP body of research is an object lesson in the dangers of relying for your health on the results of studies that make it to the media, even if those studies receive widespread attention. You may feel that you can best achieve fulfillment by keeping informed on the latest health research, but it can benefit you to do so with a critical eye.
Follow me on Twitter @swhitbo for daily updates on psychology, health, and aging. Feel free to join my Facebook group, "Fulfillment at Any Age," to discuss today's blog, or to ask further questions about this posting.
Copyright Susan Krauss Whitbourne 2016
Petticrew, M. P., Lee, K., & McKee, M. (2012). Type A behavior pattern and coronary heart disease: Philip Morris’s 'crown jewel'. American Journal Of Public Health, 102(11), 2018-2025. doi:10.2105/AJPH.2012.300816
Usami, S., Hayes, T., & McArdle, J. J. (2015). On the mathematical relationship between latent change score and autoregressive cross-lagged factor approaches: Cautions for inferring causal relationship between variables. Multivariate Behavioral Research, 50(6), 676-687. doi:10.1080/00273171.2015.1079696