Type A personality: how a heart disease theory came down to hostility

In the 1950s two San Francisco cardiologists, Meyer Friedman and Ray Rosenman, had the chairs in their waiting room reupholstered. As Friedman later told the story, the upholsterer pointed out that only the front edges of the seats were worn. Their patients sat on the edge, ready to get up. That small detail led to the idea behind our Type A personality test.

Type A and Type B

In 1959 Friedman and Rosenman described a pattern they called Type A: competitive, always in a hurry, impatient with delay and quick to anger. The opposite pattern, Type B, was easygoing and unhurried. They argued that Type A was a risk factor for heart disease in its own right, alongside smoking and high blood pressure.

To test the idea they started the Western Collaborative Group Study in 1960, which followed more than 3,000 working men in California. Men rated as Type A in a structured interview developed about twice as much coronary heart disease over the following years as Type B men. In 1974 their book Type A Behavior and Your Heart brought the term into everyday language.

What held up and what did not

Later studies were less convincing. In 1985 Richard Shekelle and colleagues, using data from the large MRFIT trial, found no link between Type A and heart disease. Other studies gave mixed results, and researchers began to look at the separate parts of the pattern instead of the whole.

The part that held up best was hostility. In 1996 Todd Miller and colleagues pooled studies on hostility and physical health and concluded that hostility was an independent risk factor for coronary heart disease. Hurry and ambition on their own looked much less harmful than cynical, angry reactions to other people.

The story has one more turn. In 2012 Mark Petticrew, Kelley Lee and Martin McKee went through internal tobacco industry documents and showed that the industry had funded Type A research for years, partly to draw attention away from smoking. That does not make every Type A study wrong, but it helps explain why the idea got so much attention.

What our test measures

Our Type A test gives three scores, one for each part of the pattern: competitiveness, impatience and hostility. It has 12 statements, four for each part, and you answer each on a five-point scale from strongly disagree to strongly agree. We wrote the statements ourselves, based on the Type A descriptions, so this is a self-reflection tool, not a validated questionnaire and not a health check.

Examples are "It is very important to me to be the best in my field" (competitiveness), "I try to do several things at once because I dislike wasting time" (impatience) and "I tend to have outbursts of anger when I make mistakes" (hostility). Half the statements describe the calmer Type B side, such as "Waiting, for example in a queue, doesn't bother me", and agreeing with them lowers your score. That way, someone who agrees with everything does not end up high on all three.

Reading your result

Look at the three scores separately rather than asking whether you are Type A. Most people fall somewhere between the two types, and the studies above point to the parts mattering more than the label. A high competitiveness score can simply reflect ambition. A high impatience score is worth noticing if hurry leaves you tired or makes you miss things. A high hostility score deserves the most attention, both for your relationships and because hostility is the part with the clearest link to health.

If hostility came out high, the anger management test and the post on how to control anger look at it in more detail. If your drive shows up as never being satisfied with your own work, try the perfectionism test.