Replicability of rating the coronary-prone behaviour pattern.

The possible involvement of a specific overt behaviour pattern in the pathogenesis of clinical coronary heart disease (CHD) has been under careful study. The characteristics of this overt behaviour pattern, called Behaviour Pattern A, have been described previously (Friedman and Rosenman, 1959). In brief, it is 6haracterized by extremes of competitiveness, striving for achievement, aggressiveness (yet sometimes stringently repressed), haste, impatience, restlessness, hyper-alertness, explosiveness of speech, tenseness of facial musculature, and feelings of being under the pressure of time and under the challenge of responsibility. In an earlier study this pattern was found to be associated with increased prevalence of CHD, Rosenman, Friedman, Straus, Wurm, Kositchek, Hahn, and Werthessen (1964). To test this finding more decisively, a collaborative prospective study of CHD was initiated in 1960-61 among 3,524 men aged 39-59 years. At the end of a mean follow-up period of 21 years, subjects classified at intake as having exhibited Pattern A showed a considerably higher incidence of new CHD than those classified prospectively as exhibiting the converse Pattern B (Rosenman, Friedman, Straus, Wurm, Jenkins, and Messinger, 1966). It therefore appeared important to the investigators to examine the adequacy of their technique for differentiating Pattern A from Pattern B. The current study tests the reliability of assessment of the behaviour patterns, both in terms of agreement between judges and stability of the rating over time. The behaviour pattern was assessed by means of an oral interview designed especially for this purpose. Detection of Behaviour Pattern A consists in determining whether a subject is in active and continuous conflict either with other subjects or with time. This condition reveals itself through various