Bipolar disorder, Type A behavior, and coronary disease

This paper describes a model for integrating two psychological constructs—bipolar disorder and the Type A behavior pattern—each of which has been associated with enhanced risk of coronary heart disease (CHD). It highlights similarities between manic/hypomanic behaviors associated with bipolarity and the behaviors observed in Type A individuals. The proposed model conceptualizes Type A behavior as an alternating pattern of coping with challenging and stressful events. Thus, initial coping efforts are manifested as behavioral hyper-reactivity (including mania/hypomania), but this gives way to hypo-reactivity (including helplessness and depression) after repeated failure to assert control and/or attain relevant goals. This alternation of Type A coping patterns resembles the affective and behavioral transitions often seen in bipolar patients. Future research on psychological, epidemiological, and pathophysiological issues concerning CHD should document areas of commonality and independence between bipolarity and Type A behavior. Such studies would benefit from consideration of a model that identifies psychosocial dimensions common to Type A, mania/hypomania, and depression.