Type A behaviour: a reappraisal of its characteristics in cardiovascular disease L. Sirri, 1 G. A. Fava, 1,2 J. Guidi, 1 P. Porcelli, 3 C. Rafanelli, 1 A. Bellomo, 4 S. Grandi, 1 L. Grassi, 5 P. Pasquini, 6 A. Picardi, 7 R. Quartesan, 8 M. Rigatelli, 9 N. Sonino 2,10 Introduction The concept of type A behaviour was introduced by the cardiologists Meyer Friedman and Ray H. Rosenman in the late 1950s to describe a ‘specific emotion-action complex’ they frequently observed in their patients (1). Friedman and Rosenman identified six core features of type A behaviour: (i) an intense drive to achieve self-selected, but usually poorly defined goals, (ii) competitiveness, (iii) a persistent desire for recognition and advancement, (iv) involvement in several functions subjected to time restrictions, (v) an accelerated rate of execu- tion of several physical and mental functions and (vi) an increased mental and physical alertness (1). Subsequently, Friedman (2) specified that type A behaviour includes both covert and overt character- istics. The former are insecurity and inadequate self-esteem, whereas the main overt components are sense of time urgency (impatience) and free- floating hostility. They result in several specific behavioural and psychomotor manifestations, such as speed in walking and eating, intense discomfort when waiting in lines, involvement in different activities simultaneously, extreme punctuality, rapid speech, tense posture, chronic facial tension, loss of temper while driving, sleeplessness because of anger or frustration, disbelief in altruism and excessive irritability or discomfort when facing trivial errors by others (2). 1 Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy 2 Department of Psychiatry, State University of New York at Buffalo, Buffalo, NY, USA 3 Psychosomatic Unit, IRCSS De Bellis Hospital, Castellana Grotte, Bari, Italy 4 Department of Medical Sciences, Psychiatry Unit, University of Foggia, Foggia, Italy 5 Section of Psychiatry, Department of Medical Sciences of Communication and Behaviour, University of Ferrara, Ferrara, Italy 6 Clinical Epidemiology Unit, Istituto Dermopatico della Immacolata (IDI-IRCSS), Rome, Italy 7 Italian National Institute of Health, Rome, Italy 8 Section of Psychiatry, Clinical Psychology and Psychiatric Rehabilitation, Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy 9 Department of Psychiatry, University of Modena and Reggio Emilia, Modena, Italy 10 Department of Statistical Sciences, University of Padova, Padova, Italy Correspondence to: Giovanni A. Fava, M.D., Department of Psychology, University of Bologna viale Berti Pichat 5 40127 Bologna, Italy Tel.: +39 051-2091339 Fax: +39 051 243086 Email: giovanniandrea.fava@unibo.it Disclosures Drs Sirri, Fava, Guidi, Porcelli, Rafanelli, Grandi, Grassi, Pasquini, Picardi, Quartesan, Rigatelli and Sonino have no conflict of interest to declare. Dr Bellomo has been sponsored SUMMARY Aims: The role of type A behaviour in cardiovascular disease is controversial and most of the research is based on self-rating scales. The aim of this study was to assess the prevalence of type A behaviour in cardiology and in other medical set- tings using reliable interview methods that reflect its original description. Methods: A sample of 1398 consecutive medical patients (198 with heart trans- plantation, 153 with a myocardial infarction, 190 with functional gastrointestinal disorders, 104 with cancer, 545 with skin disorders and 208 referred for psychiat- ric consultation) was administered the Structured Clinical Interview for the DSM-IV and the Structured Interview for the Diagnostic Criteria for Psychosomatic Research (DCPR) which identifies 12 clusters, including type A behaviour. Results: A cardiac condition was present in 366 patients. There was a significant difference in the prevalence of type A behaviour in cardiovascular disease (36.1%) compared with other medical disorders (10.8%). Type A behaviour frequently occurred together with psychiatric and psychosomatic disturbances, particularly irritable mood, even though in the majority of cases it was not associated with DSM-IV diagnoses. Among cardiac patients, those with type A behaviour were less depressed, de- moralised and worried about their illness. Conclusions: Type A behaviour was found to occur in about a third of cases of patients with cardiovascular disease. Only in a limited number of cases was it associated with depression. It has a life- style connotation that may have important clinical consequences as to stress vul- nerability and illness behaviour. What’s known • Type A behaviour (TAB) is a set of psychological features, such as competitiveness and sense of time urgency, frequently observed in cardiac patients. • The role of TAB in cardiovascular disease is controversial because of contradictory findings which may result from the use of self- administered questionnaires for TAB. • The Diagnostic Criteria for Psychosomatic Research (DCPR) provides a set of criteria for the categorical and interviewer-based identification of TAB. What’s new • TAB is significantly more prevalent in cardiovascular disease (36.1%) compared with other medical disorders (10.8%). • Both in cardiac and non-cardiac patients, TAB frequently occurs together with DCPR irritable mood, even though they are not hierarchically related. • Among cardiac patients, TAB may lead to minimise both psychological impacts of a life- threatening disease and the vulnerability to its consequences, and thus to underestimate the need to modify unhealthy lifestyles. ORIGINAL PAPER ª 2012 Blackwell Publishing Ltd 854 Int J Clin Pract, September 2012, 66, 9, 854–861. doi: 10.1111/j.1742-1241.2012.02993.x