24: Anger - Streyffeler Flashcards
______ of community-dwelling adults report experiencing anger nearly every day
33%
75% of community adults report feeling annoyed multiple times a week
__ of community adults report that their anger leads to physical violence (yelling, complaining, verbally attacking, or withdrawing were much more common)
10%
however…. textbooks and the scientific literature focus far more on depression and anxiety than anger
define anger
negative, phenomenological feeling state that motivates desires for actions, usually against others, that aim to warn, intimidate, control or attack or gain retribution
anger is associated with…
cognitive distortions and errors
physiological changes and culturally-conditioned patterns of behavor
define hostility
negative beliefs or attitudes about individuals or groups that predispose anger and aggression
define aggression
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
describe oppositional defiant disorder
- 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
describe conduct disorder
- 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
describe intermittent explosive disorder
- repeated seriously assaultive acts (striking someone or verbally threatening assault) or intentional destruction of property
- degree of aggressiveness grossly disproportionate to triggering event
describe Amok
- culture bound syndrome traditionally found in southeast asia
- single episode of acute, unrestrained violence
- individual does not remember the episode
describe disruptive mood dysregulation disorder
- 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
___ prevalence of irritability in MDD patients
50%
presence of anger/irritability may predict more severe an chronic illness and more comorbidity
disorder of anger exist independently but also frequently comorbid with other emotional disorders especially…
anxiety disorders
possibly related to frustration when efforts to manage the anxiety are thrawted or someone does something that increases anxiety
trait vs. state anger
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
in the short term, anger is _______. Longer term effects are more _______
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
____ reinforced behavior is harder to extinguish
intermittently
anger increases _________ and _______
epinephrine
norepinephrine
cardiovascular, endocrine, and limbic changes all occur. when activation is chronic, this is damaging to the body
type A personality increases risk for…
heart disease and stroke
anger is central construct
factors that will increase the likelihood an angry individual will act out
- 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
causes of dangerously disruptive behavior in pts
- psychosis (psychiatric in origin or resulting from a brain lesion)
- sociopathy
- disinhibition (from substances or neurological impairment)
- severe anxiety
- personality disorder
first step in interacting with angry pts
provide careful listening and empathy
HALT
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
psychiatric pts are more likely to be ___ of violence than _____
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
4 types of difficult pts
- 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)
managing anger technique
- 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
