Fear and Loathing: A Meta-Analytic Review of the Specificity of Anger in PTSD

doi:10.1016/j.beth.2009.01.004

Behavior Therapy

Volume 41, Issue 1, March 2010, Pages 93-105

https://doi.org/10.1016/j.beth.2009.01.004 Get rights and content

Abstract

The available empirical literature suggests that anger may be characteristic of posttraumatic stress disorder (PTSD). Meta-analytic strategies were used to evaluate the extent to which the experience of anger is specific to PTSD rather than anxiety disorders in general. Thirty-four anxiety disorder patient samples (n = 2,169) from 28 separate studies were included in the analysis. Results yielded a large effect size indicating greater anger difficulties among anxiety disorder patients versus controls. Compared to control samples, a diagnosis of PTSD was associated with significantly greater difficulties with anger than was any other anxiety disorder diagnosis. Other anxiety disorder diagnoses did not differ significantly from each other. However, the specific association between PTSD and anger did vary depending on the anger domain assessed. Difficulties with anger control, anger in, and anger out significantly differentiated PTSD from non-PTSD anxiety disorder samples, whereas difficulties with anger expression, state anger, and trait anger did not. These findings are discussed in the context of future research on the role of anger in PTSD.

Section snippets

Selection of studies

Appropriate studies were identified by conducting searches in both PsycINFO and PubMed between May and August of 2007. Seven separate searches were conducted in each database and the search criteria were limited to studies that were printed in English and key words that appeared in the abstract and/or title of the study. The searches were: (1) “phobia” and “anger”; (2) “social phobia” and “anger”; (3) “panic disorder” and “anger”; (4) “post-traumatic” and “anger,” “PTSD” and “anger”; (5)

Preliminary analyses

Across patient samples, 39.3% were female, with a mean age of 38.66 (SD = 6.33) years; across control samples, 40.3% were female, with a mean age of 36.7 (SD = 8.63) years. Neither age nor sex differed between patient and control samples, p’s > .05. Anger effect size estimates did not correlate significantly with the mean age of the patient sample (z = -.62, p = .532). Anger effect size estimates did correlate significantly with the percentage of female participants in the patient sample (z = -11.27, p <

Discussion

The present meta-analytic investigation examined the extent to which the experience of anger is specific to PTSD rather than an artifact of anxiety disorders symptoms. A comparison of specific diagnoses did yield a large effect size indicating greater anger difficulties among all anxiety disorders compared to controls, with the exception of social and specific phobia. However, the effect size for PTSD was significantly greater than that of all other anxiety disorders, none of which differed

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Citation Excerpt :
For instance, ALP anger proneness was associated with depression, PTSD, lower respiratory symptoms, and GERD symptoms over and above self-report anger proneness. This is consistent with prior research indicating that anger contributes to many poor health outcomes (Maan Diong et al., 2005) and is important and sometimes central feature in PTSD (Jakupcak et al., 2007; Olatunji et al., 2010). ALP anger proneness even predicted increases in depression over the relatively short two-year period over and above self-report anger proneness and depression symptoms at time 1.
Recent research on artificial intelligence has demonstrated that natural language can be used to provide valid indicators of psychopathology. The present study examined artificial intelligence-based language predictors (ALPs) of seven trauma-related mental and physical health outcomes in responders to the World Trade Center disaster.
The responders (N = 174, M_age = 55.4 years) provided daily voicemail updates over 14 days. Algorithms developed using machine learning in large social media discovery samples were applied to the voicemail transcriptions to derive ALP scores for several risk factors (depressivity, anxiousness, anger proneness, stress, and personality). Responders also completed self-report assessments of these risk factors at baseline and trauma-related mental and physical health outcomes at two-year follow-up (including symptoms of depression, posttraumatic stress disorder, sleep disturbance, respiratory problems, and GERD).
Voicemail ALPs were significantly associated with a majority of the trauma-related outcomes at two-year follow-up, over and above corresponding baseline self-reports. ALPs showed significant convergence with corresponding self-report scales, but also considerable uniqueness from each other and from self-report scales.
The study has a relatively short follow-up period relative to trauma occurrence and a limited sample size.
This study shows evidence that ALPs may provide a novel, objective, and clinically useful approach to forecasting, and may in the future help to identify individuals at risk for negative health outcomes.

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Fear and Loathing: A Meta-Analytic Review of the Specificity of Anger in PTSD

Abstract

Section snippets

Selection of studies

Preliminary analyses

Discussion

Behaviour Research and Therapy

Journal of Psychiatric Research

Behaviour Research and Therapy

Psychiatry Research

Clinical Psychology Review

Aggression and Violent Behavior: A Review Journal

Addictive Behaviors

Behavior Therapy

Behavior Therapy

Behaviour Research and Therapy

Clinical Psychology Review

Biological Psychiatry

Behavior Therapy

Journal of Affective Disorders

Comprehensive Psychiatry

Comprehensive Psychiatry

Journal of Affective Disorders

Behaviour Research and Therapy

Behaviour Research and Therapy

Psychiatry Research

Journal of Psychosomatic Research

Trauma, PTSD, and resilience: A review of the literature

Trauma Violence Abuse

Diagnostic and statistical manual of mental disorders

Anxiety and its disorders: The nature and treatment of anxiety and panic

Magnitude and duration of cardiovascular response to anger in Vietnam veterans with and without posttraumatic stress disorder

Journal of Consulting and Clinical Psychology

The Aggression Questionnaire

Journal of Personality and Social Psychology

Effect of cognitive-behavioral treatments for PTSD on anger

Journal of Cognitive Psychotherapy

Partners' ratings of combat veterans' anger

Journal of Traumatic Stress

Bodily changes in pain, hunger, fear and rage

Anger, impulsivity, and anger control in combat-related posttraumatic stress disorder

Journal of Consulting and Clinical Psychology

Anger regulation deficits in combat-related posttraumatic stress disorder

Journal of Traumatic Stress

Post-traumatic stress disorder in chronic post-traumatic headache patients

Headache

Statistical power analysis for the behavioral sciences

Anger and drug addiction

Psychological Reports

Nonspecific psychological distress and other dimensions of psychopathology

Archives of General Psychiatry

Psychological impact of torture: A 3-month follow-up of mass evacuated Kosovan adults in Sweden: Lessons learnt for prevention

Acta Psychiatrica Scandinavica

Anger and its association to distress and social/occupational functioning in symptomatic disaster relief workers responding to the September 11, 2001, World Trade Center disaster

Journal of Traumatic Stress

Relationship between scores on anger measures and PTSD symptomatology, employment, and compensation-seeking status in combat veterans

Journal of Clinical Psychology

Anger: Causes and consequences

Statistics

Associations of hostility and coronary artery disease: A review of studies