Trait anger and anger attacks in relation to depressive and anxiety disorders

J Affect Disord. 2019 Dec 1;259:259-265. doi: 10.1016/j.jad.2019.08.023. Epub 2019 Aug 16.


Background: Patients with various psychiatric disorders may suffer from feelings of anger, sometimes leading to maladaptive (e.g., aggressive) behaviors. We examined to what extent depressive and anxiety disorders, relevant clinical correlates, and sociodemographics determined the level of trait anger and the prevalence of recent anger attacks.

Methods: In the Netherlands Study of Depression and Anxiety (NESDA), the Spielberger Trait Anger Subscale and the Anger Attacks Questionnaire were analyzed in patients with depressive (n = 204), anxiety (n = 288), comorbid (n = 222), and remitted disorders (n = 1,107), as well as in healthy controls (n = 470) based on DSM-IV criteria.

Results: On average, participants were 46.2 years old (SD = 13.1) and 66.3% were female. Trait anger and anger attacks were most prevalent in the comorbid group (M = 18.5, SD = 5.9, and prevalence 22.1%), followed by anxiety disorder, depressive disorder, remitted disorder, and controls (M = 12.7; SD = 2.9, and prevalence 1.3%). Major depressive disorder, social phobia, panic disorder, and generalized anxiety disorder were most strongly associated to trait anger and anger attacks.

Limitations: Due to a cross-sectional design, it was not possible to provide evidence for temporal or causal relationships between anger and depressive and anxiety disorders.

Conclusions: Trait anger and anger attacks are linked to depressive and anxiety disorders, although the strength of the relationship differed among both anger constructs.

Keywords: Anger; Anxiety; Comorbidity; Depression.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aggression / psychology*
  • Anger*
  • Anxiety Disorders / diagnosis
  • Anxiety Disorders / psychology*
  • Case-Control Studies
  • Cross-Sectional Studies
  • Depressive Disorder / diagnosis
  • Depressive Disorder / psychology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Psychiatric Status Rating Scales