24: Anger - Streyffeler

Question 1

______ of community-dwelling adults report experiencing anger nearly every day

Answer 1

33%

75% of community adults report feeling annoyed multiple times a week

Question 2

__ of community adults report that their anger leads to physical violence (yelling, complaining, verbally attacking, or withdrawing were much more common)

Answer 2

10%

however…. textbooks and the scientific literature focus far more on depression and anxiety than anger

Question 3

define anger

Answer 3

negative, phenomenological feeling state that motivates desires for actions, usually against others, that aim to warn, intimidate, control or attack or gain retribution

Question 4

anger is associated with…

Answer 4

cognitive distortions and errors

physiological changes and culturally-conditioned patterns of behavor

Question 5

define hostility

Answer 5

negative beliefs or attitudes about individuals or groups that predispose anger and aggression

Question 6

define aggression

Answer 6

physical behavior enacted with the intent to harm. May occur out of anger, but also from modeling, group pressure, or social/environmental condition when anger is not present

Question 7

describe oppositional defiant disorder

Answer 7

• pattern of negativistic, hostile, and defiant behavior lasting at least 6 month
• criteria are a mixture of feelings (touchy/easily annoyed) and behaviors (deliberately annoys others)
• usually diagnosed in infancy, childhood or adolescence

Question 8

describe conduct disorder

Answer 8

• repeated pattern of violating the basic rights of others or violating age appropriate societal norms (serious physical aggression, destruction of property, theft)
• no mention of anger in criteria
• usually first diagnosed in infancy, childhood or adolescence

Question 9

describe intermittent explosive disorder

Answer 9

• repeated seriously assaultive acts (striking someone or verbally threatening assault) or intentional destruction of property
• degree of aggressiveness grossly disproportionate to triggering event

Question 10

describe Amok

Answer 10

• culture bound syndrome traditionally found in southeast asia
• single episode of acute, unrestrained violence
• individual does not remember the episode

Question 11

describe disruptive mood dysregulation disorder

Answer 11

• characterized by severe, recurrent temper outbursts occurring 3 or more times a week
• between temper outbursts, mood for most of the day, nearly every day is angry or irritable
• diagnosis not before 6 or after 18; onset by 10
• created specifically to decrease diagnosis of bipolar disorder in children

Question 12

___ prevalence of irritability in MDD patients

Answer 12

50%

presence of anger/irritability may predict more severe an chronic illness and more comorbidity

Question 13

disorder of anger exist independently but also frequently comorbid with other emotional disorders especially…

Answer 13

anxiety disorders

possibly related to frustration when efforts to manage the anxiety are thrawted or someone does something that increases anxiety

Question 14

trait vs. state anger

Answer 14

TRAIT is a relatively stable part of an individual’s personality. individuals high in triat anger become angry easily with relatively little provocation

STATE transient reaction to a current stressor or situation. an individual low in trait anger may become angry based on a significant provocation or a combination of situation vulnerabilities

we tend to overestimate traits and underestimate the influence of state

Question 15

in the short term, anger is _______. Longer term effects are more _______

Answer 15

reinforced; aversive

• targeted individual may comply with demand; self-righteous quality to anger can also be self-reinforcing
• shame and guilt; increased health risks (type A personality), poor decision making, rejected by others

Question 16

____ reinforced behavior is harder to extinguish

Answer 16

intermittently

Question 17

anger increases _________ and _______

Answer 17

epinephrine
norepinephrine

cardiovascular, endocrine, and limbic changes all occur. when activation is chronic, this is damaging to the body

Question 18

type A personality increases risk for…

Answer 18

heart disease and stroke

anger is central construct

Question 19

factors that will increase the likelihood an angry individual will act out

Answer 19

• presence of PTSD or other history of having been victimized
• living in a restricted setting (prison / locked ward)
• history of violent behavior
• individuals with significant developmental delays or brain injury

Question 20

causes of dangerously disruptive behavior in pts

Answer 20

• psychosis (psychiatric in origin or resulting from a brain lesion)
• sociopathy
• disinhibition (from substances or neurological impairment)
• severe anxiety
• personality disorder

Question 21

first step in interacting with angry pts

Answer 21

provide careful listening and empathy

Question 22

HALT

Answer 22

hungry angry lonely tired = more likely to act out in anger

• remain calm and engaged yourself
• determine the reason for the anger and address it to the extent possible
• if the pt becomes disruptive: focus on problem behaviors without blaming or avoiding the pt, set clear, firm expectations, then enforce them consistently; seek consultation sooner rather than later from a mental health professional

Question 23

psychiatric pts are more likely to be ___ of violence than _____

Answer 23

victims; perpetrators

2.5 times the likelihood of being attacked or raped than overall population risk

individuals with psychosis have higher likelihood of perpetrating violence than general population

psychiatric pts more likely to engage in agitated, disorganized violence than premeditated violent acts

Question 24

4 types of difficult pts

Answer 24

• dependent clingers (requires firm, tactful limits)
• entitled demanders (accept anger, then re-channel the entitlement into ways to obtain the good medical care they deserve)
• manipulative help-rejecters (be consistent, firm, and set appropriate limits)
• self-destructive deniers (treat depression if possible; recognize one’s own limits and provide treatment as with other terminal illnesses)

Question 25

managing anger technique

Answer 25

• relaxation techniques
• exercise (not “getting it out with angry acts”)
• changing thoughts to be calm and rational rather than emphasizing the nature and severity of the offense
• angry thought quickly become irrational. try to focus on logic and perspective
• make a plan to address problems
• focus on positive communication that identifies your own needs rather than attacking others’ behavior
• try to understand other perspective
• take a break