4.3.7 - Individual differences in stress

Personality types A and B

Not everyone reacts to the same stressor in the same way. Two students might face the same exam pressure, but one becomes constantly tense while the other stays calm and organised. For AQA, the key idea is that individual differences can moderate the stress-illness relationship. Stress matters, but the person's characteristic way of appraising and responding to pressure also matters.

One outcome used to study this moderating effect is coronary heart disease.

The best-known personality distinction was developed by the cardiologists Meyer Friedman and Ray Rosenman. They proposed that some people show a Type A behaviour pattern, while others show the contrasting Type B pattern.

The comparison category is Type B.

AO1: Type A behaviour. A Type A person tends to be ambitious, impatient and achievement-driven. They may speak quickly, interrupt others, multitask, rush through activities and become frustrated when other people slow them down. The most health-relevant feature is often thought to be hostility: anger, cynicism, mistrust and a tendency to react aggressively to frustration. The proposed mechanism is that repeated anger and time pressure keep the sympathetic nervous system active, raising blood pressure and placing strain on the cardiovascular system.

AO1: Type B behaviour. A Type B person is more patient, tolerant and able to relax. They can still be ambitious, but they are less likely to treat every delay as a threat or every task as a competition. This means they may experience less frequent physiological arousal in response to everyday stressors.

Friedman and Rosenman's evidence. Rosenman et al. (1975) reported the Western Collaborative Group Study, a prospective study of 3,154 employed Californian men aged 39-59 who were free from CHD at the start. Participants were assessed using a structured interview that looked for Type A behaviours as well as verbal answers. Over an average follow-up of 8.5 years, clinical CHD occurred in 257 participants. Type A behaviour was strongly related to CHD incidence, and the association remained after measured risk factors such as blood pressure, smoking and cholesterol were considered. Adjustment does not rule out every unmeasured difference. This supports the idea that Type A behaviour is associated with greater vulnerability to stress-related cardiovascular illness.

AO2: applying Type A and B. David is a project manager who schedules meetings back-to-back, interrupts colleagues, checks his watch while other people speak and becomes angry when a deadline slips. A strong answer would identify David as Type A and explain that his time urgency, competitiveness and hostility may produce repeated physiological arousal. By contrast, if Hana works hard but stays patient, accepts delays and does not treat work as a constant competition, she is closer to Type B.

Type C personality

Type A and Type B are usually discussed in relation to cardiovascular illness. A third pattern, Type C, has been proposed in relation to cancer and immune functioning. The evidence is more mixed, so exam answers should use careful wording: Type C has been linked with cancer in some studies, but it should not be described as a proven cause of cancer.

Lydia Temoshok (1987) described Type C as a coping style in which the person is eager to please, avoids conflict and keeps negative emotions hidden. A historical hypothesis was that long-term emotional suppression might alter stress physiology or immunity. This proposed mechanism is not evidence that emotional suppression causes cancer. For example, a person might report little distress while concealing emotions, so outward calm need not indicate low experienced pressure. That observation alone does not establish an immune change.

Dattore et al. (1980). Dattore, Shontz and Coyne studied 200 male veterans, including 75 cancer patients and 125 non-cancer patients. The researchers retrieved personality records completed before cancer diagnosis, making this useful because it did not simply ask patients to remember how they had felt after becoming ill. The cancer group showed greater emotional repression and fewer reported depressive symptoms. Prediagnosis records reduce reliance on patients’ later recollection, but this association cannot establish a cancer-causing personality. Repression scores, coping during illness and cancer onset are different claims.

Greer and Morris (1975). Greer and Morris reported psychological attributes in women who developed breast cancer, including features linked to emotional suppression and anger control. This is often used as supporting evidence for a Type C style. However, the broader Type C-cancer link is inconsistent, and some AQA resources note that associations may depend on age and other biological factors. A balanced answer should describe Type C as a proposed association with uncertain causal status. Neither a personality label nor emotional suppression demonstrates that someone will develop cancer.

AO2: applying Type C. Ted tries to keep everyone happy. When he is angry, he smiles, apologises and says "it is fine" because he cannot bear arguments. This is Type C behaviour because he avoids conflict and suppresses anger. The important exam move is not to say "Ted will get cancer". Say that this coping style may make him vulnerable to stress-related illness in some accounts, but the evidence is mixed.

Evaluating personality types

Personality patterns are probabilistic descriptions, not diagnoses or fixed destinies. Someone can show features of more than one pattern, and healthy or ill people should not be classified from a single behaviour.

AO3 strength: prospective evidence. A strength of the Type A research is that the Western Collaborative Group Study was prospective. Participants were free from CHD at the start, personality was assessed before illness developed, and later CHD outcomes were recorded over 8.5 years. This is stronger than simply comparing people who already have CHD with healthy controls, because it helps establish that the personality measure came before the illness outcome.

AO3 strength: practical value. Personality research can have real-world application if it identifies risky behaviour patterns that can be changed. For example, interventions might target hostility, anger expression, rushing and unhelpful competitiveness. This matters because cardiovascular risk is not only biological; it can also be influenced by behaviour, coping style and stress management.

AO3 limitation: the Type A label may be too broad. Type A combines several different features: competitiveness, time urgency and hostility. These may not be equally harmful. Hecker et al. (1988) reanalysed Western Collaborative Group Study interviews and found that when Type A components were separated, hostility was the clearest coronary-prone facet. Dembroski et al. (1989) also found components of hostility predicted sudden death and myocardial infarction in the Multiple Risk Factor Intervention Trial. This suggests the broad Type A label lacks construct validity if the real risk factor is mainly hostility.

AO3 limitation: not all follow-up evidence supports global Type A. Ragland and Brand's 22-year follow-up of the Western Collaborative Group Study found that traditional risk factors such as systolic blood pressure, cholesterol, smoking and age predicted CHD mortality, but Type A/B behaviour was not clearly associated with 22-year CHD mortality. This does not erase the earlier findings, but it weakens the claim that global Type A is a stable long-term predictor.

AO3 limitation: gender and culture bias. The original WCGS sample consisted of middle-aged employed men in California. Applying those findings to women or to other cultures without further evidence risks beta bias, because it assumes the same stress-personality relationship applies across groups. Egido et al. (2012) is useful here because it found stressful habits and Type A behaviour were associated with increased stroke risk in a Spanish case-control sample including men and women, but much classic evidence remains male-heavy.

AO3 limitation: Type C evidence is cautious. The Type C-cancer link is weaker and more controversial than the Type A-CHD link. Cancer has many biological, environmental and lifestyle risk factors, so reducing it to emotional suppression would be biologically reductionist. A better conclusion is that emotional suppression may affect coping, immune functioning or adjustment to illness, but it is not a complete explanation of cancer vulnerability.