Cerebellar Asymmetry of Motivational Direction: Anger-Dependent Effects of Cerebellar Transcranial Direct Current Stimulation on Aggression in Healthy Volunteers.

It has recently been theorized that the frontal asymmetry of approach- and avoidance-related motivation is mirrored in the posterolateral cerebellum. Accordingly, left-to-right dominant cerebellar activity is associated with avoidance-related motivation, whereas right-to-left dominant cerebellar activity is associated with approach-related motivation. The aim of this study was to examine the cerebellar asymmetry of motivational direction in approach-related behavior in the context of aggression. In this randomized double-blind sham-controlled crossover study, thirty healthy right-handed adult volunteers received 2 mA active or sham left cathodal-right anodal transcranial direct current stimulation (tDCS) to the cerebellum on two separate occasions while engaging in the Point Subtraction Aggression Paradigm (PSAP) task to measure aggressive behavior. Self-reported state anger was assessed before, halfway and immediately after the task, and heart rate and heart rate variability (HRV) were measured during the task. No main effects of tDCS on aggressive behavior, heart rate and HRV were found. Higher state anger before and during the PSAP task was associated with increased aggressive behavior in the active compared to sham tDCS condition. Aggressive behavior was positively correlated with heart rate during active tDCS, while an inverse association was observed during sham tDCS. Results provide support for the cerebellar asymmetry of motivational direction in approach-related behavior and illustrate the importance of affective state-dependency in tDCS-related effects.

Sleepless nights, sour moods: daily sleep-irritability links in a pediatric clinical sample.

BACKGROUND: Sleep, or a lack thereof, is strongly related to mood dysregulation. Although considerable research uses symptom scales to examine this relation, few studies use longitudinal, real-time methods focused on pediatric irritability. This study leveraged an ecological momentary assessment (EMA) protocol, assessing bidirectional associations between momentary irritability symptoms and daily sleep duration in a transdiagnostic pediatric sample enriched for irritability. METHODS: A total of N = 125 youth (Mage = 12.58 years, SD = 2.56 years; 74% male; 68.8% White) completed digital, in vivo surveys three times a day for 7 days. For a subset of youth, their parents also completed the EMA protocol. Trait irritability was measured using youth-, parent-, and clinician-report to test its potential moderating effect on the association between sleep duration and momentary irritability. RESULTS: Results from multilevel modeling dynamically linked sleep to irritability. Specifically, according to youth- and parent-report, decreased sleep duration was associated with increased morning irritability (bs ≤ -.09, ps < .049). A bidirectional association between parent-reported nightly sleep duration and anger was found-increased evening anger related to decreased nightly sleep duration, and decreased sleep duration related to increased morning anger (bs ≤ -.17, ps < .019). Trait irritability moderated this association, which was stronger for more irritable youth (b = -.03, p < .027). CONCLUSIONS: This study adds to the literature and suggests sleep-irritability dynamics as a potential treatment target.

Micro-sequences of anger and shame and non-suicidal self-injury in youth: an ecological momentary assessment study.

OBJECTIVE: Non-suicidal self-injury (NSSI) is a significant mental health concern with the highest prevalence among adolescents. NSSI has been conceptualized as one of the maladaptive strategies to cope with challenging affect or a form of self-punishment. Although characterizing moment-to-moment associations between shame and NSSI in individuals' real-world environment and partitioning between- and within-person effects is critical for mobile and timely interventions, most studies examined habitual experiences of negative affective states and focused on adults. METHOD: In this study, we focused on in vivo anger at self and others and shame and NSSI among 158 adolescents 3 weeks following their psychiatric hospitalizations using ecological momentary assessment (EMA) technology. RESULTS: We found that greater between-person levels of anger at self and others were linked to a higher number of subsequent NSSI occurrences within a day. These findings remained primarily unchanged when we statistically adjusted for participants' age, sex assigned at birth, the number of current psychiatric diagnoses, EMA response rates, and youth lifetime history of SI. Within-person increases in NSSI were linked to increased anger at self over and beyond between-person average levels of NSSI. CONCLUSIONS: These findings highlight the potential regulatory role of NSSI to decrease negative affective states and point to the clinical utility of assessing and early mobile interventions targeting challenging affect in youth.

Betrayal Trauma Anger: Clinical Implications for Therapeutic Treatment based on the Sexually Betrayed Partner's Experience Related to Anger after Intimate Betrayal.

This article provides insight into the complex anger often following the discovery of broken trust and attachment in a relationship as a result of sexual betrayal. In the past, the helping profession viewed angry betrayed partners from a pathological lens. Through research and progression in the mental health field, betrayed partners are now viewed from a trauma lens as traumatized individuals, and a greater understanding exists of why partners will most likely experience complex anger after betrayal. This article aims to add to the existing literature on the topic of betrayal trauma and provide clinical considerations for assessment and treatment of those seeking therapeutic help to manage and reduce anger. 297 sexually betrayed partners participated in a Betrayal Trauma Anger Survey. Results revealed 83.5% of participants remain in the relationships with their betrayers. 39% of betrayed partners reported not being provided specific help to manage anger from their helping professional. 87% reported self-blame and 43% considered harming themselves. Results clearly indicate that betrayed partners are significantly impacted physiologically, psychologically, behaviorally, and spiritually, and they experience feelings of intense anger with 84% reporting their experienced anger is more intense than at any other time they experienced anger prior to discovering betrayal.

Postictal psychiatric symptoms: A neurophysiological study.

OBJECTIVE: Postictal psychiatric symptoms (PPS) are a relatively common but understudied phenomenon in epilepsy. The mechanisms by which seizures contribute to worsening in psychiatric symptoms are unclear. We aimed to identify PPS prospectively during and after admission to the epilepsy monitoring unit (EMU) in order to characterize the postictal physiologic changes leading to PPS. METHODS: We prospectively enrolled patients admitted to the EMU and administered repeat psychometric questionnaires during and after their hospital stay in order to assess for postictal exacerbations in four symptom complexes: anger/hostility, anxiety, depression, and paranoia. Electroclinical and electrographic seizures were identified from the EEG recordings, and seizure durations were measured. The severity of postictal slowing was calculated as the proportion of postictal theta/delta activity in the postictal EEG relative to the preictal EEG using the Hilbert transform. RESULTS: Among 33 participants, 8 demonstrated significant increases in at least one of the four symptoms (the PPS+ group) within three days following the first seizure. The most common PPS was anger/hostility, experienced by 7/8 participants with PPS. Among the 8 PPS+ participants, four experienced more than one PPS. As compared to those without PPS (the PPS- group), the PPS+ group demonstrated a greater degree of postictal EEG slowing at 10 min (p = 0.022) and 20 min (p = 0.05) following seizure termination. They also experienced significantly more seizures during the study period (p = 0.005). There was no difference in seizure duration between groups. SIGNIFICANCE: Postictal psychiatric symptoms including anger/hostility, anxiety, depression, and paranoia may be more common than recognized. In particular, postictal increases in anger and irritability may be particularly common. We provide physiological evidence of a biological mechanism as well as a demonstration of the use of quantitative electroencephalography toward a better understanding of postictal neurophysiology.

Internalizing and externalizing behaviors in children and adolescents with Wilson's disease in the context of quality of life.

Patients with Wilson's disease (WD) are at increased risk of poor quality of life (QoL) and social-emotional outcomes. The above data has been well established in the adult population. What are the predictors of QoL in children and adolescents with WD are unknown. Our study examined whether subjective feelings about QoL are related to the psychosocial functioning in paediatric patients. A cross-sectional study among 50 children with WD, aged 7-18 years. Participants completed the KINDL QoL questionnaire and the Child Behavior Checklist assessing internalizing and externalizing behaviors. Internalizing and externalizing behaviors and their interaction are significant in predicting the QoL of children with WD. Internalizing behaviors are significant predictor of the QoL ß = -0.328 (p < 0.05). The effect of internalizing behavior on the QoL varies with the level of externalizing behavior ß = -0.344* (p < 0.05). Simple effects analysis indicates that the highest QoL for children with WD is in the group characterized by both low levels of internalizing and medium levels of externalizing behaviors, t = -3.052 (df = 46) and p < 0.01, or high levels of externalizing behaviors, t = -2.725 (df = 46) p < 0.01. The interaction between internalizing behaviors explained an additional 7.5% of the variance in scores on the QoL scale. Overall, the final regression model explained 14.9% of the scores on the QoL scale. Monitoring internalizing and externalizing behaviors will allow a better understanding of the course of treatment. In chronic disease, the QoL is an aspect that determines the doctor-patient relationship and often determines the course of the therapeutic process.

Emotion dysregulation, impulsivity and anger rumination in borderline personality disorder: the role of amygdala and insula.

Borderline Personality Disorder (BPD) is a severe mental disorder, characterized by deficits in emotion regulation, interpersonal dysfunctions, dissociation and impulsivity. Brain abnormalities have been generally explored; however, the specific contribution of different limbic structures to BPD symptomatology is not described. The aim of this study is to cover this gap, exploring functional and structural alterations of amygdala and insula and to highlight their contribution to neuropsychiatric symptoms. Twenty-eight BPD patients (23.7 ± 3.42 years; 6 M/22F) and twenty-eight matched healthy controls underwent a brain MR protocol (1.5 T, including a 3D T1-weighted sequence and resting-state fMRI) and a complete neuropsychiatric assessment. Volumetry, cortical thickness and functional connectivity of amygdala and insula were evaluated, along with correlations with the neuropsychiatric scales. BPD patients showed a lower cortical thickness of the left insula (p = 0.027) that negatively correlated with the Anger Rumination Scale (p = 0.019; r = - 0.450). A focused analysis on female patients showed a significant reduction of right amygdala volumes in BPD (p = 0.037), that correlate with Difficulties in Emotion Regulation Scale (p = 0.031; r = - 0.415), Beck Depression Inventory (p = 0.009; r = - 0.50) and Ruminative Response Scale (p = 0.045; r = - 0.389). Reduced functional connectivity was found in BPD between amygdala and frontal pole, precuneus and temporal pole. This functional connectivity alterations correlated with Anger Rumination Scale (p = .009; r = - 0.491) and Barratt Impulsiveness Scale (p = 0.020; r = - 0.447). Amygdala and insula are altered in BPD patients, and these two limbic structures are implicated in specific neuropsychiatric symptoms, such as difficulty in emotion regulation, depression, anger and depressive rumination.

Personal insult disrupts regulatory brain networks in violent offenders.

The failure to adequately regulate negative emotions represents a prominent characteristic of violent offenders. In this functional magnetic resonance imaging study, we used technical, nonsocial frustration to elicit anger in violent offenders (n = 19) and then increased the provocation by adding personal insults (social provocation). The aim was to investigate neural connectivity patterns involved in anger processing, to detect the effect of increasing provocation by personal insult, and to compare anger-related connectivity patterns between offenders and noncriminal controls (n = 12). During technical frustration, the offenders showed increased neural connectivity between the amygdala and prefrontal cortex compared to the controls. Conversely, personal insults, and thus increased levels of provocation, resulted in a significant reduction of neural connectivity between regions involved in cognitive control in the offenders but not controls. We conclude that, when (nonsocially) frustrated, offenders were able to employ regulatory brain networks by displaying stronger connectivity between regulatory prefrontal and limbic regions than noncriminal controls. In addition, offenders seemed particularly sensitive to personal insults, which led to increased implicit aggression (by means of motoric responses) and reduced connectivity in networks involved in cognitive control (including dorsomedial prefrontal cortex, precuneus, middle/superior temporal regions).

Trends of fear and anger on YouTube during the initial stage of the COVID-19 outbreak in South Korea.

BACKGROUND: The COVID-19 pandemic has been the most widespread and threatening health crisis experienced by the Korean society. Faced with an unprecedented threat to survival, society has been gripped by social fear and anger, questioning the culpability of this pandemic. This study explored the correlation between social cognitions and negative emotions and their changes in response to the severe events stemming from the COVID-19 pandemic in South Korea. METHODS: The analysis was based on a cognitive-emotional model that links fear and anger to the social causes that trigger them and used discursive content from comments posted on YouTube's COVID-19-related videos. A total of 182,915 comments from 1,200 videos were collected between January and December 2020. We performed data analyses and visualizations using R, Netminer 4.0, and Gephi software and calculated Pearson's correlation coefficients between emotions. RESULTS: YouTube videos were analyzed for keywords indicating cognitive assessments of major events related to COVID-19 and keywords indicating negative emotions. Eight topics were identified through topic modeling: causes and risks, perceptions of China, media and information, infection prevention rules, economic activity, school and infection, political leaders, and religion, politics, and infection. The correlation coefficient between fear and anger was 0.462 (p < .001), indicating a moderate linear relationship between the two emotions. Fear was the highest from January to March in the first year of the COVID-19 outbreak, while anger occurred before and after the outbreak, with fluctuations in both emotions during this period. CONCLUSIONS: This study confirmed that social cognitions and negative emotions are intertwined in response to major events related to the COVID-19 pandemic, with each emotion varying individually rather than being ambiguously mixed. These findings could aid in developing social cognition-emotion-based public health strategies through education and communication during future pandemic outbreaks.

Spice up the moment: The influence of spicy taste on people's metaphorical perspectives on time.

Embodied cognition contends that sensorimotor experiences undergird cognitive processes. Three embodied cross-domain metaphorical mappings constitute quintessential illustrations: spatial navigation and orientation underpin the conceptualization of time and emotion and gustatory sensation underlies the formulation of emotion. Threading together these strands of insights, the present research consisted of three studies explored the potential influence of spicy taste on people's metaphorical perspectives on time. The results revealed a positive correlation between spicy taste and the ego-moving metaphor for time such that individuals who enjoyed spicy taste (Study 1) and who consumed spicy (vs. salty) snack (Study 2) exhibited a predilection for the ego-moving perspective when cognizing a temporally ambiguous event. Because both spicy taste and the ego-moving metaphor are associated with anger and approach motivation, the latter two were postulated to be related to the novel taste-time relationship. Corroborative evidence for the hypothesis was found, which indicated that spicy (vs. salty) intake elicited significantly stronger anger toward and significantly greater approach-motivated perception of a rescheduled temporal event (Study 3). Taken together, the current findings demonstrate that spicy taste may play a role in people's perspectives on the movement of events in time and highlight the involved embodied interrelation between language, emotion, and cognition.

Anger and anxiety in older adults: a cross-lagged examination.

OBJECTIVES: Both anger and anxiety are common in older adulthood, with aversive consequences for individuals' physical and mental health. Theory suggests that anger can be an emotional response to the experience of anxiety. Similarly, anger can induce anxiety symptoms. Despite studies documenting the co-occurrence of anger and anxiety and their strong theoretical links, little is known about their temporal relationship. The primary aim of this study was to investigate the longitudinal cross-lagged relationship between anger expression, anger suppression, and anxiety. METHODS: A large and representative sample of older adults (N=6,852) was utilized, with data collected in two waves at an interval of four years. All variables were measured using validated self-report scales.Data were analyzed using Structural Equation Modeling. RESULTS: Results indicate that both anger suppression and anger expression are significant predictors of anxiety symptoms. Similarly, anxiety is a significant predictor of both anger suppression and anger expression. CONCLUSIONS: The effects did not differ in magnitude, suggesting a balanced reciprocity between anger and anxiety. An understanding of this reciprocal association can inform interventions and strategies aimed at promoting emotional well-being in older individuals. By addressing both anger and anxiety concurrently, interventions may have a more comprehensive impact on improving mental health outcomes in this population.

The link between anger and reactive aggression: Insights into anger rumination.

This study examined the mediating role of anger rumination in the relationship between anger and reactive aggression and the potential of adaptive anger rumination in reducing reactive aggression. Study 1, a two-wave longitudinal survey of 177 Chinese adolescents, showed that anger rumination mediated the relationship between anger and reactive aggression. Study 2, an experimental study with 160 university students, showed that the self-distanced group had lower aggression than the self-immersed group, and anger rumination mediated the impact of anger on reactive aggression in only the self-immersed group. These findings clarify the role of anger rumination concerning the relationship between anger and reactive-aggression and highlight the importance of self-distanced anger rumination in preventing reactive aggression among adolescents and young adults.

Anger is more strongly associated with alcohol and tobacco use and use disorders compared to other substances in American adults.

Background: Anger is elevated in substance use disorders (SUDs) and related to problematic use. However, it is unclear whether anger is elevated in individuals who use substances, is only heightened among those with SUDs, and whether anger is more strongly tied to use of certain substances or SUDs.Objectives: We examine the association between anger, general substance use and SUDs.Methods: Data is N = 28,753 (55% female) respondents from the NESARC-III. Participants endorsing anger and indicating negative functional impact were deemed to have experienced significant anger.Results: Logistic regression examining the relative strength of associations between anger, substance use and SUDs (alcohol, opioid, stimulant, tobacco and cannabis) indicated that having a SUD was associated with anger beyond use alone. Alcohol (adjusted odds ratio [AOR] = 1.45; 95% CI 1.32-1.6) and tobacco (AOR = 1.38; 95% CI 1.27-1.51) use displayed the strongest odds of experiencing anger above and beyond other substances in the model. Similarly, alcohol (AOR = 1.45; 95% CI 1.31-1.62) and tobacco (AOR = 1.46; 95% CI 1.3-1.64]) use disorders had the greatest odds of anger relative to other SUDs. These results were significant after controlling for mood, anxiety disorders, and PTSD and no sex differences were observed.Conclusion: These results indicate that SUDs, particularly alcohol and tobacco use and disorders, are positively associated with experiencing anger beyond just substance use. Research must identify the mechanism driving this association to enhance treatments that target anger.

The transition from physical sibling abuse to bullying perpetration through trait anger: A longitudinal study.

OBJECTIVES: Experiencing physical sibling abuse is a form of family violence that is common but understudied. While it is often perceived as a normative aspect of sibling relationships, there are apparent behavioral consequences. The current study aims to advance the literature by utilizing the displaced aggression model and I3 theory to longitudinally examine trait anger as a pathway linking physical sibling abuse to bullying perpetration. METHODS: Using data from the Bullying, Sexual, and Dating Violence Trajectories from Early to Late Adolescence in the Midwestern United States, 2008-2013, adolescents (n = 851, M = 14.8 years) completed questionnaires at baseline and were reassessed 6 months later. RESULTS: Results suggested that when adolescents experience physical sibling abuse, they are more likely to engage in bullying perpetration. Mediation analyses indicated that as adolescents were physically abused by a sibling at home, they were more likely to report higher levels of trait anger, which subsequently increased their risk of engaging in bullying perpetration. CONCLUSION: These results suggest that experiencing physical sibling abuse has long-term detrimental consequences, including elicitation of trait anger, subsequently predicting bullying perpetration.

The effect of aggressive fantasizing on aggressive inclinations: Moderating effects of dispositional anger expression.

Experiencing victimization or mistreatment often induces feelings of anger. The catharsis hypothesis suggests that venting anger may aid in alleviating these negative emotions. Although this hypothesis has faced criticism, therapeutic interventions rooted in catharsis are employed to assist victims in managing their anger. One notable application of the catharsis principle in psychotherapeutic practice with victims involves engaging in aggressive fantasies: Victims who harbor aggressive fantasies against their offenders are supported in working with these fantasies to navigate the complex emotions arising from their victimization. Research investigating the effects of aggressive fantasizing on victims has yielded inconsistent findings, with some studies indicating positive and others suggesting negative outcomes. Herein, we examine whether (instructed) aggressive fantasizing diminishes (catharsis hypothesis) or heightens (escalation hypothesis) subsequent aggressive inclinations compared to non-aggressive fantasizing. Additionally, the moderating role of victims' dispositional tendencies to express anger, specifically Anger Expression-out and Anger Expression-control, in the relationship between aggressive fantasizing and aggressive inclinations was examined. We recruited individuals (N = 245) who had experienced victimization through highly unfair treatment and instructed them to imagine confronting their wrongdoer using either aggressive or non-aggressive communication. Participants then reported their aggressive inclinations. Data supported the escalation hypothesis, revealing that aggressive fantasizing amplifies subsequent aggressive inclinations. Importantly, individuals with higher Anger Expression-out demonstrated greater susceptibility to this effect; whereas, Anger Expression-control did not moderate the link between aggressive fantasizing and inclinations. These findings further challenge the catharsis hypothesis and underscore the role of dispositional anger expression tendencies on the effects of aggressive fantasizing.

Experimentally manipulated anger activates implicit cognitions about social hierarchy.

A correlational pilot study (N = 143) and an integrative data analysis of two experiments (total N = 377) provide evidence linking anger to the psychology of social hierarchy. The experiments demonstrate that the experience of anger increases the psychological accessibility of implicit cognitions related to social hierarchy: compared to participants in a control condition, participants in an anger-priming condition completed word stems with significantly more hierarchy-related words. We found little support for sex differences in the effect of anger on implicit hierarchy-related cognition; effects were equivalent across male and female participants. Findings fit with functionalist evolutionary views of anger suggesting that anger may motivate the use of dominance to strive for high social rank in group hierarchies. Implications for downstream behaviour, including aggression and negotiation, are discussed.

Voter emotional responses and voting behaviour in the 2020 US presidential election.

Political polarisation in the United States offers opportunities to explore how beliefs about candidates - that they could save or destroy American society - impact people's thoughts, feelings, and behaviour. Participants forecast their future emotional responses to the contentious 2020 U.S. presidential election, and reported their actual responses after the election outcome. Stronger beliefs about candidates were associated with forecasts of greater emotion in response to the election, but the strength of this relationship differed based on candidate preference. Trump supporters' forecast happiness more strongly related to beliefs that their candidate would save society than for Biden supporters. Biden supporters' forecast anger and fear were more strongly related to beliefs that Trump would destroy society than vice versa. These forecasts mattered: predictions of lower happiness and greater anger if the non-preferred candidate won predicted voting, with Biden supporters voting more than Trump supporters. Generally, participants forecast more emotion than they experienced, but beliefs altered this tendency. Stronger beliefs predicted experiencing more happiness or more anger and fear about the election outcome than had been forecast. These findings have implications for understanding the mechanisms through which political polarisation and rhetoric can influence voting behaviour.

The relationship between metacognition, anger, and pain intensity among fibromyalgia patients: a serial mediation model.

Fibromyalgia is a burdensome pain causing patients a very negative emotional state that can worsen their clinical profile, perceived disability, and treatment outcomes. In particular, anger can negatively affect pain and patient adjustment to the disease. Recent studies suggest that metacognitions and anger rumination can negatively affect anger, which in turn can amplify the intensity of pain. This study aims to investigate whether anger rumination and state anger serially mediate the relationship between metacognitions and the intensity of pain. The study included 446 subjects who: declared having received a fibromyalgia diagnosis by a rheumatologist/pain physician; completed measures of metacognitions, anger rumination, state-anger, and pain intensity. The serial mediation analysis was conducted using Hayes' PROCESS macro (Model 6). Negative beliefs about worry and beliefs about the need to control thoughts indirectly influenced the intensity of pain through two significant mediating pathways: state-anger and anger rumination to state-anger. Cognitive self-consciousness affected pain intensity directly (ß = .11, p < .05) and indirectly through two significant mediating pathways: state-anger and anger rumination to state-anger. This study highlights the role of serial mediation of anger rumination and state-anger in the relationship between metacognitions and pain intensity in the field of fibromyalgia. Our work introduces new targets for anger management interventions for patients with fibromyalgia. Such interventions could be effectively addressed with a metacognitive approach considering its specific focus on dysfunctional metacognitive beliefs and repetitive negative thinking.

The inner workings of anger: A network analysis of anger and emotion regulation.

OBJECTIVE: This study aimed to investigate the interrelations between emotion regulation strategies and different types of anger using network analysis. METHOD: Data were drawn from a cross-sectional sample of 538 adults (55% females; mean age = 39.8 years, SD = 12.3) seeking treatment for anger. Data were collected between March and November 2019 in Sweden. Participants completed measures of anger problems (anger expression, anger suppression, angry reactions, anger rumination, trait anger, hostility, physical aggression, and verbal aggression) and emotion regulation (cognitive reappraisal, expressive suppression, anger relaxation, and five mindfulness strategies). To determine whether distinct clusters of anger nodes would emerge, exploratory graph analysis was employed. Based on clustering of nodes, we estimated separate networks including all measures of emotion regulation. RESULTS: Two clusters emerged: one consisting primarily of cognitive components of anger, and another of behavioral. Across networks, anger nodes were strongly interconnected, and anger rumination and anger suppression were especially influential. Several direct links were found between specific emotion regulation strategies and cognitive components of anger, whereas most strategies were only indirectly related to angry behavior. Cognitive reappraisal showed no direct link with any of the anger nodes. CONCLUSIONS: Our findings reveal potential pathways by which different emotion regulation strategies may influence different types of anger, which could serve as therapeutic targets.

Mediation analyses of longitudinal data investigating temporal associations between inflated sense of responsibility, obsessive-compulsive symptoms, and anger suppression.

OBJECTIVE: Cognitive theories emphasize the central role of anger and anger suppression in obsessive-compulsive disorder (OCD). According to these theories, anger suppression is seen as a consequence of OCD, whereas cognitive beliefs, such as an inflated sense of responsibility, are seen as antecedent factors. To extend the findings from cross-sectional studies, the current study investigated the temporal associations between OCD symptoms, an inflated sense of responsibility, and anger suppression. Consistent with cognitive considerations, we hypothesized that OCD symptoms mediate the association between feelings of responsibility and anger suppression. These associations were also explored in patients presenting particularly high checking-related symptoms. Further, the stability of effects beyond controlling for depressive symptoms and medication intake was explored. METHODS: A total of N = 48 patients with OCD (50% female, M = 32.46 [SD = 10.63] years of age) completed measures on obsessive beliefs, OCD symptoms, and anger suppression at three assessment points: before and after a metacognitive intervention as well as at a follow-up 6 months later. Mediation models investigating symptom associations at these three timepoints were conducted. Exploratory analyses investigating these associations in individuals presenting high checking-related symptoms (n = 20) and testing the stability of effects beyond controlling for depressive symptoms and medication intake were conducted. RESULTS: The sense of responsibility did not significantly predict the level of anger suppression. A temporal association between OCD symptoms (as assessed with the self-report measure) and anger suppression could be evidenced, which was stable beyond controlling for depressive symptoms and medication intake. Against the expectations based on cognitive theories, the sense of responsibility did not predict OCD symptoms. No mediating effect of OCD symptoms was found. CONCLUSION: In line with cognitive viewpoints, the present study shows that higher OCD symptoms predict higher levels of anger suppression in a longitudinal design, thereby contributing to the suppression of anger. This effect seems to be independent from depressive symptoms and medication intake. The effect of sense of responsibility on OCD symptoms was less clear and could only be found in the subgroup of patients with OCD and checking-related symptoms, who generally presented higher levels of responsibility. Overall, this is the first study demonstrating temporal associations between OCD symptoms and anger suppression. Acknowledging that anger and anger suppression may be a consequence of OCD symptoms and may also affect aspects of psychotherapy, which can ultimately inform future adjustments to psychotherapeutic treatment.