The relation between anger management style, mood and somatic symptoms in anxiety disorders and somatoform disorders

The objective of this study was to examine the relationship between anger management style, depression, anxiety and somatic symptoms in anxiety disorder and somatoform disorder patients. The subjects comprised 71 patients with anxiety disorders and 47 with somatoform disorders. The level of anger expression or anger suppression was assessed by the Anger Expression Scale, the severity of anxiety and depression by the Symptom Checklist-90-Revised (SCL-90-R) anxiety and depression subscales, and the severity of somatic symptoms by the Somatization Rating Scale and the SCL-90-R somatization subscale. The results of path analyses showed that anger suppression had only an indirect effect on somatic symptoms through depression and anxiety in each of the disorders. In addition, only anxiety had a direct effect on somatic symptoms in anxiety disorder patients, whereas both anxiety and depression had direct effects on somatic symptoms in somatoform disorder patients. However, the anxiety disorder group showed a significant negative correlation between anger expression and anger suppression in the path from anger-out to anger-in to depression to anxiety to somatic symptoms, unlike the somatoform disorder group. The results suggest that anger suppression, but not anger expression, is associated with mood, i.e. depression and anxiety, and somatic symptoms characterize anxiety disorder and somatoform disorder patients. Anxiety is likely to be an important source of somatic symptoms in anxiety disorders, whereas both anxiety and depression are likely to be important sources of somatic symptoms in somatoform disorders. In addition, anger suppression preceded by inhibited anger expression is associated with anxiety and somatic symptoms in anxiety disorders.     

A stress inoculation training program for adolescents in a high school setting: a multiple baseline approach.

This study examined the effectiveness of stress inoculation training with adolescents in a high school setting using a multiple baseline approach. Through this intervention procedure, youths were trained in cognitive restructuring, anxiety management, and problem solving skills. Self-reports of state and trait anxiety were gathered during baseline and each training session. Five of the six youths displayed improvement on state and trait anxiety scores with the initiation of treatment. In addition, significant improvements were noted on pre- to post-assessments of state and trait anxiety and trait anger. Non-significant decreases were evident on self-reports of total, daily, and major negative stress events. No changes occurred on measures of depression, self-esteem, and anger expression. Similar patterns were obtained at a 3 month follow-up.     

The relationship between pain and negative affect in older adults: anxiety as a predictor of pain

Although the relationship between pain and negative affect (e.g., depression, anxiety, and anger) has been repeatedly demonstrated in younger populations, the findings have varied widely among studies. Additionally, there has been minimal research on the relationship between negative affect and acute pain in older adults. This is especially disturbing when one considers that the population is at a higher risk for painful conditions than any other age group. The current study investigated the relative contributions of state anxiety, trait anxiety, depression, state anger, and trait anger to acute pain in an elderly, postsurgical population. The participants (n = 100) were all over the age of 65 and were receiving treatment on an inpatient rehabilitation unit following orthopedic surgery (e.g., knee or hip replacement surgery). Data were analyzed by means of multiple regression, regressing the five predictor variables on the single criterion variable. Results indicated that the only significant predictor of pain in this population was state anxiety, and that this variable alone accounted for 27% of the variance in pain. Treatment implications and suggestions for further research were discussed.     

The relation between anger expression, depression, and somatic symptoms in depressive disorders and somatoform disorders

BACKGROUND: In previous studies, the relationship between either anger suppression and depression or anger suppression and somatic symptoms was examined. However, the relationship between anger expression, depression, and somatic symptoms was not examined in depressive disorders and somatoform disorders. METHOD: The DSM-IV-diagnosed subjects included 73 patients with depressive disorders and 47 patients with somatoform disorders. The Anger Expression Scale was used to assess the level of anger expression or suppression. The severity of depression was assessed using the Symptom Checklist-90-Revised (SCL-90-R). The Somatization Rating Scale and the SCL-90-R somatization subscale were used to assess the severity of somatic symptoms. Data were collected from March 2000 to March 2001. RESULTS: The results of the path analyses showed that in depressive disorder patients, anger expression had a stronger effect on somatic symptoms through depression than did anger suppression, although both anger expression and anger suppression had a significant indirect effect on somatic symptoms. The depressive disorder group also showed a significant but negative direct effect of anger suppression on anger expression in the path from anger suppression to anger expression to depression to somatic symptoms. However, only anger suppression had an indirect effect on somatic symptoms through depression in somatoform disorder patients. CONCLUSIONS: The results suggest that anger expression might play a more predominant role in depression and somatic symptoms of depressive disorder patients than anger suppression, but only anger suppression might be associated with depression and somatic symptoms of somatoform disorder patients. In addition, incomplete anger suppression followed by anger expression is likely to be associated with depression and somatic symptoms in depressive disorders.     

Insulin-treated diabetes patients with fear of self-injecting or fear of self-testing: psychological comorbidity and general well-being.

OBJECTIVE: To examine psychological functioning and self-management behaviours of Dutch adult patients with insulin-requiring diabetes mellitus suffering from extreme fear of self-injecting (FSI) and/or fear of self-testing (FST). METHODS: A cross-sectional survey was performed in a sample of insulin-treated diabetes patients (n=1275; 51.1% male; age 49.7+/-15.8 years; 58.0% Type 1 diabetes), assessing FSI and FST. Patients completed the questionnaires concerning trait/state anxiety, depression, fear of hypoglycemia, diabetes-related distress, diabetes self-care activities, and general well-being. Comparisons were made on these measures between patients with extremely high scores on FSI and/or FST (> or = 95th percentile) and the other patients. Patients with extreme scores on FSI and/or FST were invited to take part in a second survey to assess the prevalence of major depression, common fears/phobias, and psychoneuroticism. RESULTS: People with extreme FSI/ FST scores, as compared to the other patients, reported higher levels of trait/state anxiety and depression. This group also reported more fear of hypoglycaemia and diabetes-related distress, had lower levels of general well-being, and reported less frequent self-monitoring of blood glucose. The second survey showed 11.1% of patients with extreme FSI/FST reporting scores indicating major depression. Prevalence of scores greater than or equal to the high scores on phobias (38.0-63.3%) and psychoneuroticism (27.8%) were consistently higher than norm group prevalences. DISCUSSION: Extreme levels of FSI and/or FST are associated with high diabetes-related distress, poor general well-being, and psychological comorbidity, as well as poorer adherence to the diabetes treatment regimen. It is concluded that patients with extreme FSI/FST are often burdened with more than this specific phobia.     

The relationship between trait vulnerability and anxiety and depressive diagnoses at long-term follow-up of Generalized Anxiety Disorder

The current study examined the relationship between measures of trait vulnerability and long-term outcome in 83 patients diagnosed and treated for Generalized Anxiety Disorder (GAD) 8-14 years previously. Diagnostic status was assessed by structured interview, and trait affect, trait anxiety and trait depression were measured by the Positive and Negative Affect Scale (PANAS), the State-Trait Anxiety Inventory (STAI-T) and the Personal Style Inventory (PSI), respectively. Trait measures were all highly inter-correlated, and patients with diagnoses of GAD, social phobia and depressive disorders at long-term follow-up recorded very poor scores on all three scales. Trait anxiety recorded pre-treatment was also related to both anxiety and depression at long-term follow-up. However, trait depression showed no significant association with panic disorder. Increased numbers of comorbid diagnoses were strongly related to high levels of both trait anxiety and negative affect (NA). The findings suggest that patients reporting high trait anxiety or NA may suffer from a chronic course of disorder and higher levels of comorbidity over the longer term.     

Anger profiles in social anxiety disorder

Individuals with social anxiety disorder (SAD) exhibit elevated levels of anger and anger suppression, which are both associated with increased depression, diminished quality of life, and poorer treatment outcomes. However, little is known about how anger experiences differ among individuals with SAD and whether any heterogeneity might relate to negative outcomes. This investigation sought to empirically define anger profiles among 136 treatment-seeking individuals with SAD and to assess their association with distress and impairment. A latent class analysis was conducted utilizing the trait subscales of the State-Trait Anger Expression Inventory-2 as indicators of class membership. Analysis revealed four distinct anger profiles, with greatest distress and impairment generally demonstrated by individuals with elevated trait anger, a greater tendency to suppress the expression of anger, and diminished ability to adaptively control their anger expression. These results have implications for tailoring more effective interventions for socially anxious individuals.     

Type A behaviour and other psychological factors in peptic ulcer disease

A variety of personality traits and psychological symptom states have been reported to be associated with peptic ulcer disease. In the present study, male patients with confirmed duodenal or gastric ulcer(s) are compared with patient and non-patient control groups in terms of Type A behaviour, the Eysenck personality dimensions, hostility, state and trait anxiety, and depression. By comparison with cardiac patients, the peptic ulcer groups obtained lower Type A scores but were similar on the other variables. By comparison with age and sex matched community controls. GU patients obtained higher trait anxiety and psychoticism scores while the DU group had higher state anxiety levels. The implications of these findings in terms of the role of psychological factors in the aetiology of peptic ulcer disease are discussed.     

Negative affect and the experience of chronic pain

Although it is clear from previous research that pain is associated with negative affect, the relative contribution of specific affective dimensions, e.g. depression, anxiety and anger, to the subjective experience of chronic pain is unclear. The literature is also mixed concerning the relative importance of state versus trait influences in the experience of chronic pain. The present study analyzed the ability of anxiety, anger, and depression (as measured by the State-Trait Personality Inventory, State-Trait Anger Expression Inventory, and the Beck Depression Inventory, respectively) to predict self-report of clinical pain as indicated by the McGill Pain Questionnaire (MPQ) in a sample of 60 chronic pain patients. The results of stepwise regression analyses consistently demonstrated that the state measures were more strongly related to MPQ pain ratings than trait measures. These data suggest support for the hypothesis that chronic pain adversely impacts mood rather than the opposing hypothesis that negative mood is a predisposing factor in the development of chronic pain. Furthermore, different aspects of the state emotional experience were found to be related to different components of pain report. The results of this study also suggest that attributional processes could be an important component of the relationship between negative mood and the experience of pain.     

Hysterectomy and loss of fertility: implications for women's mental health

OBJECTIVE: The objective of this study was to assess the percentage of women scheduled for hysterectomy who would have liked to have had a child or more children and associated factors. METHODS: The study sample included 1140 premenopausal women having hysterectomy for benign indications who were interviewed before and after their surgery over the course of a 2-year follow-up period. The main outcome measures for this study were desire for a (or another) child measured preoperatively; concurrent measures of psychological distress, including anxiety, depression, anger, and confusion, and seeking of professional help for emotional problems; and psychological distress measured 12 and 24 months postoperatively. RESULTS: Of the sample, 10.5% (n=120) answered yes to the question, "Before you were told you needed a hysterectomy, would you have wanted a (or another) child?" As compared with those who did not, those who desired a (another) child were younger; more likely to be nulliparous; waited longer before having surgery; were more likely to have an indication of endometriosis; had higher levels of depression, anxiety, anger, and confusion; and were more than twice as likely to have seen a mental health professional for anxiety or depression in the 3 months before their surgery. These differences in psychological distress persisted over the course of the 2-year follow-up period. CONCLUSIONS: The issue of loss of fertility should be discussed candidly with women considering hysterectomy, and those who express ambivalence, sadness, or regret at the loss of future childbearing options may benefit from further exploration of fertility-sparing treatments.     

Prevalence of anger attacks in depressive and anxiety disorders: Implications for their construct?

Aims: The present study explores anger attacks in depressive and anxiety disorders for their prevalence and some of the clinical and psychosocial correlates. Methods: The sample comprised of patients with ICD‐10‐diagnosed depressive and anxiety disorders (n = 328). All the subjects were given a demographic and clinical profile sheet, the Irritability Depression Anxiety Scale, World Health Organization Quality of Life – BREF Version and the Anger Attack Questionnaire. Using the Anger Attack Questionnaire they were divided into two groups – with anger attacks (n = 170) and without anger attacks (n = 158) – in order to study the differential profile of the two groups. Results: Anger attacks were associated with more anxiety and irritability, and poorer quality of life. Frequency of anger attacks had a positive correlation with depression, irritability and aggression, and a negative correlation with education, income, and quality of life. Panic attacks, somatic anxiety and psychological domain of quality of life predicted the categorization of subjects into those with and without anger attacks. Conclusion: Anger attacks are common among depressive and anxiety disorder cases and have a negative impact on quality of life. Status of anger attacks as either linked to anxiety and/or depression, or as an independent syndrome needs further study.     

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.     

Comparing Anorectics and Bulimics on Measures of Depression, Anxiety, and Anger

Seventeen anorectics and 33 bulimics, all female inpatients at Santa Barbara Cottage Hospital's eating disorder unit, and 57 non-eating-disordered female controls from undergraduate psychology classes at Cal Poly State University, San Luis Obispo, were compared on measures of depression, anxiety, and anger. Results indicated that both anorectics and bulimics differed from controls on depression, anxiety, and three of the six scales assessing anger. Bulimics and anorectics, however, did not significantly differ from each other in terms of depression, anxiety, and anger. The implications of these results for practice and research with eating-disordered persons are discussed.     

Emotional state and coping style among gynecologic patients undergoing surgery

The aim of the present study was to investigate changes in emotional state and the relationship between emotional state and demographic/clinical factors and coping style among gynecologic patients undergoing surgery. Using the Japanese version of the Profile of Mood States (POMS), 90 patients (benign disease: 32, malignancy: 58) were examined on three occasions: before surgery, before discharge, and 3 months after discharge. They were also examined using the Coping Inventory for Stressful Situations (CISS) on one occasion before discharge. The scores for the subscales depression, anger, and confusion were the highest after discharge while those for anxiety were the highest before surgery. The average scores of the POMS subscales for all subjects were within the normal range. With regard to the relationship between these emotional states and other factors, multiple regressions showed that the principal determinants of anxiety before surgery were religious belief, psychological symptoms during hospitalization and emotion-oriented (E) coping style; further, it was found that depression after discharge could be explained by chemotherapy, duration of hospitalization, and E coping style. The principal determinants of anger after discharge and vigor before surgery were length of education and E coping style, and severity of disease, chemotherapy, E coping style and task-oriented coping style, respectively. Those of post-discharge fatigue and confusion were length of education, psychological symptoms, and E coping style. In summary it is suggested that the following should be taken into account in patients undergoing gynecologic surgery: anxiety before surgery, depression, anger, and confusion after surgery, including coping styles.     

Emotional reactions following exposure to idealized bodies predict unhealthy body change attitudes and behaviors in women and men

OBJECTIVE: We explored the extent to which changes in emotional states following exposure to images of idealized bodies predict unhealthy body change attitudes and behaviors in women and men, and whether particular psychological traits mediate these effects. METHOD: One hundred thirty-three women and 93 men were assessed for unhealthy attitudes and behaviors related to body weight and muscles using the Eating Disorder Inventory-2 (EDI-2), the Obligatory Exercise Questionnaire, and the strategies to increase muscles subscale of the Body Change Inventory. Psychological traits assessed included body dissatisfaction (EDI-2), internalization of the thin/athletic ideal (Sociocultural Attitudes Towards Appearance Questionnaire-3), body comparison (Body Comparison Scale), self-esteem (Rosenberg Self-Esteem Inventory), depression (Beck Depression Inventory-II), and identity confusion (Self-Concept Clarity Scale). Participants were then exposed to photographs of thin female models and muscular male models, and visual analogue scales were used to measure changes in postexposure state body dissatisfaction, anger, anxiety, and depression. RESULTS: Postexposure increases in state anger, anxiety, depression, and body dissatisfaction correlated with drive for thinness and disordered eating symptomatology in women, while postexposure increases in state body dissatisfaction correlated with muscle development in men. Analyses revealed that internalization and body comparison mediated these relationships, with trait body dissatisfaction, trait depression, self-esteem, and self-concept/identity confusion serving as mediators for women only. CONCLUSION: These results are indicative of gender differences in: (a) reactions to idealized bodies; (b) psychological traits that predispose individuals to experience these reactions; and (c) types of body change behavior that are associated with these reactions.     

Comparing Anorectics and Bulimics on Measures of Depression,Anxiety, and Anger

Abstract

Seventeen anorectics and 33 bulimics, all female inpatients at Santa Barbara Cottage Hospital's eating disorder unit, and 57 non-eating-disordered female controls from undergraduate psychology classes at Cal Poly State University, San Luis Obispo, were compared on measures of depression, anxiety, and anger. Results indicated that both anorectics and bulimics differed from controls on depression, anxiety, and three of the six scales assessing anger. Bulimics and anorectics, however, did not significantly differ from each other in terms of depression, anxiety, and anger. The implications of these results for practice and research with eating-disordered persons are discussed.     

Prolonged fatigue, anxiety and depression: exploring relationships in a primary care sample.

OBJECTIVE: While prolonged fatigue states are frequently comorbid with other forms of distress, they are now the subject of independent aetiological and treatment research. The objective of this study was to use principal component analysis to clarify the relationships between proposed measures of prolonged fatigue and anxiety and depression in data obtained from patients attending primary care. METHOD: Self-report measures of prolonged fatigue and psychological distress (anxiety and depression) were administered to consecutive ambulatory care patients attending primary care. RESULTS: Data from 1593 subjects were obtained. A two-factor principal component solution (varimax rotation) demonstrated a clear separation between fatigue-related items (Cronbach's alpha = 0.81) as compared with those items describing anxiety and/or depression (Cronbach's alpha = 0.95). A four-factor solution produced similar results with two factors describing general psychological distress (contrasting anxiety and depression), with two other factors describing the profiles of mental and physical fatigue. CONCLUSIONS: The results lend weight to the argument that prolonged fatigue states can be measured independently of conventional notions of anxiety and depression in patients attending primary care. Epidemiological, aetiological and treatment research in psychiatry may need to focus greater attention on such prolonged fatigue states.     

Psychological factors in dyspepsia of unknown cause: a comparison with peptic ulcer disease

Patients with dyspepsia of unknown origin (DUO) and those with similar upper abdominal symptoms but with an organic cause (peptic ulcer) were assessed on personality and psychological symptom measures. The DUO patients had significantly more symptoms of anxiety and tension and higher scores for trait tension and hostility than the organic group. The two groups did not differ significantly in terms of depressive symptoms, neuroticism, psychoticism, or suppression of negative affects. The implications of these findings for the aetiology and diagnosis of DUO are discussed.     

The relation of essential hypertension to feelings of anxiety, depression and anger

Franz Alexander (1939) offered the hypothesis a number of years ago that hypertension can result from the inhibition of feelings of anger. Although a great deal of research has been done to test this hypothesis, the results remain equivocal. Part of the difficulty is that usually only anger was examined, making it impossible to determine the extent to which the results were specific to anger and not general for other negative emotions. A second prevalent problem has been the failure to match hypertensive and control groups on demographic variables that may be relevant to the relationship of hypertension to anger and its expression, such as education, economic level, and age. A third problem is that most studies have investigated only male hypertensives, thereby limiting the generality of the findings. The present study compares male and female hypertensives with carefully matched controls on measures of anxiety, depression, and anger and its suppression.     

The Rationality/Emotional Defensiveness Scale--II. Convergent and discriminant correlational analysis in males and females with and without cancer.

The psychological correlates of the Rationality/Emotional Defensiveness Scale and its two subscales were examined in 1236 males and 863 females from the Western Collaborative Group Study. An additional 157 males and 164 females with some form of cancer other than of the skin were also included in this analysis. Characteristics measured included self-reported emotional control, anger expression, trait personality, depressive and neurotic symptomatology, Type A behavior, hostility, and social desirability. Results indicate that the Rationality/Emotional Defensiveness Scale is most strongly related to the suppression and control of emotions, especially anger. Scores on this scale also tend to be associated with less Type A behavior and hostility and with more social conformity. Analysis of the component subscale suggests that Antiemotionality, i.e. the extent to which an individual uses reason and logic to avoid interpersonally related emotions, is most strongly marked by the control of anger, while Rationality, i.e. the extent to which an individual uses reason and logic as a general approach to coping with the environment, is related to the control of anxiety and a higher level of trait curiosity. The psychological interpretation of the scale appears to be largely invariant across gender, unaffected by residualization of the total scale score for its association with Social Desirability, and, except for a few minor instances, unrelated to the diagnosis of cancer.