Anger

Question 1

Anger is a ‘basic’, ‘primordial’ emotion. What 2 points of evidence stand by this?

Answer 1

It is arguably the first identifiable negative emotion to develop in babies. And animals also experience anger (with neurological and behavioural overlap to how humans experience anger).

Question 2

Babies experience anger, at what ages to we see changes in the development of anger?

Answer 2

We first see anger at about 4 months, then the anger is directed at someone (through eye contact) at about 7 months.

Question 3

In the 1986 large-scale telephone study, what were participants asked and what were the results?

Answer 3

Participants were asked to recall a recent situation that ‘evoked a very strong feeling’. Anger (17%) was the most frequently reported negative emotion, well ahead of sadness (12%) and fear (2%).

Question 4

In 2004 the telephone study was replicated in Switzerland with almost 3000 participants. What was the question asked this time and what were the results?

Answer 4

Participants were asked to report on an event that had provoked an emotion the day before, ‘even if your emotional reaction was weak’. Anger was the most frequently reported negative emotion (12.5%).

Question 5

The results of the telephone studies indicate what?

Answer 5

That anger is probably the most commonly occurring negative emotion in adults.

Question 6

In the telephone study, the fact that anger was recalled the most indicates what about the emotion?

Answer 6

That anger is very salient. People feel it deeply and can hold onto perceived past wrongs against them.

Question 7

Emotions aren’t always experienced in isolation and sometimes are blended together. In the telephone study, what did results indicate about emotional blends?

Answer 7

That anger/sadness is the most common emotional blend.

Question 8

Anger is a normal, primal emotion. How do we know what it is a clinical issue?

Answer 8

Because in a 6-month period, 8% of the normal population reported that anger had been a problem for them for 6 months or more (2004).
Compare that to depression that has a LIFETIME prevalence of 10%.

Question 9

What is the evidence that people seek mental health services for anger problems?

Answer 9

A 2002 study found that:

• 1/2 of 1300 psychiatric outpatients reported experiencing moderate to severe levels of subjective anger.
• 1/4 had displayed ‘behavioural aggression’ and ‘extreme levels of anger’ in the past week.

Question 10

Why is aggression a good indicator of subjective levels of anger within a person?

Answer 10

Because you can’t have aggression without anger.

Question 11

What are some behavioural consequences of anger?

Answer 11

• aggression.
• domestic violence.
• assault.
• murder.
• rape.

Question 12

What are some health consequences of anger?

Answer 12

Similar to anxiety, the sympathetic system gets activated when a person is angry. However, the parasympathetic system is MUCH LESS active in anger than anxiety. People stay tense, gives them hypertension and puts pressure on their heart.

Question 13

What are some cognitive consequences of anger?

Answer 13

Anger interferes with judgment, problem-solving & negotiating.. can lead to risky behaviours.

Question 14

Anger is associated with risky behaviours… what is on of the most dangerous behaviours in particular and what are the results of this behaviour?

Answer 14

Risky driving.

It is estimated that 1/3 of crashes and 2/3 of traffic-related deaths are attributable to angry-aggressive driving.

Question 15

What is the neuroticism-partner effect? And how does it relate to anger?

Answer 15

It has been found that people who have ‘neurotic’ partners (higher in negative emotions) are less satisfied in the relationship. However, it has been found that anger is the trait responsible for this effect. If the person is depressed or anxious, it is not as bad.

Question 16

In terms of relationships and lifestyle, what impact does high levels of anger have?

Answer 16

Higher rates of divorce, more likely to be unmarried, unemployed and receive less support from family members and less trust in close relationships.

Question 17

What are the comorbid rates of other disorders in people who have high levels of trait-anger?

Answer 17

Angry adults present with comorbid:

• Drug and alcohol issues (50%).
• Anxiety (30%).
• Depression (15%).
• Bipolar (5%).

Question 18

In terms of the comorbid disorders in angry adults, what needs to be considered in terms of their correlation?

Answer 18

Causality. What is causing what? Is the anger causing them to drink, or is the alcohol causing them to be angry?
Is the anger causing them to be isolated, which leads to depression? Or vice versa?

Question 19

How is anger represented in the DSM-5?

Answer 19

It is everywhere and nowhere. Meaning it is very transdiagnostic and shows up in lots of the disorders, but there is no specific place for anger, or chapter.

Question 20

Which adult disorders is anger listed as a ‘possible’ symptom? (And why ‘possible’?)

Answer 20

• Mania (in BD).
• Major Depressive Disorder.
• Premenstrual Dysphoric Disorder.
• Posttraumatic Stress Disorder.
• Generalised Anxiety Disorder.
  It is a ‘possible’ symptom because these disorders can present WITHOUT anger (not necessary criteria).

Question 21

The ‘Borderline’, ‘Antisocial’ and ‘Paranoid’ dimensions of personality disorders feature most frequently in angry samples (along with Narcissistic PD). How is anger described in these disorders?

Answer 21

• Borderline: ‘inappropriate, intense anger’.
• Antisocial: ‘irritability and aggressiveness’.
• Paranoid: ‘grudges’ and ‘unforgiving’.

Question 22

‘Intermittent Explosive Disorder’ is a close contender as an anger disorder. However, what does it miss out?

Answer 22

It misses out anger. It is more described as an ‘aggressive’ disorder, needing behavioural outbursts twice a week that result from inability to control aggressive impulse.

Question 23

What does ‘Intermittent Explosive Disorder’ focus on that is less of a widespread problem than actual marked anger? At what rates is this problem reported in the media compared to anger?

Answer 23

Violence and aggressive outbursts, behavioural traits that are about 10x less common than marked anger.
The media has a preoccupation on violence due to its social impact and therefore reports on violence about 10x more than on anger.

Question 24

Why does ‘Intermittent Explosive Disorder’ not apply to most angry individuals?

Answer 24

Because it doesn’t cover the covertly angry person, who broods, is impatient, critical, etc., even though this person is distressed and/or impaired by their condition.

Question 25

In a study of 25 outpatients, whose primary complaint was anger, what was found in terms of rates of aggressive problems?

Answer 25

Only 2 reported having problems with aggression. Mental health workers are more likely to encounter patients who experience anger in indirect, nonverbal ways.

Question 26

What is the ‘Suppressed-Organised’ subtype in anger?

Answer 26

It represents the largest cohort of angry individuals (2/3) who do not display outward aggression. They are the quiet, brooding types.

Question 27

The DSM-5 emphasises that ‘Intermittent Explosive Disorder’ is caused by an impulse-control problem. What does this fail to capture in angry individuals?

Answer 27

That most people who are angry are in control. They may have outbursts at home but they do not loose it at their boss or the policeman. There is a method in their madness.

Question 28

What is ‘affective’ vs. ‘instrumental’ aggression? And why is it a false dichotomy?

Answer 28

Affective (impulsive) vs. instrumental (deliberate) aggression are not always what they seem.
Impulsive aggression often HAS a rationale/is deliberate (intended to coerce or intimidate), while deliberate aggression often involves a lot of emotion.

Question 29

‘Oppositional Defiant Disorder’ is not just about being aggressive, has covert angry traits as well. Why is it problematic?

Answer 29

Well, even though it doesn’t state it is a childhood disorder (although the DSM-5 slipped up and referred to children once), it seems like a very childish disorder.
There are also traits like ‘deliberate malice’ or ‘vindictiveness’ that make the disorder seem more like the person is a psychopath than just angry.
It’s a problematic disorder.

Question 30

What about ‘Disruptive Mood Dysregulation Disorder’? Why is that not a contender for an angry disorder?

Answer 30

Because, can only be diagnosed in people under the age of 18. And was only made so that kids wouldn’t be diagnosed with Bipolar anymore, not as an explicit angry disorder.

Question 31

So, if you are an angry adult, but are not especially violent or impulsive (IED), don’t commit defiant or malicious acts (ODD) and haven’t been a brat since childhood (DMDD), then you don’t have a problem - according to the DSM-5. Why is this so wrong?

Answer 31

Because that exact type of person is the average angry client. The DSM-5 hasn’t missed some special sub-group, they have missed the main cohort of angry people.

Question 32

In a 2005 experiment, researchers created two vignette’s - one that represented a patient with GAD, and the other represented someone who had serious anger problems. When they sent the vignette to psychiatrists for diagnosis, what were the results?

Answer 32

• GAD vignette: 80% got GAD, 18% got another anxiety disorder, only 2% got it completely wrong.
• Anger vignette: 43% said a PD (either borderline or Antisocial depending on gender), 20% said IED (although no aggressive symptoms were mentioned), others said anything ranging from ‘organic brain syndrome’, to ‘psychosis’ or ‘depression’.

Question 33

In the vignette experiment where psychiatrists diagnosed a GAD case and an anger case, how frequently did the psychiatrists say that they saw these patients? Why is this worrying?

Answer 33

They said they saw patients like this in an equal amount. It is worrying because they completely misdiagnosed the anger case - that means they are potentially misdiagnosing people in the real world who are simply suffering from anger problems.

Question 34

Because ‘anger’ is underdiagnosed, what does this mean in terms of medicare rebate?

Answer 34

People who are suffering because of their anger may not get compensated psychological help as they are not able to be diagnosed. Furthermore, they may be diagnosed with something completely wrong in order to receive help.

Question 35

What evidence is there to show that anger is under-researched in Western psychology?

Answer 35

The fact that between 1971 and today, on PsychInfo there is next to no references for ‘anger’, compared with ‘Depression’ or ‘Anxiety’. It is the same with references to the treatment of ‘Anger’.

Question 36

What evidence is there to suggest that anger is under-taught in Universities?

Answer 36

In Abnormal Psychology textbooks ‘anxiety’ and ‘depression’ are referenced 25x times more than anger.
About a third of Abnormal textbooks do not mention ‘anger’ at all.

Question 37

Buddhists thought anger was the source of all evil, the Greeks were constantly debating it….

Answer 37

… but Western psychology seems to think that anger is neither here nor there.

Question 38

What is one theory why anger is so neglected in the world of psychology?

Answer 38

Angry people themselves don’t really want therapy, because by definition anger is about it always being someone else’s fault. So, they avoid or resist therapy.

On the other hand, clinicians feel that anger is really difficult to treat.

So when angry people don’t want to be treated and clinicians don’t really want to treat them… no treatment at all is convenient for both parties.

Question 39

From a behavioural perspective… why might anger be left out of the conversation?

Answer 39

Because behaviouralists conceptualise anger as being part of ‘conflict’ that involves multiple parties (they edit out the emotional component).

Question 40

What is the Freudian perspective on anger?

Answer 40

That anger is a cover for something like low self-esteem, fear, shame. But this does not treat the anger, blames the anger on something else.

Question 41

When doing a clinical masters, there is not much on the treatment of anger. So, when picking up a few books about anger management, what are the results?

Answer 41

It looks pretty grim… there are a lot of fallacies surrounding anger management, like venting (pillow), low self-esteem is the culprit, it is biological, it is a problem with social skills, it is an impulse problem, it is a mask for anxiety, people are conditioned to be angry? All wrong!

Question 42

Psychologically, what is anger driven by?

Answer 42

The feeling that you have been wronged. It is driven by rigid thinking that gets stuck on certain expectations of the world and where people have wronged you.
(But the world is unfair, nothing is as expected - need to let go of this fallacy).

Question 43

Anger is driven by “should’s”, what does that mean?

Answer 43

‘She shouldn’t have done that, she should have done that’… It is very self-righteous thinking and misses the point that there is context behind people’s behaviour.

Question 44

Anger is driven by a sense of injustice and what do the behavioural displays of this anger tend to do?

Answer 44

They tend to have the opposite effect than what the person would like, they make a situation worse, make other people feel bad. They are not problem solving.

Question 45

From an evolutionary perspective, why is anger not as relevant today as it was thousands of years ago?

Answer 45

Because today most of our problems are to do with social interactions, studying, organising, etc. Thousands of years ago the problems involved tribal issues, where displays of intimidation and dominance were important. The feelings of anger that fuel our behaviour are no longer needed.

Question 46

How can someone try and stop their anger?

Answer 46

They need to become more wise and clear-headed.

Question 47

Is anger a learned behaviour?

Answer 47

Yes, for the most part. If someone who is biologically driven to be angry (lots of testosterone) are brought up in a chilled environment with lots of tolerance and empathy, they would be fine.

Question 48

Can mindfulness help treat anger?

Answer 48

No. It doesn’t challenge your world-view. In the context of a dispute, a viewpoint is completely untouched by mindfulness, even if they arrive at the scene calm - it doesn’t mean they can’t become angry.