Mechanisms by which stress can lead to coronary heart disease.

Much stress is of psychological origin and due to emotional arousal. The mechanisms by which anger, helplessness, or a sense of control and serenity exert their various neuroendocrine effects are discussed. Primacy is given to three systems; to the catecholamines, to testosterone and to cortisol. Evidence that they interact to accelerate the arteriosclerotic process is cited. The protective aspects of intimacy are discussed together with evidence that certain personality types promote it in the marital situation while others do not. It is suggested that the post-traumatic stress syndrome may relate to the coronary-prone personality for it involves an alexithymic disturbance of the emotional competence required for successful intimacy.