Anger: The Forgotten Emotion Flashcards
1
Q
Why anger?
A
- The forgotten emotion: no anger related disorder in DSM
- ‘One of the ‘3 poisons’ Buddhists teach are the root of all suffering (along with attachment and ignorance)
- Anger one of the ‘basic’ emotions
- Arguably first identifiable negative emotion to develop in infants → emerges at 4 months, directed at another person by 7 months
- Most frequent → Large scale survey found anger is the emotion individuals feel most commonly
2
Q
Effects of anger
A
- 8% of normal population reported that anger had been a problem for them for six months or more
- As many clients seek mental health services for anger as do for depression and anxiety
- Critical mediator in various forms of aggression, from domestic violence through to assault, murder, rape
- Consistently identified as a risk factor in hypertension and heart-related illness
- Anger interferes with judgment, problem-solving, negotiating; leads to risky behaviours
- 1/3 of crashes and 2/3 of traffic-related deaths are attributable to angry-aggressive driving
3
Q
Anger and relationships
A
- Responsible for what was previously called the neuroticism partner effect, over and above depression and anxiety
- More predictive of divorce 5 years later than ‘poor communication’
- Subjects with higher trait anger were significantly more likely to be unmarried (and unemployed)
- Individuals with higher trait anger reported receiving less support from family members and less trust in their close relationships
4
Q
Comorbidity
A
- Angry adults present with high levels of comorbid drug and alcohol issues (over 50%)
- Anxiety disorders (about 1/3)
- Depression and dysthymia (about 15%). Note well: vast majority of angry individuals not depressed
- And bipolar (about 5%)
5
Q
Is Anger in the DSM?
A
No, but there are a few semblances of anger disorders, which have led many to believe DSM has anger covered
6
Q
Anger as symptom of other disorders
A
- Mania (and hence Bipolar)
- (Pediatric) Major Depressive Disorder (MDD)
- Premenstrual Dysphoric Disorder (PDD)
- Post-Traumatic Stress Disorder (PTSD)
- Generalised Anxiety Disorder (GAD)
- 3 Axis-II disorders: Borderline (‘inappropriate, intense anger’) Antisocial (‘irritability and aggressiveness’) & Paranoid (‘grudges’ and ‘unforgiving’)
–> Also, a large proportion of individuals with High Trait Anger, and of individuals who present for anger-management, do not have PDs
7
Q
Intermittent Explosive Disorder
A
- The disorder most commonly diagnosed to people presenting with anger issues – even without aggression
- A. Recurrent behavioural outbursts representing a failure to control aggressive impulses as manifested by either:
o Verbal outbursts, or physical aggression that does not result in damage or injury, twice weekly (on average) for at least 3 months; or
o Behavioural outbursts that do result in damage an/or injury, 3 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 6 years old
- F. The outbursts are not better explained by another mental disorder or medical condition (e.g. head trauma or Alzheimer’s)
8
Q
Why Intermittent Explosive Disorder isn’t Anger
A
This is an aggression disorder, not an anger disorder
- This diagnosis would not apply to the very angry individual who is rarely or never overtly aggressive
- Reflects a broader overemphasis on aggression in the (academic) community: Violence is mentioned 10 times more often than anger in abnormal texts, for example, though it occurs approximately 10 times less often
- DiGiuseppe and Tafrate (2007) assessed 25 successive outpatients whose primary complaint was anger. Only 2 were diagnosed as having aggression problems
- In a larger and more recent assessment of 197 anger outpatients (Ahmed, Kingston, DiGiuseppe, Bradford, & Seto, 2012), 64% did not report impulsive aggression and the single largest identifiable subtype representing over 1/3 or the sample, was a group they labelled ‘Suppressed-Organised”, who did not display problematic aggression of any kind, just angry individuals
9
Q
IED Overemphasis on Impulse Control
A
- DSM appears to be suggesting that the aggression in IED is caused by a general impulse-control problem
- DSM-5 themselves concede: “IED appears to be quite common regardless of the presence or absence of ADHD or disruptive, impulse control, and conduct disorders”
- The treatment implications are that you would presumably recommend behavioural control, rather than cognitive treatment
10
Q
Method in the Madness
A
- Affective vs. instrumental aggression distinction arguably a false dichotomy in practice
- Most (if not all) angry aggression can be seen to serve some purpose, e.g. to ‘operate on the world’ (usually for some variation of power, intimidation, money, status, sex, etc.). This is because aggression develops in part via operant learning
- E.g. Parents with their children (compliance, subordination), husbands with their wives (power, sex), road rage (intimidation, free passage), etc. → Is aggression committed to achieve some objective?
- Even behaviours as seemingly pointless as slamming doors, smashing plates, breaking tennis rackets, etc. appear to function as dramatic displays intended to coerce or intimidate
11
Q
Oppositional Defiant Disorder
A
- A pattern of angry/irritable mood, argumentative/defiant behaviour, or vindictiveness lasting as least 6 months as evidenced by at least 4 symptoms from any of the following categories, and exhibited during interaction with at least one individual who is not a sibling
- Angry/irritable mood (Often loses temper, Is often touchy or easily annoyed, Is often angry or resentful)
- Argumentative/defiant behaviour (Often argues with authority figures,Often actively defies or refuses to comply with requests from authority figures or with rules, Often deliberately annoys others, Often blames others for his/her mistakes or misbehaviour)
- Vindictiveness (Has been spiteful or vindictive at least twice within the past 6 months)
12
Q
Problems with ODD as Anger
A
- Not strictly exclusive to children, but sounds like its intended for them
- Criteria 4-8 unlikely apply to most adults
- 6-8 imply ‘deliberate malice’, which is unrelated to anger (more related to psychopath or antisocial traits)
13
Q
Disruptive Mood Dysregulation Disorder
A
- 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)
o Added feeling emotional state of anger !
14
Q
Problems with Disruptive Mood Dysregulation Disorder
A
o Criteria G and H: The Diagnosis should not be made for the first time after 18, and the age of onset must be before 10
o Explicit directive of the DSM was not to create an anger disorder, but to prevent children being diagnosed as Bipolar
15
Q
Disorders suggestive of anger
A
IED
ODD
DMDD
