Journal of Behavioral Medicine

, Volume 12, Issue 1, pp 1–11 | Cite as

Neuroticism, symptom reports, and Type A behavior: Interpretive cautions for the Framingham scale

  • Timothy W. Smith
  • Jennifer L. O'Keeffe
  • Kenneth D. Allred


The Framingham Type A Scale (FTAS) is one of three primary measures of Type A behavior. Unlike the structured interview (SI) and Jenkins Activity Survey (JAS), the FTAS is correlated with neuroticism. Further, neuroticism and FTAS scores predict angina-like chest pain complaints but not more definitive coronary heart disease (CHD) end points. Thus, the FTAS may be unique among Type A measures in its susceptibility to the neuroticism-symptom reporting confound. The present study examined associations of the SI, JAS, and FTAS with neuroticism and symptom reporting in two independent samples of undergraduate males. Unlike the SI and JAS, the FTAS was correlated with neuroticism and symptom reporting. Further, the correlations of FTAS scores and symptoms were due to shared variance with neuroticism. The findings are discussed in terms of a possible alternative interpretation of the Framingham Study and the need to consider neuroticism in studies of personality and health.

Key words

Type A behavior neuroticism personality symptom reports 


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  1. Bass, C., and Wade, C. (1984), Chest pain with normal coronary arteries: A comparative study of psychiatric and social morbidity.Psychol. Med. 14: 51–61.Google Scholar
  2. Brodman, K., Erdmann, A. J., and Wolff, H. G. (1960).The Cornell Medical Index-Health Questionnaire Manual, Cornell University Press, New York.Google Scholar
  3. Chesney, M. A., Black, G. W., Chadwick, J. H., and Rosenman, R. H. (1981). Psychological correlates of the Type A behavior pattern.J. Behav. Med. 4: 217–229.Google Scholar
  4. Cohen, F. (1979). Personality, stress, and the development of physical illness. In Stone, G. C., Cohen, F., and Adler, N. E. (eds.),Health Psychology—A Handbook, Jossey-Bass, San Francisco, pp. 77–111.Google Scholar
  5. Costa, P. T., Jr. (1986). Is neuroticism a risk factor for CAD? Is Type A a measure of neuroticism? In Schmidt, T., Dembroski, T. M., and Blumchen, G. (eds.),Biological and Psychological Factors in Cardiovascular Disease, Spinger-Verlag, New York, pp. 85–95.Google Scholar
  6. Costa, P. T., Jr., and McCrae, R. R. (1980). Somatic complaints in males as a function of age and neuroticism: A longitudinal analysis.J. Behav. Med. 3: 245–257.Google Scholar
  7. Costa, P. T., Jr., and McCrae, R. R. (1985). Hypochondriasis, neuroticism, and aging: When are somatic complaints unfounded?Am. Psychol. 40: 19–28.Google Scholar
  8. Costa, P. T., Jr., & McCrae, R. R. (1987). Neuroticism, somatic complaints, and disease: Is the bark worse than the bite?J. Personal. 55: 299–316.Google Scholar
  9. Costa, P. T., Jr., Fleg, J. L., McCrae, R. R., and Lakatta, E. G. (1982). Neuroticism, coronary artery disease, and chest pain complaints: Cross-sectional and longitudinal studies.Exp. Aging Res. 8: 37–44.Google Scholar
  10. Costa, P. T., Jr., Zonderman, A. B., Engel, B. T. Baile, W. F., Brimlow, D. S., and Brinker, J. (1985). The relation of chest pain symptoms to angiographic findings of coronary artery stenosis and neuroticism.Psychosom. Med. 47: 285–293.Google Scholar
  11. Dembroski, T. M. (1978). Reliability and validity of methods used to assess coronary-prone behavior. In Dembroski, T. M., Weiss, S. M., Shields, J. L., Haynes, S. G., and Feinleib, M. (eds.),Coronary-Prone Behavior, Spinger-Verlag, New York, pp. 95–106.Google Scholar
  12. Dembroski, T. M., and Costa, P. T., Jr. (1987). Coronary prone behavior: Components of the Type A pattern and hostility.J. Personal. 55: 211–235.Google Scholar
  13. Depue, R. W., and Monroe, S. M. (1986). Conceptualization and measurement of human disorder in life stress research: The problem of chronic disturbance.Psychol. Bull. 99: 36–51.Google Scholar
  14. Elias, M. F., Robbins, M. A., Blow, F. C., Rice, A. P., and Edgecomb, J. C. (1982). A behavioral study of middle-aged chest pain patients: Physical symptom reporting, anxiety, and depression.Exp. Aging Res. 8: 45–51.Google Scholar
  15. Eysenck, H. J., and Eysenck, S. B. G. (1964).Manual for the Eysenck Personality Inventory, University Press, London.Google Scholar
  16. French-Belgian Collaborative Group (1982). Ischemic heart disease and psychological patterns: Prevalence and incidence studies in Belgium and France.Adv. Cardiol. 29: 25–31.Google Scholar
  17. Hagman, M., Wilhelmsen, L., Wedel, H., and Pennert, K. (1987). Risk factors for angina pectons in a population study of Swedish men.J. Chron. Dis. 40: 265–275.Google Scholar
  18. Haynes, S. G., and Feinleib, M. (1982). Type A behavior and the incidence of coronary heart disease in the Framingham Heart Study.Adv. Cardiol, 29: 85–95.Google Scholar
  19. Haynes, S. G., Feinleib, M., and Kannel, W. B. (1980). The relationship of psychosocial factors to coronary heart disease in the Framingham study. III. Eight year incidence of coronary heart disease.Am. J. Epidem. 111: 37–58.Google Scholar
  20. Haynes, S. G., Levine, S., Scotch, N., Feinleib, M., and Kannel, W., B. (1978). The relationship of psychosocial factors to coronary heart disease in the Framingham study. I. Methods and risk factors.Am. J. Epidem. 107: 362–383.Google Scholar
  21. Holroyd, K. A., and Coyne, J. (1987). Personality and health in the 1980s: Psychosomatic medicine revisited?J. Personal. 55: 359–375.Google Scholar
  22. Jemmott, J. B., III (1987). Social motives and susceptibility to disease: Stalking individual differences in health risks.J. Personal. 55: 267–298.Google Scholar
  23. Jenkins, C. D., Rosenman, R. H., and Zyzanski, S. J. (1974). Prediction of clinical coronary heart disease by a test for the coronary-prone behavior pattern.N. Engl. J. Med. 290: 1271–1275.Google Scholar
  24. Kobassa, S. C. (1982). The hardy personality: Toward a social psychology of stress and health. In Sanders, G. S., and Suls, J. (eds.),Social Psychology of Health and Illness, Erlbaum, Hillsdale, N.J., pp. 3–32.Google Scholar
  25. Krantz, D. S., and Hedges, S. M. (1987). Some cautions for research on personality and health.J. Personal. 55: 351–357.Google Scholar
  26. Krantz, D. S., Glass, D. S., and Snyder, M. L. (1974). Helplessness, stress level, and the coronary-prone behavior pattern.J. Exp. Soc. Psychol. 10: 284–300.Google Scholar
  27. Marx, M. B., Garrity, I. F., and Bowers, F. R. (1975). The influence of recent life experience on the health of college freshman.J. Psychosom. Res. 19: 87–98.Google Scholar
  28. Matthews, K. A. (1988). CHD and Type A behaviors: Update on and alternative to the Booth-Kewley and Friedman quantitative review.Psychol. Bull. 104: 373–380.Google Scholar
  29. Matthews, K. A., and Haynes, S. G. (1986). Type A behavior pattern and coronary disease risk: Update and critical evaluation.Am. J. Epidem. 123: 923–960.Google Scholar
  30. Medalie, J. H., and Goldbourt, U. (1976). Angina pectoris among 10,000 men. II. Psychosocial and other risk factors as evidenced by a multivariate analysis of a five-year incidence study.Am. J. Med. 60: 910–920.Google Scholar
  31. McCrae, R. R., and Costa, P. T., Jr. (1984).Emerging Lives, Enduring Dispositions: Personality in Adulthood, Little, Brown, Boston.Google Scholar
  32. McCrae, R. R., and Costa, P. T., Jr. (1987). Validation of the five factor model of personality across instruments and observers.J. Personal. Sec. Psychol. 52: 81–90.Google Scholar
  33. Ockene, I. S., Shay, M. J., Alpert, J. S., Weiner, B. H., and Dalen, J. E. (1980). Unexplained chest pain in patients with normal coronary arteriograms.N. Engl. J. Med. 303: 1249–1252.Google Scholar
  34. O'Keeffe, J. L., and Smith, T. W. (1988). Self-regulation and Type A behavior.J. Res. Personal. 22: 232–251.Google Scholar
  35. Ormel, J. (1983). Neuroticism and well being inventories: Measuring traits or states?Psychol. Med. 13: 165–176.Google Scholar
  36. Ostfeld, A. M., Lebovitis, B. Z., Shekelle, R. B., and Paul, O. (1964). A prospective study of the relationship between personality and coronary heart disease.J. Chron. Dis. 17: 265–276.Google Scholar
  37. Roll, M., and Theorell, T. (1987). Acute chest pain without obvious organic cause before age 40—personality and life events.J. Psychosom. Res. 31: 215–221.Google Scholar
  38. Rosenman, R. H., Brand, R. J., Jenkins, C. K., Friedman, M., Straus, R., and Wurm, M. (1975). Coronary heart disease in the Western Collaborative Group Study: Final followup experience of 8-1/2 years. JAMA 233: 872–877.Google Scholar
  39. Scheier, M. F., and Carver, C. S. (1987). Dispositional optimism and physical well-being: The influence of generalized outcome expectancies on health.J. Personal. 55: 169–210.Google Scholar
  40. Schoken, D. D., Greene, A. F., Worden, T. J., Harrison, E. F., and Spielberger, C. D. (1987). Effects of age and gender on the relationship between anxiety and coronary artery disease.Psychosom. Med. 49: 118–126.Google Scholar
  41. Smith, T. W., and O'Keeffe, J. L. (1985). The inequivalence of self-reports of Type A behavior: Differential relationships of the Jenkins Activity Survey and Framingham Type A scale with affect, stress, and controlMotiv. Emot. 9: 299–311.Google Scholar
  42. Smith, T. W., Houston, B. K., and Zurawski, R. M. (1983). The Framingham Type A scale and anxiety, irrational beliefs, and self-control.J. Hum. Stress 9(2): 32–37.Google Scholar
  43. Smith, T. W., Follick, M. J., and Korr, K. S. (1984). Anger, neuroticism, Type A behavior and the experience of angina.Br. J. Med. Psychol. 57: 249–252.Google Scholar
  44. Smith, T. W., Korr, K. S., Follick, M. S., and McCartney, J. R. (1986). The Framingham Type A scale and severity of coronary artery disease.Br. J. Med. Psychol. 59: 359–363.Google Scholar
  45. Spielberger, C. D., Gorsuch, R. L., and Lushene, R. (1970)Manual for the State-Trait Anxiety Inventory, Consulting Psychologists Press, Palo Alto, Calif.Google Scholar
  46. Suls, J., and Rittenhouse, J. D. (1987). Personality and physical health: An introduction.J. Personal. 55: 155–167.Google Scholar
  47. Taylor, J. A. (1953). A personality scale of manifest anxiety.J. Abnorm. Soc. Psychol. 48: 285–290.Google Scholar
  48. Watson, D., and Clark, L. A. (1984). Negative affectivity: The disposition to experience aversive emotional states.Psychol. Bull. 96: 465–490.Google Scholar
  49. Watson, D., and Pennebaker, J. W. (1989). Health complaints, stress, and distress: Exploring the central role of negative affectivity.Psychol. Rev. (in press).Google Scholar
  50. Wielgosz, A. T., Fletcher, R. H., McCants, C. B., McKinnis, R. A., Haney, T. L., and Williams, R. B., Jr. (1984). Unimproved chest pain in patients with minimal or no coronary disease: A behavioral phenomenon.Am. Heart J. 108: 67–72.Google Scholar
  51. Young, L. D., Richter, J. E., Bradley, L. A., and Anderson, K. O. (1987). Disorders of the upper gastrointestinal system: An overview.Ann. Behav. Med. 9(3): 7–12.Google Scholar

Copyright information

© Plenum Publishing Corporation 1989

Authors and Affiliations

  • Timothy W. Smith
    • 1
  • Jennifer L. O'Keeffe
    • 1
  • Kenneth D. Allred
    • 1
  1. 1.Department of PsychologyUniversity of UtahSalt Lake City

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