خشم، آسیب شناسی روانی و مهار شناختی: مطالعه از خدمتگزاران بریتانیا

A link between anger and psychopathology, and aggression and cognitive impairment has been postulated. This study examined the relationships between anger, psychopathology, and neurocognitive function in a military sample of 136 men without overt brain disease. A battery of neurocognitive tests was administered, including the State-Trait Anger Expression Inventory (STAXI), which recognises different experience and expression components of anger. Significant positive correlations between anger and psychopathogical measures were revealed, with the exception of anger control which exhibited a negative relationship. Correlations between anger measures and neuropsychological variables were weaker, few were significant, and no specific pattern emerged. Structural equation modelling indicated that psychopathogical variables and their relationship with neurocognitive variables, rather than anger, contributed significantly to the model. We propose that anger appears to be a manifestation of non-specific psychopathology (anxiety and depression), and that any relationship between anger and cognitive function is likely to be mediated through depression.

Anger is probably latent in all individuals and cultures (Kovecses, 2000). A large body of evidence exists to suggest that anger is related to a number of negative health outcomes (House, 2002, Peters, 2001 and Tennant and Mclean, 2001). 1. Anger, depression and post-traumatic stress disorder (PTSD) Psychodynamic formulations associate depression with anger turned inwards (Freud 1917[1958]) and this notion finds some support in recent studies (e.g. Biaggio and Godwin, 1987 and Tschannen et al., 1992). Indeed, Clay, Anderson, and Dixon, (1993) found inwardly directed anger to be a significant predictor of depression, while Kellner, Hennanders, and Pattak (1992) found depression to be a significant predictor of self reported anger inhibition. A number of studies also support the theory of catharsis, that the release of anger reduces depression (e.g. Wadsworth & Barker, 1976), although doubt has been cast on the effectiveness of therapeutic approaches employing catharsis (see Lewis & Bucher, 1992). Goldman and Haaga (1995) found that despite depressed people reporting higher levels of anger experience and suppression than their non-depressed counterparts, they often report lower or equivalent levels of anger expression. Indeed most studies show a rather complex association between depression and various expressions of anger (see Culbertson and Spielberger, 1996, Folkman and Lazarus, 1980 and Thomas and Atakan, 1993). Post-traumatic stress disorder (PTSD) is associated with depression and anxiety, yet the clinical picture is often characterised by irritability and anger (American Psychiatric Association, 1994). Riley, Treibel, and Woods (1989) investigated the relationship between anger/hostility and depression in normal people, depressed, and PTSD patients. They reported that both clinical groups scored more highly on anger experience than normals, with the PTSD group exhibiting the highest level of anger experience and expression, findings corroborated by Pitman, Orr, Forgue, de Jong, and Clairborn (1987) and Chemtob, Hamada, Roitblat, and Muraoka (1994) and most recently by Biddle, Elliott, Creamer, Forbes, and Devilly (2002). Riley et al also reported that the depressed group showed higher levels of anger suppression than the other two groups, who did not differ on this measure. Summarising the above studies, it appears that there is a general association between anger and certain types of psychopathology including post-traumatic stress disorder, anxiety and depression, rather than a specific link between types of anger expression or experience and depressed mood. 2. Anger and neuropsychology It is well documented that depression is associated with impaired neuropsychological performance (Hartlage et al., 1993 and Weingartner et al., 1981). A similar association between anger and cognition is less well established. The research that addresses this issue comes from studies of aggression rather than anger per se. The clinical literature is replete with reports of increased aggression, liability of mood including anger, and impulsivity following frontal lobe lesions (Stuss and Benson, 1984, Damasio, 1994 and Lishman, 1998). Seguin, Phil, Tremblay, and Boulerice (1995) followed a cohort of boys from the age of 6–18, divided into one of three groups; stable aggressive, unstable aggressive, and non-aggressive. They found that the former group performed most poorly on a series of neuropsychological tests, and that the strongest association was with tests of “executive cognitive functioning”, presumed to reflect frontal lobe activity. Aggressive behaviour and executive function was investigated by Giancola, Martin, Tarter, Pelham, and Moss (1996) in a sample of 10–12 year old boys. The authors found that under circumstances of high provocation, poor executive function was associated with aggressive behaviours, even after controlling for IQ. Lau and Pihl (1996) reported that, low executive functioning individuals failed to inhibit aggression in order to receive a reward. They also found that their high executive functioning group was able to successfully inhibit aggression which followed intoxication. Finally, Best, Williams, and Coccaro, (2002) showed that impulsive responding to an experimental gambling task’ characterised patients diagnosed with ‘intermittent explosive disorder’ in comparison to healthy controls. Anger research has been facilitated by the development of a psychometric instrument which operationalises and quantifies different aspects of anger. The State-Trait Anger Expression Inventory (STAXI) developed by Spielberger (1996) distinguishes anger from other related concepts, and separates the experience of anger, conceptualised as comprising ‘state’ and ‘trait’ components, from the expression of anger, viewed as having three components, anger-in, anger-out, and anger-control. The aim of the current study was to examine in more detail the relationships between anger, using the STAXI, and, on the one hand, psychopathology (symptoms of depression and PTSD), and on the other, specific neurocognitive functions in the absence of overt brain disease. It was hypothesised that (a) higher levels of anger would be positively associated with both elevated depression and PTSD scores; and (b) higher levels of anger would be associated with poorer cognitive performance on tasks which appear to be related to such executive processes as inhibition of inappropriate responses, freedom from distraction and maintenance of set.