The comorbidity of anger symptoms with personality disorders in psychiatric outpatients.

OBJECTIVES: Although many psychiatric disorders are "emotional" disorders, no disorders exist for which dysfunctional anger is a necessary feature. This study examined whether dysfunctional anger could be considered a diagnosis independent from Personality Disorders. DESIGN: We analyzed data on 1,158 psychiatric outpatients who underwent a semi-structured interview for Axis II disorders and ascertained the co-occurrence of dysfunctional anger and Personality Disorders. RESULTS: The overlap between dysfunctional anger and all Personality Disorders was low. Data analyses showed dysfunctional anger was not well accounted for by Axis II diagnoses. CONCLUSIONS: Dysfunctional anger can be viewed by researchers and clinicians as an independent diagnostic entity. The implications of these results for the diagnosis and treatment of patients with anger symptoms is discussed.

An open trial of a comprehensive anger treatment program on an outpatient sample.

BACKGROUND: This pilot study was designed to investigate the efficacy of a cognitive behavioral treatment for anger. METHOD: Twelve (5 men and 7 women) outpatient adults completed 2-hour group sessions for 16 sessions. Participants were diagnosed with 29 Axis I and 34 Axis II disorders with high rates of comorbidity. Empirically supported techniques of skills training, cognitive restructuring, and relaxation were utilized. In this protocol, cognitive restructuring emphasized the use of the ABC model to understand anger episodes and the Rational Emotive Behavior Therapy (REBT) techniques of disputing irrational beliefs and rehearsing rational coping statements, but additional cognitive techniques were used, e.g. self-instructional training (SIT). Skills training included problem-solving and assertiveness. Relaxation training was paced respiration. Motivational interviewing, imaginal exposure with coping, and relapse prevention were also included. RESULTS: Significant improvements were found from pre- to post-treatment on the following measures: the Trait Anger Scale of the State-Trait Anger Expression Inventory-II; and Anger Disorder Scale total scores; idiosyncratic anger measurements of situational intensity and symptom severity; and the Beck Depression Inventory-II. CONCLUSIONS: In order to extend the significant research findings of this pilot study, future investigations should involve larger sample sizes, populations drawn from various settings, and contact control groups.

Clinicians' diagnosis of a case with anger problems.

Psychiatrists and psychologists responded to case vignettes to assess the prevalence, severity, and diagnostic confidence clinicians had concerning treating anger disordered clients compared with clients with generalized anxiety disorder. Five hundred and forty-two clinicians (a response rate of 30%) assessed one of two matched case histories by mail. One described generalized anxiety disorder (GAD) and the other a case of anger disorder (AD). Cases were identical except for thoughts and affect relevant to the disorders. Both male and female versions were used. More than 95% of the participants viewed the cases they received as pathological. The disorders were rated as equally common. The clinicians reported treating equal numbers of patients with similar anger or anxiety symptoms in the past year. Although the case histories were alike in length and detail, AD participants rated their case as less complete and had lower confidence in their diagnoses. The diagnostic consensus was high for GAD clinicians, but low for AD. Forty-three percent of participants selected an Axis II diagnosis for AD, compared with 3% for GAD. Clinicians appeared to encounter patients with chronic anger about as frequently as they see GAD, but they displayed diagnostic confusion and bias toward personality disorder diagnoses when presented with the anger symptoms. The findings support the development of a diagnostic category for primary anger. The wide dispersion of diagnoses for anger underscores the need for focused differential assessment.