Clinical correlates of irritability, anger, hostility, and aggression in posttraumatic stress disorder.

Abstract

Objective: Although irritability, anger, and aggression are diagnostic symptoms of posttraumatic stress disorder (PTSD), their clinical significance and associations with psychopathology remain unclear. Method: In a sample of community adults with probable PTSD (n = 151), we measured irritability, physical aggression, verbal aggression, anger, and hostility with the Brief Irritability Test and the Brief Aggression Questionnaire. Participants' psychopathology, including depression, attention deficit and hyperactivity disorder (ADHD), psychotic-like experiences, insomnia, as well as suicidal behaviors were also assessed. Results: Correlation analysis showed that irritability and anger were modestly related to all PTSD dimensions; physical aggression was related to avoidance, negative alterations in cognitions and mood (NACM), and hyperarousal; hostility was related to reexperiencing, NACM, and hyperarousal; while verbal aggression was not significantly related to any PTSD dimensions. After adjustment for trauma exposure and PTSD symptoms, irritability was associated with almost all psychopathology and suicidal behaviors, however, anger, hostility, and aggression were sparsely related to some psychopathology or suicidal behaviors. Particularly, anger was only related to ADHD and insomnia. Latent profile analysis based on PTSD, irritability, anger, hostility, and aggression indicated two discrete subgroups: the high severity group (33.8%) and the low severity group (66.2%), with high severity group reporting higher rates of comorbidity and suicidal behaviors. Conclusions: The findings support irritability, aggression, anger, and hostility as separate constructs; moreover, irritability, anger, and aggression should be independently measured in PTSD. Our findings also suggest the significance of irritability as a separate hallmark of PTSD and the need to incorporate PTSD dimensions. Clinical Impact StatementIrritability, anger, hostility, and aggression are highly related but distinct constructs, which should be assessed independently by well-validated instruments in trauma-exposed populations. Irritability might be added into posttraumatic stress disorder (PTSD) dimensions, given that it is one important indicator for comorbidity of PTSD and risk of suicide. There might be one subgroup of PTSD characterized by high severity of irritability, anger, and aggression. The findings highlight the understanding of psychopathological mechanisms of irritability, anger, and aggression in PTSD, and targeted interventions for irritability, anger, or aggression in PTSD treatment.

Validity of the Korean Version of the Brief Irritability Test in Psychiatric Patients

“…This underscores the close association between stress and irritability, as stress-induced cortisol secretion can impact the emotion-regulating brain area, potentially leading to irritability [ 38 ]. In a previous study, irritability emerged as a key symptom in the post-traumatic stress disorder patient group and was identified an important indicator of clinical severity and risk of suicide [ 39 ]. Considering these findings, an emotion-regulating intervention focused on irritability may be considered for individuals experiencing recent stress events.…”

“…38 In a previous study, irritability emerged as a key symptom in the post-traumatic stress disorder patient group and was identified an important indicator of clinical severity and risk of suicide. 39 Considering these findings, an emotionregulating intervention focused on irritability may be considered for individuals experiencing recent stress events.…”