Therapist Insights / High-Achiever Identity
Type A personality, and what survived the research.
Almost everything most people believe about Type A personality comes from a research programme that later failed to replicate, and that was substantially funded by the tobacco industry. One component of it did survive, and it is not the one people think.
THE QUICK TAKEAWAY
Type A personality is not a diagnosis and appears nowhere in DSM-5-TR. The idea that it predicts heart disease came from early findings in the Western Collaborative Group Study, and that cohort's own 22-year follow-up later found no association with coronary mortality, a standardised relative hazard of 0.98. The MRFIT trial was also null. What survived the collapse is the anger and hostility component, which still shows modest associations with cardiovascular outcomes. The urgency and ambition did not.
§01 / 09 / Definition
What Type A personality was meant to describe.
Type A personality was described in the 1950s by the cardiologists Meyer Friedman and Ray Rosenman as a coronary-prone behaviour pattern combining time urgency, competitiveness and hostility. It is a research construct rather than a clinical category, and it appears in no diagnostic manual.
Start with what the term is and is not. Type A personality is not a diagnosis, is not a personality type in any validated taxonomy, and has no clinical instrument in current use. DSM-5-TR recognises ten personality disorders across three clusters, and Type A is not among them; the Cluster A label in that manual refers to paranoid, schizoid and schizotypal personality disorders and has nothing whatever to do with Type A, a collision of names that confuses readers constantly. The construct was described by Friedman and Rosenman, two cardiologists, as a behaviour pattern they believed predisposed people to coronary heart disease: urgency about time, competitive drive, and an easily provoked hostility. Type B was defined as the absence of Type A, which is not really a category at all. The description survives in ordinary speech because it is recognisable. The theory attached to it did not survive contact with better studies.
Five behaviours the original description tried to capture
Time urgency
A persistent sense that there is not enough time, expressed as impatience with queues, with slow speakers, and with any process that cannot be compressed.
Competitiveness that does not switch off
Not competitiveness at work, which is often appropriate, but the version that turns a family board game or a motorway lane change into something with a result.
Hostility and easy irritation
The component that turned out to matter most, and the one people are least likely to volunteer. It is also the one that lands on the people who did not cause it.
Polyphasic activity
Doing two things at once as a default state rather than a response to pressure. Friedman described this as characteristic; it is now so normalised as to be almost unremarkable.
Achievement as the settling mechanism
Effort deployed not toward a goal but toward a feeling, which is why the next target appears before the last one has registered. This is where the pattern overlaps with anxiety.
▶ Research
The cohort that made the Type A hypothesis famous later contradicted it. Ragland and Brand followed the 3,154 men of the Western Collaborative Group Study for 22 years and reported in the American Journal of Epidemiology in 1988 that Type A and B behaviour showed no association with coronary heart disease mortality, a standardised relative hazard of 0.98 with a 95% confidence interval of 0.85 to 1.12. In one follow-up interval the association was significantly negative, at 0.70. Their conclusion was that the results raise a substantial question about the importance of Type A and B behaviour as a risk factor for coronary heart disease mortality.1
What is actually left of the idea
The global construct did not replicate
Two large studies settled this. The founding cohort's own 22-year follow-up found nothing, and the MRFIT Behavior Pattern Study of 3,110 men found an adjusted relative risk of 0.87 with a confidence interval spanning 1.
Hostility is the component that survived
Anger and hostility remain associated with cardiovascular outcomes in modern cohorts, at modest effect sizes and for specific endpoints. Urgency, ambition and competitiveness carry no comparable signal.
The research programme has a funding problem
Petticrew, Lee and McKee documented in the American Journal of Public Health in 2012 that the tobacco industry was a major funder of Type A research, with selected results used to counter concerns about tobacco and health.
Three findings that decide what you can still say
The Type A literature is one of the clearest examples in health psychology of a promising early result that later evidence reversed. Three studies do most of the work.
Western Collaborative Group Study, 22-year follow-up
3,154 men followed to 1982 and 1983, with almost 99% of the cohort accounted for and 214 coronary deaths. Type A and B behaviour showed no association with coronary mortality, at 0.98. Traditional risk factors did.
The MRFIT Behavior Pattern Study
Behaviour pattern assessed by interview in 3,110 men, with a mean 7.1 years of follow-up. The adjusted relative risk for Type A against Type B was 0.87, and a parallel analysis of 12,772 men using a different instrument was also null.
The tobacco documents analysis
An analysis of internal tobacco industry documents published in the American Journal of Public Health, concluding that industry involvement partly explains the pattern of initially promising results followed by negative findings.
§02 / 09 / Telehealth
How the coronary claim collapsed.
Driven, competitive professionals are usually surprised to learn the Type A heart-disease link failed to replicate. The early positive results came from the Western Collaborative Group Study and the Framingham Study; the later null results came from the same cohort followed for longer, and from a larger multicentre trial.
The early results were real findings
Petticrew and colleagues note the theory was supported by positive findings from the Western Collaborative Group Study and the Framingham Study. This was not fabricated, and treating it as fraud from the start misdescribes what happened.
The follow-up reversed them
At 22 years the same Western Collaborative cohort showed no association with coronary mortality, and in one interval Type A looked protective. MRFIT, with two different instruments, found nothing either.
The measurement was never one thing
Type A was assessed by a Structured Interview and by the self-report Jenkins Activity Survey, which correlate poorly and were used inconsistently across studies. MRFIT ran both, and both were null.
§03 / 09 / Mechanism
The part that survived, and the funding problem.
Hostility and anger are the components of the Type A pattern that still show cardiovascular associations. In a Swedish cohort of 47,077 adults, reporting anger at least weekly was associated with cardiovascular mortality at a hazard ratio of 1.23 and with heart failure at 1.19, though not with myocardial infarction.
The surviving signal is narrow and should be described precisely. Titova and colleagues, writing in European Heart Journal Open in 2022, followed 47,077 Swedish adults aged 56 to 94 for up to nine years. Compared with people reporting anger never or seldom, those reporting it at least weekly had a hazard ratio of 1.23 for cardiovascular mortality, 1.19 for heart failure and 1.16 for atrial fibrillation. The heart failure association was present in men at 1.30 and absent in women at 1.02. Frequent anger was not significantly associated with myocardial infarction, aortic valve stenosis or abdominal aortic aneurysm. These are observational associations with residual confounding, so associated with is the right phrase and causes is not.
Note what that leaves behind. Nothing in the modern literature supports treating time urgency, competitiveness or ambition as cardiac risk factors. If you recognise yourself in the description and the thing you recognise is impatience with slow queues, the evidence does not give anyone grounds to worry you about your heart. If what you recognise is anger that arrives quickly and often, that is the component with a signal attached, and it is also the component most likely to be damaging the people around you regardless of what it does to your arteries.
The funding history deserves stating because it explains the shape of the literature. Petticrew, Lee and McKee analysed internal tobacco industry documents and reported in the American Journal of Public Health in 2012 that the industry was a major funder of Type A behaviour pattern research, with selected results used to counter concerns regarding tobacco and health, and that industry involvement partly explains the decline effects seen in the epidemiology. What that does not mean, and what nobody should claim, is that Friedman and Rosenman invented the construct at the industry's request in the 1950s. The documented claim is about the funding of the later research programme and the use made of its results.
► Standard advice vs. CEREVITY's approach
Standard therapy
"Tell a driven client their personality is raising their heart risk"
CEREVITY
"Separate hostility, which has a modest signal, from urgency and ambition, which do not"
Standard therapy
"Treat Type A and Type B as a validated typology of people"
CEREVITY
"Treat it as a retired research dichotomy and work on the specific behaviours instead"
Standard therapy
"Repeat the 1970s doubling-of-risk figure from secondary sources"
CEREVITY
"Cite the follow-up results, which found no association across 22 years"
| Standard insurance-based therapy | CEREVITY's specialized approach |
|---|---|
| "Tell a driven client their personality is raising their heart risk" | "Separate hostility, which has a modest signal, from urgency and ambition, which do not" |
| "Treat Type A and Type B as a validated typology of people" | "Treat it as a retired research dichotomy and work on the specific behaviours instead" |
| "Repeat the 1970s doubling-of-risk figure from secondary sources" | "Cite the follow-up results, which found no association across 22 years" |
A break from the page
The trait is not the problem. The cost is.
If urgency and irritability are running the week and landing on people who did not earn them, that is workable. CEREVITY is a nationwide network of independent licensed clinicians working private-pay, with no insurance claim submitted. You can send a private inquiry in about two minutes.
§04 / 09 / Cases
Common challenges we address.
The executive who has been told to slow down for twenty years
The patternSomeone who has heard the Type A warning since their thirties, dismissed it because the record kept improving, and now arrives with a partner's ultimatum rather than a health scare. The advice was always vague and they were right to ignore most of it.
What we addressThe work drops the personality frame and targets the specific behaviours that carry cost, chiefly the anger. Where the urgency is driven by anticipation of consequential moments, high-stakes anxiety therapy is often the more accurate target than anything labelled Type A.
The client whose irritability is a household problem
The patternSomeone whose colleagues describe them as demanding and whose family describes something harder. The person themselves rarely sees the two as connected, because at work the intensity is rewarded and at home it is simply present.
What we addressTreatment addresses the anger directly, since it is both the component with a cardiovascular signal and the one doing interpersonal damage now. Where the relationship has taken most of the load, couples therapy is frequently the more useful unit of work.
§05 / 09 / Methods
Evidence-based treatment approaches.
Nothing treats Type A personality, because it is not a condition. What CEREVITY clinicians treat are the components that carry cost: hostility and anger, the anxiety underneath chronic urgency, perfectionism, and the depletion that a decade of self-imposed pressure produces.
Assessment that drops the label
The first task is establishing what is actually present. Anger, anxiety, perfectionism and burnout are separable, have different treatments, and are all routinely filed under one retired research term.
Work on anger and hostility
This is the component with a cardiovascular signal and the one causing damage in relationships now. Cognitive and behavioural approaches to anger are well established and are the most defensible target in the whole Type A picture.
Treating the anxiety underneath urgency
Time urgency in accomplished people frequently sits on top of anticipatory anxiety. Where that is the case, treating the anxiety changes the urgency, which is a more productive route than trying to slow someone down.
Perfectionism and standards
The standard that built the career and the standard that makes ordinary life unlivable are often the same standard. Separating them is careful work, and it does not require anyone to lower their ambitions.
Coordination with a physician
Cardiovascular risk is assessed and managed by physicians using established risk factors: blood pressure, cholesterol, smoking and age were the significant predictors in the Western Collaborative cohort. Therapy is not a substitute for that assessment.
§06 / 09 / Investment
Understanding the investment in private-pay care.
Private-pay, nationwide, and matched to what is actually there
At CEREVITY, our online individual therapy sessions are structured as a direct investment in your mental agility and overall well-being. The investment includes:
- Licensed mental health professional specializing in urgency, hostility and pressure in driven professionals
- Evidence-based, one-on-one approaches proven effective for chronic stress, hostility, and self-imposed pressure
- Flexible online scheduling including evenings and weekends
- Complete privacy with no insurance involvement or red tape
- Driven, competitive professionals expertise and understanding
- Outcome tracking and progress measurement
The cost of the Type A pattern going unaddressed
Consider what is at stake when the Type A pattern goes unaddressed:
What the pattern costs, accurately stated
The honest accounting is not cardiac. It is the relationships absorbing the irritability, the anxiety underneath the urgency, and the depletion that arrives after years of treating achievement as a settling mechanism. The one health association that survived is anger, at a hazard ratio of 1.23 for cardiovascular mortality in a 47,077-person cohort. View our current rates here: cerevity.com/our-pricing-for-therapy/.
Formats and access
Sessions are delivered by secure telehealth nationwide across all 50 states. Anger and perfectionism work runs best in settling into the same time slot every week, because it depends on what happens between sessions. Where a session keeps ending mid-thought, what the extra forty minutes actually buys covers the longer format, and why some people choose an intensive instead explains the concentrated option. What you can actually book lists the full set.
§07 / 09 / Evidence
What the research shows.
The rise and fall of this hypothesis is unusually well documented. Friedman and Rosenman described the Type A behaviour pattern in the 1950s and argued it was an important risk factor for coronary heart disease, and as Petticrew, Lee and McKee summarise, the theory was supported by positive findings from the Western Collaborative Group Study and the Framingham Study. Then the follow-ups arrived. Ragland and Brand followed the original 3,154 Western Collaborative men for 22 years, accounting for almost 99% of the cohort and 214 coronary deaths, and found Type A and B behaviour unrelated to coronary mortality at a standardised relative hazard of 0.98, while systolic blood pressure, serum cholesterol, smoking status and age were all highly significant predictors. Shekelle and colleagues, reporting the MRFIT Behavior Pattern Study in 1985, assessed 3,110 men by interview across eight centres and found an adjusted relative risk of 0.87 with a confidence interval of 0.59 to 1.28, concluding that the results raise questions regarding the robustness of the Type A hypothesis in its present form.
► Three numbers that changed the answer
standardised relative hazard for Type A behaviour and 22-year coronary heart disease mortality in the original Western Collaborative cohort of 3,154 men.
Ragland and Brand, American Journal of Epidemiology, 1988
adjusted relative risk of a first major coronary event for Type A against Type B in 3,110 men over a mean 7.1 years, with a confidence interval spanning 1.
Shekelle et al., American Journal of Epidemiology, 1985
hazard ratio for cardiovascular mortality among adults reporting anger at least weekly, in 47,077 Swedish adults followed up to nine years.
Titova et al., European Heart Journal Open, 2022
Two things complete the picture. The first is the surviving component: Titova and colleagues, in 47,077 Swedish adults followed up to nine years, found weekly-or-more anger associated with cardiovascular mortality at 1.23, heart failure at 1.19 and atrial fibrillation at 1.16, but not with myocardial infarction, and with the heart failure association present in men and not in women. The second is the funding history. Petticrew, Lee and McKee analysed internal tobacco industry documents and reported that the industry was a major funder of Type A research, with selected results used to counter concerns regarding tobacco and health, and that this partly explains the decline effects in the epidemiology. Two limits belong with all of it. Every landmark cohort here was male, and largely white and middle-aged, so none of it generalises to women. And no study cited establishes that Type A predicts career success, income or promotion; that claim has no evidence base at all.
§§ / 09 / Recap
Key takeaways.
Five things to remember
- Type A is not a diagnosis It appears nowhere in DSM-5-TR, which recognises ten personality disorders across three clusters. The Cluster A label in that manual is unrelated and the name collision misleads readers constantly.
- The coronary link failed to replicate The founding Western Collaborative cohort's own 22-year follow-up found no association with coronary mortality, at 0.98, and the MRFIT study of 3,110 men returned an adjusted relative risk of 0.87.
- Hostility is what survived Weekly-or-more anger was associated with cardiovascular mortality at 1.23 in 47,077 Swedish adults. Time urgency, competitiveness and ambition carry no comparable modern signal.
- The literature has a funding problem An analysis of internal tobacco documents in the American Journal of Public Health found the industry was a major funder of Type A research and used selected results to counter concerns about tobacco and health.
- CEREVITY provides this through online individual therapy nationwide, with full privacy through its private-pay concierge network and no insurance involvement.
§08 / 09 / FAQ
Frequently asked questions.
What is a Type A personality?
Type A personality is a research construct rather than a clinical category, described in the 1950s by the cardiologists Meyer Friedman and Ray Rosenman as a coronary-prone behaviour pattern. Its components are time urgency, competitive drive, and hostility, often alongside a habit of doing several things at once. Type B was defined simply as the absence of Type A, which is why it was never really a category in its own right. The construct appears in no diagnostic manual, there is no validated cutoff and no clinical instrument in current use, and no clinician can diagnose it. It survives in ordinary speech because the description is recognisable, not because the underlying typology held up.
Is being Type A bad for your health?
The evidence does not support the global claim, and the specific version is narrower than most people expect. The Western Collaborative Group Study's own 22-year follow-up of 3,154 men found no association between Type A behaviour and coronary heart disease mortality, at a standardised relative hazard of 0.98, and the MRFIT study of 3,110 men returned an adjusted relative risk of 0.87 with a confidence interval spanning 1. What does still show a signal is anger: in 47,077 Swedish adults, reporting anger at least weekly was associated with cardiovascular mortality at 1.23 and heart failure at 1.19, though not with myocardial infarction. So hostility carries a modest association, and time urgency and ambition do not.
Can you change a Type A personality?
The more useful question is which part you would want to change, because the components come apart. Nothing in the evidence suggests that ambition, competitiveness or working quickly needs treating, and no research cited here shows those traits carry health risk. Hostility is different: it has the surviving cardiovascular association and it is usually the part doing damage to relationships now, and anger has well-established cognitive and behavioural treatments. Chronic time urgency frequently sits on top of anticipatory anxiety, in which case treating the anxiety changes the urgency more reliably than trying to slow someone down. Approaching this as a personality overhaul is both unnecessary and, in practice, the reason people never start.
What is the difference between Type A and Type B personality?
Type A personality and Type B form a retired research dichotomy rather than a typology of persons, and it is worth knowing that Type B was defined only as the absence of Type A rather than as a positive category. There is no validated cutoff between them, no clinical instrument in current use, and the original assessment was done with two different tools, a Structured Interview and the self-report Jenkins Activity Survey, which correlate poorly with each other. The MRFIT study ran both and both produced null results. The distinction persists as useful vernacular shorthand for self-description, and that is the only weight it will bear.
Did the tobacco industry fund Type A research?
Yes, and it is documented in the peer-reviewed literature. Petticrew, Lee and McKee analysed internal tobacco industry documents and reported in the American Journal of Public Health in 2012 that the industry was a major funder of Type A personality research, with selected results used to counter concerns regarding tobacco and health, and that industry involvement partly explains the pattern of initially promising findings followed by negative ones. Two things that analysis does not claim, and that nobody should assert: it does not say Friedman and Rosenman invented the construct at the industry's request in the 1950s, and it names no dollar figures or individual recipients that can be verified from the public abstract.
Is Type A the same as Cluster A in the DSM?
No, and the two have nothing to do with each other despite the name. DSM-5-TR groups ten personality disorders into three clusters: Cluster A covers paranoid, schizoid and schizotypal personality disorders, Cluster B covers antisocial, borderline, histrionic and narcissistic, and Cluster C covers avoidant, dependent and obsessive-compulsive. Type A personality is a separate construct from cardiology research in the 1950s and appears in none of those clusters or anywhere else in the manual. The collision of labels causes real confusion, and it is worth being explicit that identifying as Type A carries no diagnostic implication whatsoever.
How does your private-pay pricing structure work?
As a private-pay concierge network, we offer structured investments in your mental health without the restrictions or privacy risks of insurance. You can review our full fee schedule and specific session lengths directly on our website. While this costs more than insurance copays, it provides the flexibility, total privacy, and highly specialized care that standard options cannot offer. View our current rates here.
How do you protect my privacy?
Privacy is foundational to our network. As a private-pay network, your sessions never appear on insurance records or EOBs that could be seen by employers, boards, or family members. We use HIPAA-compliant nationwide telehealth platforms, and you can attend sessions from anywhere with a private internet connection.
§09 / 09 / Begin
If the drive is fine and the anger is not.
Nobody needs to give up ambition, urgency or competitiveness to be well. What is worth treating is the hostility that arrives quickly, the anxiety underneath the hurry, and the depletion that follows years of both. CEREVITY is a nationwide network of independent licensed clinicians providing confidential, private-pay care. Call (562) 295-6650 or send a private inquiry.
Available by appointment 7 days a week, 8 AM to 8 PM (PST)§§ / Author
About Christa Smith, PhD.
Christa Smith, PhD
Dr. Smith is a Licensed Clinical Psychologist who specializes in psychological and neuropsychological assessment and evidence-based therapy for adults. Her clinical work integrates cognitive behavioral therapy, acceptance and commitment therapy, and trauma-informed approaches with formal assessment when clarity on diagnosis or cognition is needed. She sees clients through CEREVITY's nationwide private-pay telehealth network. View full bio →
§§ / Sources
References.
- American Journal of Public Health (record via LSHTM Research Online). Type A behavior pattern and coronary heart disease: Philip Morris's crown jewel. 2012. researchonline.lshtm.ac.uk
- American Journal of Epidemiology. The MRFIT Behavior Pattern Study: II. Type A Behavior and Incidence of Coronary Heart Disease. 1985. academic.oup.com
- American Journal of Epidemiology. Coronary Heart Disease Mortality in the Western Collaborative Group Study: Follow-up Experience of 22 Years. 1988. academic.oup.com
- European Heart Journal Open. Anger frequency and risk of cardiovascular morbidity and mortality. 2022. academic.oup.com
- StatPearls, NCBI Bookshelf (National Library of Medicine). Personality Disorder. 2024. ncbi.nlm.nih.gov
- CEREVITY. Our services. cerevity.com/services
- CEREVITY. Concierge therapy membership. cerevity.com/concierge-therapy-membership
- CEREVITY. Couples therapy. cerevity.com/couples-therapy
⚠ Crisis resources
If you are experiencing a mental health crisis or having thoughts of suicide, please reach out immediately. 988 Suicide & Crisis Lifeline · Call or text 988 Crisis Text Line · Text HOME to 741741 National Alliance on Mental Illness · 1-800-950-NAMI (6264)
