Elsevier

Journal of Affective Disorders

Volume 189, 1 January 2016, Pages 169-175
Journal of Affective Disorders

Research report
Emotion-relevant impulsivity predicts sustained anger and aggression after remission in bipolar I disorder

https://doi.org/10.1016/j.jad.2015.07.050Get rights and content

Highlights

  • Some, but not all, persons with bipolar I disorder report ongoing struggles with anger and aggression that are sustained after remission.

  • Impulsivity in the context of emotion is robustly related to problems with anger and aggression after remission.

  • The effects of emotion-relevant impulsivity remain significant after controlling for many of the variables traditionally found to predict problems with anger and aggression within bipolar disorder.

Abstract

Recent evidence suggests that anger and aggression are of concern even during remission for persons with bipolar I disorder, although there is substantial variability in the degree of anger and aggression across individuals. Little research is available to examine psychological models of anger and aggression for those with remitted bipolar disorder, and that was the goal of this study. Participants were 58 persons diagnosed with bipolar I disorder using the Structured Clinical Interview for DSM-IV, who were followed with monthly symptom severity interviews until they achieved remission, and then assessed using the Aggression-Short Form. We examined traditional predictors of clinical parameters and trauma exposure, and then considered three trait domains that have been shown to be elevated in bipolar disorder and have also been linked to aggression outside of bipolar disorder: emotion-relevant impulsivity, approach motivation, and dominance-related constructs. Emotion-relevant impulsivity was related to anger, hostility, verbal aggression, and physical aggression, even after controlling for clinical variables. Findings extend the importance of emotion-relevant impulsivity to another important clinical outcome and suggest the promise of using psychological models to understand the factors driving aggression and anger problems that persist into remission among persons with bipolar disorder.

Section snippets

. Introduction

Although not a universal concern, bipolar disorder (BD) is related to elevated rates of aggression and violence in adults (, ) as well as children (, ). In the NESARC community-based representative sample, 25.34% of those with bipolar I disorder and 13.58% of those with bipolar disorder II reported aggressive behavior after age 15 as compared to <1% in the general population (Latalova, 2009), and rates of violence among those with BD were 5.9 times the rate in the general population (Van Dorn

Sources of anger and aggression in BD

Previous research has suggested that anger and aggression within BD can be related to comorbid conditions and trauma exposure. One possibility is that anger and aggression follow from comorbid conditions, such as substance-related diagnoses (, , ) and PTSD (Garno et al., 2008). There is also evidence that aggression within BD is related to childhood abuse (, ) and adulthood violent victimization (, ). It remains unclear, however, whether such variables predict aggression and anger during

Method

Study procedures were approved by the university Institutional Review Board. Data were gathered as part of a broader study (Muhtadie and Johnson, 2015).

Sample characteristics

The 58 participants had a mean age of 35.93 (SD=12), and a mean level of education of 15.23 years (SD=1.96). The sample was 54.2% women, and 42.4% employed. Per the SCID, 20.9% were diagnosed with PTSD, 55.2% with an anxiety disorder other than PTSD, and 57.6% with an alcohol or substance use disorder during their lifetime. Fully 80.6% of the sample reported a history of traumatic events.

In a previous report (Johnson et al., in press), we described that the bipolar group attained significantly

Discussion

Previous research documented that persons diagnosed with BD reported significantly more difficulty with anger, verbal aggression, physical aggression, and hostility than did control participants, and that these difficulties were sustained across follow-up (Ballester et al., 2014) and even during a state of remission (Johnson et al., in press). Not all persons with BD have such difficulties, however. The goal of this study was to identify variables that might explain why some people show

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