Research has shown that anger may be related to the development and maintenance of posttraumatic stress disorder (PTSD). This study investigates the impact of anger on patients with PTSD in a general psychiatric population. Participants diagnosed with PTSD were grouped according to current levels of subjective and inappropriately expressed anger: (a) low subjective and expressed anger; (b) elevated subjective anger and low expressed anger; (c) low subjective anger and elevated expressed anger; and (d) elevated subjective and expressed anger. It was hypothesized that participants reporting elevated levels of subjective anger coupled with recent overt expression would be more impaired and distressed than individuals with PTSD in the other anger groups, after comorbid diagnoses were controlled. The elevated subjective and expressed anger group was more impaired/distressed on global measures and their elevated anger affected some measures of behavioral functioning. Findings are discussed in light of the literature on anger and PTSD.
Get full access to this article
View all access options for this article.
References
1.
American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
2.
Beckham, J. C., Feldman, M. E., Kirby, A. C., Hertzberg, M. A., & Moore, S. D. (1997). Interpersonal violence and its correlates in Vietnam veterans with chronic posttraumatic stress disorder. Journal of Clinical Psychology, 53, 859-869.
3.
Beckham, J. C., Moore, S. D., & Reynolds, V. (2000). Interpersonal hostility and violence in Vietnam combat veterans with chronic posttraumatic stress disorder: A review of theoretical models and empirical evidence. Aggression and Violent Behavior, 5, 451-466.
4.
Berman, M. E., Fallon, A. E., & Coccaro, E. F. (1998). The relationship between personality psychopathology and aggressive behavior in research volunteers. Journal of Abnormal Psychology, 107, 651-658.
5.
Bollinger, A. R., Riggs, D. S., Blake, D. D., & Ruzek, J. I. (2000). Prevalence of personality disorders among combat veterans with posttraumatic stress disorder. Journal of Traumatic Stress, 13, 255-270.
6.
Breslau, N., Chilcoat, H. D., Kessler, R. C., & Davis, G. C. (1999). Previous exposure to trauma and PTSD effects of subsequent trauma: Results from the Detroit area survey of trauma. American Journal of Psychiatry, 156, 902-907.
7.
Byrne, C. A., & Riggs, D. S. (1996). The cycle of trauma: Relationship aggression in male Vietnam veterans with symptoms of posttraumatic stress disorder. Violence and Victims, 11, 213-223.
8.
Davidson, J. R. T., Kudler, H. S., Saunders, W. B., & Smith, R. D. (1990). Symptom and comorbidity patterns in World War II veterans with posttraumatic stress disorder. Comprehensive Psychiatry, 31, 162-170.
9.
Endicott, J., Cohen, J., Nee, J., Fleiss, J., & Sarantakos, S. (1981). Hamilton depression rating scale: Extracted from regular and change versions of the schedule for affective disorders and schizophrenia. Archives of General Psychiatry, 38,98-103.
10.
Endicott, J., & Spitzer, R. L. (1978). A diagnostic interview: The schedule for affective disorders and schizophrenia. Archives of General Psychiatry, 35, 837-844.
11.
Feeny, N. C., Zoellner, L. A., & Foa, E. B. (2000). Anger, dissociation, and posttraumatic stress disorder among female assault victims. Journal of Traumatic Stress, 13, 89-100.
12.
First, M. B., Spitzer, R. L., Williams, J. B. W., & Gibbon, M. (1997). Structured Clinical Interview for DSM-IV (SCID). Washington, DC: American Psychiatric Association.
13.
Foa, E. B., Riggs, D. S., Massie, E. D., & Yarczower, M. (1995). The impact of fear activation and anger on the efficacy of exposure treatment for posttraumatic stress disorder. Behavior Therapy, 26,487-499.
14.
Foa, E. B., & Rothbaum, B. O. (1997). Treating the trauma of rape. New York: Guilford.
15.
Green, B. L., Goodman, L. A., Krupnick, J. L., Corcoran, C. B., Petty, R. M., Stockton, P., et al. (2000). Outcomes of single versus multiple trauma exposure in a screening sample. Journal of Traumatic Stress, 13, 271-286.
16.
Hiley-Young, B., Blake, D. D., Abueg, F. R., Rozynko, V., & Gusman, F. D. (1995). Warzone violence in Vietnam: An examination of premilitary, military and postmilitary factors in PTSD in-patients. Journal of Traumatic Stress, 8,125-141.
17.
Keane, T. M. (1995). The role of exposure therapy in the psychological treatment of PTSD. NCP Clinical Quarterly, 5(4), 3-6.
18.
Kolko, C. E. (1992). Characteristics of child victims of physical violence: Research findings and clinical implications. Journal of Interpersonal Violence, 7, 244-276.
19.
Margolin, G., & Gordis, E. B. (2000). The effects of family and community violence on children. Annual Review of Psychology, 51, 445-479.
20.
Pfohl, B., Blum, N., & Zimmerman, M. (1997). Structured Interview for DSM-IV Personality. Washington, DC: American Psychiatric Press.
21.
Posternak, M. A., & Zimmerman, M. (2002). Anger and aggression in psychiatric outpatients. Journal of Clinical Psychiatry, 63, 665-672.
22.
Riggs, D. S., Dancu, C. V., Gershuny, B. S., Greenberg, D., & Foa, E. B. (1992). Anger and posttraumatic stress disorder in female crime victims. Journal of Traumatic Stress, 5, 613-625.
23.
Southwick, S. M., Yehuda, R., & Giller, E. L. (1993). Personality disorders in treatment-seeking combat veterans with posttraumatic stress disorder. American Journal of Psychiatry, 150, 1020-1023.
24.
van der Kolk, B. A., Hostetler, A., Herron, N., & Fisler, R. E. (1994). Trauma and the development of borderline personality disorder. Psychiatric Clinics of North America, 17, 715-729.
25.
Wyatt, G. E., Guthrie, D., & Notgrass, C. M. (1992). Differential effects of women's child sexual abuse and subsequent sexual revictimization. Journal of Consulting and Clinical Psychology, 60, 167-173.
26.
Zimmerman, M., & Mattia, J. I. (1999). Is posttraumatic stress disorder underdiagnosed in routine clinical settings?Journal of Nervous and Mental Disease, 187, 420-428.
27.
Zimmerman, M., & Mattia, J. I. (2001). The psychiatric diagnostic screening questionnaire: Development, reliability, and validity. Comprehensive Psychiatry, 42, 175-189.
