Hostility Seen as ‘Toxic Core’ in Behavior of Type A People

Cynicism, mistrust and anger toward others are “the toxic core” of Type A behavior--the precise forms of hostility that place many workaholics at increased risk of heart disease and early death, new research suggests.

The research, conducted at Duke University and discussed Monday at an American Heart Assn. forum here, found that lawyers who fit a broad definition of hostility while they were in law school were more than four times more likely than others to die during the ensuing 25 years.

At especially high risk were those inclined to harbor a cynical mistrust of the motives of others, and who openly and frequently expressed their anger: Their death rate over the 25-year period was 5 1/2 times as high as that of more trusting attorneys in the study.

“Trusting hearts last longer,” concluded Dr. Redford B. Williams Jr., a professor of psychiatry at Duke University Medical Center in Durham, N.C. Williams said his research is helping to “refine” the long-controversial hypothesis that ambitious, impatient, Type A people are more prone than others to heart disease.

Williams also offered a theory to explain that link. He suggested that hostile, Type A people may be endowed with a weak parasympathetic branch of the autonomic nervous system--the branch responsible for exerting a calming effect after the “fight or flight” response triggered in people faced with emergencies.

In a recent study of the effects of a drug that stimulates the fight-or-flight response, Williams said the calming, parasympathetic branch seemed to kick in sooner in Type B men. That study and others suggest that the fight-or-flight response is blunted more quickly in non-hostile, Type B men than in Type A men, he said.

The Type A hypothesis emerged during the 1960s and ‘70s as a result of a long-range study that found impatient, ambitious and hostile men were twice as likely as their more easygoing counterparts to suffer some form of coronary disease. Those conditions included the blocked coronary arteries that lead to heart attacks.

But more recent studies have challenged those findings, suggesting the link between personality and health is more subtle and complex. In recent years, researchers have focused on hostility as perhaps the most pernicious quality in Type A behavior. The findings presented Monday point to the specific aspects of hostility that are most harmful.

In his most recent study, to be published this spring, Williams studied 118 lawyers who had undergone psychological testing in law school. Twenty-five years later, the death rate among those with high “hostility scores” was 4.2 times higher than the rate among the others.

The rate was even higher among those who were especially cynical and mistrustful--the type of people, Williams said, inclined to blow up over slow elevators and long lines at banks and supermarkets.

“We’re talking about attitudes and beliefs,” Williams said. He said such people think the worst of others. For example, they think to themselves, “Someone’s holding up the elevator. Why don’t the people in the bank line have their checks ready?”

Williams’ findings drew a cool response Monday from Dr. Meyer Friedman, one of the two San Francisco cardiologists who first developed the Type A theory in the 1960s. While Friedman said he agrees that hostility is a component of Type A behavior, he said “a sense of time urgency” is equally important.

“The countries that are fighting (the pressures of) time are the countries that are fighting heart disease,” Friedman said in a telephone interview. He noted that while there is much hostility in prison systems, there is no sense of time urgency and therefore no increased rate of heart attacks.

Friedman, now medical director of the Meyer Friedman Institute at Mt. Zion Hospital and Medical Center in San Francisco, also challenged Williams’ emphasis on cynicism. He said he believes that inadequate self-esteem and insecurity are more significant personality characteristics leading to increased heart disease.

Examining the biology underlying such reactions, Williams said he has found that Type A men asked to perform mental arithmetic in a competitive setting--and offered a prize for the fastest results--show a more marked fight-or-flight response. That response was examined by measuring blood pressure, heart rate and muscle blood flow.

They also experienced greater response to the stress hormone cortisol, Williams said. That hormone prolongs the effects of the emergency response, stimulating the release of norepinephrine and epinephrine, commonly known as adrenaline.

All this may play a role in increasing coronary risk, Williams said. For example, large increases in the body chemicals, such as cortisol, involved in the stress response may contribute to changes in the lining of arteries that lead to arteriosclerosis.

“If we wanted to do something about this, we should do something to reduce hostility, increase trust and reduce aggression toward others,” Williams said. He said there is some preliminary evidence that such behavior modification might in the long run reduce the risk of heart disease.

Williams himself recommends a series of steps, including monitoring one’s cynical thoughts, in order to begin to control them and learning both to laugh at oneself and to be assertive in those instances in which one is genuinely being mistreated.