Anger attacks are episodes of intense anger with autonomic arousal, which occur in response to often trivial provocations. This study explores some of the antecedents, concomitants, and consequences of anger attacks in patients with depression. The sample comprised three groups: depression with anger attacks (n = 20), depression without anger attacks (n = 20) and normal controls (n = 20). Subjects were administered the Mini International Neuropsychiatric Interview, the Anger Attack Questionnaire, Irritability, the Depression Anxiety Scale, the State-Trait Anger Expression Inventory, the Psychoticism Extraversion Neuroticism Inventory, the Hassles Scale, the World Health Organization Quality of Life-BREF Version and the Dysfunctional Analysis Questionnaire. Depressed patients with anger attacks exhibited more suicide-related phenomena and dysfunction scores in comparison to depressed patients without anger attacks. Depressed patients with anger attacks also had higher scores of anxiety, irritability, trait-anger, anger-out, anger expression, psychoticism, hassles, and poor quality of life in comparison to the other two groups. In conclusion, anger attacks adversely affect the lives of depressed patients and their family members and may serve as a qualifier for partially distinct syndrome of depression.
Anger attacks are characterized by a rapid onset of intense anger and a crescendo of autonomic arousal and often occur in response to trivial provocations (Fava et al., 1991). Such attacks have been reported more often in depressed patients than in normal controls (Fava et al., 1991, Fava et al., 1993a, Fava et al., 1993b and Fava et al., 1997). Patients of depression (major depression, dysthymia, atypical depression and seasonal affective disorder-depression) with anger attacks are reported to differ from those without such attacks in terms of comorbid psychiatric disorder, symptom-profile, personality traits and biological variables (Fava et al., 1991, Fava et al., 1993a, Fava et al., 1993b, Rosenbaum et al., 1993, Fava et al., 1997, Mammen et al., 1999, Winkler et al., 2005a and Winkler et al., 2005b).
The factors that might influence the occurrence of anger attacks in depression and the possible consequences of these attacks in the lives of depressed subjects and their caregivers have not been well studied. Based on our earlier review (Painuly et al., 2005), we hypothesised that compared to normal controls depressed patients with anger attacks would have higher scores on measures of neuroticism and psychoticism [subcomponent of neuroticism and psychoticism dimensions, respectively (Digman, 1990)]; perceived stress (daily hassles); severity of anger, irritability, depression, and anxiety; and dysfunction and quality of life. Also, that depressed patients without anger attacks would have an intermediate position for the above variables except severity of depression and neuroticism, which would be expected to be similar to that of depressed patients with anger attacks.
The aim of the present study was to examine whether depression with and without anger attacks differed in terms of the antecedents (personality variables and daily hassles), concomitants (severity of anger, irritability, depression, and anxiety and occurrence of comorbid disorders) and consequences (dysfunction and quality of life).
