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PubMedDate not supplied

Under assault: the experience of work-related anger in female registered nurses.

This article is Part I of a three part article. Part I describes work-related experiences of anger of female registered professional nurses (N = 9) who participated in phenomenological interviews. Participants ranged in age from 29 to 56 and had practiced nursing for a period of 7 to 34 years. Nurses described being "under assault" in a hostile environment. Military metaphors and similes permeated all the interviews. Subtheme of "under assault" included scapegoating, disrespectful treatment, and lack of support. Anger was a weapon used by the nurse to defend or advocate for patients or self, as well as to attack doctors, peers, patients, and self. Factors within the self such as control versus powerlessness influenced nurses' anger experience and expression. Infighting within the profession prevents mobilization of resources to confront the larger issues of healthcare reform. Nurses must reframe anger as a constructive means of empowerment, rather than a weapon to defend against assault. Part II addresses anger experiences of male registered nurses, and Part III provides recommendations for channeling anger constructively.

Adaptation, Psychological↗
PubMed2006

Triggering of acute coronary syndromes by physical exertion and anger: clinical and sociodemographic characteristics.

OBJECTIVE: To investigate the role of vigorous physical exertion and anger as triggers of acute coronary syndromes (ACS) and to identify the clinical and sociodemographic correlates of triggering. DESIGN: Prospective observational clinical cohort study. SETTING: Four coronary care units in the London area. PATIENTS: 295 men and women with electrocardiographically and biochemically verified ACS. MAIN OUTCOME MEASURES: Physical exertion in the 1 h and anger in the 2 h before symptom onset were assessed with structured interviews. Control periods were the equivalent hours one day earlier and usual rates over the past six months. Data were analysed by case-crossover methods. RESULTS: Physical exertion was reported by 10% and anger by 17.4% of patients in the hazard period. The risk of ACS onset after physical exertion compared with light or no activity was 3.50 (95% confidence interval (CI) 1.37 to 10.6). The risk of onset with anger was 2.06 (95% CI 1.12 to 3.92). Physical exertion during the hazard period was related to an absence of premonitory symptoms, presentation with an ST elevation myocardial infarction (STEMI), low socioeconomic deprivation and higher future cardiovascular risk. Anger during the hazard period was more common in younger, socioeconomically deprived patients who presented with a STEMI. CONCLUSIONS: Triggers are relevant across the spectrum of ACS. The distinct clinical and sociodemographic factors associated with physical exertion and anger suggest that different pathophysiological processes may be involved.

Age Factors↗
PubMed1997

Anger, impulsivity and suicide risk.

BACKGROUND: To examine the relationship between anger, impulsivity and suicidality. METHODS: Thirty psychiatric inpatients admitted for suicidal behavior were compared with 30 nonsuicidal psychiatric inpatients and 32 healthy controls on measures of anger, impulsivity and suicide risk. RESULTS: The three groups were similar on demographic variables, but the suicidal group scored higher on the suicide risk scale, impulsivity scale and anger scale. Anger and impulsivity correlated significantly with suicide risk. High anger and impulsivity contributed synergistically to the suicide risk. Whereas anger was specific to both psychiatric groups, suicidals and nonsuicidals, only impulsivity was specific to the suicidal group. CONCLUSIONS: These findings may have important implications for therapists and primary prevention workers, and may pave the way for the recognition of risk factors and for effective intervention in patients with a high suicide risk.

Adult↗
PubMed1987

Delayed myocardial ischemia induced by anger.

The objectives of this study were to develop a reproducible behavioral model that simulates the anger state and to characterize its influence on myocardial blood flow in both the normal and compromised coronary circulations. Fourteen mongrel dogs of both sexes were studied. The animals were instrumented for the recording of electrocardiogram, arterial blood pressure, and left circumflex coronary arterial blood flow. A critical level of coronary stenosis was achieved with an adjustable occluder placed just distal to the flow probe. Anger was induced in the instrumented animals by having another dog challenge their access to food. In the absence of coronary artery stenosis, provocation of anger increased heart rate from 107 +/- 6 to 215 +/- 15 beats/min, arterial blood pressure from 95 +/- 4 to 142 +/- 5 mm Hg, and coronary blood flow from 31 +/- 5 to 72 +/- 9 ml/min. These variables returned to the preanger levels within 2 to 4 min. Induction of anger was repeated after a critical stenosis was applied to the left circumflex coronary artery. Anger increased heart rate from 112 +/- 6 to 210 +/- 16 beats/min, arterial blood pressure from 99 +/- 3 to 142 +/- 6 mm Hg, and coronary arterial flow from 23 +/- 5 to 35 +/- 7 ml/min. Within 2 to 4 min after the bout of anger, all dogs exhibited significant reductions in coronary arterial flow (35% of baseline; p less than .001), increases in coronary vascular resistance (557% of baseline; p less than .002), and ischemic ST segment changes in leads II, III, and aVF.(ABSTRACT TRUNCATED AT 250 WORDS)

Anger↗
PubMed1976

The functions and regulation of the arousal of anger.

Anger is paradoxically one of the most talked about but least studied of human emotions. The author presents a model of anger arousal that emphasizes the adaptive as well as the maladaptive roles of anger in terms of the diverse functions anger serves in affecting behavior. In light of the fact that competence in anger management involves dealing with stress situations that require patience, composure, and constructive thought for their resolution, he discusses cognitive self-control processes affecting the regulation of anger.

Adaptation, Psychological↗
PubMed1993

Anger attacks in unipolar depression, Part 2: Neuroendocrine correlates and changes following fluoxetine treatment.

OBJECTIVE: Neuroendocrine derangements have been reported in both depression and aggressive behavior. The purpose of this study was to evaluate whether the subset of depressed patients with anger attacks have a distinctive neuroendocrine abnormality. METHOD: The thyrotropin-releasing hormone (TRH) test was administered to 25 patients with major depression, 12 of whom reported having anger attacks, at the Depression Research Program of the Clinical Psychopharmacology Unit at the Massachusetts General Hospital. Twenty-two subjects underwent the TRH test again after 8 weeks of treatment with fluoxetine, a relatively selective serotonin uptake inhibitor. RESULTS: The depressed patients with anger attacks had a blunted prolactin response to TRH stimulation compared to the depressed patients without anger attacks. Treatment with fluoxetine was followed by an overall increase in the prolactin response to TRH among the depressed patients with anger attacks. The prolactin response to TRH also tended to predict the degree of response to treatment. CONCLUSIONS: These results suggest that the subset of depressed patients with anger attacks may have a greater central serotonergic dysregulation than depressed patients without such attacks.

Adolescent↗
PubMed2001

Clinical outcome and client satisfaction of an anger management group program.

This retrospective quasi-experimental study evaluated the effectiveness of an anger management group program for clients with mental health problems. The program, based on the cognitive-behavioral approach, was offered by outpatient mental health occupational therapy services of a community general hospital. Sixty-four clients, about 59% diagnosed with depressive disorder, enrolled in the program and participated in the study. The pre-treatment and post-treatment scores of the participants on the Anger Control Inventory and the State-Trait Anger Expression Inventory were compared. The results indicated significant reduction in the overall experience of intense anger, improvement in cognitive and behavioural coping mechanisms, and significant improvement in anger control after treatment. Most respondents (90%) found the program definitely helpful. The pace of the program and the variety of learning activities were identified as areas for improvement. The results showed the program had positive impact on anger management. Useful suggestions were identified for continuous quality improvements of the program.

Adaptation, Psychological↗
PubMed1989

Learning problems, anger, perceived control, and misbehavior.

Fifty-four students diagnosed as having learning disabilities (LD) and 73 students in regular education were administered the School Anger Inventory and the Perceived Control at School Scale. Teachers and parents rated student deportment and motivation. Predictably, those in the LD sample indicated higher school anger levels and were rated as exhibiting more negative behavior, less positive behavior, and lower motivation for on-task performance. The samples did not differ in their ratings of perceived control, which was moderate, and were given comparable positive teacher ratings for recall of relevant and interesting material. Significant correlations between school anger and behavior were found only in the LD sample, and there was no significant overall relationship between school anger, behavior, and perceived control within either sample. Overall, however, students who reported both a high level of anger and high perceived control were found to exhibit more negative behavior than those with high anger and low perceived control.

Adolescent↗
PubMed2002

The utility of the State-Trait Anger Expression Inventory with offenders.

Self-report instruments can provide useful information as part of a thorough clinical assessment. However, their use in forensic settings can be problematic. The State-Trait Anger Expression Inventory (STAXI) has recently been proposed as an effective instrument for screening and outcome measurement in anger management programs. This study evaluated the effectiveness of this instrument in a sample of both voluntary and court-ordered anger-management clients, all of whom were determined through diagnostic interviews to have significant anger problems. Contrary to findings in nonforensic samples, the STAXI Trait Anger scale identified only about half of the participants as having anger-management problems severe enough to require intervention. Supplemental analysis with two additional scales did not significantly improve sensitivity. In addition to thorough diagnostic interviewing, forensic use of the STAXI (like similar assessment methods) may require additional validity scales to detect denial or socially desirable response patterns.

Adolescent↗
PubMed1998

Factor structure of the State-Trait Anger Expression Inventory for middle-aged men and women.

Recently, Forgays, Forgays, and Spielberger (in press) reported the first exploratory factor analysis of the total 44-item State-Trait Anger Expression Inventory (STAXI) by gender. The analyses were based on a sample of over 700 male and female university students and identified quite well six of the original STAXI scales and subscales. In addition, a seventh factor, "Feel-Like-Expressing-Anger," emerged for women. In the present study, we examined the STAXI responses from a middle-aged adult population. Exploratory factor analyses replicated the majority of the original structure of the STAXI measure including a Feel-Like-Expressing-Anger factor for men and women. In addition, we employed confirmatory factor analyses and cross-validation procedures to test the validity of Spielberger's (1988) AHA! model. Based on these procedures, we found (a) that a seven-factor model provided a better fit than a six-factor solution for each gender and (b) evidence of robust gender differences for two factors: Feel-Like-Expressing-Anger and State Anger. These gender differences are consistent with the social costs for anger expression in women and the social benefits for men.

Adult↗
PubMed2006

The relation of free plasma tryptophan to anger, hostility, and aggression in a nonpatient sample of adult men and women.

BACKGROUND: Dysregulation of central nervous system serotonergic (5-HT) activity is implicated in behavioral states and psychological traits associated with depression and aggression, with some studies suggesting possible gender-related differences. PURPOSE: This study examined the relation of free plasma tryptophan (TRP) to aggression and depression in a sample of 138 nonsmoking adults recruited from the general community. It was hypothesized that TRP would be associated with anger, hostility, and aggression. METHODS: To minimize effects of diurnal variation and menstrual cycle, fasting blood samples were collected in the morning, and, for women, during the follicular phase of the menstrual cycle. Participants were administered questionnaires following blood draw. Plasma TRP was determined by high performance liquid chromatography. RESULTS: In women, but not men, higher levels of TRP were associated with trait hostility, propensity for anger, a tendency to express anger outwardly, and an antagonistic interpersonal style. For men and women, greater severity of depressive symptoms, anger, and the verbal expression of anger were associated with higher TRP. These associations were independent of age, body mass index, fasting albumin, and race and ethnicity. CONCLUSIONS: These data suggest that in women, but not men, higher plasma levels of TRP, the precursor to 5-HT, are associated with anger-hostility-aggression and that these associations are independent of various potential confounds. Implications of these observations to studies employing acute TRP depletion studies are discussed.

Adolescent↗
PubMed1981

Reliability and validity of four anger scales.

To assess the test-retest reliability of four anger scales: the Buss Durkee Hostility Inventory (BDHI), the Reaction Inventory (RI), the Anger Self Report (ASR), and the Anger Inventory (NI), 60 student volunteers were twice administered the four inventories (two weeks apart). They also filled out a Personal Incidents Record of all anger-provoking incidents for two weeks of their daily life, and participated in imaginal and role-play laboratory provocations, after which physiological readings and self-reports of anger arousal were assessed. The BDHI and RI evidenced good test-retest reliability, the ASR fair reliability, and the NI poor reliability. Many ASR subscales demonstrated good predictive validity. The RI and BDHI possessed some ability to predict the experience of anger, but most of the BDHI subscales did not seem to be measuring specific states or behavior. The NI did not correlate with any of the criterion measures.

Anger↗
PubMed1999

Normative data for the Novaco Anger Scale from a non-clinical sample and implications for clinical use.

OBJECTIVES: To provide non-clinical normative data for the Novaco Anger Scale. To identify the ability of the scale to discriminate between clinical and non-clinical populations. DESIGN: Postal survey of individuals from a non-clinical sample. METHOD: A non-clinical sample of 212 NHS employees was sent a questionnaire pack, including the Novaco Anger Scale. A clinical sample of 58 outpatient anger-management referrals was identified from a retrospective case-note analysis. RESULTS: Descriptive data are presented for both samples. t-score conversions are provided, based on the non-clinical data. Results from a discriminant function analysis demonstrated that the Novaco Anger Scale classified participants as clinical or non-clinical with 94% accuracy. CONCLUSION: From this study it appears that the Novaco Anger Scale is able to discriminate between clinical and non-clinical populations. These data offer further support to the validity of the Novaco Anger Scale and its use in clinical assessment.

Adult↗
PubMed2004

Doing anger differently: a group percussion therapy for angry adolescent boys.

This paper describes Doing Anger Differently (DAD), a group treatment for young adolescent boys with high levels of anger. The approach is school-based, 10 weeks long, and utilizes music in the form of percussion to engage this difficult to treat population into treatment and to represent the experience of anger. A tri-level intervention is described: the experience of anger and its influence on action; the formation of meaning and identity resulting from anger and aggression; and the emphasis on group work and the interpersonal basis of anger. Techniques used throughout the group are discussed and illustrative case vignettes are provided.

Adolescent↗
PubMed1994

Psychometric evidence that mercury from silver dental fillings may be an etiological factor in depression, excessive anger, and anxiety.

Scores on the Beck Depression Inventory were compared for 25 women who had silver dental fillings (amalgams) and for 23 women without amalgams. Women with amalgams had significantly higher scores and reported more symptoms of fatigue and insomnia. Anger scores from the State-Trait Anger Expression Inventory showed that the women with amalgams had statistically significantly higher mean scores on expressing anger without provocation and experiencing more intense angry feelings. The women without amalgams scored significantly higher on controlling anger, which suggested they invested more energy in monitoring and preventing the experience and expression of anger. Anxiety scores from the State-Trait Anxiety Inventory showed the women with amalgams scored significantly less pleasant, satisfied, happy, secure, and steady, and had a more difficult time making decisions. They had significantly higher Trait Anxiety scores. The women with amalgams also had significantly higher levels of mercury in the oral cavity before and after chewing gum. The study suggests that amalgam mercury may be an etiological factor in depression, excessive anger, and anxiety because mercury can produce such symptoms perhaps by affecting the neurotransmitters in the brain.

Adult↗
PubMed1994

Anger, curiosity, and optimism.

We examined with 500 Italian subjects the relationship between the subscales of the State-Trait Anger Expression Inventory and a measure of the sense of well-being, the Life Orientation Test. As predicted, associations were not significant with scores on the scale of optimism; however, all coefficients were negative and the smallest ones were with the Anger Control scale. We also correlated scores on state and trait curiosity with those on 3 anger-expression scales; values indicated these dimensions were also unrelated to anger. The results indicate that, while anger has been proposed as an important component in the association of emotions with health, the specific type of anger expression may not be critical for one's sense of well-being. They also suggest that the construct of curiosity deserves further study as a potential measure of one's sense of well-being.

Adult↗
PubMed2002

Narcissism and anger: an exploration of underlying correlates.

Many have posited that narcissistic individuals are sensitive to insults and prone to react to such criticism with anger and hostility. Given that such anger is provoked by criticism from others, it was hypothesized that narcissistic traits which relate to perceived position of authority or superiority and an inflated sense of entitlement would make it easier for someone to perceive a remark as threatening and feel angry. It was hypothesized that these aspects of narcissism, as measured by the subscales of the Narcissistic Personality Inventory by Raskin and Hall would correlate differentially with anger, as measured by the Novaco Anger Scale in a sample of undergraduate men. Results partially confirmed the hypothesis and indicated that scores on Entitlement and Authority were positively associated with anger scores; however, superiority was not. The results imply that specific narcissistic traits such as a perceived position of authority and an inflated sense of entitlement, but not necessarily the global diagnosis of Narcissistic Personality Disorder, might be important to investigate as correlates of anger.

Adult↗
PubMed1990

Theoretical and empirical perspectives on anger.

This article reviews theoretical and empirical perspectives on anger as well as conceptualizations of anger through history. Although anger was once considered a sin or a madness to be avoided, Darwinian evolutionary theory and Freudian theory gave rise to a ventilationist approach that views expression of anger as an unequivocal good. However, global facilitation of anger can be harmful, and its benefits are not supported by research evidence. Other myths and assumptions about anger are challenged in this literature review. To the extent that psychiatric/mental-health nursing practice is based on inadequate theories or dated or flawed research, or both, our clients are not well served.

Anger↗