This study examined whether relationships between anger management style (anger suppression; anger expression) and adjustment variables for patients with chronic pain depend on patient hostility, and/or depend on a patient's gender. A 'spouse response model' was also evaluated to test whether patient expression of hostile anger is linked to infrequent positive and frequent negative responses from spouses, and hence to poor adjustment. The sample of 127 married chronic pain patients was assessed prior to entry into a multidisciplinary pain treatment program. Hierarchical multiple regressions revealed significant 'Anger Expression x Hostility x Gender' interactions for pain severity, activity interference and activity level: High Anger Expressor/Low Hostile women reported the lowest pain and highest activity; Low Anger Expressor/High Hostile men reported the highest pain and highest interference. Among men, support was also found for a spouse response model: pain severity and activity interference for High Anger Expressors was partly accounted for by negative spouse responses. Results suggest that discriminations among patients may be made based on anger management style in interaction with level of hostile attitude and the patient's gender, and that these distinctions may have implications for understanding mechanisms of pain and disability, and for designing appropriate treatment.