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PubMed1997

Anger suppression, reactivity, and hypertension risk: gender makes a difference.

The present study investigated gender-related differences in cardiovascular reactivity and the role of anger inhibition and risk for future hypertension. Tonic blood pressure served as an index of hypertension risk. Twenty-eight female and 26 male college students with high and low normal blood pressure were recruited on the basis of their mean arterial pressure. Continuous measures of heart rate and blood pressure were taken while participants carried out a series of behavioral manoeuvres including mental arithmetic, interpersonal challenge, a frustrating psychomotor test, and the cold pressor test. Participants also completed inventories assessing trait anxiety, trait anger, anger expression, and Type A. The results are in concordance with previous findings and show higher cardiovascular reactivity in men than in women and in subjects at risk for hypertension. Within the male group, a combination of hypertension risk and anger suppression led to the highest reactivity, whereas in female subjects, differences in anger-in had no effect on reactivity. The implications of these results are discussed in light of sex differences in cardiovascular morbidity and mortality.

Adolescent↗
PubMed2006

Response categories and anger measurement: do fewer categories result in poorer measurement?: development of the DAR5.

BACKGROUND: Anger is a key long-term outcome from trauma exposure, regardless of trauma type, and it is implicated as a moderator of response to treatment. It therefore seems important that anger is assessed in both epidemiological studies of trauma sequelae and in intervention evaluation research. This study explored the measurement properties of a recently investigated anger scale, the Dimensions of Anger Reactions (DAR) Scale. In our previous study, the DAR was found to be a measure of trait anger, but although brief, the nine response categories per item may have confused respondents, suggesting fewer response categories may work equally well. Additionally, our previous analysis suggested there were two redundant items within the DAR. METHODS: Three samples of Australian veterans were used to investigate the psychometric properties associated with alterations to the response categories of the DAR; veterans who participated in the DAR validation study, those participating in group therapy programmes for post-traumatic stress disorder, and veterans participating in lifestyle programmes. Item response theory analysis was used to explore the internal properties of competing DAR models, and models were assessed against external criteria. RESULTS: The results showed that the number of item responses in the DAR exceeded channel capacity, and that response bias occurred in the second half of the instrument. We hypothesized that this was due to respondents not discriminating among the many response categories. Based on a modelling exercise in which we reduced the number of DAR items from 7 to 5 and the number of response categories from 9 to 5, validation tests showed that there was no loss of sensitivity, reliability or validity. To avoid confusion with the DAR, we have referred to the revised version of the DAR as the DAR5. CONCLUSIONS: We conclude that the DAR5, which abbreviates the original DAR to half its original length, has similar psychometric properties and is therefore to be preferred especially for use with persons who are under stress, cognitively impaired or less mature. The study findings regarding the optimum number of response categories have implications for the development of other instruments.

Adult↗
PubMed2006

Scopolamine induces impairments in the recognition of human facial expressions of anger and disgust.

RATIONALE: Recent psychopharmacological studies lend support to the notion of partially dissociable neuronal systems dedicated to processing specific emotions. For example, GABA-ergic enhancement after an acute dose of the benzodiazepine, diazepam, produces specific impairments in anger and fear recognition. However, it is unclear if these impairments are a general property of benzodiazepines and other drugs that produce a similar profile of neurocognitive impairment to benzodiazepines, such as the anticholinergic, scopolamine. OBJECTIVE: We investigated the effects of scopolamine and the benzodiazepine, lorazepam, on emotion-recognition accuracy. METHODS: A double-blind independent group design was used with 48 healthy volunteers to compare the effects of scopolamine and lorazepam with an inactive placebo on a commonly used emotion-recognition task. Control measures included an episodic memory task and subjective mood ratings. RESULTS: Anger and disgust recognition accuracy was impaired after scopolamine. In contrast, lorazepam produced no impairment in emotion-recognition despite producing similar levels of sedation and anterograde amnesia to scopolamine. CONCLUSIONS: Scopolamine-induced cholinergic hypofunction selectively impaired the recognition accuracy of disgust and anger facial expressions. The effects of scopolamine on emotion-recognition are similar to those found in Huntington's disease patients. Furthermore, the impairments in anger and fear recognition previously observed with diazepam do not appear to be a general property of benzodiazepines. This suggests that alterations in emotional processing involving changes in the ability to recognize threat-related emotions (particularly, fear and anger) may not be a principal mechanism underlying anxiolysis or paradoxical aggression seen with benzodiazepines.

Adolescent↗
PubMed2005

Anger and emotional distress in patients with migraine and tension-type headache.

The objective was to evaluate the prevalence and the characteristics of anger and emotional distress in migraine and tension- type headache patients. Two hundred and one headache patients attending the Headache Center of the University of Turin were selected for the study and divided into 5 groups: (1) migraine, (2) episodic tension-type headache, (3) chronic tension-type headache, (4) migraine associated with episodic tension-type headache and (5) migraine associated with chronic tension-type headache. A group of 45 healthy subjects served as controls. All the subjects completed the State-Trait Anger Expression Inventory, the Beck's Depression Inventory and the Cognitive Behavioral Assessment. Anger control was significantly lower in all headache patients (p<0.05) except in migraineurs. Patients with migraine and tension-type headache showed a significantly higher level of angry temperament and angry reaction (p<0.05). In addition, chronic tension-type headache and migraine associated with tension-type headache patients reported a higher level of anxiety (p<0.05), depression (p<0.001), phobias (p<0.001) and obsessive-compulsive symptoms (p<0.01), emotional liability (p<0.001) and psychophysiological disorders (p<0.001). Our study shows that chronic tension-type headache and migraine associated with tension-type headache patients present a significant impairment of anger control and suggests a connection between anger and the duration of headache experience.

Adult↗
PubMed2006

Categorical perception of anger and disgust facial expression is affected by non-clinical social anxiety: an ERP study.

Anxiety has been associated with a bias for interpreting threatening information. Faces expressing anger seem to be more easily detected by socially anxious individuals than by non-anxious individuals. Similarly, disgust on a face may also reflect a negative social judgment. We tested the hypothesis that individuals displaying non-clinical social anxiety would be as sensitive to disgust as to anger interpretation by comparing individuals scoring high or low on the fear of social evaluation scale (FNE, Watson and Friend, 1969). Event-related potentials (ERP) were recorded in response to repetitions of a particular facial expression (e.g. anger) and in response to two deviating (rare) stimuli obtained by a morphing procedure, where one depicted the same emotion as the frequent stimulus, while the other depicted a different facial expression (e.g. disgust). The classic effect of categorical perception was reproduced: at a behavioral level, people detected more easily rare faces depicting a different emotion than faces depicting the same emotion. ERP results suggest that deviant faces depicting a different emotion evoked an earlier attentional N2b/P3a wave complex, together with an earlier and enhanced P3b. More interestingly, participants with non-clinical social anxiety manifested a reduced N2b wave when they had to detect a change in intensity of anger presentation. However, these individuals did not show facilitation to disengage from disgust when they have to detect angry faces, which was displayed by control participants. Implications and suggestions for further research about the role played by anger and disgust in psychopathology are outlined.

Adolescent↗
PubMed2006

Anger and ego-defence mechanisms in non-psychiatric patients with irritable bowel syndrome.

BACKGROUND: Irritable bowel syndrome is commonly accepted as a disorder closely influenced by affective factors, which can either trigger the symptoms or contribute to their persistence, independently from their aetiology. It has been previously documented that irritable bowel syndrome patients respond to a variety of emotional states (anger, fear and anxiety) with an increase in colonic motility. AIMS: The aim of this study was to evaluate the experience and the expression of anger and the prevalent ego-defence mechanisms in a group of non-psychiatric patients with irritable bowel syndrome. SUBJECTS: Fifty-two patients with irritable bowel syndrome (18 males, 34 females) and 100 healthy volunteers from the community (44 males, 56 females) matched for age, level of education and social-status were enrolled. METHODS: Assessment was conducted using the State-Trait Anger Expression Inventory and the Defence Mechanism Inventory. RESULTS: No important differences between the two examined groups were found using the State-Trait Anger Expression Inventory and Defence Mechanism Inventory. CONCLUSIONS: It can be hypothesised that stable personality features and habits, such as anger disposition and defence mechanisms, play only a marginal role in irritable bowel syndrome, while psychological and psychosocial influences may act as predisposing or precipitating factors which contribute to the pathogenesis or expression of irritable bowel symptoms.

Adult↗
PubMed2006

Toward an integrative model of the spectrum of mood, behavioral and personality disorders based on fear and anger traits: I. Clinical implications.

Current formal psychiatric approaches to nosology are plagued by an unwieldy degree of heterogeneity with insufficient appreciation of the commonalities of emotional, personality, behavioral, and addictive disorders. We address this challenge by building a spectrum model that integrates the advantages of Cloninger's and Akiskalian approaches to personality and temperament while avoiding some of their limitations. We specifically propose that "fear" and "anger" traits--used in a broader connotation than in the conventional literature--provide an optimum basis for understanding how the spectra of anxiety, depressive, bipolar, ADHD, alcohol, substance use and other impulse-control, as well as cluster B and C personality disorders arise and relate to one another. By erecting a bidimensional approach, we attempt to resolve the paradox that apparently polar conditions (e.g. depression and mania, compulsivity and impulsivity, internalizing and externalizing disorders) can coexist without cancelling one another. The combination of excessive or deficient fear and anger traits produces 4 main quadrants corresponding to the main temperament types of hyperthymic, depressive, cyclothymic and labile individuals, which roughly correspond to bipolar I, unipolar depression, bipolar II and ADHD, respectively. Other affective temperaments resulting from excess or deficiency of only fear or anger include irritable, anxious, apathetic and hyperactive. Our model does not consider schizophrenia. We propose that "healthy" or euthymic individuals would have average or moderate fear and anger traits. We further propose that family history, course and comorbidity patterns can also be understood based on fear and anger traits. We finally discuss the implications of the new derived model for clinical diagnosis of the common psychiatric disorders, and for subtyping depression and anxiety as well as cognitive and behavioral styles. We submit this proposed schema represented herein as a heuristic attempt to build bridges between basic and clinical science.

Alcoholism↗
PubMed2006

Toward an integrative model of the spectrum of mood, behavioral and personality disorders based on fear and anger traits: II. Implications for neurobiology, genetics and psychopharmacological treatment.

Current psychiatry relies on a purely categorical paradigm for diagnosis of mental disorders that profoundly impacts research and clinical practice. However, high comorbidity rates and relative non-specificity of family history for psychiatric disorders suggests that this categorical approach fails to identify the underlying diathesis. As an attempt to overcome such limitations, we developed a bidimensional model based on fear and anger traits or temperaments which does not preclude the use of a categorical approach. As a result, it is hypothesized that mood, behavioral and personality disorders share a neurobiological substrate according to combinations of fear and anger traits. Both fear and anger, when excessive or deficient, lead to increased risk for mental disorders and should be considered in genetic, neurobiological and neuroimaging studies. Fear traits are much influenced by the amygdala and the serotonergic, noradrenergic and GABAergic systems, whereas anger seems to be mostly regulated by the nucleus accumbens and the dopaminergic and glutamatergic systems. Pharmacological treatments with antidepressants and anxiolytics can be considered as essentially restraint on fear, whereas lithium and alpha2 noradrenergic agonists would attenuate fear deficiency. Dopaminergic antidepressants and psychostimulants are anger enhancers and antipsychotics and mood stabilizers, such as divalproate and carbamazepine, may share antianger effects. Drugs effective for manic and depressive phases probably have both antianger and antifear effects. This framework may lead to a better understanding of the neurobiological basis of mental health and disease, providing an integrative approach for future research.

Anger↗
PubMed2006

Anger- and aggression-related traits are associated with polymorphisms in the 5-HT-2A gene.

BACKGROUND: This study investigates the association of four single nucleotide polymorphisms (SNPs) in the serotonin 2A (5-HT-2A) receptor gene with anger-, aggression- and suicide-related behavior in a total of 566 subjects (203 German suicide attempters and 363 German community-based healthy volunteers). METHODS: Anger- and aggression-related traits were assessed by using the State Trait Anger Expression Inventory (STAXI) and the Questionnaire for Measuring Factors of Aggression (FAF). RESULTS: Three (rs643627-rs594242-rs6311: A-C-T), two (rs594242-rs6311: C-T) and a single functional (rs6311: T) marker were protective against suicidal behavior. The complementary makers (rs594242-rs6311: G-C and rs6311: C) were associated with increased risk for non-violent (p=0.01; p=0.009 respectively) and impulsive suicidal behavior (p=0.03; p=0.01 respectively). Furthermore, CC-homozygotes for the functional SNP rs6311 reported more anger- (p=0.004) and aggression-related behavior (p=0.011). CONCLUSION: We conclude that variations in the 5-HT-2A gene may modify the phenotype of suicide-, anger-, and aggression-related behavior. Further studies should especially focus on intermediate personality traits in this context.

Adolescent↗
PubMed2005

Curvilinear relationships of expressed anger and blood pressure in women but not in men: evidence from two samples.

OBJECTIVE: Early psychosomatic research proposed a hydraulic model for anger expression and blood pressure (BP); that is, people who express their anger were believed to have lower BP. Unfortunately, subsequent evaluations of this model have produced inconsistent results. In this paper, it is posited that weak methods of measuring BP, failure to address gender differences, and exclusive emphasis on linear models may have contributed to inconsistent results. DESIGN AND MEASURES: We investigated the possibility of curvilinear relationships between expressed anger and resting BP after controlling for traditional risk factors. PARTICIPANTS: Data from two samples of varying cardiovascular health status (one healthy, the other hypertensive) and ages were examined. RESULTS: Across both samples, very low and very high self-reported expressed anger was associated with the lowest diastolic BP in women. There was no equivalent finding in men. CONCLUSION: Women, but not men, have lower BP when they report to openly express their angry feelings. The results support the value of exploring curvilinear relationships and gender differences in anger expression effects on cardiovascular health.

Anger↗
PubMedDate not supplied

Imaginal exposure for anger reduction in adult outpatients: a pilot study.

Although exposure procedures have been widely accepted in the treatment of anxiety disorders, they have rarely been applied to the treatment of anger. The present paper describes an initial attempt to apply an imaginal exposure strategy to adult outpatients (n = 6) referred for anger management. This investigation reflects an empirical clinical practice approach rather than a controlled outcome study. Thus, this paper provides a clinical description of the imaginal exposure program, pre-to-posttest effectiveness data, an exploration of habituation patterns for each participant, and 15-month follow-up data from several patients. In considering the impact of the intervention, statistically significant change was found on most anger variables, the majority of patients met a criteria for clinically significant improvement on important indices of anger, and treatment effect sizes were large and compared favorably to previously studied interventions. Process data revealed a consistent habituation effect, across patients and anger stimuli, in response to repeated exposure practice. Participants' satisfaction was also positive. Finally, statistically significant and clinically meaningful change was evident at 15-months following the intervention. Data from the current pilot project are encouraging and hopefully will stimulate more methodologically rigorous clinical trials.

Adult↗
PubMed2001

Experimentally induced anger, cardiovascular reactivity, and pain sensitivity.

It was investigated whether an angry state, induced by a computer task with harassing comments, would lead to a decrease in cold pressor pain threshold and tolerance in comparison to a neutral situation. It was hypothesized that an increase in cardiovascular activity might partially mediate effects of anger. Furthermore, it was examined whether subjects given the opportunity to express anger would show reduced cardiovascular activity and pain report compared to subjects not given this opportunity. Finally, trait measures for anger expression style and hostility were included. The results show an increase instead of the expected decrease in pain tolerance for subjects in the harassment condition compared to those in the neutral condition. While cardiovascular reactivity was positively related to pain threshold and tolerance, increased anger was associated with increased pain report. It is suggested that anger and cardiovascular reactivity may have important but sometimes opposing influences on pain.

Adult↗
PubMed1999

A simple laboratory method for inducing anger: a preliminary investigation.

To facilitate the experimental study of anger, we developed a simple laboratory method to induce anger. This anger induction (AI) is similar in format to the Velten Mood Induction Procedure for depression (VMIP-D), and involves reading descriptors of anger experience, recalling relevant personal memories, and evoking the mood suggested by the sentence/memory. We administered the AI and VMIP-D to 81 undergraduate men and women and collected mood ratings before, during, and after each mood induction. The AI exhibited good sensitivity and specificity in that it induced moderate to greater increases in anger (>1 SD change) in 68% of the sample, significant decreases in happiness, and minimal changes in other emotions. Mood responses to the AI and VMIP-D were influenced by gender and order of presentation. Uses and limitations of this method are discussed.

Adult↗
PubMed2003

Anger types and the use of cigarettes and smokeless tobacco among Native American adolescents.

BACKGROUND: Although tobacco use appears common among Native Americans, the study of dual use of cigarettes and smokeless tobacco has been neglected. The current study examines tobacco use among a sample of Native American adolescents. Also, it considers how the psychological factor of anger may relate to tobacco use. METHODS: The participants were 513 Native American students from a national sample in grades 6, 8, and 10 in the United States. Cluster analysis was used to identify anger types, and these types were compared on their tobacco use. RESULTS: Cluster analysis identified four anger types. One type was the Externalizing Type, characterized by the tendency to show externalizing behaviors such as fighting and yelling. This type had an elevated rate of tobacco use. In terms of an odds ratio, the Externalizing Type was about 10 times more likely to smoke, about 6 times more likely to use smokeless tobacco, and about 8 times more likely to show dual use. The majority of dual users were the Externalizing Type. CONCLUSIONS: The results suggest that externalizing anger types are more likely to use tobacco, and that smoking cessation programs for teens could be more effective when they address anger issues.

Adaptation, Psychological↗
PubMed2000

Adrenocorticotropin responses to interpersonal stress: effects of overt anger expression style and defensiveness.

This study evaluated the influence of overt anger expression style and defensiveness on the hypothalamic-pituitary-adrenocortical (HPA) responses to acute psychological stress. These personality traits are thought to modulate the stress cardiovascular response and influence disease risk, however, little is known about their influence on HPA responses. Forty-six young, healthy male volunteers worked on counterbalanced extended public-speaking and mental arithmetic. The sample was dichotomitized into groups low vs. high in anger-out, using Spielberger's Anger-Expression Inventory, and in defensiveness, using the Marlowe-Crown Social Desirability Scale. Serum cortisol and adrenocorticotropic hormone (ACTH) concentrations were measured before and after performing each task. Heart rate (HR) and blood pressures (BP) were obtained continuously in 2-min intervals before, during and after the tasks. Public speaking produced greater adrenocortical and cardiovascular stress responses than mental arithmetic, and the greatest increases in ACTH occurred in subjects high in anger-out and defensiveness. These preliminary findings provide evidence that a mismatch between traits of preferred anger expression style and defensive style produces pronounced adrenocorticotropic responses during socially salient stress.

Adrenocorticotropic Hormone↗
PubMed2000

Frontal electrocortical and cardiovascular reactivity during happiness and anger.

The present study investigated electrocortical and cardiovascular reactivity during positive and negative emotion, and examined the relation of asymmetric frontal lobe activation to cardiovascular responses. Participants were 30 healthy, right-handed university students (mean age, 23.9; 60% female; 76% Caucasian). Electroencephalographic (EEG), blood pressure (BP), and heart rate (HR) responses were assessed while subjects engaged in laboratory tasks (personally-relevant recall tasks and film clips) designed to elicit happiness or anger. Happiness-inducing tasks evoked more prominent left than right frontal EEG activation, and greater left frontal EEG activation than anger-inducing tasks. However, anger-inducing tasks were, on average, associated with comparable left and right frontal EEG activation. Irrespective of emotional valence, cardiovascular activation was more pronounced during personally-relevant recall tasks than during the viewing of film clips. During anger recall, both greater left frontal EEG response (r=-0.46, P<0.02) and greater right frontal EEG response (r=-0.45, P<0.02) were correlated significantly with increased HR reactivity during the task. In addition, a right lateralized frontal EEG response during anger-inducing tasks was associated with greater concomitant systolic BP (P<0.03) and diastolic BP (P<0.008) reactivity. Exploratory analyses also indicated that men who displayed a left lateralized frontal EEG response during happiness-inducing tasks showed the greatest concomitant systolic BP and HR reactivity (P's<0.03). These findings suggest that asymmetric frontal EEG responses to emotional arousal may elicit different patterns of cardiovascular reactivity in healthy adults.

Adult↗
PubMedDate not supplied

Group interventions for anger in people with intellectual disabilities.

This paper describes an evaluation of a group intervention for reducing inappropriately expressed anger (as aggression) in people with intellectual disabilities. Group intervention was compared to a treatment as usual group consisting of people referred to the group but who had to wait to participate. The intervention used was based on the work of Novaco (1976; 1978) and Benson (1994). However, further modifications to the group that emphasized the contextual perspective of anger, such as the participants being accompanied by a support worker and more collaborative recording procedures, were devised. A reduction in expressed anger and measured levels of depression occurred after group treatment. Reductions in expressed anger were maintained at 6 and 12 months follow up. However, scores on the depression scale tended to increase on follow up. While caution must be expressed when considering these results, this type of intervention shows promise for reducing inappropriately expressed anger in people with intellectual disabilities Suggestions are made for future research and clinical practice.

Adult↗
PubMed2002

An open pilot study of nefazodone in depression with anger attacks: relationship between clinical response and receptor binding.

Nefazodone has been widely used as an antidepressant, but it has not been tested for depression with anger attacks. In an open study, we administered nefazodone (maximum 600 mg/day) for 12 weeks to 16 outpatients who had major depression with anger attacks. Assessment instruments comprised the Structured Clinical Interview for DSM-IV (SCID), Anger Attacks Questionnaire (AAQ), 17-item Hamilton Rating Scale for Depression (HAM-D-17), Clinician Global Impression Scale (CGI), Symptom Questionnaire (SQ), Modified Overt Aggression Scale (MOAS), and MOAS-Self-Rated. Three subjects underwent positron emission tomography (PET) with [18F]-setoperone for 5-HT2 binding potential (BP) and [11C]-SCH-23,390 for D1 BP, both at baseline and after 6 weeks of treatment. Eight subjects underwent PET with [18F]-setoperone and with [11C]-SCH-23,390 at baseline only. In an examination of whether D1 and 5HT2 (data available in six subjects) receptor BP predicted treatment response, we found significant decreases in the HAM-D-17, CGI-S, weighted MOAS, MOAS verbal scale, OAS Self-Rated verbal, SQ Depression and Anger/Hostility scales after nefazodone; 50% responded to nefazodone (defined as >or=50% decrease in HAM-D-17 score), and 44% reported disappearance of anger attacks. A statistically significant percentage decrease in 5HT2 BP was observed for the right mesial frontal and left parietal regions after 6 weeks of treatment. No significant change was observed in D1 BP in any region. Although CGI-I scores correlated significantly with D1 BP in the left thalamic region, the correlation was not significant after Bonferroni correction. The effectiveness of nefazodone for depression with anger attacks may be related to widespread changes in 5HT2 receptor BP.

Adult↗