(PS2-11) Characterization of Anger Attacks Among Those with Anxiety Disorders

Background: Anger attacks, sudden bouts of anger accompanied by physiological features, are prevalent (11.5%). Anger is associated with higher attrition rates and poorer treatment outcome for people with anxiety disorders. Anger and anger attacks have been associated with some factors (e.g., gender, distress tolerance [DT], anxiety sensitivity [AS], emotion regulation [ER]) but are not yet well understood across anxiety disorders. We aimed to clarify psychological factors relevant to anxiety disorders and anger attacks, hypothesizing that those with anxiety disorders would have more anger and anger attacks compared to controls, with higher levels for men than women with anxiety disorders. We also explored the association of gender and anger attacks with transdiagnostic factors in anxiety disorders.

Methods: 479 participants (M_age = 30.4; 63.9% female; 69.9% white) completed a structured clinical interview, including 65.1% (N = 312) with a primary anxiety disorder (n = 162 generalized anxiety disorder; n = 137 social anxiety disorder; n = 13 panic disorder) and 34.9% (N = 167) controls. Participants completed questionnaires for demographics and psychological variables: anger attacks past 6 months (Anger Attack Questionnaire – questions 1 & 3; 1 [always] – 4 [never]), ER (DERS), AS (ASI-3), and DT (DTS; total mean item response); means were examined with t-tests, chi-square, and ANOVA.

Results: Those with anxiety disorders (M±SD = 2.87±0.64) had significantly higher levels of anger (v. controls: M±SD = 3.54±5.6; t(477) = 11.47; p < .001) and reported more anger attacks (χ²(1,479) = 21.13; p < .001). For anxiety disorders, women (M±SD = 2.82±0.65) reported higher anger than men (M±SD = 2.97±0.60; t(310) = 2.05; p = .02) but anger attacks did not differ (χ²(1,312) = 0.21; p = .648). The 2(gender) X 2(anger attacks) ANOVA demonstrated no significant effects of anger attacks or interactions (ps = .064 - .701) for ER, DT, and AS in the anxiety disorder group. However, small effects for the interactions on ER (h² = 0.01, p = .064) and DT (h² = 0.01, p = .089) at trend levels were suggestive that women with anger attacks may have worse ER and DT than women without anger attacks. The anxiety disorder group demonstrated a significant effect of gender for ER (F(1, 293) = 7.98; p = .005), and DT (F(1, 292) = 11.42; p < .001), but not AS (p = .613). Women demonstrated worse ER (M±SD = 94.17±23.27), and lower DT (M±SD = 2.73±0.88) than men (M_ER±SD= 88.51±21.53; M_DT±SD = 3.03±0.78).

Discussion: Results from this well-characterized sample support the presence of elevated anger and anger attacks in adults with anxiety disorders, as well as gender differences in psychological vulnerability factors associated with anger attacks. Despite non-significant small trend level effects for the interactions, it remains possible that some women with greater ER and DT challenges are at higher risk for anger attacks. Longitudinal work in men and women with anxiety disorders examining daily fluctuations in emotion regulation and anger attacks is needed to disentangle these issues. Understanding these psychological mechanisms and ultimately their impact on outcomes is important to identify effective person-centered, evidence-based treatments that address anger alongside anxiety.