Models of personality and disease: an interactional approach to type A behavior and cardiovascular risk

Type A behavior has been established as a risk factor for coronary heart disease. Enhanced cardiovascular and neuroendocrine responsiveness to stressors has been suggested as a pathophysiological link between the behavior pattern and disease. The present article describes a model that places this link in an interactional context. Specifically, it is hypothesized that via cognitive and overt behaviors, Type As construct a subjective and objective environment rich in those classes of stimuli known to elicit enhanced physiological reactivity. This approach differs from previous ones by emphasizing that the Type A pattern represents an ongoing process of challenge and demand engendering behavior. That is, Type A persons do not simply respond to challenges and demands; they seek and create them through their cognitions and actions. This constructed environment also elicits and maintains further Type A behavior. The present view of Type A behavior as a challenge and demand engendering style is contrasted with other conceptual approaches, and implications are discussed.