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PubMed1989

The validity of multidimensional self-report anger and hostility measures.

The present study assessed the convergent and discriminant validity of multidimensional measures of anger and hostility and validated abbreviated neurotic and reactive hostility subscales of the Buss Durkee Hostility Inventory. A sample of 120 adults were administered the abbreviated Buss Durkee Reaction (RH) and Neurotic Hostility (NH) subscales, State-Trait Anger Scale (ST), Anger Self-Report General (ASRG) subscale, Multidimensional Anger Inventory (MAI), and Framingham Anger-in (FI), Anger-out (FO), and Discuss (FD) scales. An intercorrelation matrix supported the convergent and discriminant validity of these measures except for the Anger-in/Brood subscale of the MAI and the FO scale. Factor analysis of the scales resulted in three factors: anger experience/hostility, verbal/adaptive anger expression, and maladaptive/physical anger expression. Implications for future research on anger assessment, specifically the components of anger experience and anger expression or suppression, were discussed.

Adaptation, Psychological↗
PubMed1999

Anger state during acute insulin-induced hypoglycaemia.

This study sought to examine the effects of insulin-induced hypoglycaemia on anger state, and to describe the associations between change in the anger state and measures of anger trait and anger expression (assessed using the State-Trait Anger Expression Inventory). A hyperinsulinaemic glucose clamp was used to achieve controlled euglycaemia (5.0 mmol/L) and hypoglycaemia (2.6 mmol/L) in 18 nondiabetic subjects and 30 people with insulin-dependent diabetes mellitus (IDDM). Subjects underwent both hypoglycaemic and euglycaemic conditions, separated by 2 weeks, in a counterbalanced order. During each study condition subjects were asked to complete a questionnaire on anger state. Results at euglycaemia and hypoglycaemia were compared, and differences between the conditions were correlated with measures of anger trait and anger expression. Hypoglycaemia caused both nondiabetic and IDDM subjects to report a significant increase in feelings of anger, despite being in a nonconfrontational setting. However, there were no clear associations between an individual's change in reported anger and measures of anger trait and anger expression. No association was found between the change in anger state and the intensity of an individual's symptomatic response to hypoglycaemia.

Adult↗
PubMed2003

Emotion induction moderates effects of anger management style on acute pain sensitivity.

Anger management style (AMS) is related to both acute and chronic pain intensity. Recent work suggests that an anger expressive AMS in particular may influence acute pain, and that this effect may be most pronounced during anger provocation. The present study examined whether AMS was related to subsequent pain sensitivity without regard to prior emotion induction, only when a strong negative emotion was evoked, or only when anger was provoked. Sixty-four healthy normals partook in semi-structured interviews in which they recalled and verbally described an event in which either anger, sadness, or joy was elicited. They then underwent a cold pressor pain task. Results of hierarchical multiple regressions showed that an anger expressive AMS was related positively to pain threshold only for participants in the anger-recall condition, and that this effect was largely accounted for by their low SBP reactivity during emotion induction. An anger suppressive AMS was related positively to increases in self-reported pain severity, irrespective of emotion-induction condition, and this effect was not accounted for by reactivity in any cardiovascular index. Results extend those of previous studies by illuminating the potential importance of behavioral anger expression for individuals prone to express anger in modulating their reactivity and pain sensitivity. Findings suggest that the detrimental effects of an anger expressive style on pain sensitivity may be ameliorated under conditions in which behavioral anger expression occurs. Results are discussed in terms of recent work suggesting that an expressive AMS is associated with endogenous opioid dysfunction in the absence of behavioral anger expression.

Acute Disease↗
PubMed2004

Who me, angry? Patterns of anger diversion in women.

Researchers suggest that women's experience of anger is very complex and may not be accounted for by existing anger models. The current study was an attempt to clarify a model of women's anger proposed by Cox, Stabb, and Bruckner in Women's Anger: Clinical and Developmental Perspectives, 1999. Anger diversion focuses on women's attempts to bypass anger awareness, to use indirect means to cope with anger, or both. A sample of predominantly college and graduate student women (N = 514) completed a vignette questionnaire assessing diversionary anger styles as well as instruments evaluating symptoms, anger behaviors, emotional expression, and tendencies to respond in socially desirable ways. The results of the study partially support Cox and colleagues' model, particularly in distinguishing between diverting anger and expressing anger assertively. We found that women who divert anger are more vulnerable to symptoms such as depression, anxiety, and somatization than are women who use an assertive approach to coping with anger.

Adaptation, Psychological↗
PubMedDate not supplied

Anger in early adolescent boys and girls with health manifestations.

BACKGROUND: Some theorists suggest that boys and girls might experience and express anger in different ways, while others do not, making the study of sex differences in anger an important area for investigation. Further, much has been written theoretically about the health implications of anger, but there is a paucity of studies that have examined the relationship between anger and health variables in early adolescent boys and girls separately. OBJECTIVES: The objectives of this study were to examine sex differences in anger in early adolescents, and to examine the relationship between anger and several health variables, e.g., current health status, clinical health, eudaimonistic health for boys and girls separately. METHODS: This study compared differences in five anger variables between boys and girls, and examined relationships between the anger variables and health variables for boys and girls separately. The final sample consisted of 148 seventh and eighth graders, ages 12 to 14; 81 were girls and 67 were boys. They responded to the State-Trait Anger Expression Inventory and instruments measuring three health variables. RESULTS: Using multisample analysis via LISREL 7 and independent t tests, findings indicated that boys and girls did not differ in the experience and expression of anger. Pearson correlations were used to examine the relationships between the anger variables and the health variables for boys and girls separately. Of the 30 relationships examined, 12 were statistically significant; seven of these correlations were for girls, while five were for boys. CONCLUSIONS: Early adolescent boys and girls may not differ in any meaningful way in self-reported experiences and expressions of anger, but they may differ in health outcomes in relation to various types of anger.

Adolescent↗
PubMed1995

Triggering of acute myocardial infarction onset by episodes of anger. Determinants of Myocardial Infarction Onset Study Investigators.

BACKGROUND: Many anecdotes and several uncontrolled case series have suggested that emotionally stressful events, and more specifically, anger, immediately precede and appear to trigger the onset of acute myocardial infarction. However, controlled studies to determine the relative risk of myocardial infarction after episodes of anger have not been reported. METHODS AND RESULTS: We interviewed 1623 patients (501 women) an average of 4 days after myocardial infarction. The interview identified the time, place, and quality of myocardial infarction pain and other symptoms, the estimated usual frequency of anger during the previous year, and the intensity and timing of anger and other potentially triggering factors during the 26 hours before the onset of myocardial infarction. Anger was assessed by the onset anger scale, a single-item, seven-level, self-report scale, and the state anger subscale of the State-Trait Personality Inventory. Occurrence of anger in the 2 hours preceding the onset of myocardial infarction was compared with its expected frequency using two types of self-matched control data based on the case-crossover study design. The onset anger scale identified 39 patients with episodes of anger in the 2 hours before the onset of myocardial infarction. The relative risk of myocardial infarction in the 2 hours after an episode of anger was 2.3 (95% confidence interval, 1.7 to 3.2). The state anger subscale corroborated these findings with a relative risk of 1.9 (95% confidence interval, 1.3 to 2.7). Regular users of aspirin had a significantly lower relative risk (1.4; 95% confidence interval, 0.8 to 2.6) than nonusers (2.9; 95% confidence interval, 2.0 to 4.1) (P < .05). CONCLUSIONS: Episodes of anger are capable of triggering the onset of acute myocardial infarction, but aspirin may reduce this risk. A better understanding of the manner in which external events trigger the onset of acute cardiovascular events may lead to innovative preventive strategies aimed at severing the link between these external stressors and their pathological consequences.

Adrenergic beta-Antagonists↗
PubMed1999

Anger expression and incident stroke: prospective evidence from the Kuopio ischemic heart disease study.

BACKGROUND AND PURPOSE: High levels of anger are associated with an increased risk of coronary heart disease and hypertension, but little is known about the role of anger in stroke risk. METHODS: Anger expression style and risk of incident stroke were examined in 2074 men (mean age, 53.0+/-5.2 years) from a population-based, longitudinal study of risk factors for ischemic heart disease and related outcomes in eastern Finland. Self-reported style of anger expression was assessed by questionnaire at baseline. Linkage to the FINMONICA stroke and national hospital discharge registers identified 64 first strokes (50 ischemic) through 1996. Average follow-up time was 8.3+/-0.9 (mean+/-SD) years. RESULTS: Men who reported the highest level of expressed anger were at twice the risk of stroke (relative hazard, 2.03; 95% CI, 1.05 to 3.94) of men who reported the lowest level of anger, after adjustments for age, resting blood pressure, smoking, alcohol consumption, body mass index, low-density and high-density lipoprotein cholesterol, fibrinogen, socioeconomic status, history of diabetes, and use of antihypertensive medications. Additional analysis showed that these associations were evident only in men with a history of ischemic heart disease (n=481), among whom high levels of outwardly expressed anger (high anger-out) predicted >6-fold increased risk of stroke after risk factor adjustment (relative hazard, 6.87; 95% CI, 1.50 to 31.4). Suppressed anger (anger-in) and controlled anger (anger-control) were not consistently related to stroke risk. CONCLUSIONS: This is the first population-based study to show a significant relationship between high levels of expressed anger and incident stroke. Additional research is necessary to explore the mechanisms that underlie this association.

Anger↗
PubMed2004

What do we know? Process analysis and the search for a better understanding of Project MATCH's anger-by-treatment matching effect.

OBJECTIVE: A consistent matching result from Project MATCH was the impact of patient trait anger on the effectiveness of alcohol treatments. Despite that finding, subsequent work failed to identify mechanisms underlying the effect. The present study examined a potential mediator, therapist directiveness, to determine its relationship with patient anger, treatment modality and drinking outcomes. METHOD: Observers rated therapist directiveness for 140 patients (70% men) at one MATCH aftercare site. ANOVA was used to test for the interaction between directiveness and patient anger, treatment differences in level of directiveness, the interaction between treatment modality and anger, and directiveness as a mediator of treatment modality effects. RESULTS: A disordinal interaction was found between patient anger and therapist directiveness. Directiveness was associated with worse drinking outcomes among high anger patients and associated with less frequent drinking among low anger patients. Patient anger also interacted with treatment modality. Motivational enhancement therapy (MET) was more effective than cognitive behavioral therapy (CBT) for patients high in anger, whereas the reverse was true for patients low in anger. A lower level of therapist directiveness in MET mediated its superiority over CBT for high anger patients. Twelve-step facilitation therapy (TSF) was comparably effective to MET for high anger patients; it is interesting to note that TSF and MET did not differ in directiveness. CONCLUSIONS: Therapist directiveness is important to consider when working with patients at varying levels of trait anger. Analysis of the therapy process and tests for mediation are critical to further understand active ingredients of psychosocial treatment.

Adult↗
PubMed2006

[Association of anger expression patterns and health status in health care workers].

PURPOSE: The purpose of this study was to examine anger-expression patterns and their association with state and trait anger and physical and psychological health status in health care workers. METHOD: Four hundred and forty eight nurses, physicians and technicians from a large medical center completed standardized questionnaires of anger, anger-expression patterns and mood. They also had blood pressure, cholesterol, blood glucose and body mass index measured during their annual physical examinations. Data was analyzed using descriptive statistics, independent t-test, chi-square and ANOVA. RESULTS: Subjects showed two major clusters of anger-expression patterns: anger-control and anger-in/out. Subjects with the anger-in/out pattern reported higher state and trait anger and more anxiety, depression and fatigue than subjects with the anger-control pattern. Physical health indicators, however, were not significantly different between the two clusters of anger-expression patterns. CONCLUSION: Anger-expression patterns are associated with psychological health status but not with physical health status. Anger-expression patterns, however, need to be examined over time to assess their long-term effects on the physical and psychological health status in future studies.

Adult↗
PubMed2002

Predominance of anger in depressive disorders compared with anxiety disorders and somatoform disorders.

OBJECTIVE: The object of this study was to make a comparison regarding various dimensions of anger between depressive disorder and anxiety disorder or somatoform disorder. METHOD: The subjects included 73 patients with depressive disorders, 67 patients with anxiety disorders, 47 patients with somatoform disorders, and 215 healthy controls (diagnoses made according to DSM-IV criteria). Anger measures--the Anger Expression Scale, the hostility subscale of the Symptom Checklist-90-Revised (SCL-90-R), and the anger and aggression subscales of the Stress Response Inventory--were used to assess the anger levels. The severity of depression, anxiety, phobia, and somatization was assessed using the SCL-90-R. RESULTS: The depressive disorder group showed significantly higher levels of anger on the Stress Response Inventory than the anxiety disorder, somatoform disorder, and control groups (p < .05). The depressive disorder group scored significantly higher on the anger-out and anger-total subscales of the Anger Expression Scale than the somatoform disorder group (p < .05). On the SCL-90-R hostility subscale, the depressive disorder group also scored significantly higher than the anxiety disorder group (p < .05). Within the depressive disorder group, the severity of depression was significantly positively correlated with the anger-out score (r = 0.49, p < .001), whereas, in the somatoform and anxiety disorder groups, the severity of depression was significantly positively correlated with the anger-in score (somatoform disorder: r = 0.51, p < .001; anxiety disorder: r = 0.57, p < .001). CONCLUSION: These results suggest that depressive disorder patients are more likely to have anger than anxiety disorder or somatoform disorder patients and that depressive disorder may be more relevant to anger expression than somatoform disorder.

Adult↗
PubMed1991

[Responsibility for damage and anger].

Anger about frustration or damage was assumed to depend on how much responsibility can be attributed to the perpetrator. This hypothesis was tested experimentally (N = 120). Drawing upon constituents of the action concept (e.g. free will), three everyday situations (e.g. being obstructed while driving) were varied with regard to responsibility. Twenty subjects each were asked to imagine the three situations from one of the six levels of responsibility and to indicate how angry they would feel. In addition to state anger, anger in, anger out, and anger control were assessed. When trait anger was controlled for, state anger as well as anger out increased as a function of the perpetrator's responsibility, whereas anger control decreased. These results were in line with theoretical expectations. They demonstrate that the expression of anger is subject to social norms and depends largely on the situation. This finding complements original assumptions on the trait-like nature of anger in, anger out, and anger control.

Anger↗
PubMed2004

[Relationship between depression and anger in patients with antisocial personality disorder].

OBJECTIVE: This study examined the relationship between aggression and depression in male antisocial patients with and without comorbid depression and in normal control subjects. METHOD: Seventy-two antisocial patients were evaluated for depression using SCID. The antisocial patients were treatment-seeking soldiers, mostly substance use is recruited from military hospitals. The control group consisted of forty age and sex matched subjects. Twenty of these antisocial patients were diagnosed with depressive disorder (major depression or dysthymia). In order to assess aggression and depression the Beck Depression Inventory and the State-Trait Anger Scale (STAS) were used. RESULTS: Antisocial patients with depression and without depression had higher trait anger, anger-in and anger-out scores than the controls. Antisocial patients without comorbid depression had lower scores than the antisocial patients without depression in the anger control subscales of STAS. On the other hand, in this subscale, scores of the antisocial patients with depression did not differ from those of the normal controls. Correlation analysis revealed a significant positive relationship between BDI scores and trait anger, anger-in and anger-out scores. CONCLUSION: The result of our study did not fully support the view of depression which assumes that depressive disorder is related to anger and hostility at least in antisocial patients. According to our results higher anger scores and lower anger control scores were related to being antisocial rather than being depressive and also not only suppressed anger but also outwardly expressed anger were increased in depressive antisocial patients.

Adult↗
PubMed2003

Anger and core beliefs in the eating disorders.

OBJECTIVE: The link between emotion and eating pathology has long been established, but relatively little is known about the role of anger, partly because the existing literature has tended to concentrate on anger as a unitary construct. Nor is there any understanding of the cognitive factors that drive this affect in the eating disorders. This study had two aims: to determine levels of different facets of anger across eating disorder diagnoses and behaviors; and to investigate whether facets of anger are related to the individual's negative core beliefs. METHOD: The sample consisted of 140 women who met DSM-IV criteria for eating disorders, and 50 female control participants (university undergraduates). The women completed self-report questionnaires of anger levels and unhealthy core beliefs, and the presence of bulimic behaviors was recorded at assessment. RESULTS: The eating-disordered women had higher levels of state anger and anger suppression, particularly if the diagnosis included bulimic symptoms. Different aspects of anger were associated with specific bulimic behaviors. Unhealthy core beliefs were associated with higher levels of trait anger in both groups but with anger suppression in the clinical women only. DISCUSSION: Suggestions are made regarding ways in which state anger and anger suppression might be understood and treated in women with eating disorders.

Adult↗
PubMed2005

Anger management style and associations with self-efficacy and pain in male veterans.

UNLABELLED: Despite the high prevalence of anger and maladaptive anger management among persons with chronic pain, the association between pain and anger has received little empirical attention. The purpose of the current study was to investigate the relationship between pain and anger management style and test for the hypothesized role of self-efficacy as a moderator of this association. Five hundred sixty-four veterans with chronic pain were administered measures of pain, self-efficacy, and anger management. As expected, the results demonstrated a significant positive relationship between pain intensity and maladaptive anger management and a significant negative association between self-efficacy and maladaptive anger. Furthermore, pain intensity and the interaction of self-efficacy and pain intensity were significant predictors of maladaptive anger management. Surprisingly, patients reporting high self-efficacy and high pain intensity demonstrated more maladaptive anger management than individuals reporting high self-efficacy and low pain intensity. Patients reporting low self-efficacy demonstrated high levels of maladaptive anger management, regardless of pain intensity level. PERSPECTIVE: Maladaptive anger management is associated with pain intensity and self-efficacy beliefs. Additional research is needed to explore the interaction of pain and self-efficacy and its impact on anger management.

Adaptation, Psychological↗
PubMed2006

Hostility, anger, and sense of coherence as predictors of health-related quality of life. Results of an ASCOT substudy.

OBJECTIVE: The aim of this study was to investigate the relationship of hostility and anger expression to sense of coherence (SOC) and their role as predictors of health-related quality of life (HQL). It was hypothesised that SOC would mediate the impact of hostility and anger on HQL. METHODS: This is a substudy of the Anglo-Scandinavian Cardiac Outcomes Trial, which evaluates different treatment strategies to prevent cardiovascular disease in hypertensive patients. At baseline, SOC was assessed with a short form measure, and hostility-anger with the Cynical Distrust scale and with the Anger Expression scales. HQL was assessed at 6 months with the RAND-36. The sample comprised of 774 subjects (77.5% men). RESULTS: Results showed that strong SOC associates with ability to control expression of anger and with low levels of suppressed or openly expressed anger. Anger control and SOC were related to good HQL; cynicism, anger-out, and anger-in correlated negatively with HQL. Path models revealed that SOC was the strongest predictor of HQL while hostility and anger lost their direct impact on HQL. CONCLUSIONS: Given the significant associations of hostility and anger with SOC, it is concluded that the salutogenic theory of Antonovsky (A. Antonovsky, Health, Stress, and Coping: New Perspectives on Mental Health and Physical Well-Being, Jossey-Bass Inc, San Francisco, 1979) should be extended to include hostility-related constructs. The impact of hostility and anger on HQL is, to a great extent, mediated through SOC, which implies that in future studies, the role of hostility as a risk factor of ill health should be reconsidered from the SOC theory perspective.

Adaptation, Psychological↗
PubMed1999

Anger, hostility, and visceral adipose tissue in healthy postmenopausal women.

Central obesity is an important risk factor for chronic disease. Its etiology remains unclear. We examined whether anger and hostility, ie, psychological attributes that influence cardiovascular morbidity and mortality, prospectively predict central visceral obesity across 13 years. Visceral adipose tissue (VAT) was determined by x-ray computed tomography (CT) at the L4-L5 disc space in a population-based sample of 157 postmenopausal Healthy Women Study participants. Standardized tests were completed to measure separately trait anger (anger frequency and intensity), style of anger expression (holding anger in and expressing it outwardly), and hostile (mistrustful) attitudes. The higher the VAT score, the higher the trait anger and anger-out scores measured 13 years earlier (Ps < .04) and the higher the concurrent hostile attitudes score (P < .02). Moreover, the higher the VAT score, the greater the increase in trait anger over the study period (P < .03). Trait anger and hostility predicted VAT independent of fasting insulin levels, although both predicted an increase in fasting insulin over time. Women were categorized into three groups according to the distribution of the average percent increase in trait anger and in weight across the study period, respectively. The mean VAT scores increased with the likelihood of being in the highest tertile of increasing trait anger (means: 129.1, 131.1, and 155.8, P < .048) and in the highest tertile of increasing weight (means: 122.4, 131.1, and 162.2, P < .003). The association between a high trait anger score and VAT remained significant, controlling for weight gain. We conclude that hostile attributes, fasting insulin, and weight gain in midlife may contribute to the development of VAT in healthy Caucasian women.

Adipose Tissue↗
PubMed1998

Anger and blood pressure readings in children.

This study investigated the relationship of state and trait anger measured by the Jacob's Pediatric Anger Scale, patterns of anger expression measured by Jacob's Pediatric Anger Expression Scale, and blood pressure readings (BPR) in 230 third-grade children. Analysis of data revealed significant inverse relationships between anger suppression and diastolic BPR and anger reflection and control and both diastolic and systolic BPR. As anger suppression increased, diastolic BPR decreased. As anger reflection and control increased, both systolic and diastolic BPR decreased. When gender was considered, the relationship between anger reflection and control and systolic BPR was apparent only for girls, whereas the relationship between anger reflection and control and diastolic BPR was apparent only for boys. When correlations were computed based on gender and race, a significant inverse relationship between anger reflection and control and systolic BPR in Black girls was found. The results suggest that the influence of race and gender on the relationships between anger expression and systolic and diastolic BPR, which has been documented in adults, may be present in childhood.

Analysis of Variance↗
PubMed1998

It hurts most around the heart: a phenomenological exploration of women's anger.

Women's anger experience has been poorly understood and insufficiently researched. Yet the emotion of anger is vitally important to women's physical and mental health, and to the quality of their relationships. This phenomenological study was undertaken as an expansion and extension of the Women's Anger Study, the first large survey of the genesis, manifestations and correlates of anger in American women. Although the earlier study contributed to understanding of anger, a deeper examination of the context and meanings of anger experience was sought. Twenty-nine Caucasian women ranging in age from 21 to 66 years were interviewed. Illustrative occupations ranged from homemaker, student, waitress to business executive, professor, and human service professional. Analysis involved thematizing by the researchers independently and within a multidisciplinary phenomenological research group. The thematic structure of women's anger involved a building over time of a confusing mixture of feelings (hurt, frustration, disillusionment) precipitated by a violation of the core values of the self. The precipitant of anger was unfair and/or disrespectful treatment or lack of reciprocity in relationships. When the anger was confined within self, the woman felt helpless and powerless. However, powerlessness was also evident when anger was externalized in an outburst. To the study participants, an angry outburst meant a loss of control rather than ability to achieve control. Women reported a sense of power when using anger to restore justice, respect, and relationship reciprocity. Clinicians can assist women to reflect on their core values and use the power of their anger effectively. Further studies are in progress to examine the relevance of these findings for women of other races and cultural contexts.

Adaptation, Psychological↗