One of the classic scenarios in psychological evaluations is to show a person a glass that is 50% filled with water. Is the glass half full or half empty? How the person answers that question can determine a lot about their psychological state and may show their risk for future heart disease.
For years the face of heart disease was a man who was highly ambitious, competitive, aggressive, impatient, goal- directed and willing to take risks. The type A personality was originally described in the 1950's by two cardiologists. They went on to show that the type A person had higher levels of cholesterol and a higher risk for heart disease. In addition, they found that the opposite of the type A, a relaxed, easy going, laid-back person, a type B personality, had a lower risk for heart disease. These stereotypes have persisted to this day. More recent data found no significant link between type A personality and heart disease. However, two components of the type A personality, anger and hostility, are strongly associated with cardiac disease. Studies have shown that anger and hostility significantly increase the risk for cardiac events in healthy people as well as those with established heart disease. Anger causes excess catecholamine (adrenaline) release, an increase in heart rate and elevated blood pressure which can lead to angina and a heart attack. An outburst of anger is a well-established trigger for an acute heart attack. Chronic anger and hostility lead to the initiation and progression of blockages in the heart arteries, especially in young men. A new personality type was identified in 2000 and named type D (or “distressed”) personality. The type D personality has two components. The person exhibits negative emotions (anxiety, worry, neurotic) and social inhibition (can’t express emotions, thoughts or behaviors in a social situation). It is often associated with anger, hostility and social isolation as well. The type D personality is associated with cardiac disease including angina, heart attack and an increased risk for cardiac death
Neuroticism is another personality trait tied to adverse cardiac disease. Neurotic individuals have emotional instability, difficulty handing stressful situations and “fly off the handle” when under pressure. On the other hand, those with low neuroticism scores are more emotionally stable, calmer, even-tempered and less reactive to stress. Individuals with high neuroticism scores have more anxiety, moodiness, fear, anger, frustration, pessimism, and loneliness than those with lower scores. They often turn to maladaptive behaviors (substance abuse, alcohol). In addition, people with high neuroticism scores were more likely to develop atrial fibrillation and to be diagnosed at an earlier age then those with lower scores.
On the other hand, certain personality traits are cardioprotective. These include optimism, conscientiousness, openness to new experiences and curiosity. Optimism is defined as the expectation of good things in the future (while its opposite, pessimism, is expecting something bad to happen down the road). Individuals with high optimism scores have lower risk for angina, heart attack, stroke, cardiac death and all cause death. Why is this? Optimists and people with psychological well-being have favorable physiologic parameters including lower blood pressure, better cholesterol levels and less sympathetic activation (lower adrenaline levels). They smoke less, exercise more, eat better and have less tendency for obesity. In addition, optimists are more likely to seek help in difficult social situations. They have larger and stronger social networks for support. They act on medical advice more readily. Lastly, optimists can weather the harmful effects of stress due to their inner and outer support systems. Meanwhile, pessimism has been shown to increase the risk for cardiovascular mortality.
So, when confronted with the question about that glass of water, don’t get angry. Don’t become hostile. Don’t get depressed if you can’t come up with an answer. Look for the positives, try to maintain an optimistic viewpoint and say that it is half full. Your heart will thank you.
