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PubMed1999

Repressed anger and patterns of cardiovascular, self-report and behavioral responses: effects of harassment.

We hypothesized that anger repressors would show discrepancies between self-reported anger and cardiovascular and behavioral responses only during harassment. Subjects (N=102) were assigned randomly to condition. In the nonharassment condition, subjects told stories about eight Thematic Apperception Test cards without any harassment. In the harassment condition, subjects told four stories without harassment, and then told four more stories with harassment. Words connoting aggressive behavior and angry/hostile affect were coded from story content. Subjects were classified into low anger expressor, anger repressor, high anger expressor, and defensive anger expressor categories based on median splits of the Anger-Out Subscale and Marlowe-Crowne Social Desirability Scale. Results showed that harassed anger repressors reported anger comparable to that of low anger expressors but less than high expressors, whereas their heart rate (HR) reactivity was comparable to high expressors, but greater than low anger expressors. Increases in anger words did not distinguish repressors from other groups. Repressed anger may represent a distinct anger management style characterized by a discrepancy between acknowledged anger and cardiovascular reactivity--effects that become fully manifest only during interpersonal provocation.

Acting Out↗
PubMed2003

Differential effects of expressive anger regulation on chronic pain intensity in CRPS and non-CRPS limb pain patients.

Research has shown that the anger management styles of both anger-in (suppression of anger) and anger-out (direct verbal or physical expression of anger) may be associated with elevated chronic pain intensity. Only the effects of anger-out appear to be mediated by increased physiological stress responsiveness. Given the catecholamine-sensitive nature of pain mechanisms in complex regional pain syndrome (CRPS), it was hypothesized that anger-out, but not anger-in, would demonstrate a stronger relationship with chronic pain intensity in CRPS patients than in non-CRPS chronic pain patients. Thirty-four chronic pain patients meeting IASP criteria for CRPS and 50 non-CRPS (predominantely myofascial) limb pain patients completed the McGill Pain Questionnaire-Short Form (MPQ), the Anger Expression Inventory (AEI), and the Beck Depression Inventory (BDI). Analyses revealed no diagnostic group differences in mean scores on the anger-in (AIS) and anger-out (AOS) subscales of the AEI, or on the BDI (values of P>0.10). Results of general linear model analyses revealed significant AOS x diagnostic group interactions on both the sensory (MPQ-S) and affective (MPQ-A) subscales of the MPQ (values of P<0.05). In both cases, higher AOS scores were associated with more intense chronic pain in the CRPS group, but with less intense pain in the non-CRPS limb pain group. Inclusion of BDI scores as a covariate did not substantially alter the AOS x diagnostic group interactions, indicating that these AOS interactions were not due solely to overlap with negative affect. Although higher AIS scores were associated with elevated MPQ-A pain intensity as a main effect (P<0.05), no significant AIS x diagnostic group interactions were detected (values of P>0.10). The AIS main effect on MPQ-A ratings was accounted for entirely by overlap with negative affect. Results are consistent with a greater negative impact of anger-out on chronic pain intensity in conditions reflecting catecholamine-sensitive pain mechanisms, presumably due to the association between anger-out and elevated physiological stress responsiveness. These results further support previous suggestions that anger-in and anger-out may affect pain through different mechanisms.

Adult↗
PubMedDate not supplied

Anger and incident heart disease in the caerphilly study.

OBJECTIVE: The idea that anger may predict ischemic heart disease (IHD) is more than 30 years old. Some, but not all, prospective studies have supported this suggestion. Attention has focused on hostility as the critical component of anger for IHD risk. This idea is explored using prospective data from the Caerphilly study. METHODS: A sample of 2890 men aged 49 to 65 years living in and around Caerphilly, South Wales, was identified. Anger was assessed using the Framingham scales comprising "anger symptoms," "anger in," "anger out," and "anger discuss." A new "suppressed anger" scale was also constructed. Cardiovascular risk factors assessed included baseline blood pressure, total and high-density lipoprotein cholesterol, fibrinogen, white cell count, psychiatric caseness as assessed by the General Health Questionnaire, social support, smoking habit, alcohol consumption, leisure exercise, body mass index, and calorie intake. Prediction of IHD, measured as the occurrence of a major event over a follow-up period of 9 years, was assessed using multiple logistic regression analysis. RESULTS: A low anger out score predicted increased risk of a major IHD event (relative odds (RO) = 1.70; 95% confidence interval = 1.26-2.29 for all RO). This association was unchanged on controlling for physiological risk factors (RO = 1.74), psychosocial risk factors (RO = 1.72), and behavioral risk factors (RO = 1.69). Suppressed anger showed associations with incident IHD similar to those of anger out but identified the population at risk more closely. CONCLUSIONS: Anger out and suppressed anger were predictive of incident IHD. Neither of these constructs are overtly similar to hostility. These findings suggest there may be mechanisms other than hostility by which anger predicts IHD risk and that a conceptually varied approach to anger is currently appropriate.

Aged↗
PubMed1989

Gender differences in anger expression: health implications.

Anger expression modes were examined in a diverse sample of mid-life men and women (N = 139) participating in the third phase of a longitudinal study of health that began in 1982 at the World's Fair and a metropolitan general hospital in Tennessee. Contrary to previous studies, men and women did not differ in the likelihood of suppressing their anger (anger-in), nor were there gender differences in anger-out. However, t tests revealed significant differences between men and women in the likelihood of discussing anger and expressing anger via physical symptoms (women higher on both). The only mode of anger expression related to poorer health status was expression of anger via physical symptoms; anger-in, anger-out, and anger-discuss modes were unrelated. Correlates of anger symptoms for both men and women included lower levels of education and optimism, poorer health habits, and external locus of control beliefs. Several correlations were found to be gender-specific; e.g., women who exhibited more anger symptomatology were not suppressors of their anger, but directed it outward, taking it out on others and blaming others. Implications were discussed.

Adaptation, Psychological↗
PubMed1998

Adult attachment style and individual differences in functional versus dysfunctional experiences of anger.

Three studies examined the association between adult attachment and anger. Study 1 examined attachment-style differences in self-reports of anger-proneness, anger expression, anger goals, and responses to anger. Study 2 assessed attachment style, physiological signs of anger, and attribution of hostile intent. Study 3 used a lexical-decision task for studying attachment-style differences in expected anger outcome. Secure persons scored lower in anger-proneness, endorsed more constructive anger goals, reported more adaptive responses and more positive affect in anger episodes, attributed less hostile intent to others, and expected more positive outcomes than insecure persons. For ambivalent persons, the anger experience also included lack of anger control and anger-in. For avoidant persons, it included high hostility, escapist responses, and lack of awareness of physiological signs of anger. The underlying action of working models is emphasized in the discussion.

Adult↗
PubMed1989

Potential for hostility and dimensions of anger.

Recent reviews have linked Potential for Hostility derived from the Structured Interview (SI) to coronary artery disease, independent of the global Type A pattern. The present study examined the construct validity of Potential for Hostility ratings by correlating Potential for Hostility with 21 scales from four widely used anger/hostility measures: 7 scales from the Anger Self-Report, 8 scales from the Buss-Durkee Hostility Inventory, the total score from the Novaco Anger Inventory, and 5 scales from the Multidimensional Anger Inventory. The pattern of correlations revealed that Potential for Hostility was significantly related to scales reflecting awareness and arousal of anger, particularly the verbal expression of anger. To identify underlying anger dimensions, the 21 scales were factor-analyzed. Examination of two and three rotated principal components confirmed previous solutions. The first component, representing anger-arousing and -eliciting situations and anger awareness, was labeled Experience of Anger. The second component, consisting of scales dealing with either physical assault or verbal expression of anger, was labeled Expression of Anger. When a third factor was retained, it contained scales of suspicion, mistrust-suspicion, and guilt: It was therefore labeled Suspicion-Guilt. Potential for Hostility was correlated only with the Expression of Anger factor in the two-factor solution; in the three-factor solution, Potential for Hostility was correlated equally with the Experience of Anger and Expression of Anger factors but was not correlated with the Suspicion-Guilt factor. The implications of these results for the assessment of hostility are discussed.

Adult↗
PubMed1989

Associations of blood pressure with self-report measures of anger and hostility among black and white men and women.

This study examined associations between blood pressure (BP) and dispositional variables pertaining to anger and hostility. Black and White 25- to 44-year old male and female normotensives and unmedicated mild to moderate hypertensives completed four reliable self-report scales--the Cook-Medley Hostility (Ho) Scale, the Trait Anger subscale of the State-Trait Anger Scale (STAS-T), and the Cognitive Anger and Somatic Anger subscales of the Cognitive-Somatic Anger Scale--plus the Framingham Anger Scale and the Harburg Anger Scale. They also engaged in three laboratory tasks--Type A Structured Interview (SI), a video game, and a cold pressor task--that elicit cardiovascular reactivity. Ambulatory BP readings at home and at work were also obtained from most subjects. Blacks had significantly higher Ho and lower STAS-T scores than did Whites. Women reported higher levels of somatic anger than did men. White women showed significant positive correlations between STAS-T and systolic BP (SBP) and diastolic BP (DBP) both at rest in the laboratory and during the SI. Black women revealed significant positive relationships between STAS-T and SBP and DBP at rest in the laboratory and at work as well as with DBP during the cold pressor test. For Black men, cognitive anger and DBP at rest were positively related. In contrast, White men revealed significant negative correlations between Ho scores and SBP at rest and during the video game; these men also showed significant negative relationships between somatic anger and SBP and DBP reactivity during the cold pressor test. Women, but not men, showed significant positive relationships between all four anger measures and ambulatory BP at work. Whereas main effects relating anger and cardiovascular measures were not apparent as a function of race, Blacks demonstrated significantly greater SBP and DBP reactivity than Whites during the cold pressor test, with the converse occurring during the SI. Men demonstrated significantly greater DBP reactivity than women during the video game. The present findings indicate that self-reports on anger/hostility measures and cardiovascular responses to behavioral tasks differ as a function of race but that relationships between anger and BP regulation need to take into account possible race-sex interactions and selection of anger/hostility measures.

Adult↗
PubMed2002

The relation of anger expression with blood pressure levels and hypertension in rural and urban Japanese communities.

OBJECTIVE: To examine the relation of anger expression with blood pressure and hypertension among Japanese. DESIGN: A cross-sectional study. METHODS: Subjects were 4374 men and women aged 30-74 years from rural and urban communities. Anger expression was estimated using the anger-out and anger-in scores of the Spielberger Anger Expression Scale. Multiple linear regression analyses were performed to estimate the associations of anger expression scores with blood pressure. Proportions of hypertensives among the tertiles of anger expression scores and the relative odds of hypertension for low versus high tertiles of anger expression scales were calculated using logistic regression models. RESULTS: The anger-out score was inversely associated with systolic and diastolic blood pressure levels for men; a four-point (one standard deviation) lower anger-out score was associated with 1.6 mmHg [95% confidence interval (CI), 0.6-2.6] greater systolic blood pressure and 0.6 mmHg (95% CI, -0.03 to 1.2) greater diastolic pressure after adjustment for age, body mass index, alcohol intake, smoking category, and parental history of hypertension. The adjusted relative odds of hypertension for low versus high tertiles of anger-out was 1.60 (95% CI, 1.19-2.15). These inverse associations were more evident among men with low coping behavior than among those with high coping behavior. For women, the anger-out score was not associated with blood pressure. There was no relation between the anger-in score and either blood pressure or hypertension in either men or women. CONCLUSIONS: This study suggests that Japanese men who do not express their anger, especially when they have low coping behavior, may have an increased risk of high blood pressure.

Adult↗
PubMed1989

Anger and hostility in depression.

The present study examined the relationship between depression and various dimensions of anger using multiple measures of anger and hostility and comparing depressed subjects with both a normal sample and a clinical sample with predominant anger difficulties. Three groups of subjects were obtained: a normal sample of 120 parents of elementary school children, 36 psychiatric inpatients meeting Research Diagnostic Criteria for major depressive episode, and 54 hospitalized veterans meeting Diagnostic Interview Schedule criteria for posttraumatic stress disorder (PTSD). The three groups differed significantly on all measures of anger experience, hostility, anger suppression, and anger expression. The depressed group reported greater levels of hostility and anger experience than the normal group but less than the PTSD group. On measures of anger suppression and expression, the depressed group exhibited more suppression than either the normal or the PTSD group and generally reported levels of anger expression comparable with the normal group's. The PTSD group reported the highest levels of anger expression. Within the depressed group, severity of depression was positively associated with levels of hostility and anger experience but was not related to measures of anger expression and was only partially related to anger suppression. These results are discussed as they relate to the "anger turned in" hypothesis of psychodynamic theories of depression, and directions for future research are noted.

Adult↗
PubMed1992

Effectiveness of negative-thought-reduction, meditation and placebo training treatment in reducing anger.

Twenty-nine highly angry subjects who obtained high scores on Spielberger's Trait component of State-Trait Anger Scale went through a thought-listing procedure to determine their negative self-statements in response to high, medium, and low anger-arousing situations. It was found that subjects made more negative self-statements in response to a high anger-arousing situation compared to the medium and low anger-arousing situations. The subjects were divided into four groups. Subjects in one group were trained to reduce their negative thoughts, subjects in a second group were trained to meditate, subjects in the third group were asked to imagine the high anger-arousing situations (placebo procedure), and subjects in the fourth group were given no treatment. It was found that the subjects in the Negative-thought-reduction, Meditation and Placebo groups showed improvement in trait anger, anger aroused through high-anger situations, anger scores across a wide variety of situations, unconstructive coping, and anger measured through physiological symptoms. The gains made through intervention were maintained at a 6-week follow-up. The No-treatment Group showed no significant change in anger scores across a wide variety of situations, unconstructive coping, and physiological symptom scores but showed a small but significant improvement in trait anger and in anger aroused by high-anger situations.

Adult↗
PubMedDate not supplied

Major depressive disorder with anger: a bipolar spectrum disorder?

BACKGROUND: Depression with anger may be more common in bipolar disorders. The aim of the study was to assess whether major depressive disorder (MDD) with anger could be included in the bipolar spectrum, by comparing it to MDD without anger and to bipolar II disorder. METHODS: Consecutive outpatients (281 bipolar II disorder and 202 MDD) presenting for major depressive episode (MDE) treatment were interviewed with the DSM-IV structured clinical interview. Clinical variables used to support the inclusion of MDD with anger in the bipolar spectrum were age of onset, many MDE recurrences, atypical features of depression, depressive mixed state (an MDE plus some concurrent hypomanic symptoms), and bipolar family history. RESULTS: Frequency of MDE with anger was 50.5% [61.2% in bipolar II, and 35.6% in MDD (z = 5.5, p = 0.0000, 95% CI 16.8-43.3%)]. Logistic regression of MDE with anger (dependent variable) versus bipolar variables showed that MDE with anger was significantly associated with all bipolar variables, apart from recurrences. MDD with anger, compared with MDD without anger, had significantly lower age of onset, more marked depressive mixed state, a bipolar family history with more cases, but comparable atypical features and Global Assessment of Functioning scores. MDD with anger, compared with bipolar II disorder, had significantly higher age of onset, less atypical features, and a bipolar family history with less cases. CONCLUSIONS: MDE with anger was common in outpatients (more in bipolar II disorder). MDD with anger may be midway between MDD without anger and bipolar II disorder, and might be included into the bipolar spectrum. However, MDD with anger does not appear to be associated with the often reported negative response to monotherapy with antidepressants.

Adult↗
PubMed2004

Anger management style, blood pressure reactivity, and acute pain sensitivity: evidence for "Trait x Situation" models.

BACKGROUND: Anger management style is related to acute and chronic pain, but it is not clear whether anger arousal is needed for these associations to emerge or whether physiological mechanisms mediate these links. PURPOSE: "Trait x Situation" models were examined to determine whether relationships between anger-out and pain and anger-in and pain depended on anger provocation's preceding pain induction and whether pain sensitivity variance explained by anger management style overlapped with variance in harassment-induced blood pressure reactivity. METHODS: Healthy individuals (N = 53) underwent either mental arithmetic with harassment and then a cold pressor (MA/CP) or vice versa (CP/MA). The Spielberger Anger Expression Inventory assessed anger-out using the Anger-Out subscale (AOS) and anger-in using the Anger-In subscale (AIS). RESULTS: AOS x Order and AIS x Order interactions for pain tolerance emerged, such that (a) AOS was related negatively to tolerance among MA/CP participants, whereas AOS and tolerance were not related in CP/MA; (b) AIS was related positively to tolerance in MA/CP, whereas AIS was related negatively to tolerance in CP/MA; and (c) tolerance variance accounted for by AOS in MA/CP overlapped substantially with tolerance variance accounted for by diastolic blood pressure reactivity. CONCLUSIONS: Findings support the notion that anger management style affects pain and are consistent with evidence that deficient endogenous opioid functioning may be one mechanism through which anger-out is linked to both pain sensitivity and cardiovascular stress reactivity, a connection that appears most reliably when anger is provoked.

Adaptation, Psychological↗
PubMedDate not supplied

State anger and the risk of injury: a case-control and case-crossover study.

PURPOSE: Previous studies have examined anger at a given moment (state anger) and proxies for injury, or anger as a trait and injuries per se. Findings have been inconsistent. We sought to define further the relationship between state anger and risk of injury. METHODS: We conducted a case-control and case-crossover study in all 3 emergency departments in 1 county in Missouri. Cases were patients seeking care for an acute injury. They were compared with 2 controls: the patient himself or herself 24 hours before, and an individual recruited by telephone from the community and matched for age-group, sex, and time. Self-reported anger was assessed with 3 Likert scale items. Anger just before the injury was compared in case-crossover analyses with the respondent's own level of anger 24 hours before, and in standard case-control analyses with community participants' level of anger at the same hour the same day of the week in a subsequent week. RESULTS: Of 2,517 patients, 2,446 provided data on anger just before the injury, and 2,117 reported data for 24 hours before injury. Of 1,856 community individuals, 1,533 provided complete data. Anger was prevalent. Of injured patients, 9%, 7%, and 4% reported feeling "quite a bit" or "extremely" "irritable," "angry," and "hostile," respectively, just before injury. Odds ratios for risk of injury were notably higher for greater degrees of anger; for example, for "angry," they were 1.8 (95% confidence interval, 1.1-2.7) for "quite a bit" and 7.2 (3.9-13) for "extremely." Odds ratios in women were substantially lower than those in men. Anger was not associated with fall and traffic injuries, but anger was strongly associated with intentional injuries inflicted by another person in both men and women. CONCLUSIONS: High levels of self-reported state anger increase the risk of injury, especially among men, and specifically the risk of intentional injury in both sexes.

Accidents↗
PubMed2004

[Anger, problem behaviors, and health status in adolescent women].

PURPOSE: This cross-sectional study was designed to identify anger-expression types of adolescent women and investigate the relation between the identified anger-expression types and their problem behaviors and health status. METHOD: One hundred ninety nine high school freshmen were recruited from September to November, 2003. Data was analyzed using descriptive statistics, cluster analysis, chi(2)-test, ANOVA, and Duncan's multiple comparison test. RESULT: Three anger-expression types in adolescent women were found; Anger-out/in, Anger-control/in, and Anger- control type. Adolescent women with frequently using the anger-out/in type and with higher state anger reported more delinquent behaviors, more health risk behaviors, and higher psychosomatic symptoms. However, adolescent women with lower state anger and frequently using the anger-control type reported more depression scores. CONCLUSION: There is a need to further clarify the relationship between anger-expression types and depression in adolescent women. The findings suggest the necessity of a development of the program for lowering the anger level and controlling the unfavorable anger expression types such as the anger-out in.

Adolescent↗
PubMed2005

[A correlational study among perceived stress, anger expression, and depression in cancer patients].

PURPOSE: This study was to identify the relationship between perceived stress, anger expression, and level of depression in cancer patients. METHOD: A cross-sectional descriptive study design was used. Data was collected by questionnaires from 185 in- and out-patients who were diagnosed with cancer at 3 university hospitals and the National Cancer Center using Spielberger et al.'s Anger Expression Scale, Cohen, Kamarch & Mermelstein's Perceived Stress, and Derogatise's SCL-90. The data was analyzed using descriptive statistics, Pearson correlation coefficient, and stepwise multiple regression with SAS/PC. RESULT: The perceived stress in cancer patients indicated a significant positive correlation to anger-in(r=.288, p=.000), anger-out(r=.232, p=.001), and depression(r=.68, p=.000), but no significant correlation to anger-control. The anger-in of cancer patients showed a significant positive relationship to anger-out(r=.53, p=.000), and depression(r=.383, p=.000), but no significant correlation to anger-control. Anger-out showed a significantly negative correlation to anger-control(r=-.248, p=.001) and a positive correlation to depression(r=.240, p=.001). The most significant predictor which influenced depression in cancer patients was perceived stress, followed by anger-in and hobby, and these factors explained their depression with a variance of 54%. CONCLUSION: These results suggested that cancer patients with a high degree of perceived stress are likely to be high in anger-out and anger-in. Perceived stress and anger-in are major factors which affect depression in cancer patients.

Adult↗
PubMed2005

[Anger and health status in late school-age children].

PURPOSE: This cross-sectional study was designed to identify anger-expression types in late school-age children and investigate the relation between the identified anger-expression types and their health status. METHOD: One thousand twenty seven children in elementary school fifth and sixth grades were recruited from November to December, 2004. Data was analyzed using descriptive statistics, cluster analysis, 2-test, ANOVA, Duncan's multiple comparison test, and Wilcoxon rank sum test. RESULTS: Three anger-expression types in late school-age children were found; Anger-out/in, Anger-control, and Low anger-expression types. Children frequently using the anger-out/in type among the three types and with a higher state anger reported higher psychosomatic symptoms and depression. Children from a divorced or separated family reported higher state anger. CONCLUSION: This study suggests that a specific anger management program needs to be developed for late school-age children with high state anger and frequently using the anger out/in expression type. For understanding the anger level and the anger expression types of Korean school-age children, further research needs to be done with large samples using a randomized sampling method.

Anger↗
PubMed2006

[Anger, cardiovascular health and depression in middle-aged Korean men: the mediating effect of social support].

PURPOSE: A descriptive correlational study was designed to examine the relationship of trait anger and anger expression to blood pressure, cholesterol, and depression in middle-aged Korean men. In addition, this study investigated the mediating effect of social support in relation to anger and other variables. METHODS: Two hundred and ninety nine men aged 40 to 64 years were recruited from a health center at K University Hospital located in Ansan City, Kyungki province, Korea. The instruments used were Spielberger's state trait anger expression inventory-the Korean version for trait anger and anger expression, Beck's depression inventory for depression, and a Personal resource questionnaire for perceived social support. RESULTS: Men with high trait anger showed significantly higher systolic blood pressure(BP) and diastolic BP. The level of cholesterol did not have a significant relationship with trait anger and anger expression. The severity of depression was significantly higher in men with high trait anger or more frequent uses of anger-in or anger-out. The perceived social support had a significant mediating effect in relation to trait anger and depression. CONCLUSIONS: Various nursing interventions for managing anger or improving social support need to be developed in a future study.

Adult↗
PubMed2000

Education and the activation, course, and management of anger.

Using data from the 1996 General Social Survey, I examine education's association with the activation, course, and management of anger. I argue that education--as a source of stratification (status) and as a personal resource (human capital)--organizes the conditions that influence anger-related processes. In analyses of anger activation, education is associated with lower odds of family-related anger. The well educated have fewer children and more income--factors associated with a lower risk of family anger. Conversely, education is associated with higher odds of work-related anger, but income and personal control account for that association. In analyses of the course of anger, I document a nonlinear association between education and anger duration. Adjustment for the sense of control--which is negatively associated with anger duration--sharpens that parabolic association. Education is positively associated with perceived appropriateness of anger and negatively associated with the display of anger. In both cases, adjustment for control accounts for education's effect. The sense of control also suppresses education's significant positive effect on anger processing. In analyses of anger management, education increases the odds of cognitive flexibility and problem solving, but its effect on communication depends on the sense of control. In sum, education organizes personal and social circumstances that influence anger-related processes.

Anger↗