Type a Behaviour, Anxiety and Neuroticism: Reconceptualizing the Pathophysiological Paths and Boundaries of Coronary-Prone Behaviour

The preeminent status of the Type A behaviour pattern (TABP) as an explanatory concept in cardiovascular epidemiology has now been established for three decades, but like all important ideas, it has not been without challenge. Recent epidemiological evidence has failed to support the broad predictive power of the TABP for clinical episodes of coronary disease, and though these studies might themselves be criticized on methodological grounds, they have stirred calls for a reevaluation of the entire construct of the TABP. Type A behaviour has, over its history of 30 or more years, been variously equated with emotional distress and with already identified and preexisting patterns of personality, notably that of neuroticism. This article draws on several sources of data to challenge these attempts to subsume the TABP within the framework of other supposedly more fundamental constructs, and argues instead that the manifest behaviour pattern itself derives from a single underlying cognitive predisposition, that being competitiveness. The article then goes on to argue that manifest Type A behaviours arising from the underlying existence of competitiveness achieve their greatest pathophysiological toxicity if they are frustrated in their expression and realization. Some data are presented to support this view. While these data are tentative, support by further work, whether epidemiological or pathophysiological, would suggest a new and potentially more powerful and specific model for the influence of the TABP on risk or incidence of coronary disease.