Type A Behavior and Diabetic Control: Implications of Psychological Reactance for Health Outcomes

ABSTRACT

According to laboratory research, Type A coronary-prone individuals are sensitive to threats to their personal control and react to such threats with active and often stressful coping responses. The present investigation tested the prediction that these features of Type A behavior would interfere with blood glucose regulation in insulin-dependent diabetes mellitus patients. Two independent hypotheses were investigated. Because elevated sympathetic arousal, a concomitant of stressful coping, is associated with elevated glucose levels, it was predicted that Type A diabetics experiencing high levels of life stress would display poorest blood glucose control (indexed by Hemoglobin A₁c). The second hypothesis was derived from the observation that Type As are more likely than Type Bs to respond to control threats with reactance in order to restore the perception of control. Given that illness or treatment can reduce personal control, it was predicted that Type A diabetics would be most reactant and, thus, most medically noncompliant. To test these hypotheses, 37 Type 1 diabetics were assessed for Type A behavior, life change, attributional style, desire for control (both within treatment and in general), and specific perceptions of and actions to their diabetes. Type As were more likely than Type Bs to show poor blood glucose control. However, for patients in general, and Type As in particular, blood glucose regulation was not related to life stress. Rather, those Type As who displayed poor glucose control made more extreme self-attributions about the cause of their diabetes, were angrier about it, and felt they should fight it. The implications of these findings for a reactance-Type A model of medical compliance are discussed.