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Anger in the combat zone.

A U.S. Army Reserve Combat Stress Control prevention team was dispatched to Afghanistan in support of Operation Enduring Freedom to provide preventative mental health care to a U.S. Army airborne division and Special Operations forces. The team's mission was to ensure mental health readiness of units in the area of operations. In Bagram, Afghanistan, the Combat Stress Control team identified anger as a very prevalent emotion in the combat zone. Anger management interventions with individual and group counseling were implemented to help soldiers cope with anger. Of 7,000 military personnel stationed there during the team's rotation, there was not one completed suicide or homicide. This article describes how the 113th Medical Company identified, treated, and controlled anger at Bagram Airbase, Afghanistan, between June 20, 2002, and December 20, 2002, with anger management interventions. This article does not address the psychophysiological features of anger.

Afghanistan↗

Aggressive verbal behaviour as a function of experimentally induced anger in persons with psoriasis.

The importance of psychosocial factors on the etiology and fluctuating disease activity of psoriasis has been discussed in recent years. The present experiment investigated whether psoriatics in an anger-inducing situation show less aggressive verbal behaviour than average person. Twenty-six psoriatics and 26 matched healthy controls were randomly assigned to either an anger-inducing or a non-anger-inducing social situation. The experimental conditions were arranged so that the persons were confronted with either negative, derogatory, or positive, favorable feedback on eight characteristics (intelligence, appearance, maturity, tolerance, honesty, friendliness, humor, and helpfulness). Standardized feedback was given by a confederate of the experimenter. Immediately after the feedback was received by the subjects the photo hand test (PHT) was applied. The PHT is an item-analyzed, validated projective test for aggression. Two independent raters categorized the subjects' responses into six mutually exclusive categories, including a category for responses with aggressive content. 2 x 2 analysis of variance (psoriatics vs controls; anger-induced vs non-anger induced) were calculated for the aggressive responses and the acting-out score (AOS). The results showed a significant interaction, suggesting that psoriatics did indeed exhibit fewer verbal aggression responses under anger-inducing circumstances than the controls.

Adult↗

Constraints for emotion specificity in fear and anger: the context counts.

We investigated psychophysiological responses to fear and anger inductions during real-life and imagination. Female participants (N = 158) were assigned to a fear-treatment, fear-control, anger-treatment, or anger-control group. Context (real-life, imagination) was varied in two sessions of fixed order. Eleven self-report and 29 somatovisceral variables were registered. Results showed that (a) except during anger imagination, control groups were emotionless; (b) in control groups, contexts prompted diverging somatovisceral responses, but similar emotion self-reports; except during fear imagination, the emotion inductions (c) were successful and (d) produced specific emotion reports; (e) during real-life, somatovisceral fear and anger responses exhibited a marked cardiovascular defense reflex; (f) in addition, real-life fear showed an adrenaline-like specific response pattern, whereas real-life anger showed specific forehead temperature and EMG extensor increases, accompanied by an elevated DBP during imagination. A Component Model of Somatovisceral Response Organization is proposed.

Adolescent↗

Anger attacks in depressed outpatients and their response to fluoxetine.

"Anger attacks" are spells of anger that are inappropriate to the situation and have physical features resembling panic attacks. The Anger Attacks Questionnaire, designed to assess these attacks, was administered to 79 consecutive patients (25 men and 54 women, mean age 38.8 +/- 10.3 years) diagnosed as having major depression with the Structured Clinical Interview for DSM-III-R. Of these 79 depressed patients, 34 (13 men and 21 women) reported having anger attacks according to our criteria. The prevalence of anger attacks in a group of 31 younger depressed patients (48%) was significantly higher (p = .048) than that of 29 normal controls (21%) of similar age. Of the 79 depressed patients, 19 (7 men, 12 women) were treated openly with fluoxetine at 20 mg/day for at least 8 weeks. At pretreatment, 9 patients (47%) had reported anger attacks, only 3 (16%) continued to report them after treatment, and the difference was statistically significant (p less than .05).

Adult↗

Educational attainment, anger, and the risk of triggering myocardial infarction onset. The Determinants of Myocardial Infarction Onset Study Investigators.

BACKGROUND: While it has recently been shown that anger may trigger the onset of acute myocardial infarction, there has been no study of the role of socioeconomic factors in such triggering. Socioeconomic factors, such as educational attainment, may modulate the risk of triggering because of their influence on individual reactivity to external stressors and on the prevalence of traditional cardiac risk factors. OBJECTIVE: To evaluate the influence of educational attainment on the relative risk of myocardial infarction onset following episodes of anger. METHODS: We interviewed 1623 patients (501 women) an average of 4 days following a myocardial infarction. Data were collected on standard demographic variables as well as risk factors for coronary artery disease. Educational attainment was categorized into 3 levels: less than high school, completed high school, and at least some college. Anger was assessed by the Onset Anger Scale, a single-item, 7-level, self-report scale. Occurrence of anger in the 2 hours preceding the onset of myocardial infarction was compared with its expected frequency using self-matched control data based on the case-crossover study design. RESULTS: The risk of having a myocardial infarction triggered by isolated episodes of anger declined consistently and significantly with increasing levels of educational attainment (P = .03). The relative risk was twice as high among those with less than high school education (relative risk, 3.3; 95% confidence interval, 2.0-5.4) compared with patients with at least some college education (relative risk, 1.6; 95% confidence interval, 0.9-2.9). CONCLUSIONS: These findings indicate that socioeconomic factors are potent modulators of the risk of triggering acute cardiovascular disease onset. A better understanding of the physiological mechanisms underlying this association may lead to novel approaches to prevent acute cardiovascular events.

Adult↗

[Coping with anger and the premenstrual syndrome].

OBJECTIVE: Investigations in recent years confirm the importance of "anger coping-behaviour" for women suffering from different diseases such as migraine, high blood pressure and coronary heart disease. The hypothesis for this investigation was that "anger-in" coping (anger-suppression) is a possible causal factor in the premenstrual syndrome. METHODS: Data analysis was undertaken on 38 patients (average age 32 years) fulfilling the inclusion criteria. The Menstrual Distress Questionnaire (MDQ) was used for measuring the intensity of premenstrual symptoms. As a result of a cluster analysis of MDQ scores, the 38 patients were divided into 3 subgroups (group 1: mild symptoms, n = 16; group 2: moderate symptoms, n = 10; groups 3: severe symptoms, n = 12). The 3 groups were compared by using different questionnaires regarding the variables anger, attitudes to menarche and menstrual bleeding, anxiety and depression. Additionally, sociodemographic data were obtained and a daily record taken for 2 days premenstrually and 5 day postmenstrually of subjective replies to a standardized protocol. RESULTS: Contrary to our expectations the results showed no significant differences for "anger coping" between the 3 subgroups. Increased daily stress (professional and familial double load) statistically significantly influenced the intensity of premenstrual symptoms. Additional significant factors were a general tendency towards somatization disorder, a negative attitude toward menarche and menstrual bleeding, as well as a tendency to depressive mood in patients with severe premenstrual symptoms. CONCLUSION: Emotional disorders (anger, anxiety) showed less influence on the premenstrual syndrome in the investigated women than daily stress and medical anamnesis.

Adaptation, Psychological↗

Dysphoria, vulnerability and identity. An eulogy for anger.

Compared with the bulk of psychiatric literature dedicated to sadness or euphoria, dysphoric states have received relatively little attention. Perhaps we find ourselves facing a removal of anger from the horizon of contemporary psychopathology. Even less attention is given to the 'doublets' of anger. Anger marks off a region of the psyche within which the game of identity is played: as indignation, it defends the limits of that which is tolerable, the border upon which to keep watch, the trench from which to fight. But as fury, in the excess of the absolute affirmation of one's own existence, it incarnates the wreckage and the bloody fall of identity - i.e. pathology. The topic then collects the interweaving of the subjectivising character of rage on the one side, and on the other the explosive one, which breaks up the unifying and conciliatory direction which rationality enforces upon the subject - 'anger of life' and 'anger of death'. Both dimensions are explored with special concern to the reason for empathising with anger.

Death↗

Young children's adjustment as a function of maltreatment, shame, and anger.

Maltreated children are at increased risk for behavior problems. This study examines a model in which shame mediates the potential relation between maltreatment and anger, and anger mediates the potential relation between shame and behavior problems. Participants were 177 children (ages 3 to 7 years) and their mothers, 90 of whom had histories of perpetrating neglect and/or physical abuse. Physical abuse, but not neglect, was related to increased shame during an evaluative task; shame was related to increased anger; and anger to teacher ratings of total behavior problems and externalizing problems. Age moderated the relation between physical abuse and adjustment, as abuse was related to more total problems only among the younger children. Anger was a significant mediator of shame and both behavior problems and externalizing problems. Shame, anger, age, and type of maltreatment appear to be important factors in explaining variance in behavioral adjustment following a history of maltreatment.

Adaptation, Psychological↗

Buddhist conceptualization and treatment of anger.

From the Buddhist point of view, anger is a form of suffering-because the angry individual suffers as well as his or her victims. In the traditional Buddhist view, suffering is caused by three mental factors, The Three Poisons: Desire, Aversion, and Ignorance. The dynamics of anger are conceptualized on the basis of these three mental factors, as well as the biology of anger and aggression. The treatment of anger is presented in seven steps: (i) Taking Responsibility; (ii) Becoming Aware; (iii) Understanding Anger; (iv) Reflection; (v) Decision: (vi) Relaxation; and (vii) Opening the Heart.

Aggression↗

Research review on anger in psychotherapy.

This article selectively reviews clinically relevant research on the theory and treatment of anger. Anger is first defined, within the context of emotion theory, as the cognitive, behavioral, physiological, experiential, and social manifestations of a central nervous system process. The theories and techniques used to treat anger from several theoretical perspectives are then evaluated, making conceptual links to a basic affective model. We then review research on the treatment of anger in clinical populations (aggressive adults and children, clients with post-traumatic stress disorder, and clients with cardiovascular disease). We conclude with a discussion of anger suppression and inhibition.

Adult↗

End piece: reflections on the treatment of anger.

Research on the nature of anger and how it differs from other emotions is reviewed. Dimensions that differentiate disturbed from normal anger are also discussed. Based on the research and results of several reviews of anger treatment, an ideal treatment package for the treatment of anger is presented. The components include: (i) addressing motivation; (ii) cultivating the therapeutic alliance; (iii) managing physiological arousal; (iv) fostering cognitive change; (v) implementing behavior change; (vi) providing environmental supports for change; (vii) teaching relapse-prevention skills; and (viii) initiating restitution and reintegration. Also, the articles describing experiential, self psychology, cognitive-behavioral, Buddhist, and systems approaches to anger are compared and contrasted. Each of these treatment approaches is compared with the ideal treatment components.

Anger↗

Expression of anger as a function of assertiveness and sex.

Examined differences between asserters and nonasserters and between the sexes on anger expression. Thirty-seven male and 53 female college students were administered the College Self-Expression Scale, the Buss Durkee Hostility Inventory, and the Anger Self-Report. As hypothesized, asserters and males expressed more anger and aggression, and nonasserters experienced more covert anger. The clinical/treatment implications of these findings were discussed. A finding discrepant with previous research and the present researchers' expectations, that men scored higher than women on guilt and condemnation of anger, was thought to reflect this study's sample rather than an actual population difference.

Aggression↗

The expression of anger and its relationship to symptoms and cognitions in obsessive-compulsive disorder.

We compared the association between obsessive-compulsive disorder (OCD) and the expression of anger in a sample of 71 patients and 71 college students. Some authors [Rubenstein et al., J Anxiety Disord 1995;9:1-9] have proposed that anger and hostility underlie the symptoms of OCD; however, there has been little empirical study of this relationship. One recent study [Whiteside and Abramowitz, Cog Therapy Res 2004;28:259-268] with college undergraduates found that the association between OCD symptoms and anger was attributable to depressive symptoms. In the present study, we compared the expression of anger in a sample of patients diagnosed with OCD and nonclinical volunteers. Consistent with the previous study, we found increased levels of anger in patients with OCD as compared to control participants; however, these differences could be attributed to between-group differences in general distress. These results were discussed within the framework of the cognitive theory of OCD.

Adult↗

Adolescents' experiences of anger in a residential setting.

There is a substantial literature, covering a range of populations, looking at the phenomenon of anger and its expression. However, remarkably little is known about adolescent experiences of anger. The present study looks at adolescent anger within the confines of a residential establishment. Using a qualitative methodology to consider young peoples' own account of anger-provoking incidents, a description is given of typical settings, reactions, and outcomes in angry incidents. The implications of this information for both staff training and anger management programmes is explored.

Adolescent↗

Cardiovascular consequences of expressing, experiencing, and repressing anger.

Psychoanalytic theory's pathogenic view of repression gave rise to the widely held belief that the expression of anger is beneficial to mental and physical health. The present paper reviews a number of experimental and correlational studies which demonstrate that the full expression of anger, with its vocal manifestations, is associated with significant cardiovascular hyperreactivity. Furthermore, epidemiological studies indicate that such expression of anger are also related to coronary heart disease (CHD) and to some physiological and hormonal changes that have been implicated in the pathophysiology of CHD. On the other hand, neither the mere experience of anger nor its repression has any of the above negative cardiovascular consequences, although the repression of anger seems to have other untoward health consequences.

Adult↗

Covariation of sexual desire and sexual arousal: the effects of anger and anxiety.

To test Kaplan's model of hypoactive sexual desire, this investigation examined the effects of anger and anxiety presented during sexual stimuli. Subjects included 24 male undergraduates, free from psychological and medical problems that interfere with sexual function. Each subject was presented with three audiotapes, containing sexual content and statements by the participants that were designed to evoke anger or anxiety or that were situationally appropriate (control condition). Penile tumescence and sexual desire were monitored continuously. Results indicated significant differences in sexual desire in each of the three conditions, with desire highest during the control condition, followed by the anxiety condition, and last, the anger condition. Tumescence was decreased during the anger condition, relative to the control and anxiety conditions, which were not significantly different from one another. These findings partially support Kaplan's model of maintaining factors in hypoactive sexual desire, by demonstrating that anger may be the primary mechanism through which sexual desire and arousal are inhibited. In this study, anxiety impaired desire but did not affect tumescence. Implications for the study of emotional influences on sexual responding are discussed, including the need for investigation of other parameters of sexual motivation.

Adolescent↗

Anger expression and chronic pain.

Intensity of angry feelings and styles of expressing anger were examined for their relationship to measures of the chronic pain experience. Subjects were 142 chronic pain patients. Multiple regression analyses revealed that a style of inhibiting the expression of angry feelings was the strongest predictor of reports of pain intensity and pain behavior among a group of variables including demographics, pain history, depression, anger intensity, and other styles of anger expression. In a similar manner anger intensity contributed significantly to predictions of perceived pain interference and activity level. More conservative hierarchical regression analyses supported these findings. Results are consistent with explanatory models of pain and disability that hypothesize an etiologic role of a pervasive inability to express intense negative emotions, particularly anger.

Adult↗

The association between anger and hostility and risk factors for coronary heart disease in children and adolescents: a review.

We reviewed the published literature on the association between anger and hostility and risk factors, both physiologic and behavioral, for coronary heart disease (CHD) in youth. The rationale for this review is based on observations that pathology and risk factors associated with CHD in adults, as well as patterns of expressing anger and hostility, often begin in childhood and adolescence; hence, it is imperative that we better understand the relationship between anger and CHD risk factors in young people if we are to develop interventions to change risk factor profiles. The first section discusses development of CHD risk factors and describes studies of the pathologic precursors of CHD that demonstrate the early age of onset for pathologic changes, the tracking of physiologic and behavioral risk factors from youth to adulthood, and the young age of initiation of behavioral risk factors associated with CHD. The second section discusses both the development and tracking of the constructs of anger and hostility. The third section provides a review of the epidemiologic studies that assess the association between anger or hostility and both physiologic and behavioral CHD risk factors among school-age children. The final section provides an analysis and synthesis of the preceding sections and makes suggestions for further research.

Adolescent↗