The type A personality vs type B distinction proposes that competitive, impatient, hard driving people (Type A) face higher heart disease risk than calm, easygoing people (Type B). A 2001 meta analysis pooling 74,326 people found the overall association is essentially zero. The cardiotoxic part is hostility. Achievement striving is separate, and predicts performance.
Most readers carry three assumptions into this topic. The first is that Type A and Type B are real, separable personality types, the way blood groups are. The second is that being Type A is bad for your heart. The third is that hiring Type A people gives you stronger performers because they are hungrier and faster. All three are wrong, partially wrong, or so oversimplified that acting on them produces poor decisions.
The original idea came from a 1959 JAMA paper by cardiologists Meyer Friedman and Ray Rosenman, who proposed that a specific overt behavior pattern, marked by intense drive, competitiveness, and time urgency, was linked to coronary artery disease. That idea became a theory. The theory became a global business cliche. Then the theory ran into 60 years of data, and most of it collapsed. What replaced it is more useful but less catchy, which is why the cliche still wins in HR conversations. This article walks through what survives, what does not, and what HR leaders should do with the part that remains.
Where did the Type A and Type B personality idea come from?
Type A behavior is a pattern of competitiveness, time urgency, and hostility, with Type B as its calmer and more easygoing counterpart. The concept was always a behavioral category in cardiology research, not a personality type in the modern psychological sense, and it gained traction in the 1960s and 1970s on the strength of a single very large prospective study.
That study was the Western Collaborative Group Study, which followed employed men aged 39 to 59 for an average of 8.5 years. The 1975 JAMA report showed that 257 of the men developed coronary heart disease during the follow up. The Type A behavior pattern was strongly associated with that risk, and the association could not be explained by smoking, blood pressure, cholesterol, or family history. The result spread fast. By the 1970s, Type A had become a fixture of medical advice, magazine articles, and corporate folklore.
The replication problem began soon after. A 2012 historical analysis reported that, in a systematic review of 18 etiologic and 15 prognostic studies, the studies finding a significant Type A and heart disease link were in the minority in both groups. The same 2012 paper traced internal tobacco industry documents showing Philip Morris funded a substantial portion of Type A research, partly to push the framing that personality, rather than smoking, was responsible for coronary disease. The underlying science was not corrupted, but the public conversation was nudged. HR practitioners who repeat Type A frames are unknowingly carrying that legacy forward.
What does the evidence say about Type A personality and heart disease?
Type A behavior, taken as a single overall pattern, shows almost no relationship with coronary heart disease in modern meta analyses. The cardiotoxic effect lies in one narrow component, hostility, not in the full Type A package.
The most rigorous test of the original theory remains the comprehensive meta analysis introduced at the opening of this article, by Michael Myrtek, which covered every prospective study published from 1966 to 1998. Across 74,326 people, the overall population effect size between Type A behavior and coronary heart disease was not statistically significant. Hostility, examined separately in 15,038 people, showed a significant but small association with heart disease, which the author still described as too weak to drive practical prediction or prevention. The cardiotoxic part of Type A was hiding inside one of its components, and even there the effect was modest.
A 2009 meta analysis by Yoichi Chida and Andrew Steptoe at University College London strengthened the hostility finding. It pooled 25 prospective studies of healthy people and 19 prospective studies of people who already had coronary heart disease. In healthy people, anger and hostility raised the risk of a heart event by 19%. In people who already had the disease, anger and hostility raised the risk of a recurrence by 24%. The effect was greater in men than in women.
Two things matter about that finding. First, the size of the effect is real but modest. Second, much of the relationship runs through behavior, not through a direct biological pathway. A study of 1,022 patients from the Heart and Soul Study followed people with stable coronary disease for an average of 7.4 years. People in the highest quartile of hostility had a 58% greater risk of further cardiac events than those in the lowest quartile. After adjusting for smoking and physical inactivity, the association was no longer statistically significant. The behaviors that travel with hostility did much of the damage.
The headline is simple. Being competitive at work has not been shown to raise heart disease risk. Being chronically hostile carries a measurable risk, partly through unhealthy behaviors.
Is Type A personality a real personality type?
Type A is not a personality type in the way modern psychology uses the term. It is a behavior pattern made up of separate traits that travel together unevenly. A 2004 review by Timothy Smith and colleagues in the Journal of Personality argued that the cardiotoxic component of Type A is best understood as hostility and antagonism positioned inside the interpersonal tradition of personality psychology, rather than as a unified type. Hostile traits are characterized in that review as cynicism, mistrust, and antagonistic responses to others, and the same paper documents that hostile individuals consistently exhibit patterns of smoking, lower physical activity, higher body mass, and dietary indiscretion. That is the same behavior cluster that explained the Heart and Soul findings cited earlier.
How does Type A vs Type B affect work performance?
The clearest workplace finding is that the achievement striving piece of Type A predicts higher performance, while the impatience and irritability piece predicts worse health and no performance benefit. A 1987 Journal of Applied Psychology study by Janet Spence, Robert Helmreich, and Robert Pred at the University of Texas factor analyzed the Jenkins Activity Survey, the standard self report Type A measure. They identified two statistically independent factors. They labeled them Achievement Strivings and Impatience and Irritability. Across two samples of college students, Achievement Strivings was significantly correlated with grade point average, while Impatience and Irritability was not. Impatience and irritability were significantly correlated with physical health complaints, while achievement striving was not. The two factors did opposite work. The authors noted that future research on the personality factors linked to coronary disease would do better to focus on the impatience and irritability factor than on the broader Type A label, which exactly tracks what the later meta analytic evidence has shown.
What is the actual difference between Type A and Type B personality?
The conventional difference between Type A and Type B is a bundle of behaviors. Type A people are described as competitive, time pressured, fast talking, hard driving, achievement focused, and easily provoked. Type B people are described as relaxed, patient, reflective, even tempered, and steady. The HCH article on Type B personality walks through how those Type B descriptions are used in popular workplace writing.
The more useful distinction, supported by the factor analytic research described in the Spence study cited above, is between Achievement Strivings and Impatience and Irritability. Achievement Strivings reflects ambition, focus, and a willingness to work hard for goals. Impatience and Irritability reflects time urgency, hostility, and a short fuse with other people. The ambitious, focused, deadline driven employee that managers love is high in achievement striving. The angry, cynical, blame throwing employee that managers fear is high in impatience and irritability. Old Type A theory treated them as the same person. The factor analytic evidence says they are not.
Should HR use Type A vs Type B in hiring or development?
Type A versus Type B should not be used as a hiring filter or a development category. The construct is multidimensional, its components predict opposite outcomes, and the categorical Type A versus Type B label collapses things that should be kept separate. The same pattern shows up in related personality constructs.
A 2025 meta analysis by Aishwarya Bellam and Thomas Curran in the Journal of Occupational and Organizational Psychology examined how perfectionism, a construct that overlaps with achievement striving, predicts work performance. The analysis pooled 28 samples, 77 effect sizes, and 9,560 workers. Perfectionistic strivings, the high standards and drive to excel dimension, showed small positive relationships with both hours worked and performance. Perfectionistic concerns, the anxious and self critical dimension, predicted more hours worked but no performance gain. The same pattern echoes the achievement striving versus impatience split in Type A research. Multidimensional traits split when you study them carefully. Categorical Type A and Type B labels do not let you see that split.
The Big Five framework used by contemporary selection science measures Conscientiousness, Extraversion, Neuroticism, Agreeableness, and Openness as continuous scores rather than as types, and HR teams that want to assess the same behaviors carried by old Type A descriptions should be working from that framework.
Can a person change from Type A to Type B?
People do not switch types because the types themselves are loose categories. What can change, and what matters, is the hostile and impatient component. The Recurrent Coronary Prevention Project, a randomized trial reported in the American Heart Journal in 1986, followed 1,013 post heart attack patients for 4.5 years. The 592 patients randomly assigned to receive group cardiac counseling plus Type A behavioral counseling had a cumulative cardiac recurrence rate of 12.9%, compared with 21.2% in the 270 patient control group that received cardiac counseling alone. The intervention worked by lowering hostility, time urgency, and angry reactivity, not by stripping out ambition. Achievement striving did not need to be removed for the cardiac benefit to appear.
What this means for you as an HR leader
If you have been using Type A and Type B language in hiring conversations, performance reviews, or leadership development programs, you are working from a model that no longer fits the evidence. That does not mean the everyday observations behind the model are wrong. Some employees are hard driving and impatient. Some are calm and steady. But the two letter labels mislead.
They flatten useful complexity. A high performer who is conscientious and ambitious gets sorted into the same bucket as a hostile and reactive colleague. The evidence reviewed above says those two profiles run in opposite directions on health and performance. They overpredict harm. Telling a competitive employee that their personality is heart attack fuel is not supported by the modern meta analytic evidence. They underpredict harm. Treating a chronically hostile employee as merely Type A misses the real cardiovascular and interpersonal risk that hostility carries.
The practical move is to drop the two letter labels and use what works. Assess for the Big Five during selection. Watch for hostility in leadership pipelines, because the cynical and contemptuous leader hurts both their own health and the health of their team. Treat ambition as separate from anger. That single distinction would fix most of how HR currently talks about this topic.
Key Takeaways
1. Type A and Type B were proposed in 1959 as a cardiology framework, not as a personality model in the modern psychological sense, and the original concept defined Type A as a pattern of intense drive, competitiveness, and time urgency.
2. The Western Collaborative Group Study, the foundational prospective trial, reported a strong Type A and heart disease link independent of traditional risk factors. Later prospective research did not consistently reproduce that link.
3. Across the most comprehensive meta analysis of prospective studies covering 74,326 people, overall Type A behavior shows essentially no relationship with coronary heart disease.
4. The cardiotoxic part of Type A is hostility. In healthy people, hostility raises heart event risk by 19%. In people with existing disease, hostility raises recurrence risk by 24%, with a stronger effect in men.
5. Much of the hostility heart disease link runs through smoking and physical inactivity. When those behaviors are controlled, the direct association weakens.
6. The Type A construct splits into two independent factors. Achievement Strivings predicts performance. Impatience and Irritability predicts physical health complaints and offers no performance benefit.
7. Cognitive behavioral counseling that lowers hostility, time urgency, and angry reactivity has reduced cardiac recurrence rates in a randomized trial, without removing achievement striving.
Implications for Practice
Stop using Type A and Type B as labels in job adverts, interview guides, manager training, or coaching conversations. The evidence shows the labels collapse two separable signals that move in opposite directions, ambition and hostility, into one bucket. Replace them with the language of specific traits, ambition, conscientiousness, emotional reactivity, and interpersonal warmth, which are easier to observe and easier to develop.
If your organization uses personality assessment in selection, audit which instruments you rely on. Move away from any tool that produces a binary Type A or Type B output. Move toward validated Big Five instruments that produce continuous scores on multiple traits, because that is what contemporary selection research supports.
In leadership development, treat hostility as a coachable risk factor, not as part of someone’s identity. Leaders who score high on cynicism, contempt for colleagues, and easily triggered anger should be supported through behavioral coaching of the kind shown to reduce cardiac risk in the Recurrent Coronary Prevention trial cited earlier, not labeled and left in role. The cardiovascular evidence makes this a wellbeing issue as much as a performance issue.
In wellness programs, reframe the conversation. Stress education that warns Type A people to slow down misses the real target. The intervention that matters is reducing chronic hostility and angry rumination, which is the component the meta analytic evidence has tied to heart disease. Direct programs at the specific behaviors, not at the label.
Finally, when employees ask about their type, take the opportunity to teach. The popularity of Type A and Type B in workplaces tells us something about how much people want a clean story about themselves. Offer a more accurate one. A short conversation about the Big Five, hostility risk, and the difference between ambition and anger does more for self awareness than a label ever could.
Related Reading on The Human Capital Hub
For more on related personality frameworks discussed at The Human Capital Hub, see the article on Type C personality, another popular workplace label, and the Big Five and Type B articles referenced earlier in the body of this piece.
