The Myth of the "Type A" Personality

It doesn’t take an advanced degree in psychology, or any degree at all for that matter, to be familiar with the “Type A” personality. That the hard-driving, perfectionistic, angry, and competitive qualities associated with this personality place people at risk for heart disease is a firmly-established idea in popular psychology. Less well-known perhaps, but equally accepted by most who’ve heard about it, is the idea that there is a “Type C personality” who is at high risk for cancer (hence the “C”) due to a tendency to be lacking in assertiveness and autonomy.

Empirical support for the existence of these personality types came from two types of investigations. In observational studies, researchers tested individuals with standard questionnaire measures and then waited to see if they developed heart disease and/or cancer, leading to higher rates of mortality. In intervention studies, researchers compared groups receiving psychological treatments intended to alter the problematic personality traits leading to these health problems. Any subsequent improvements among participants in their health risk could then be attributed to the intervention.

With studies establishing the validity of the personality-health risk dating back to the 1980s, there was little reason to question the value of their findings. You’re Type A? Then you need to find ways to become more of the opposite, or “Type B.” Type C? This is a bad indication that you could develop a deadly form of cancer due to your inability to stand up for yourself.

Where Did These Personality Types Come From?

In the 1980s, Professor Hans Eysenck, of the Institute of Psychiatry (IoP) at King’s College (London) began a program of research with coauthor Professor Ronald Grossarth-Maticek leading to the publication of 26 studies in such well-respected journals as British Medical Journal and Behaviour Research and Therapy. Eysenck, referred to by Health Psychology Editor David Marks (2019) as one of the “world’s leading psychologists” developed a widely-employed personality test for such qualities as introversion and neuroticism known as the “Maudsley Personality Inventory” that became part of what is now known as the “Five-Factor Model.”

The scientific community along with the lay public were led to believe in the validity of the IoP research team’s claims, as indicated by the widespread attention that their work received. These claims were stated in no uncertain terms by the authors; to quote from one of their papers, “It has long been established that personality and stress are contributory factors leading to the development of neoplastic disorders [i.e. cancer]… and recent work has given strong factual support to this hypothesis” (p. 1). The authors then go on to compare 4 personality-based groups that they define as Type 1 (cancer-prone type; later called Type C), Type 2 or the coronary heart disease (CHD) prone (what we now call Type A), Type 3 a “mixed type with psychopathic tendencies,” and Type 4, the “healthy autonomous type” (p. 2).

Going even further, the authors note that the health risk profiles of these types “remain highly significant even when smoking, cholesterol level, and blood pressure are partialed out… and indeed it has been shown in the same paper that psychosocial causes are over 6 times as predictive as physical ones” (p. 3). A new method of therapy the authors proposed called “creative novation” could purportedly correct these personality deficiencies by helping patients learn “an alternative type of autonomous behavior” in which they can independently satisfy their own needs rather than relying dependently on others.

Adding further to the likelihood that the personality-health link would become clinical lore, in this same paper Eysenck and Grossarth-Maticek preview a second, experimental study in their series, in which they conclude that “the methods here discussed do in fact have powerful prophylactic effect, and can also prolong the lives of patients suffering from terminal cancer.” What’s more, there is the “final possibility” of “the actual cure of cancer by means of behaviour therapy,” as suggested by an “unpublished study” of 7 cases of “spontaneous cancer regression” (p. 13).

Who wouldn’t believe such strong claims, especially when “supported” by both observational and intervention studies? That personality “in fact” can not only cause but cure terminal illness—as the evidence contained in these studies was supposed to show—would provide a new avenue of both treatment and hope for people seeking to prolong their lives when traditional medical methods couldn't accomplish either.

As a result of this and other similar studies in the published literature, you can now find “Type A” and “Type C” popping up throughout websites everywhere, including colorful infographics on Pinterest. Decades in the past, most people can’t even recall where they first heard these terms, and with the backing of dozens of studies such as the 1991 paper, psychology lore continued to reify these constructs. That is, until an ominous warning appeared in 2019 in the form of an inquiry published by Eysenck's former employer, Kings College London.

Not Just Invalid, but Unsafe

Turning now to this published inquiry, it was the basis for a retraction by the editors of the Journal of Behavior Therapy and Experimental Psychiatry (2021; see below for reference) of a 1990 paper entitled “Prophylactic effects of psychoanalysis on cancer-prone and coronary heart disease-prone probands, as compared with control groups and behaviour therapy groups.” Indeed, it’s not even possible to view this paper because the retraction scrubbed it from all possible online sources. The basis for the inquiry was “to ascertain (as far as possible) that the joint publications were safe in terms of presenting rigorous results relating personality factors with cancer, coronary heart disease, and other outcomes.”

Having first established that Grossarth-Maticek was never employed at the IoP (though such was claimed in his publications), the committee went on to investigate all the articles published by the two authors together and though having no access to the data were able to dig up some attempted replications showing the original findings to be spurious, at best.

As stated further, although the IoP was cited as the institutional affiliation of the authors, there was no evidence that the investigations were vetted in the usual process that research institutions and universities use for determining that the studies complied with ethical standards. Given the high stakes of the findings (i.e. cures for cancer), such a lapse is ominous indeed.

Moving on to the substance of the inquiry, the Kings College committee cites a handful of studies published even back in the late 1980s that questioned the Eysenck/Grossarth-Maticek findings. These concerned a variety of methodological issues pertaining to the “validity of the datasets” as well as the “implausibility of the results presented, many of which show effect sizes virtually unknown in medical science… [that are] incompatible with modern clinical science and the understanding of disease processes.”

Not only are the published results considered “unsafe,” concludes the committee, but the editors of the journals themselves are at fault for having allowed the studies to see the light of day. Each of these editors is individually cited by name along with the journals themselves in a listing of “Addresses of editors of journal that published potentially unsafe results.”

What Does this Retraction Mean for Your Personality—and Your Health?

That it took decades for the retraction to come about might be a bit unnerving to you, regardless of the subject matter. If scientists were suspicious back in the 1990s, why weren’t those concerns enough at the time to call for a retraction? Wouldn’t this have meant the avoidance of the spread of these unsafe findings?

The answer seems to be deeply embedded in the nature of scientific publishing. Researchers, and the editors who evaluate their work prior to publication, rely on experts in the field to determine whether the findings pass muster. The process of peer review is intended to ensure that every dark corner of a study’s data is examined with scrutiny and if not, to demand the authors to revise or seek another publishing outlet. Clearly, something failed in the case of this line of investigation.

However, the retraction of previous findings due to the accumulation of subsequent suspicion isn’t unique to this work nor is it unique to psychology. In most cases, the retraction involves a single instance, though, not an entire body of work by a particular author team. That this is such a rare event (estimated at 2 out of 10,000 papers) supports the integrity of the scientific process doing what it’s supposed to do. In their defense, prior to his death, Eysenck responded to previous critiques, and Grossarth-Maticek continues to do so as well. However, the Kings College scientific committee along with the editors of the journal were not persuaded to retract their retraction.

For you, as the consumer of information in health and psychology, what can you do to protect yourself from similar “unsafe” claims in the future? You are told to look for peer-reviewed articles before taking any advice, and these were indeed peer-reviewed. Even gut-checking the findings of a study that claims to be able to “cure” cancer by psychological treatment wouldn’t necessarily provide the best strategy because, as is said so often, you should “follow the science.”

The answer is: There is no easy answer. However, luckily, science has moved away from the burial of data in dusty files of researchers, never to be available for fact-checking. The open science framework now exists so that many researchers register their studies before collecting the first iota of data, along with their stated hypotheses. You, as a consumer, can go not only to the publications (often for free) but to the data files themselves. If you don’t feel confident in your own abilities to sift through these materials, you can ask for help from a professional you’re seeing for a medical or psychological disorder, and take advantage of their expertise. You can even write to the authors of the research themselves for access to their articles if not their data.

To sum up, the behavioral health field has taken a beating from this very serious challenge to one of its largest lines of inquiry, but as a result, the field will undoubtedly become that much stronger—and safer—in the years ahead.

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