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Interpersonal rejection sensitivity in childhood sexual abuse survivors: mediator of depressive symptoms and anger suppression.

This study investigated whether interpersonal rejection sensitivity serves a mediating role between childhood sexual abuse (CSA) and three long-term psychological correlates of CSA in adult female survivors: depressive symptoms, anger suppression, and attenuated emotional expression. Interpersonal rejection sensitivity has been shown to be a risk factor for the development of depression and is elevated in CSA survivors. Similarly, attenuated emotional expression, particularly anger, has been related to adjustment difficulties in CSA survivors. Participants in this study were 355 female undergraduates, 34 of whom reported a history of CSA. Results demonstrated that interpersonal rejection sensitivity mediates the relationship between CSA and later depressive symptoms. Interpersonal rejection sensitivity partially mediated the relationship between CSA and anger suppression; however, it did not mediate the relationship between CSA and attenuated emotional expression. These results are examined within the context of the current literature on adult CSA survivors and their implications are discussed.

Adolescent↗

Anger-coping types, blood pressure, and all-cause mortality: a follow-up in Tecumseh, Michigan (1971-1983).

This study examined prospectively (1971-1983) the relationship between anger-coping types, blood pressure, and all-cause mortality in a sample of men and women aged 30-69 (n = 696) of the Tecumseh Community Health Study. Subjects who indicated that they were likely to suppress their anger in response to two hypothetical anger-provoking situations had 1.7 times the mortality risk of those who expressed their anger (95% confidence interval (CI) = 1.03-3.05). Subjects who suppressed their anger when unjustifiably confronted by their spouse had twice the mortality risk of those who expressed their anger (95% CI = 1.13-3.38). For high vs. low suppressed anger towards a policeman, the mortality risk was 1.24 (95% CI = 0.72-2.14). These relationships were invariant across age, sex, and education groups, even when medical risk factors were adjusted for, i.e., smoking, relative weight, blood pressure, coronary heart disease status, forced expiratory volume at one second (FEV1), and chronic bronchitis. However, suppressed anger measures significantly interacted with elevated blood pressure to predict the highest mortality risk. These results suggest that persons with high mortality risk can be identified in part by how they cope with anger, and by the joint effect of anger-coping type (a behavioral trait) and elevated blood pressure (a biologic trait).

Adaptation, Psychological↗

Anger-coping styles and blood pressure in black and white males: Buffalo, New York.

Data from a random survey of household residents in the urban area of Buffalo, stratified by race and education, showed relations between anger-coping styles and age-weight adjusted blood pressure (BP) among males (N = 720). Findings show that older black males with a high reflective mode of anger (constrain anger and try to solve the problem) had significantly lower blood pressure than those with low scores on this mode. In contrast, older black males with a high Anger-out mode (impulsive anger strongly expressed) had significantly higher blood pressure than those low on this mode. This Anger-out pattern was also found for older white men; but for younger whites, only higher alcohol and lower education were significantly related to higher BP levels. An Anger-in mode (impulsive anger not expressed) was not significantly related to blood pressure. The limitations of the Anger-in measures are examined. and a concept of a resentful anger style is discussed and presented for further research.

Adaptation, Psychological↗

Alexithymia, anger, and interpersonal behavior.

BACKGROUND: We explored the relationship between alexithymia and interpersonal behavior, particularly the expression of anger. METHODS: Ninety-eight college students completed the Toronto Alexithymia Scale. A median split was used to divide participants into a low-alexithymia and a high-alexithymia group. The experimenter intentionally engaged in a series of anger-provoking behaviors. RESULTS: Compared to individuals in the low-alexithymia group, individuals in the high-alexithymia group were more interpersonally avoidant and exhibited more nonverbal anger, yet there was a trend for them to describe their lab experience as more pleasant. Among individuals in the high-alexithymia group, the different measures of anger and interpersonal behavior were less strongly associated than they were among individuals in the low-alexithymia group. CONCLUSIONS: The results provide evidence of a complex association between alexithymia and anger, and of the lack of coherence in the communication of individuals with high levels of alexithymia.

Adolescent↗

Emotion expression processes in children's peer interaction: the role of peer rejection, aggression, and gender.

The goal of the current study was to investigate sociometric status, aggression, and gender differences in children's expression of anger, happiness, and sadness. Participants were 111 second-grade African American boys and girls, half rejected and half average sociometric status, and half aggressive and half nonaggressive as assessed by their peers. Children interacted with a confederate in two standardized competitive game paradigms. Participants' expressions of anger, happiness, and sadness were observationally coded across facial, verbal intonation, and nonverbal modalities. Rejected children expressed more facial and verbal anger than average-status children. Rejected children also expressed more nonverbal happiness than average children, but only during turns of the game that were favorable to the participant. Finally, boys expressed more facial, verbal, and nonverbal anger than girls.

Black or African American↗

Behavioral treatment of essential hypertension: a comparison between cognitive therapy and biofeedback of heart rate.

The efficacy and the mechanisms of action of two behavioral treatments for essential hypertension were compared: cognitive group therapy for anger control and biofeedback for heart rate control. The cognitive therapy aimed at lowering the "general anger" level and helping overt expression of "anger out;" heart rate biofeedback aimed at slowing heart rate in stress situations. Ninety-seven essential hypertensive patients were randomly assigned to three groups; after 20 dropouts, 77 patients fully participated in the study: cognitive treatment (N = 30), biofeedback (N = 27), and control (no treatment, N = 20). The treatments were held in 17 weekly sessions; during treatment, blood pressure was measured once a month, and during follow-up after 1 and 6 months. The anger level and heart rate control were assessed at the beginning and the end of treatment. The main results were: 1) a significant decrease of blood pressure for both treatments as compared with control, 2) a significant decrease of blood pressure with heart rate biofeedback as compared with cognitive therapy, and 3) a better control in anger achieved with cognitive therapy and a lesser control in heart rate as compared with biofeedback.

Adaptation, Psychological↗

It's not because I'm fat: perceived overweight and anger avoidance in marriage.

Employed married Israeli women responded to questions about their perceived weight, their husbands' evaluation of their appearance, and their expression of anger in marriage. Our data, based on 125 questionnaires and five in-depth interviews, supports the possibility that women who perceive themselves as overweight, that is, "fail" to live up to the standards of female beauty in society, often suppress their anger and express it in limited areas. Our findings suggest that women who have not been able to resist the appearance-directed normative imperative in the constitution of their feminine self have to work harder to meet gender norms that require "emotion work" in the form of anger avoidance.

Adult↗

Angry drivers: a test of state-trait theory.

Tested hypotheses from state-trait theory applied to anger while driving. College student drivers high in trait driving anger were compared to drivers low in trait driving anger. High anger drivers were more frequently angered in day-to-day driving (frequency hypothesis). They reported more intense anger in their most angering driving situations, when visualizing provocative driving events, and in day-to-day driving (intensity hypothesis). Driving diaries and surveys showed they engaged in more aggressive behavior and expressed their anger through more verbal, physical, and vehicular means (aggression hypothesis). They reported handling of their anger less well when visualizing provocative events and on the Adaptive/Constructive Expression scale (reduced adaptive expression hypothesis). They engaged in risky behavior (risky behavior hypothesis) and experienced more moving violations, close calls, and losses of concentration, but not more major or minor accidents (partial support for crash-related outcomes hypothesis). High anger drivers were more generally angry and impulsive and employed more negative, less controlled forms of general anger expression. Results supported state-trait theory and added to the literature showing that high anger drivers have some other psychological and behavioral characteristics that may interact negatively with anger behind the wheel.

Accidents, Traffic↗

Teenage depression: a cultural-interpersonal-intrapsychic perspective.

The "crossroads families" are caught between old value systems and American mainstream goals. Traditional family and sex-related roles and orientations conflict with those of the new social system. In turn, neither of the teenager's orientations--toward home or toward peer activity--is validated. In the clinical case presented, Anna, at adolescence, wants to relinquish many of her household chores and enter her social world more fully. She needs unconflictual support for such a move. If this does not take place, her autonomous movement represents an unconscious betrayal of her depleted and controlling mother as well as an abandonment of the parental coalition. This leaves her feeling resentful, guilty, and ultimately unlovable. Attitudes marked by helplessness and confusion are thus significant to the depressed affect that brings this teenager into family therapy. Teenagers of non-Hispanic background who enter family therapy reveal gross overlap with teenagers of the Hispanic "crossroads" family model. Here, the family gives mixed messages for homebound and intimate closeness as well as accomplishment in the societal mainstream. A primary difference between ethnic groups involves the freer expressions of anger and pain between husband and wife in the non-Hispanic families. This is not similar to the backgrounds of the more individuated Hispanic teenagers. While more open expressions of anger within the family do indicate higher levels of autonomy, the hostility that is expressed by the parents presents serious complications when this includes "triangulating" the child into the family tension. Here, as cited, the mother often uses her daughter as a confidant and ally at times of severe parental discord. This places additional strain on the child's conflict with separation. Importantly, the daughter experiences renewed rejection and betrayal when the mother "submits" to her spouse. These are significant family processes that heighten mixed messages around autonomy. Milagros, a depressed (more individuated) adolescent, is consistently entangled into her parent's abrasive relationship. Her interpersonal family struggles have become intrapsychic and, ultimately, transferential.

Acculturation↗

Emotional coping and tonic blood pressure as determinants of cardiovascular responses to mental stress.

OBJECTIVES: The aim was to assess the combined influence of biological risk for hypertension and patterns of emotional control upon cardiovascular responses to mental stress tests. DESIGN: The study involved the administration of mental stress tests in the laboratory, designed to elicit substantial blood pressure and heart rate responses accompanied by suppression of cardiac baroreflex sensitivity. METHODS: Thirty-seven young men were selected as being at relatively high or low risk through having high or low normal blood pressure. Blood pressure, recorded continuously using the Finapres, heart rate, cardiac baroreflex sensitivity, skin conductance and respiration rate were monitored at rest and during mental arithmetic and mirror drawing tasks. RESULTS: Hypertension risk category had no overall effect upon cardiovascular reactions to mental stress. Two dimensions of emotional coping were identified through factor analysis of psychological questionnaires--anxious emotional inhibition (ratings of trait anxiety, anger in and self-concealment), and anger experience and expression (ratings of trait anger and anger out). Subjects with high and low scores on these dimensions were equally represented in the two blood pressure risk categories. Hypertensive risk interacted with anxious emotional inhibition, with the greatest systolic blood pressure and heart rate responses (accompanied by cardiac baroreflex inhibition) being recorded in subjects at high risk coupled with high anxious emotional inhibition. Anger experience and expression did not interact with hypertension risk, but had a direct effect upon cardiovascular responses to mental stress. No differences were seen in skin conductance or respiratory responses, suggesting specific disturbances of cardiovascular regulation. CONCLUSIONS: The results suggest that normotensives at risk for future hypertension are likely to show heightened stress-related cardiovascular responses if they also tend to inhibit the expression of negative emotions. This pattern may be relevant to the postulated links between hypertension and emotional inhibition.

Adaptation, Psychological↗

Do people aggress to improve their mood? Catharsis beliefs, affect regulation opportunity, and aggressive responding.

Do people aggress to make themselves feel better? We adapted a procedure used by G. K. Manucia, D. J. Baumann, and R. B. Cialdini (1984), in which some participants are given a bogus mood-freezing pill that makes affect regulation efforts ineffective. In Study 1, people who had been induced to believe in the value of catharsis and venting anger responded more aggressively than did control participants to insulting criticism, but this aggression was eliminated by the mood-freezing pill. Study 2 showed similar results among people with high anger-out (i.e., expressing and venting anger) tendencies. Studies 3 and 4 provided questionnaire data consistent with these interpretations, and Study 5 replicated the findings of Studies 1 and 2 using measures more directly concerned with affect regulation. Taken together, these results suggest that many people may engage in aggression to regulate (improve) their own affective states.

Acting Out↗

Loss of libido.

Loss of libido is caused by unconscious anger and it can be restored if the feeling of anger is expressed. The common causes of such anger are classified and case histories suggest how the doctor/patient encounter can be used to help patients.

Adult↗

Effects of daily workload on subsequent behavior during marital interaction: the roles of social withdrawal and spouse support.

This article examines daily variability in 2 marital behaviors, social withdrawal and the expression of anger, as a function of daily taskload at work. Thirty-three air traffic controllers (ATCs) and 27 wives completed surveys on 3 consecutive days. Subjective and objective indicators of daily workload (air traffic volume and visibility at the airport) were related to the couples' descriptions of the ATCs' behavior after work. Despite a positive association between withdrawal and anger, workload seemed to influence these 2 behaviors in opposite ways. On high spouse-support evenings, work overload was associated with increased social withdrawal and less expression of anger. Social withdrawal may help an aroused individual return to a baseline emotional and physiological state. By facilitating their stressed partner's social withdrawal, supportive spouses may buffer the effects of minor daily stressors.

Anger↗

Psychosocial function during treatment for familial hypercholesterolemia.

OBJECTIVE: To determine whether children treated for familial hypercholesterolemia (FH) have greater psychosocial dysfunction compared with their peers. CHILDREN: Children were 86 boys and 66 girls 7-16 years of age attending a lipid clinic. They were screened and instructed to follow a diet low in saturated fat and cholesterol 18 months to 9 years earlier (mean, 4 years), and their mean dietary intake, estimated by a quantitative food frequency questionnaire, was within recommended limits. One-fourth had lost a parent or had a parent who had had cardiovascular disease due to FH (parental disease group). METHODS: Results of the Child Behavior Checklist, Teacher's Report Form, and Youth Self-Report were compared with a population sample. A semistructured interview, the Child Assessment Schedule, was administered to the children with FH and a well-functioning comparison group from the population (epidemiologic cohort; n = 62). RESULTS: Psychosocial scores were similar in the children with FH and the population sample. The Child Assessment Schedule showed that, compared with the epidemiologic cohort, children with FH did not have increased symptoms in any area of function, and scores for family, mood, and expression of anger were lower (less symptomatic). The prevalence of psychiatric diagnoses was 10%, which was not greater than expected. Children from the parental disease group had higher symptom scores in the areas of school and expression of anger than the rest of the children with FH. Their mean Children's Global Assessment Score (CGAS, which gives average children scores of 70-79) was slightly lower (77 vs 79). Belonging to the parental disease group predicted a lower CGAS in multivariate regression analyses, as did male sex, parental divorce, and low parental educational level. These factors explained up to 19% (95% confidence interval, 9%-31%) of the variance in CGAS. CONCLUSIONS: We found that the prevalence of psychosocial dysfunction was not greater than expected in children treated for FH. Psychosocial function within the group was associated with the usual demographic characteristics and with the loss or disease of a parent, beyond the period of bereavement or immediately after the event.

Adolescent↗

[Personality-related differences in recognition of facial emotional expression and cortical evoked potentials].

A correlation between some characteristics of the visual evoked potentials and individual personality traits (by the Kettell scale) was revealed in 40 healthy subjects when they recognized facial expressions of anger and fear. As compared to emotionally stable subjects, emotionally unstable subjects had shorter latencies of evoked potentials and suppressed late negativity in the occipital and temporal areas. In contrast, amplitude of these waves in the frontal areas was increased. In emotionally stable group of subjects differences in the evoked potentials related to emotional expressions were evident throughout the whole signal processing beginning from the early sensory stage (P1 wave). In emotionally unstable group differences in the evoked potentials related to recognized emotional expressions developed later. Sensitivity of the evoked potentials to emotional salience of faces was also more pronounced in the emotionally stable group. The involvement of the frontal cortex, amygdala, and the anterior cingulate cortex in the development of individual features of recognition of facial expressions of anger and fear is discussed.

Adult↗

Strategic risk management: reducing malpractice claims through more effective patient-doctor communication.

Many malpractice suits are brought not because of malpractice nor even because of complaints about the quality of medical care but as an expression of anger about some aspect of patient-doctor relationships and communications. The theory presented is that under the stress of anxiety and physical illness, some patients regress to childhood needs; physicians are not generally trained to fill such needs. Thus, these patients, angry because of this, express their anger in malpractice suits. This theory has been taught to physicians and medical students as part of a physician continuing medical education (CME) seminar on Loss Prevention/Risk Management through demonstration of active-listening techniques to seminar participants. Physicians who understand and can respond appropriately to the emotional needs of their patients are less likely to be sued. This may also translate into a more fulfilled practice of medicine by those physicians who are most aware of the importance of a positive relationship.

Anger↗

Anger and aggression among drivers in three European countries.

Recent reports of 'road rage' in the British media give the impression that driver aggression is escalating. In order to understand this phenomenon we need to know what it is about driving that provokes motorists to feel anger and then to go on to express that anger in the form of aggression. A postal questionnaire survey of more than 2500 drivers was carried out in three European countries: Britain, Finland and the Netherlands. The study had three main aims: (a) to discover how angry, if at all, a range of situations on the road make drivers, (b) to find out how many drivers are likely to react aggressively to those situations, and (c) to investigate individual and/or cultural differences in terms of anger and/or aggressive responses among motorists. Results indicate that the same types of behaviour provoke anger and aggression in all three countries, and that traffic density may play a role.

Adolescent↗

Aggression and anger-related traits associated with a polymorphism of the tryptophan hydroxylase gene.

BACKGROUND: Central nervous system (CNS) serotonergic activity correlates inversely with human aggressive behavior, and individual differences in aggressive disposition are at least partially heritable. This study was conducted to evaluate the possible association between measures of antagonistic behavior and an intronic polymorphism of the gene coding for tryptophan hydroxylase (TPH), the rate-limiting enzyme in serotonin biosynthesis. METHODS: Locally recruited men and women (n = 251) were genotyped for the A218C polymorphism located in intron 7 of the TPH gene. All subjects were administered standard interview and questionnaire indices of aggression and anger-related traits of personality; in a portion of subjects, CNS serotonergic activity was assessed by neuropsychopharmacologic challenge (prolactin response to fenfluramine hydrochloride). RESULTS: Persons having any TPH U allele scored significantly higher on measures of aggression and tendency to experience unprovoked anger and were more likely to report expressing their anger outwardly than individuals homozygous for the alternate L allele. In men, but not women, peak prolactin response to fenfluramine was also attenuated among subjects having any U allele, relative to LL homozygotes. CONCLUSIONS: Individual differences in aggressive disposition are associated with an intronic polymorphism of the TPH gene in a nonpatient sample of community-derived volunteers.

Aggression↗