Anger Flashcards
What are some damages associated with problematic anger?
Critical mediator for different types of aggression (e.g. domestic violence, rape)
Risk factor in hyper-tension and heart-related problems
Anger-related driving –> 1/3 of crashes and 2/3 of traffic-related deaths
Breaks relationships
Anger: Comorbid conditions?
50%: Substance (Alcohol/Drug) Abuse
33% Anxiety disorders
15% Depression/Dysthymia
5% Bipolar
How is anger everywhere in the DSM, and where can we find it?
Anger as symptom of many disorders:
Mania (Bipolar), MDD, Premenstrual Dysphoric Disorder, PTSD, GAD, as well as PD’s (Axis II): Borderline, Antisocial, Paranoid
How is anger nowhere in the DSM?
Anger does not have its own section or disorder. However, there are some that resemble anger:
- Intermittent Explosive Disorder
- Oppositional Defiant Disorder (ODD)
- Disruptive Mood Dysregulation Disorder (DMDD)
Intermittent Explosive Disorder (IED): DSM Description
A.Recurrent behavioural outbursts representing a failure to control aggressive impulses as manifested by either:
- Verbal outbursts, or physical aggression that does not result in damage or injury, twice weekly (on average) for at least three months; or
- Behavioural outbursts that do result in damage and/or injury, three times in 12 months
B. The aggression is disproportionate to the provocation
C. The outbursts are not premeditated (i.e. they are impulsive and/or anger-based) and are not committed to achieve some tangible objective (e.g. money, power, intimidation)
D. These outbursts cause distress and/or impairment
E. The individual must be at least six years old
F. The outbursts are not better explained by another mental disorder or medical condition (e.g. head trauma or Alzheimer’s)
Why is Intermittent Explosive Disorder (IED) an inappropriate diagnosis for patients with problematic anger?
An aggression disorder, not anger disorder.
Would not apply to very angry individuals who are rarely/never overtly aggressive. (This reflects overemphasis on aggression in academic community)
Suggests that aggression in IED is due to impulse control problems –> implicates behavioural control treatment
- Patronising, and there is method to the madness
Oppositional Defiant Disorder (ODD): DSM Description
A pattern of angry/irritable mood, argumentative/defiant behaviour, or vindictiveness lasting at least 6 months as evidenced by at least four symptoms from any of the following categories, and exhibited during interaction with at least one individual who is not a sibling.
Angry/irritable mood
1.Often loses temper
2.Is often touchy or easily annoyed
3.Is often angry or resentful
Argumentative/defiant behaviour
4. Often argues with authority figures
5. Often actively defies or refuses to comply with requests from authority figures or with rules
6. Often deliberately annoys others
7. Often blames others for his or her mistakes or misbehavior
Vindictiveness
8. Has been spiteful or vindictive at least twice within the past 6 months.
Is ODD an appropriate diagnosis for adults with anger issues?
No. Although it is not exclusive to children, ODD sounds like it is intended for them, as criteria 4-8 are unlikely to apply to adults. Moreover, Criteria 6-8 implies “deliberate malice”, which is unrelated to anger and is more related to psychopathy or antisocial traits.
Disruptive Mood Dysregulation Disorder: DSM Criteria
A.Severe recurrent temper outbursts […] that are grossly out of proportion to the situation or provocation
B.They are inconsistent with developmental level
C.They occur on average 3 or more times weekly
D.The mood between outbursts is persistently irritable or angry most of the day, nearly every day, and is observable by others (e.g. parents, teachers, peers)
DMDD: Why can’t most people with anger symptoms be diagnosed with this?
Criteria G and H: The Dx should not be made for the first time after 18, and the age of onset must be before 10. Shucks.
Misdiagnosed: In Lachmund, DiGiuseppe and Fuller (2005)’s study, how did clinicians diagnose people with phobia and anger?
Social phobia: 80% clinicians diagnosed correctly, 18% got another anxiety disorder, 2% wrong
Social Anger: 20% IED (despite no aggr in case description), 80% diagnosed PD (borderline/antisocial, depending on gender) though no PD traits were alluded to
Clinicians reported just as frequently seeing patients with social anger as those with social phobia.
Underserviced
Not funded under Medicare –> very expensive for clients to get treatment with psychologists
Underresearched
No one researches on Anger lol, while lots of research is going into depression and anxiety
Undertaught
Textbooks: Anxiety/Depression are referenced 25x more than anger, and 1/3 of textbooks don’t mention anger at all!
Misunderstood: What are some fallacies associated with anger?
- Venting is useful (pillow techniques)
- Low self-esteem is the culprit (treated as depression)
- Anger is biological, physical, genetic… (relaxation)
- Anger is a social skills problem (assertiveness)
- Anger is an impulse problem (self-instructional training)
- Anger is really just a mask for anxiety (treated as anxiety)
- Anger is classically conditioned (treated with exposure
