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PubMed1991

Hostility-related variables and plasma lipid levels.

The present study was conducted to examine whether lipid levels would be related to cynical hostility (an attitudinal component of hostility), expressive hostility (a behavioral component of hostility), and neurotic hostility (an emotional component of hostility). Subjects were 74 men and 54 women who were free of potential medical factors affecting lipoprotein levels. Across both genders, expressive hostility was found to be positively related to total cholesterol and low-density lipoprotein (LDL). Neurotic hostility was not related to lipid levels for either men or women. These results are congruent with other evidence, suggesting that expressive hostility but not hostile emotions contributes to atherogenesis. For men but not women, cynical hostility was found to be positively related to LDL. These results for men are congruent with findings, albeit not consistent, of a relation between cynical hostility and coronary artery disease.

Adult↗

PubMed1999

Socioeconomic status, hostility, and risk factor clustering in the Normative Aging Study: any help from the concept of allostatic load?

OBJECTIVE: To examine the relationships between socioeconomic status (SES), psychosocial vulnerability (hostility), and allostatic load. Allostatic load refers to the cumulative physiological cost of adaptation to stress. METHOD: We examined the relationships between SES (as measured by educational attainment), hostility, and allostatic load in the Normative Aging Study, a longitudinal study of community-dwelling men aged 21 to 80 years and free of known chronic medical conditions at entry in the 1960s. In 1986, the revised Minnesota Multiphasic Personality Inventory was administered by mail, from which a hostility measure was derived by summing the scores from three Cook-Medley subscales: Hostile Affect, Hostile Attribution, Aggressive Responding. An index of allostatic load was constructed from data collected during physical exams conducted between 1987 and 1990 (i.e. measures reflecting "wear and tear" on the cardiovascular, endocrine, and metabolic systems). Cross-sectional relationships between education, hostility, and allostatic load were examined in 818 men. RESULTS: Separate linear regression analyses indicated that lower levels of educational attainment and greater hostility were both associated with higher allostatic load scores (p < .05 and p < .01, respectively). Less education was also associated with higher hostility (p < .001). When allostatic load was regressed simultaneously on education and hostility, the effect of education was attenuated, while hostility (p < .05) maintained an independent effect. CONCLUSIONS: Our findings suggest that lower levels of education and greater hostility are associated with greater "wear and tear" on the body. The effects of education on allostatic load may be mediated by hostility.

Adaptation, Physiological↗

PubMed2004

Hostility and facial affect recognition: effects of a cold pressor stressor on accuracy and cardiovascular reactivity.

The effects of hostility and a cold pressor stressor on the accuracy of facial affect perception were examined in the present experiment. A mechanism whereby physiological arousal level is mediated by systems which also mediate accuracy of an individual's interpretation of affective cues is described. Right-handed participants were classified as high hostile (N = 28) or low hostile (N = 28) using the Cook Medley Hostility Scale. The high-hostile group met joint selection criteria. Only high-hostile participants who showed cardiovascular reactivity to the cold pressor, with systolic BP change exceeding the group mean were included. Groups were further subdivided into cold pressor and non-cold pressor test conditions. It was predicted that high-hostile men, relative to low-hostile men, would show decreased perceptual accuracy when presented with happy, angry, and neutral facial configurations within the left visual field (LVF). Results indicated that high-hostile men were less accurate than low-hostile men in the LVF. Further, pre-stress accuracy scores in the high-hostile men were similar to the post-stress accuracy scores of the low-hostile men. The lateralization of affective function and the role of physiological arousal in affective facial perception are discussed.

Affect↗

PubMed1991

Hostility and coronary artery disease.

Studies of the association between type A behavior and coronary heart disease have yielded inconsistent findings. A possible explanation for these inconsistent findings is that type A behavior is simply a marker for other behaviors that are truly related to coronary heart disease. Hostility is one such behavior that has been found in several recent studies to predict coronary heart disease and coronary atherosclerosis; however, several other studies have found null results. In the present study, the predictive power of hostility was tested in a study population of hospitalized men (n = 118) and women (n = 40) scheduled for coronary angiography. Potential coronary risk behaviors were assessed in the angiography patients and they were given the type A Structured Interview. Hostility was measured with the Cook-Medley Hostility Inventory and the Behavior Pattern Hostility Index, a measure of hostility derived from the type A Structured Interview. No significant positive associations were found for either Cook-Medley hostility or behavior pattern hostility and coronary occlusion. This was true whether hostility or coronary occlusion was treated as a dichotomous variable or as a continuous variable. In fact, most of the observed associations were opposite to the predicted direction, although none was statistically significant. Replicating cutpoints of the Cook-Medley Hostility Inventory used in other studies that have reported positive associations with coronary heart disease also yielded null findings. The association between hostility and coronary occlusion was slightly modified by age and sex, but the interaction coefficients were not significant. The sample size yielded adequate statistical power to detect the hypothesized associations, and there was no evidence that selection bias, measurement error, or unexamined confounding accounted for the null findings. These results failed to confirm some earlier reports showing a positive association between hostility and coronary artery disease.

Age Factors↗

PubMed1997

Discriminating borderline from antisocial personality disorder in male patients based on psychopathology patterns and type of hostility.

Dimensions of psychopathology and patterns of hostility, as well as the relationship of hostility to psychopathology, were studied in 85 male young adults: 41 with borderline personality disorder (BPD) and 44 with antisocial personality disorder (APD). Diagnoses were based on DSM-III. The following instruments were also used: Brief Psychiatric Rating Scale, Hamilton Depression Rating scale, State-Trait Anxiety Inventory, and Hostility and Direction of Hostility Questionnaire. BPD patients compared with APD patients showed higher levels of overall psychopathology and depression, whereas both groups had equally high anxiety. Total hostility was quite high in both groups. However, BPD patients had more introverted hostility and APD patients had more extroverted hostility. In BPD patients, introverted hostility was related to overall psychopathology, depression, and trait anxiety, whereas in APD patients, no significant relationship of any type of hostility to various dimensions of psychopathology was observed. In conclusion, when comprehensively assessed, BPD patients can be discriminated from APD patients based on certain dimensions of psychopathology and differences in the direction of their hostility. Moreover, the relationship between psychopathology and hostility patterns suggests that the direction of patients' hostility plays an important role in the development of disorder-specific symptomatology.

Adult↗

PubMed2006

Angry breathing: A prospective study of hostility and lung function in the Normative Aging Study.

BACKGROUND: Hostility and anger are risk factors for, or co-occur with, many health problems of older adults such as cardiovascular diseases, all-cause mortality, and asthma. Evidence that negative emotions are associated with chronic airways obstruction suggests a possible role for hostility in the maintenance and decline of pulmonary function. This study tests the hypothesis that hostility contributes to a faster rate of decline in lung function in older adults. METHODS: A prospective examination was undertaken of the effect of hostility on change in lung function over time. Data are from the VA Normative Aging Study, an ongoing cohort of older men. Hostility was measured in 1986 in 670 men who also had an average of three pulmonary function examinations obtained over an average of 8.2 years of follow up. Hostility was ascertained using the 50-item MMPI based Cook-Medley Hostility Scale. Pulmonary function was assessed using spirometric tests to obtain measures of forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC). RESULTS: Baseline pulmonary function differed between high and medium/low hostility groups (mean (SE) percent predicted FEV(1) 88.9 (18.5) v 95.3 (16.9) and FVC 92.5 (16.5) v 98.9 (15.9), respectively; p < 0.01 for both). This overall association between higher hostility and reduced lung function remained significant after adjusting for smoking and education, although the effect size was attenuated for both FEV1 and FVC. Higher hostility was associated with a more rapid decline in lung function, and this effect was unchanged and remained significant for FEV1)in multivariate models but was attenuated for FVC. Each standard deviation increase in hostility was associated with a loss in FEV1 of approximately 9 ml/year. CONCLUSIONS: This study is one of the first to show prospectively that hostility is associated with poorer pulmonary function and more rapid rates of decline among older men.

Age Factors↗

PubMed2005

Hostility, conflict and cardiovascular responses in married couples: a focus on the dyad.

This study examined the relations of one's own total trait hostility and one's spouse's hostility as influences on cardiovascular (CV) responses to couple interactions (including conflict discussions) in 45 married couples aged 24-50. Systolic blood pressure and cardiac index (CI) reactivity to conflict discussion and recovery after conflict was greater in low hostile males if they were interacting with high hostile wives (p < .02). Vascular resistance index (VRI) reactivity to interactions was greater in high hostile husbands with high hostile wives (p < .05). Women showed no adverse CV effects of having a hostile spouse when their own hostility was low. Instead, seeming to anticipate the subsequent couple interactions, wives from duos in which both partners were high in hostility had higher baseline VRI levels and lower baseline CI compared to wives from duos in which both were low in hostility (ps < .05), and they simply maintained these group differences with no greater CV reactivity during the interactions. Findings suggest that CV responses before, during, and after marital discussions, particularly those characterized by conflict, may be influenced not only by one's own hostility but by the hostility of one's partner as well.

Adult↗

PubMed2004

Hostility differentiates the brain metabolic effects of nicotine.

The brain mechanisms underlying the cause of nicotine dependence are unknown, however, hostility traits are associated with increased susceptibility to nicotine dependence. We used FDG PET to measure brain metabolic response to nicotine administered by patch while the subject performed the Bushman aggression task in 86 high- and low-hostility subjects. Low-hostility trait subjects demonstrated no significant change in brain metabolic response to nicotine. In marked contrast, high-hostility non-smokers subjects demonstrated dramatic metabolic changes to low dose (3.5 mg patch) as did high-hostility smokers to high dose nicotine (21 mg patch) throughout the brain bilaterally (p<0.025). Correlational analyses demonstrated greater metabolic changes in response to nicotine in subjects with greatest hostility trait measures. The observed differences were not a consequence of plasma nicotine or cotinine levels. These metabolic changes were not observed when subjects performed a sustained attentional task (continuous performance task; CPT). Behaviorally, high-hostility subjects had higher ratings of anger, impatience, irritability and nervousness, and lower ratings of happiness, relaxation and curiosity than low-hostility subjects. Smokers had significantly greater scores on impatience and restlessness than non-smokers. This PET study demonstrates a conspicuous lack of the brain metabolic response to nicotine in low-hostility non-smokers in contrast to a dramatic brain response to nicotine in high hostility subjects. This biological difference in brain metabolic response to nicotine between high and low hostility trait subjects may explain differences in susceptibility to nicotine dependence.

Adolescent↗

PubMed2005

Irritable-hostile depression: further validation as a bipolar depressive mixed state.

BACKGROUND: "Hostile depression" has unofficially long been described as a depressive subtype, but since DSM-III, the affect has been made a defining characteristic of borderline personality disorder. The related affect of irritability in DSM-IV-TR subsumes various hostile nuances and is included in the stem question for mood disorders--especially for hypomanic episodes; in children, it is nonetheless a sign of depression. Then, there is the unofficial more general concept of depression with anger attacks, until recently ostensibly a "unipolar" (UP) disorder. A veritable tower of Babel indeed. In the present analyses, our aim was to extend previous research on irritable-hostile depression to more specific parameters of bipolarity and depressive mixed state (DMX). METHODS: Consecutive 348 bipolar-II (BP-II) and 254 unipolar (UP) major depressive disorder (MDD) outpatients (off psychoactive agents, including substances of abuse), were interviewed with the Structured Clinical Interview for DSM-IV, the Hypomania Interview Guide, and the Family History Screen. Borderline personality, a confounding variable, rare in the FB setting, was excluded. Irritability was defined according to DSM-IV-TR, which includes various features of hostility and anger. Depressive mixed state (DMX) was defined as a major depressive episode (MDE) plus three or more concurrent intradepressive hypomanic symptoms, whether it occurred in BP-II or MDD. RESULTS: MDE with irritability was present in 59.7% (208/348) of BP-II and in 37.4% (95/254) of MDD (p=0.0000). In BP-II, MDE with, versus MDE without, irritability had significantly younger index age, higher rates of axis I comorbidity, atypical depressive features, and DMX. Upon logistic regression, we found a significant independent association between BP-II MDE with irritability and DMX. In UP, MDE with, versus without, irritability had significantly younger age and age at onset, higher rates of atypical depression, DMX, and bipolar family history. Logistic regression revealed a significant independent association between MDE with irritability and DMX. Given that we had excluded patients with borderline personality, the high prevalence of irritable-hostile depressives in this outpatient population means that hostility cannot be considered the signature of that personality. Factor analysis revealed independent "psychomotor activation" and "irritability-mental activation" factors. Odds ratios of irritability for DMX were highest in the "UP" MDD group (=12.2); for predicting DMX, irritability had the best psychometric profile of sensitivity of 66.3% and a specificity of 86.1% for this group as well. LIMITATION: We did not use specific instruments to measure irritable, hostile, and angry affects. CONCLUSIONS: These analyses show that irritable-hostile depression is distinct from agitated depression. Whether arising from a BP-II or MDD baseline, irritable-hostile depression emerges as a valid entity with strong links to external bipolar validators, such as bipolar family history. Irritable-hostile phenomenology in depression appears to be a strong clinical marker for a DMX. Irritable-hostile depression as a variant of DMX deserves the benefit of what seems to work best in practice, i.e., anticonvulsant mood stabilizers and/or atypical antipsychotics. Formal treatment studies are very much needed.

Adult↗

PubMed1998

Serum lipid concentrations, hostility and cardiovascular reactions to mental stress.

The objective of the present study was to determine whether serum lipid concentrations interact with hostility to affect cardiovascular responses to mental stress. One-hundred and seventy-four male subjects were screened with the Cook and Medley hostility scale (Ho), the anger expression inventory by Spielberger and a general health questionnaire. Subjects in the upper (n = 22) and lower (n = 22) quartile of the Ho score distribution were asked to take part in a laboratory experiment. Continuous measures of heart rate, blood pressure, respiration and electrodermal activity were taken while participants carried out a series of behavioral maneuvres, including mental arithmetic and mirror star tracing. Prior to the experiment fasting blood samples were taken for lipid determinations. The results show higher heart rate reactivity in high hostile than low hostile subjects. High hostile subjects also reported more anger and frustration in response to tasks. Hostility groups differed in lipid levels in that high hostiles had higher triglyceride and VLDL-c concentrations than low hostiles. Cholesterol levels showed an inverse association with cardiovascular reactivity but only in low hostile subjects. No such associations could be found in high hostiles. We conclude that there is partial support for both, the hyperreactivity and the health behavior model linking hostility and cardiovascular disorder.

Adult↗

PubMed1997

Hostility, cigarette smoking and alcohol consumption in the general population.

Hostility has been associated with coronary heart disease, and hostility may affect coronary risk through its influence on risk factors such as cigarette smoking and alcohol consumption. The objective of this study was to determine relationships between hostile personality, cigarette smoking and alcohol consumption in the general population. The Edinburgh Artery Study comprises a cross-sectional survey of 1592 men and women aged 55-74 years sampled from age-sex registers of 10 general practices throughout the city. The Bedford-Foulds Personality Deviance Questionnaire was used to elicit extrapunitiveness (including hostile thoughts), dominance (including hostile acts) and intropunitiveness. Social class, age and deprivation score were controlled for in multivariate analyses. The hostile thoughts scale emerged as a significant independent predictor of alcohol consumption in men and women (P < or = 0.01), and the models accounted for 4-9% of the variance in alcohol consumption. Hostile acts were independently predictive of smoking in men (P < or = 0.001), with the model accounting for 5% of the variance in smoking. Hostile thoughts were independently predictive of smoking in women (P < or = 0.001), and the model accounted for 4% of the variance in their smoking. We conclude that hostility may affect coronary risk through its influence on lifestyle-related coronary risk factors, although in future further elucidation of hostility type and standard measurement of hostility are necessary.

Aged↗

PubMed1998

Blood pressure morning surge and hostility.

This study examined the effects of hostility on blood pressure (BP) during the early morning hours before awakening and several hours afterward. Our objective was to determine whether the pattern of BP change and the slope of the morning BP surge were related to hostility. The subjects were 32 patients with a history of Stage 1 hypertension. The morning surge in BP was derived from ambulatory BP monitoring of sleeping and waking hours, which were averaged per subject and centered around the wake-up hour. The periods used were 3 h before and 3 h after awakening. Only systolic blood pressure (SBP) is being reported on in this paper as this is the primary measure found relevant to the morning surge phenomenon. Hostility was assessed by the Buss-Durkee Hostility Inventory (total score). The results revealed significant differences between low and high hostility subjects for overall levels of sleep SBP: 120 +/- 11.4 mm Hg for low hostility and 131.3 +/- 14.9 mm Hg for high hostility subjects (P = .02). Low hostility subjects showed a steep rise in SBP from sleeping to waking while high hostility subjects had almost reached their post-sleep level of SBP in the hours immediately before waking up (P = .03). These data indicate that individual differences in hostility are related to different patterns of BP during sleep and the early morning hours, a period of the day that has been associated with an increased risk of cardiovascular incidents. The data also suggest the need for further study of the significance of hostility and other personality traits and the relationship of these traits to the mechanisms of the morning surge and the risk of cardiovascular events.

Adult↗

PubMed2005

Adolescents' behavior in the presence of interparental hostility: developmental and emotion regulatory influences.

Within-family covariation between interparental hostility and adolescent behavior across three interactions over a 2-year period was explored in a sample that included 37 typical adolescents and 35 adolescents recently hospitalized for psychiatric difficulties. More interparental hostility across the three interactions was associated with more adolescent hostility and more positive engagement (at a trend level) regardless of psychiatric background. Parent-to-child hostility in each interaction mediated the link for adolescent hostility but not for positive adolescent engagement. Emotion regulation capacities and age were linked to variability in adolescents' behavior in the presence of interparental conflict. In interactions with more interparental hostility, adolescents with greater capacity to tolerate negative affect were more likely to show increased positive engagement, and adolescents who were better able to modulate their emotional expression were less likely to show increased hostility. Covariation between interparental and adolescent hostility across the three family interactions decreased as the adolescent aged. These findings are consistent with the theory that exposure to interparental hostility is emotionally disequilibrating, and that adolescent responses may reflect differences in emotion regulation and other developmentally based capacities. Gender and variations across families in overall levels of hostile parenting were also linked with adolescent behavior in the presence of interparental hostility.

Adolescent↗

PubMed1995

Gender differences in hostility among depressed and medical outpatients.

We assessed possible gender differences in state and trait hostility in a large sample of depressed outpatients and in a group of medical outpatients. We administered the Cook and Medley Hostility Scale, measuring trait hostility and aggressiveness, and the Symptom Questionnaire, including a state measure of irritability and hostility, to 218 depressed outpatients and 51 medical outpatients. There was a statistically significant positive correlation between severity of depression and our state measure of hostility, and a weak, although statistically significant, relationship between severity of depression and total score of our trait measure of hostility. Among depressed outpatients, trait hostility was greater in men than in women, while no significant gender difference was observed in state hostility. Among medical outpatients, the state hostility scale scores were significantly higher in men than in women. These gender differences in both groups remained significant even after adjusting for severity of depression. Thus, it appears that men with depression tend to have higher scores than women on state and trait measures of hostility, suggesting that men may be at greater risk than women of developing patterns of pathologic aggression and hostile behavior.

Adult↗

PubMedDate not supplied

Social support and health behavior in hostile black and white men and women in CARDIA. Coronary Artery Risk Development in Young Adults.

OBJECTIVE: These cross-sectional analyses of the Coronary Artery Risk Development in Young Adults (CARDIA) data were stimulated by previous CARDIA analyses that showed an adverse association between hostility and several health behaviors: physical activity, cigarette smoking, alcohol consumption, and caloric intake, in both black and white men and women, such that the higher the hostility, the worse the health behavior profile. The current study investigated whether high social support was associated with better health behavior than low social support in individuals with high hostility scores. METHODS: The subjects were 5115 healthy black and white men and women ranging in age from 18 to 30 years. The hypothesis was that the association between hostility and certain adverse health behaviors would be diminished in the presence of high social support. Race-gender specific median cutpoints of the Cook-Medley Hostility scale and an index of social support defined levels of high and low hostility and social support. RESULTS: After controlling for age and body mass index (BMI), support was positively associated with more exercise in all groups except black women, but when coupled with high hostility, this positive association between support and exercise remained only in men. White women with high support were less often smokers but this association did not hold when examined only in the high-hostile group. Black men and white women with high support in the presence of high hostility consumed more alcohol, but the amount was moderate. CONCLUSIONS: We conclude that social support in the presence of high hostility only sometimes reduces the association of hostility to adverse health behaviors and that these effects are complex. Additional research investigating types of social support on health behavior in different race-gender groups is advocated.

Adolescent↗

PubMed1996

Social support and hostility interact to influence clinic, work, and home blood pressure in black and white men and women.

The effects of hostility and social support on clinic, work, and home systolic (SBP) and diastolic (DBP) blood pressures were evaluated in 129 healthy adults. High hostility was related to higher SBP and DBP in Whites; low hostility was related to higher SBP and DBP in Blacks. These relationships were significant for men at home and at work and for women at screening. The relationship between low hostility and higher BP in Blacks was largely due to Black men who reported low hostility plus high anger-in (suggesting suppressed hostility). In contrast, high hostile Black men with high tangible support tended to exhibit lower BP than all other Black men. In White women, high belonging support was related to lower BP, independent of hostility, and low tangible support plus high hostility was related to higher clinic BP. In high hostile subjects, regardless of ethnicity or gender, high appraisal support was related to lower overall BP. These data suggest that the adverse BP effects of hostility and the beneficial effects of social support interact in a complex manner, reflecting contextual, ethnic, and gender specificities.

Adult↗

PubMed2003

Hostile behaviors predict cardiovascular mortality among men enrolled in the Multiple Risk Factor Intervention Trial.

BACKGROUND: Hostility is associated with incident coronary disease in most large population-based studies, but little is known about its association with cardiovascular disease (CVD) mortality in high-risk individuals. The aim of this study was to assess the association of hostility with CVD mortality in the subsequent 16 years in the Multiple Risk Factor Intervention Trial (MRFIT) participants and to explore the influence of hostility in the subset that had a nonfatal CVD event during the trial. METHODS AND RESULTS: We coded the Structured Interview responses of 259 men who died of CVD during the 16 years of follow-up and 259 matching living control subjects. Signs of hostility were assessed by use of the Interpersonal Hostility Assessment Technique. Matching was based on center, intervention group, age, race, and interviewer; covariates included study entry diastolic blood pressure, cholesterol, smoking status, and nonfatal CVD event during the trial. High-hostile men were more likely to die of CVD than were low-hostile men. Adjusted odds ratio (OR) and 95% confidence intervals (CIs) were 1.61, 1.09 to 2.39. After the trial, high-hostile men who also had a nonfatal event during the trial were particularly likely to die of CVD, OR, 5.06, 1.42 to 8.22, compared with low-hostile men without a nonfatal event during the trial. CONCLUSIONS: Hostility may be a risk factor for CVD mortality among high-risk men. Interventions aimed at anger management and stress reduction along with risk factor modification may be useful for hostile patients.

Adult↗

PubMed1993

Measurement of hostility, anger, and depression in depressed and nondepressed subjects.

This study examined the relationship between hostility and depression in depressed and nondepressed subjects as well as the reliability and validity of several measures of anger, hostility and depression. Sixty-nine subjects were evaluated for depression using the Hamilton Rating Scale for Depression (HRSD; Hamilton, 1960). These subjects were then administered the Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Ergaugh, 1961), Buss-Durkee Hostility Inventory (BDHI; Buss & Durkee, 1957), Hostility and Direction of Hostility Questionnaire (HDHQ; Foulds, Caine, & Creasy, 1960) and the State-Trait Anger Scale (STAS; Spielberger, Jacobs, Russell, & Crane, 1983). Results showed the BDI, STAS-TRAIT, HDHQ, and BDHI to have good temporal stability. Support was found for the convergent validity of all measures of depression, hostility, and anger. Limited discriminant validity was found between measures of anger and hostility and measures of depression. This latter finding was interpreted as lending support for the relationship between hostility and depression rather than as an indication of limited construct validity for the measures. Intercorrelations among hostility, anger, and depression scales offer some support for the hypothesis that depression is linked most strongly with attitudinal versus motoric forms of hostility. However, normative data suggests that both forms of hostility increase with severity of depression. Clinical implications and directions for further research are discussed.

Adult↗