This type of personality concerns how people respond to stress. However, although its name implies a personality typology, it is more appropriately conceptualized as a trait continuum, with extremes of Type A and Type B individuals on each end.
Type A personality is characterized by a constant feeling of working against the clock and a strong sense of competitiveness.
Individuals with a Type A personality generally experience a higher stress level, hate failure, and find it difficult to stop working, even when they have achieved their goals.
Key Takeaways
- A/B Continuum: Type A and Type B describe extremes of a behavioural style, not fixed boxes; most people fall somewhere in between.
- Hostility Matters Most: of the whole Type A pattern, hostility is the strongest and most consistent predictor of coronary heart disease.
- Relative Risk: the original study found Type A roughly doubled CHD risk, but most Type A men never developed heart disease.
- Survivor Paradox: Type A men who survive a heart attack tend to die at a lower rate afterwards than Type B survivors.
- Not Fixed: Type A is a pattern triggered by challenging situations, not a fixed trait, so the same person can act differently in different settings.
- Type D: the modern descendant of this research links negative affectivity and social inhibition to worse outcomes in existing heart patients.
Research Background
Friedman and Rosenman (both cardiologists) actually discovered the Type A behavior by accident after they realized that their waiting-room chairs needed to be reupholstered much sooner than anticipated.
When the upholsterer arrived, he carefully inspected the chairs. He noted that the upholstery had worn in an unusual way: “there’s something different about your patients, I’ve never seen anyone wear out chairs like this.”
Unlike most patients, the cardiac patients could not sit still. They wore out the arms of their chairs, perching on the edge of the seat and leaping up frequently.
However, the doctors initially dismissed this remark, and it was only five years later that they began their formal research.
They later called this pattern Type A Behavior Pattern (TABP).
Friedman and Rosenman first described it in 1959, in a paper published in the Journal of the American Medical Association. Men who showed the pattern had a much higher rate of clinical coronary heart disease than men who did not. The link was clear.
Their subsequent research confirmed that people with a Type A personality run a higher risk of heart disease and high blood pressure than Type Bs.
Although originally called “Type A personality” by Friedman and Rosenman it has now been conceptualized as a set of behavioral responses collectively known as Type A behavior Pattern.
Type A Behavior Pattern (TABP)
Competitiveness
Type A individuals tend to be very competitive and self-critical. They strive toward goals without feeling a sense of joy in their efforts or accomplishments.
Interrelated with this is the presence of a significant life imbalance. This is characterized by a high work involvement.
Type A individuals are easily ‘wound up’ and tend to overreact. They also tend to have high blood pressure (hypertension).
Time Urgency and Impatience
Type A personalities feel a constant sense of urgency. They experience life as a constant struggle against the clock.
They quickly grow impatient with delays and unproductive time. Traffic, queues, and slow speakers irritate them far out of proportion to the actual delay involved.
They also schedule commitments too tightly, packing more into a day than can realistically be done. Many multitask compulsively, such as reading while eating or watching television while working.
Hostility
Type A individuals tend to be easily aroused to anger or hostility, which they may or may not express overtly. Such individuals tend to see the worst in others, displaying anger, envy, and a lack of compassion.
This hostility can be dangerous.
When this behavior is expressed overtly (i.e., physical behavior), it generally involves aggression and possible bullying (Forshaw, 2012).
Hostility appears to be the main factor linked to heart disease and is a better predictor than the TABP as a whole.
Type B Personality
The Type B personality sits at the opposite end from Type A: a relaxed, patient, and easygoing disposition. People with this style are flexible, low in competitiveness, and rarely feel rushed by time pressure.
They tolerate delays well and adapt easily to change. They work steadily toward their goals, enjoying achievements without becoming stressed when a goal is missed.
Type B individuals also tend to be more reflective, less anxious, and more imaginative than their Type A counterparts.
Empirical Research
Aim: Rosenman, Friedman and colleagues (1975) designed the Western Collaborative Group Study (WCGS) to test whether Type A behavior predicted new coronary heart disease, independent of standard risk factors.
Method: The study followed 3,154 healthy, employed men aged 39 to 59 from ten Californian companies for eight and a half years. Each man was assessed for standard risk factors and classified as Type A or Type B.
Participants were asked to complete a questionnaire. Examples of questions asked by Friedman and Rosenman:
- Do you feel guilty if you use spare time to relax?
- Do you need to win in order to derive enjoyment from games and sports?
- Do you generally move, walk and eat rapidly?
- Do you often try to do more than one thing at a time?
From their responses, and from their manner, each participant was put into one of two groups:
Type A behavior : competitive, ambitious, impatient, aggressive, fast talking.
Type B behavior : relaxed, non-competitive.
According to the results of the questionnaire, 1589 individuals were classified as Type A personalities, and 1565 Type B.
Findings
Results: Type A men developed coronary heart disease at more than twice the rate of Type B men. This gap held even after adjusting for smoking and lifestyle. By the 8.5-year mark, 257 participants had developed coronary heart disease, and 70% of them were Type A personalities.
Conclusion: The Type A behavior pattern was an independent, incremental risk factor for coronary heart disease, beyond the standard biomedical risk factors already known.
Type A behavior makes people more prone to stress-related illnesses such as CHD and raised blood pressure. It also triggers their flight or fight response more readily.
Circulating stress hormones for longer periods then raises the risk of further stress-related illness. This is the proposed mechanism linking personality to disease.
Research Evaluation
Limitations of the study involve problems with external validity. Because the study used an all-male sample, it is unknown if the results could be generalised to a female population. Women may cope with stress differently, and may be less vulnerable to its effects.
Studies of women have not found such a large difference between Type A and Type B in later health. Coping strategies may matter just as much as personality.
The study did control for smoking and lifestyle. This strengthens the findings, since these variables could otherwise have confounded the results.
The original study could not show which specific trait of the Type A pattern actually leads to CHD.
Barefoot, Dahlstrom and Williams (1983) later followed 255 physicians for 25 years and found that hostility, not the broader Type A pattern, predicted both CHD and overall mortality.
Dembroski et al. (1989) reached a similar conclusion. Reanalysing data from a separate large trial, they found that hostility ratings, not global Type A scores, best predicted sudden death and heart attacks.
A 27-year follow-up of the original participants, by Carmelli and colleagues (1991), told a different story. It found that Type A behaviour itself tends to decline substantially as people age, which complicates interpretation of long-term outcomes.
Theoretical Evaluation
The Type A and Type B model has been highly influential, but it faces several serious challenges. Before exploring each in detail, here are the main criticisms:
- Categorical, Not Continuous: the theory forces people into two boxes, when behaviour actually varies along a continuum.
- Cultural Specificity: the model was built on middle-aged American men and assumes competitiveness is unhealthy, an assumption that fits some cultures more than others.
- The Survivor Paradox: Type A men who had already suffered a heart attack went on to die at a lower rate than Type B survivors.
- Narrowed to Hostility: later research showed it is hostility specifically, not the full Type A pattern, that predicts heart disease.
Categorical, Not Continuous
Some individuals with a Type A personality are driven yet well-balanced. They never develop CHD. Some people classified as Type B are quietly suppressing hostility and ambition.
They go on to develop CHD anyway, despite their label.
This is why most researchers now treat Type A and Type B as extremes of a continuum. Very few people are purely one type or the other in everyday life.
Dimensional trait models capture this better. Smith and Williams (1992) argued that what looks like Type A is really a mixture of two continuous traits.
Everyone has some degree of each.
This reframing links the construct to the wider study of Big Five personality traits, rather than treating it as an isolated clinical curiosity.
Cultural Specificity
The original Western Collaborative Group Study sampled only men. Later studies of women have not consistently reproduced the same pattern. Coping strategies may differ by sex. Hormonal and social factors may matter just as much as behavioural style itself.
Whether someone counts as Type A may simply reflect their own culture’s norms.
The theory also carries a cultural assumption. In individualist cultures, men are socialised to display competitive, Type A behaviour. The theory treats this striving as unhealthy. That framing fits Western, industrialised societies more comfortably than it fits others.
Collectivist or agrarian societies may read the same behaviour quite differently. Competitive striving might be rare there. Or it might be valued, rather than pathologised. A construct built on 1960s American businessmen cannot simply be assumed to generalise everywhere.
The Survivor Paradox
Ragland and Brand’s (1988) 22-year follow-up of the original study confirmed the original finding.
Type A men were still more likely to develop coronary heart disease than Type B men. But it also produced an unexpected twist.
Among men who had already survived a coronary event, Type A men went on to die at a much lower rate than Type B survivors. Researchers call this the “survivor paradox.”
Several explanations compete. Differences in rehabilitation could explain it.
Selection effects among the most severely affected men might explain it too, or genuine physiological differences in how the two groups respond to a cardiac event.
Whichever explanation is correct, the paradox matters. A risk factor for getting ill is not necessarily the same risk factor for dying from the illness.
Narrowed to Hostility
The major problem with the Type A and Type B theory was pinning down exactly which factor drives coronary heart disease.
Some research concentrated on hostility instead. Johnston (1993) argued hostility was the key ingredient, not competitiveness or time urgency.
A large meta-analysis by Miller et al. (1996) confirmed this. It pooled 45 separate studies.
Hostility was reliably, if modestly, linked to CHD and physical illness across those studies. This finding effectively replaced the broader Type A construct as the personality factor of clinical interest, at least for clinicians.
The field did not abandon the theory.
It narrowed the theory to the one component that actually predicted disease, treating hostility as the active ingredient all along. This mirrors what would later happen to Type D, below.
Contemporary Research
The most recent large-scale test of these typologies looked at Type D personality, a modern descendant defined by high negative affectivity plus social inhibition.
Lodder et al. (2023) pooled individual patient data from 19 cohort studies. This covered 11,151 people with heart disease.
It relied on raw records, not published summary statistics.
They found strong evidence that Type D predicts non-fatal cardiac events, such as further heart problems. The data did not support an effect on mortality, though.
Where a mortality signal did appear, it came from negative affectivity alone, not the full Type D combination the theory was built on.
The lesson repeats.
This is the same pattern seen a generation earlier with Type A and hostility. The field’s best evidence keeps narrowing these typologies to their most predictive component, rather than confirming them as originally proposed.
A more sophisticated model is still needed. It would have to out-predict Friedman and Rosenman’s original Type A and Type B approach. Personality type could even be the result of prolonged stress, rather than only its cause.
References
Barefoot, J. C., Dahlstrom, W. G., & Williams, R. B., Jr. (1983). Hostility, CHD incidence, and total mortality: A 25-year follow-up study of 255 physicians. Psychosomatic Medicine, 45(1), 59-63. https://doi.org/10.1097/00006842-198303000-00008
Carmelli, D., Dame, A., Swan, G., & Rosenman, R. (1991). Long-term changes in Type A behavior: A 27-year follow-up of the Western Collaborative Group Study. Journal of Behavioral Medicine, 14(6), 593-606. https://doi.org/10.1007/bf00867173
Dembroski, T. M., MacDougall, J. M., Costa, P. T., & Grandits, G. A. (1989). Components of hostility as predictors of sudden death and myocardial infarction in the Multiple Risk Factor Intervention Trial. Psychosomatic Medicine, 51(5), 514-522. https://doi.org/10.1097/00006842-198909000-00003
Forshaw, M., & Sheffield, D. (Eds.). (2012). Health psychology in action. John Wiley & Sons.
Friedman, M., & Rosenman, R. H. (1959). Association of specific overt behavior pattern with blood and cardiovascular findings. Journal of the American Medical Association, 169(12), 1286-1296. https://doi.org/10.1001/jama.1959.03000290012005
Johnston, D. W. (1993). The current status of the coronary prone behavior pattern. Journal of the Royal Society of Medicine, 86(7), 406.
Lodder, P., Wicherts, J. M., Antens, M., Albus, C., Bessonov, I. S., Condén, E., Dulfer, K., Gostoli, S., Grande, G., Hedberg, P., Herrmann-Lingen, C., Jaarsma, T., Koo, M., Lin, P., Lin, T.-K., Meyer, T., Pushkarev, G., Rafanelli, C., Raykh, O. I., … Kupper, N. (2023). Type D personality as a risk factor for adverse outcome in patients with cardiovascular disease: An individual patient-data meta-analysis. Psychosomatic Medicine, 85(2), 188-202. https://doi.org/10.1097/psy.0000000000001164
Miller, T. Q., Smith, T. W., Turner, C. W., Guijarro, M. L., & Hallet, A. J. (1996). A meta-analytic review of research on hostility and physical health. Psychological Bulletin, 119(2), 322-348. https://doi.org/10.1037/0033-2909.119.2.322
Ragland, D. R., & Brand, R. J. (1988). Coronary heart disease mortality in the Western Collaborative Group Study: Follow-up experience of 22 years. American Journal of Epidemiology, 127(3), 462-475. https://doi.org/10.1093/oxfordjournals.aje.a114823
Rosenman, R. H., Brand, R. J., Jenkins, C. D., Friedman, M., Straus, R., & Wurm, M. (1975). Coronary heart disease in the Western Collaborative Group Study: Final follow-up experience of 8 1/2 years. Journal of the American Medical Association, 233(8), 872-877. https://doi.org/10.1001/jama.1975.03260080034016
Rosenman, R. H., Brand, R. J., Sholtz, R. I., & Friedman, M. (1976). Multivariate prediction of coronary heart disease during 8.5 year follow-up in the Western Collaborative Group Study. The American Journal of Cardiology, 37(6), 903-910. https://doi.org/10.1016/0002-9149(76)90117-X
Smith, T. W., & Williams, P. G. (1992). Personality and health: Advantages and limitations of the five-factor model. Journal of Personality, 60(2), 395-425. https://doi.org/10.1111/j.1467-6494.1992.tb00978.x
