Bipolar disorder, Type A behaviour and coronary disease

This paper presents a model for integrating two psychological constructs - bipolar disorder and the Type A behaviour pattern - each of which has been associated with enhanced risk of coronary heart disease (CHD). It describes similarities between manic/hypomanic behaviours associated with bipolarity and the behaviours observed in Type A individuals. The proposed model highlights the importance of alternating patterns of coping with challenging and stressful life events. Thus, initial coping efforts are manifested as behavioural hyper-reactivity (i.e., Type A behaviours and 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 what originally were regarded as Type A coping patterns resembles the affective and behavioural 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 behaviour. Such studies would benefit from consideration of a model that identifies psychosocial dimensions common to Type A, mania/hypomania and depression.