We describe a typology of regulatory deficits associated with anger in combat-related posttraumatic stress disorder (PTSD). Cognitive, arousal, and behavioral domain deficits in anger regulation were observed clinically in PTSD patients with high levels of anger who were participating in a multi-year trial of a structured anger treatment. We also describe a category of patients whose anger type we have termed "ball of rage." These patients exhibit regulatory deficits in all three domains of anger regulation. We offer a conceptual framework to advance the understanding of anger associated with PTSD and to guide its effective treatment.
We examined whether combat-related PTSD was differentially associated with particular dimensions of anger on two multi-index, psychometric instruments and whether the proportion of variation in PTSD scores explained by anger was significantly greater than that by demographic and exposure variables. We also examined the reliability and validity of a subset of Mississippi Scale items as an anger measure. Participants were 143 Vietnam combat veterans. Anger accounted for over 40% of the variance in Mississippi PTSD scores (minus the anger items) above that associated with age, education, and combat exposure. Veterans with structured-interview-diagnosed PTSD were significantly differentiated from those without PTSD on all anger indices. The results point to anger treatment as a high priority for combat-related PTSD.
Systematic assessment of anger among people with developmental disabilities has been lacking, especially for hospital inpatients. Reliability and validity of anger self-report psychometric scales were investigated with 129 male patients, mostly forensic. Anger prevalence and its relationship to demographic, cognitive, and personality variables and to hospital assaultive behavior were examined. High internal and intermeasure consistency, and some concurrent validity with staff ratings, were found. Retrospective validity regarding physically assaultive behavior in the hospital was obtained. Hierarchical regressions revealed that patient-reported anger was a significant predictor of assaults postadmission, controlling for age, length of stay, IQ, violence offense history, and personality variables.
There is a need for a brief specific measure of anger for use in assessment of posttraumatic mental health problems. One unpublished short scale is the Dimensions of Anger Reactions (DAR; R. Novaco, 1975). This study examined the psychometric properties of the DAR using intake and 12-month data for 192 Australian Vietnam veterans with combat-related PTSD. Results showed the DAR to be unidimensional, reliable, and sensitive to change over time, and removal of two items improved the scale's properties. The DAR measures anger disposition directed towards others. Assessment of convergent validity indicated that the DAR primarily measures Trait Anger. Results suggest that the DAR is a psychometrically strong measure, potentially useful for the evaluation of anger in PTSD.
With a randomized group design, a 12-session anger treatment was evaluated with severely angry Vietnam War veterans suffering combat-related posttraumatic stress disorder (PTSD). Eight participants in anger treatment and 7 in a routine clinical care control condition completed multiple measures of anger control, anger reaction, and anger disposition, as well as measures of anxiety, depression, and PTSD at pre- and posttreatment. Controlling for pretreatment scores, significant effects were found on anger reaction and anger control measures but not on anger disposition or physiological measures. Eighteen-months follow-up (for both completers and dropouts) supported the posttreatment anger control findings. The challenges of treatment research with this refractory population are discussed.
Conditions of transportation were investigated as sources of psychological stress as they affect the physiology, task performance, and mood of commuters. Participants in the study were 100 employees of industrial firms. Traffic congestion was construed as a behavioral constraint in terms of the concept of impedance which is defined by the parameters of distance and time. It was expected that the effects of impedance would be mediated by personality factors, such as locus of control. Multivariate tests of the internal validity of the impedance factor were significant. However, significant main effects for impedance were obtained only for mood and residential adaptation. The predicted interactions of impedance with locus of control were obtained across task performance indices. In multiple regression analyses, the distance and speed of the commute to work were found to account for significant proportions of variation in blood pressure, while several indices of personal control had significant regression effects on the task measures. The implications of the results for research in community psychology are discussed.
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