Defensive hostility and cardiovascular disease: Theoretical and empirical bases for an interpersonal approach-avoidance conflict perspective

Abstract

For thousands of years and across different cultural contexts, social, psychological, and physical well-being has been associated with the balance versus imbalance of natural forces within the person [1],[2].As suggested by such ancient physicians as Hippocrates, a linkage between physical health and personality/emotional factors has been evident [3]. During the late nineteenth century, a defense against unconscious, psychological conflict was seen as a cause of the psychosomatic disorder of conversion hysteria (e.g., limb paralysis in the absence of a discernible organic cause; [3]). With respect to the cardiovascular system, William Harvey, in 1628, noted that a mental disturbance that induces either pleasant or painful affective states influences activity of the heart, and Sir William Osler, in 1910, characterized cardiac patients as ambitious men who constantly pushed the machinery of the body to its limits [4]. Alexander [5] posited the theory that high blood pressure of unknown origins (essential or primary hypertension) was prevalent among persons oriented to social status and the defensive inhibition of the cognitive and emotive aspects of anger in an effort to avoid interpersonal conflict. With theoretical and methodological advances in physiology, psychology, medicine and sociology, pre-scientific and 19-20th century speculations evolved to a rigorous examination of the scientific basis for the role of the experience, management and expression of emotion in the etiology and pathophysiology of disease. Although inconsistent findings have been reported, a substantial body of evidence shows a link between stressors and cardiovascular disease (CVD). © 2006 Springer-Verlag Milan.