Pain,anger and illness behaviour

A 52-item Illness Behaviour Questionnaire (I.B.Q.) was administered to 100 patients referred for the management of pain that had not responded adequately to conventional treatment. A comparison group of 40 patients attending rheumatology, radiotherapy, pulmonary, and physiotherapy clinics, that reported pain as a prominent symptom, also completed the I.B.Q. Responses to two items from the questionnaire assessing the frequency and expression of angry feelings were used to classify patients. Patients from the intractable pain group reported an incidence of anger inhibition (53%) significantly higher than that of the comparison group (33%). Within the intractable pain group, patients' reports of the frequency and expression of angry feelings were found to be related to more general aspects of their illness behaviour. Patients who inhibited anger were more likely to have a “psychological” view of their symptoms and to be affectively disturbed. Patients who angered easily were more likely to be hypochondriacal as well as affectively disturbed. The findings of this study indicate that individual differences in illness behaviour must be recognized as influencing observed relationships between pain and anger.     

Relationship of anger and anger attacks with depression

Anger is a common and potentially destructive emotion that has considerable social and public health importance. The occurrence of anger, irritability and hostility in depression have been known for many years, but the prevalence, significance for treatment and prognosis and the mechanisms involved remain poorly understood. More recently, anger attacks have been proposed as a specific form of anger in depression. They are characterized by a rapid onset of intense anger and a crescendo of autonomic arousal occurring in response to trivial provocations. Though the presence or absence of hostility, anger and aggression in depression has been a matter of controversy, anger attacks have been found to occur more often in depressed patients in comparison to healthy controls. Some studies have reported that depressed patients with anger attacks differ from those without such attacks in terms of clinical profile, comorbid personality disorders and certain biological variables. Serotonergic dysfunction may characterize this distinct subtype of depression – depression with anger attacks.     

Temporal and frontal lobe initiation and regulation of the top-down escalation of anger and aggression

The widespread, across-species strategy of stagewise escalation of aggression in agonistic encounters can be understood in terms of resource capture and control with least risk and cost. Human anger likely follows similar principles. As an adaptive phenomenon, escalation may involve particular neural circuitry. To advance beyond a standard view that the frontal lobe tonically inhibits subcortical circuits of aggression, a model is proposed which starts with the general rostrally directed flow of information in the brain. Earlier stage processing of visual and auditory input is transmitted from posterior and middle temporal cortices to anterior temporal lobe where rudimentary appraisals of threat and provocation are developed. These directly but diffusely activate cortical/subcortical anger/aggression response systems. At the same time, the anterior temporal loci transmit the modality-specific perceptual information to orbito-frontal cortex where it is integrated with information about, e.g., the opponent's relative dominance/social status and evaluated for likelihood of potential rewards and punishments associated with different modes of responding and so forth. These frontal areas then impose an inhibitory gating or modulation and focusing of activity initiated by the anterior temporal loci through their projections to GABAergic interneurons in the same cortical/subcortical circuits. Escalation occurs as the inhibition imposed by the frontal areas is progressively lifted. Exploration of the implications, applications and hypotheses flowing from this model will improve our understanding of the biologically important and socially significant phenomena of escalation.     

Relationship of perceived parenting practices to anger regulation and coping strategies in African-American adolescents

This study examined the relationship of perceived parenting practices to anger and coping in a sample of 70 African-American adolescents. Regression analyses reveled that perceptions of parental strictness were negatively related to anger temperament, anger-out, and avoidance (all p<0.05), and was positively associated with engaging in demanding activities (p<0.02). Additionally, perceptions of parental involvement were positively related to seeking diversions (p<0.04), and perceptions of parental autonomy granting were negatively related to anger-out (p<0.02). These findings highlight the potential importance of the perceived parent-adolescent relationship for African-American adolescents.     

Aggressiveness, anger, and hostility in eating disorders

Objective

Despite evidence of a link between the behavioral and cognitive dimensions of aggressiveness and eating disorders, only few studies have tested this relation empirically.

Methods

A total of 112 female patients with anorexia nervosa (n = 61) or bulimia nervosa (n = 51) and 631 young girls attending 7 high schools in the same health district as the patients (northeast Italy) were invited to fill in a set of self-report instruments including the Eating Attitudes Test, the Bulimic Investigatory Test of Edinburgh, the Body Attitudes Test, and the Buss-Perry Aggression Questionnaire (AQ).

Results

In both healthy controls and patients, scores on the measures of eating disorder symptoms were positively related to the scores on the AQ: the strength of the association did not differ between healthy controls and patients. However, patients diagnosed with eating disorders were not more likely to disclose a propensity to aggression than the healthy controls drawn from the community: patients with anorexia nervosa scored lower than controls on the physical aggression and on the verbal aggression subscales of the AQ (P < .05). On the other hand, patients with bulimia nervosa scored higher than controls on the anger subscale of the AQ (P < .05) but did not differ from them on the other subscales of the questionnaire.

Conclusions

The results confirm the higher propensity to anger in patients with bulimia nervosa; in patients with anorexia nervosa, difficulties in expressing anger and outward-directed aggressiveness can be a prevailing feature. The younger age of controls and exclusive reliance on self-report measures might have concealed some differences between patients and community subjects.     

Understanding clinical anger and violence: the anger avoidance model

Although anger is a primary emotion and holds clear functional necessities, the presence of anger and its behavioral manifestations of aggression/violence can have serious emotional, health, and social consequences. Despite such consequences, the construct of clinical anger has to date suffered from few theoretical and treatment advancements and has received insufficient research attention. Thus, the purpose of this article is to introduce the Anger Avoidance Model, which is a new conceptualization of clinical anger and its behavioral manifestations. The Anger Avoidance Model suggests that among anger patients, a chronic early aversive history leads to information processing biases and emotion regulation deficits, which in turn result in intense efforts to avoid the experience of anger. This avoidance takes the form of hostile rumination (cognitive avoidance) and aggressive and violent behavior (behavioral avoidance). This model holds clear implications for research and treatment of this challenging clinical phenomenon.     

Impact of mindfulness training on attentional control and anger regulation processes for psychotherapists in training

Abstract

Objectives: Little empirical literature focuses on psychotherapists' cultivation of internal states of mind necessary for controlling attention and responding empathically to the client. We explore the effects of mindfulness training on emotional and attentional measures in Spanish resident intern psychiatrists and clinical psychologists. Method: One hundred and three residents were assigned to an experimental group (n = 60) that completed an 8-week mindfulness training versus a wait-list control group (n = 43). We evaluated emotional variables (sadness, anxiety, and anger, using standard instruments), state of mindfulness (using the Mindfulness Awareness Attention Scale), and attentional control variables using objective measures such as a continuous performance task and the Stroop task before and after mindfulness training. Results: Our study provides data that suggest that mindfulness training significantly improves measures of trait anger and attentional control. Conclusions: Further research is needed to replicate these findings, explore the effects of mindfulness training on other aspects of emotional regulation and cognition, and evaluate the impact of these effects within clinical situations.     

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.     

Cytokine dysregulation, inflammation and well-being

Cytokines mediate and control immune and inflammatory responses. Complex interactions exist between cytokines, inflammation and the adaptive responses in maintaining homeostasis, health, and well-being. Like the stress response, the inflammatory reaction is crucial for survival and is meant to be tailored to the stimulus and time. A full-fledged systemic inflammatory reaction results in stimulation of four major programs: the acute-phase reaction, the sickness syndrome, the pain program, and the stress response, mediated by the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system. Common human diseases such as atopy/allergy, autoimmunity, chronic infections and sepsis are characterized by a dysregulation of the pro- versus anti-inflammatory and T helper (Th)1 versus Th2 cytokine balance. Recent evidence also indicates the involvement of pro-inflammatory cytokines in the pathogenesis of atherosclerosis and major depression, and conditions such as visceral-type obesity, metabolic syndrome and sleep disturbances. During inflammation, the activation of the stress system, through induction of a Th2 shift, protects the organism from systemic 'overshooting' with Th1/pro-inflammatory cytokines. Under certain conditions, however, stress hormones may actually facilitate inflammation through induction of interleukin (IL)-1, IL-6, IL-8, IL-18, tumor necrosis factor-alpha and C-reactive protein production and through activation of the corticotropin-releasing hormone/substance P-histamine axis. Thus, a dysfunctional neuroendocrine-immune interface associated with abnormalities of the 'systemic anti-inflammatory feedback' and/or 'hyperactivity' of the local pro-inflammatory factors may play a role in the pathogenesis of atopic/allergic and autoimmune diseases, obesity, depression, and atherosclerosis. These abnormalities and the failure of the adaptive systems to resolve inflammation affect the well-being of the individual, including behavioral parameters, quality of life and sleep, as well as indices of metabolic and cardiovascular health. These hypotheses require further investigation, but the answers should provide critical insights into mechanisms underlying a variety of common human immune-related diseases.     

Adolescent anger

Adolescent hostility, resentment, blame, and reproach are dynamically determined and serve important defensive, alloplastic, and restitutional aims. The author examines how these negative affects, the accompanying victim role, and oppositional defiance enable angry adolescents to defend against depression and loss, to demand nurturance from others, to protect their precarious inner autonomy, and to undo their humiliation and shame by vengeance and reversal. The author suggests that adolescent anger arises from an underlying wish to coerce objects into providing all-giving restitution for losses and narcissistic injuries, not necessarily from a wish to sadistically or enviously destroy them.     

Aggressiveness, anger and eating disorders: a review

Anger and aggressive behaviours, especially those self-directed, are frequent in subjects suffering from anorexia nervosa and bulimia nervosa. They increase the complexity of the clinical features, change the prognosis and cause a more difficult management of these disorders. In order to elucidate the complex relationships between eating disorders, anger and aggressiveness, the history of traumatic experiences, the prevalence of dissociative, obsessive, impulsive and compulsive symptoms, as well as the role of severe personality disorders in subjects suffering from anorexia nervosa, bulimia nervosa and self-injurious behaviours are considered. In the final section of this paper, a model exploring such a relationship in the light of the undefined sense of self is described.     

Posttraumatic stress disorder, anger and hostility, and physical health status

Accumulating evidence suggests that posttraumatic stress disorder (PTSD) is linked to both objective and subjective indices of poorer health. Less is known about processes that may explain this association. This study examined anger/hostility as a possible mediator and moderator of PTSD and health status among a sample of 134 medical patients. Participants completed a structured interview of PTSD and questionnaires assessing health perceptions and anger and data on physician-diagnosed illnesses were gathered from computerized databases. Trait anger and anger-in partially explained the association between PTSD and poorer general health perceptions. There was a significant association between anger-in and the presence of a circulatory disorder only in patients with PTSD.     

Factors associated with anger and anger expression in caregivers of elderly relatives

Objectives: Anger is a common feeling among family caregivers of elderly dependents. However, this feeling has received less attention than other emotional effects of caring. This study measures anger in caregivers and analyzes its predictors.

Method: Trait anger and anger expression (expression-in, expression-out and expression index), caregiver and care recipient features, stressors (e.g. care demands and support), appraisal (e.g. burden) and resources (e.g. coping, self-efficacy) were assessed in 111 caregivers of elderly dependent relatives. Staged stepwise multiple linear regression analyses were carried out for each of the four anger scores.

Results: Caregivers presented mild anger levels and showed expression-in rather than expression-out of anger. Stepwise multiple linear regression analyses showed that a bad relationship between caregiver and care recipient, the presence of disruptive behaviors and caregivers’ low efficacy to handle them, and mostly the use of emotion-focused coping were the significant predictors of trait anger, anger expression index and anger expression-out. Explained variance for each of these regression models was 38%, 33% and 27%, respectively. Burden was the only significant predictor for internal anger expression (8% explained variance).

Conclusion: Results highlight that interventions aimed to improve caregivers’ strategies to address memory and behavior problems and to promote the use of effective coping strategies could be helpful to prevent anger and expression-out of anger. Reducing burden in caregivers might result in reductions of anger expression-in. Data underscore the need to consider anger feeling and both in-expression and out-expression of anger separately in order to understand anger experience in caregivers.     

Work,well-being and presence among researchers

The aim of this study was to investigate which work factors researchers in the institute sector consider important for their well-being and presence at work. We interviewed eight researchers in depth regarding work, well-being, and presence at work. By use of content analysis, we identified five main themes associated with well-being and presence at work: performing high-quality research; meaningful work; job demands; autonomy; and social support. The opportunity to perform high-quality research was the most important condition for the researchers’ well-being and presence at work. This theme seems to be intertwined with the association between all the other four themes and well-being and presence, and may therefore be regarded as being at a higher level than the other themes. To promote well-being and presence at work, it is important to provide administrative support and to organize work so that the researchers can concentrate on what they regard as core work tasks.     

Antecedents, concomitants and consequences of anger attacks in depression

Anger attacks are episodes of intense anger with autonomic arousal, which occur in response to often trivial provocations. This study explores some of the antecedents, concomitants, and consequences of anger attacks in patients with depression. The sample comprised three groups: depression with anger attacks (n=20), depression without anger attacks (n=20) and normal controls (n=20). Subjects were administered the Mini International Neuropsychiatric Interview, the Anger Attack Questionnaire, Irritability, the Depression Anxiety Scale, the State-Trait Anger Expression Inventory, the Psychoticism Extraversion Neuroticism Inventory, the Hassles Scale, the World Health Organization Quality of Life-BREF Version and the Dysfunctional Analysis Questionnaire. Depressed patients with anger attacks exhibited more suicide-related phenomena and dysfunction scores in comparison to depressed patients without anger attacks. Depressed patients with anger attacks also had higher scores of anxiety, irritability, trait-anger, anger-out, anger expression, psychoticism, hassles, and poor quality of life in comparison to the other two groups. In conclusion, anger attacks adversely affect the lives of depressed patients and their family members and may serve as a qualifier for partially distinct syndrome of depression.     

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.