Anger and Posttraumatic Stress Disorder in Disaster Relief Workers Exposed to the September 11, 2001 World Trade Center Disaster

Department of Psychiatry, Weill Medical College of Cornell University, New York, New York 10065, USA.
The Journal of nervous and mental disease (Impact Factor: 1.69). 12/2008; 196(11):844-6. DOI: 10.1097/NMD.0b013e31818b492c
Source: PubMed


Although anger is an important feature of posttraumatic stress disorder (PTSD) it is unclear whether it is simply concomitant or plays a role in maintaining symptoms. A previous study of disaster workers responding to the terrorist attacks of September 11, 2001 () indicated that those with PTSD evidenced more severe anger than those without. The purpose of this study was to conduct a 1-year follow-up to assess the role of anger in maintaining PTSD. Workers with PTSD continued to report more severe anger than those without; there were statistically significant associations between changes in anger, PTSD severity, depression, and psychiatric distress. Multiple regression analysis indicated initial anger severity to be a significant predictor of PTSD severity at follow-up, which is consistent with the notion that anger maintains PTSD. One implication is that disaster workers with high anger may benefit from early intervention to prevent chronic PTSD.

Download full-text


Available from: Nimali Jayasinghe, Sep 23, 2014
  • Source
    • "The prominence of anger as an outcome following traumatic events has been particularly evident in combat veterans, where anger has also been associated with aggression and interpersonal violence (Elbogen, Beckham, Butterfield, Swartz, & Swanson, 2008; McManus, Grey, & Shafran, 2008). Anger and anger-related cognitions also appear to play a significant role in the development and maintenance of key posttraumatic mental health disorders such as posttraumatic stress disorder (PTSD) (Jayasinghe et al., 2008; Koenen, Stellman, Stellman, & Sommer, 2003) with evidence of it attenuating gains in PTSD treatment, most notably in combat veterans (Forbes, Creamer, Hawthorne, Allen, & McHugh, 2003; Forbes et al., 2008). "
    [Show abstract] [Hide abstract]
    ABSTRACT: After a traumatic event many people experience problems with anger which not only results in significant distress, but can also impede recovery. As such, there is value to include the assessment of anger in routine post-trauma screening procedures. The Dimensions of Anger Reactions-5 (DAR-5), as a concise measure of anger, was designed to meet such a need, its brevity minimizing the burden on client and practitioner. This study examined the psychometric properties of the DAR-5 with a sample of 163 male veterans diagnosed with Posttraumatic Stress Disorder. The DAR-5 demonstrated internal reliability (α = 0.86), along with convergent, concurrent and discriminant validity against a variety of established measures (e.g. HADS, PCL, STAXI). Support for the clinical cut-point score of 12 suggested by Forbes et al (2014) was observed. The results support concluding the DAR-5 as a preferred screening and assessment measure of problematic anger.
    Full-text · Article · Oct 2014 · Journal of Anxiety Disorders
  • Source
    • "Individuals with hostility less often visited medical clinics in the aftermath of a disaster [16], although they are in higher risk for cardiovascular problems [17], they may have higher levels of lipids in their blood, [18] [19], their cortisol levels are increased [20] and they are in higher risk of all-cause mortality independently of other risk factors (e.g., smoking, cholesterol levels) [4] [21]. In addition it has been suggested that severity of anger and hostility is a risk factor of family violence and substance abuse [22], and also that is a factor for maintenance of psychological problems and mostly PTSD [7]. On the other hand, it has been proposed that in some cases the return of anger and hostility can be a sign of a return to normal [23]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Previous studies reported that anger and hostility are often presented in the victims of a disaster. This study investigates the symptoms of anger and hostility after a wildfire disaster in a rural area of Greece. Cross sectional case control study of adult population (18 -65 years old). Face to face interview. Data collected were demographic, Symptom Checklist 90-Revised for assessment of hostility, type and number of losses, trust in institutions personal and social attitudes. It was found that more of the victims of the wildfires reported symptoms of hostility compared to controls but this difference was disappeared when we adjust for other variables. Risk factors for development of hostility among the victims were mistrust in military forces and media, high levels of anxiety and distress, younger age and having higher education. It was concluded that anger and hostility after a disaster perhaps are not only related to disaster but other factors concerning demographic and personal cha-racteristics may play an important role.
    Preview · Article · Jan 2011 · Open Journal of Psychiatry
  • Source
    • "Although posttraumatic distress has been linked with elevated levels of somatization in both male and female survivors of physical or sexual assault (Rentoul & Appleboom, 1997; Stein et al., 2003), health-related concerns have not been compared across genders within an interpersonal assault population. Elevated anger and guilt have also been identified as predominant clinical features within the PTSD population (Forbes et al., 2008; Jayasinghe, Giosan, Evans, Spielman, & Difede, 2008). Historically, attention to anger within the male combat population has promoted the conception that anger is a common male response to trauma (Chemtob, Hamada, Roitblat, & Muraoka, 1994; Woolfolk & Grady, 1988). "
    [Show abstract] [Hide abstract]
    ABSTRACT: This study compares a sample of PTSD-positive, female survivors of interpersonal assault (n = 162) to a sample of similarly traumatized male counterparts (n = 45) on a number of variables, including PTSD-symptom severity, depressive symptoms, anger, guilt, and health-related concerns. Results indicate that male and female interpersonal assault survivors presented similarly with respect to PTSD and depressive symptomatology and reported comparable levels of guilt and that women reported significantly more health-related complaints than men did. With respect to the experience of anger, men report significant elevations on the state anger subscale of the State-Trait Anger Expression Inventory compared to women.
    Full-text · Article · May 2010 · Journal of Interpersonal Violence
Show more