Anger Attacks in Depression – Evidence for a Male Depressive Syndrome

Background: The term ‘posttraumatic embitterment disorder’ (PTED) was recently introduced to describe a subtype of adjustment disorders, characterized by prolonged embitterment, severe additional psychopathological symptoms and great impairment in most areas of life in reaction to a severe negative but not life threatening life event. The aim of this study is an empirical description and validation of the clinical concept of PTED, by comparing clinically defined PTED patients with patients suffering from other mental disorders on measures of posttraumatic stress and psychopathological distress. Methods: Fifty inpatients, suffering from PTED according to previously defined clinical diagnostic criteria, were compared with another 50 patients, matched by age and gender, who did not meet clinical criteria for PTED but for other mental disorders. Psychiatric diagnoses were assessed by the Mini International Neuropsychiatric Interview. Self-report measures included the Bern Embitterment Scale, the Impact of Event Scale, the PTED Self-Rating Scale and the SCL-90. Results: According to the Mini International Neuropsychiatric Interview both groups fulfilled the criteria for many disorders with a significantly higher occurrence of major depression and chronic adjustment disorder but less generalized anxiety disorder lifetime in PTED patients. Patients with PTED scored significantly higher on the global scores and on most subdimensions of the SCL-90, the Impact of Event Scale, the Bern Embitterment Scale and the PTED Self-Rating Scale. Conclusions: Clear differences were found between PTED patients and patients with other mental disorders in regard to the quality and intensity of psychopathological as well as posttraumatic stress symptoms. PTED can help further subclassify and specify adjustment and reactive disorders.

Section: Discussionmentioning

confidence: 99%

Posttraumatic Embitterment Disorder in Comparison to Other Mental Disorders

Lindén

Baumann

Rotter

et al. 2007

“…Migraine patients display higher levels of internalized anger [9,10,11]; introjection and externalization of anger correlate with depression and anxiety levels, respectively [12]. Furthermore, anger attacks have been suggested to play an important role in the symptomatology of depression, especially in male patients [13]. …”

Section: Introductionmentioning

confidence: 99%

Anger, Depression and Personality Dimensions in Patients with Migraine without Aura

Abbate-Daga

Fassino

Giudice

et al. 2007

Background: Migraine without aura causes acute and chronic pain and partially compromises patients’ social functioning and work performance. Over the past years, psychiatric comorbidities were frequently observed in these patients, together with coping difficulties and typical personality traits. The aim of this study was to identify whether migraine patients and controls share distinctive personality traits. Methods: 105 consecutive patients suffering from migraine without aura referred to the Headache Center of Turin University were enrolled in the study and compared to a control group of 79 healthy subjects. Patients and controls completed several psychometric questionnaires, including the Temperament and Character Inventory, the Beck Depression Inventory and the State-Trait Anger Expression Inventory. Results: Patients suffering from migraine show more depressive symptoms, difficult anger management with a tendency to hypercontrol, and a distinctive personality profile with high harm avoidance, high persistence and low self-directedness. When a logistic regression was performed, the only significant predictors of migraine were temperament variables. Conclusions: The results suggest that the personality traits and psychosomatic mechanisms of migraine patients may make them vulnerable to stress and less skilled in coping with pain. These traits correlate with dysregulated neurotransmitter systems which may also be part of the psychobiological components of personality, depressive disorders and migraine itself.

“…This sample comprises outpatients and inpatients, who have already been reported elsewhere [7, 8]. Patients were diagnosed according to the DSM-IV [1].…”

Section: Methodsmentioning

confidence: 99%

Validation of a Simplified Definition of Anger Attacks

Winkler¹,

Pjrek²,

Kindler³

et al. 2006

Self Cite

Background: Anger attacks, sudden spells of anger with vegetative hyperarousal, are highly prevalent symptoms in depression. Assessment normally requires the use of specific instruments. The aim of this study was the validation of a simplified definition for anger attacks. Methods: Anger attacks were assessed in 203 patients suffering from major depression with the Anger Attacks Questionnaire. The first three items of the questionnaire (irritability, overreaction to minor annoyances, episodes with inappropriate anger or rage) were compared separately with the diagnosis, and their value as single screening questions to establish the diagnosis was assessed. Results: Irritability was only weakly associated with the diagnosis of anger attacks (Cohen’s kappa ĸ = 0.214 ± 0.058) and yielded a rather low specificity (0.302), while overreaction to minor annoyances (ĸ = 0.869 ± 0.037) and the question about episodes with inappropriate anger or rage (ĸ = 0.901 ± 0.032) had a high degree of agreement with the diagnosis of the questionnaire (specificity 0.918 and 0.935, respectively). The combination of the two later items resulted in an almost perfect reclassification of cases (ĸ = 0.955 ± 0.022; specificity = 0.971). Conclusions: As anger attacks are probably underdiagnosed in clinical practice, simplification of the diagnostic process is imperative. Our results demonstrate that asking one or two simple screening questions suffices to recognize the majority of patients with anger attacks.