Anger in Adults a Red Flag for Childhood Trauma
PARIS ― Adults who are easily angered may have experienced trauma during childhood, according to new findings that investigators believe warrant routine trauma screening for patents with depression and/or anxiety.
Investigators examined data on more than 2250 individuals who were asked about trauma during childhood and a subsequent tendency toward anger or angry outbursts 4 years later.
Results showed that emotional neglect during childhood was associated with approximately a 40% increased likelihood of subsequent anger, while psychological abuse was linked to a 30% increased likelihood.
Childhood physical abuse was also significantly associated with anger in adults, with an increased risk of approximately 40%. The researchers found no link between childhood sexual abuse and adult anger.
“We can’t definitively say that the trauma causes the anger, but the link is clear,” said study investigator Nienke De Bles, PhD student, Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands, in a release.
“Being easily angered can have several consequences,” she continued. “It can make personal interactions more difficult, and it can have consequences for your mental health and well-being, but people who get angry easily also have a greater tendency to discontinue psychiatric treatment, so this anger may mean that it reduces their chances of a better life,” she added.
De Bles believes that “it should be standard practice to ask depression and anxiety sufferers about anger and past trauma, even if the patient is not exhibiting current anger.”
The findings were presented here at the European Psychiatric Association (EPA) 2023 Congress.
A “Red Flag” for Abuse
“Psychiatric treatments for past trauma may differ from treatments for depression, so psychiatrists need to try to understand the cause so that they can offer the correct treatment to each patient,” said De Bles.
De Bles noted that childhood trauma has many negative consequences later in life and that it is associated with a higher prevalence of adult depression and anxiety.
“There are several potential mechanisms for psychopathology in the context of childhood trauma, and emotion regulation seems to be one of the key mechanisms,” she said.
The researchers previously found that anger was highly prevalent among patients with affective disorders. It was present in 30% of those with current anxiety or depressive disorder and in 40% of those with comorbid depression and anxiety with a tendency toward anger, vs 5% of healthy control persons.
Other studies have shown that anger is associated with poor treatment outcomes and dropping out of treatment.
To further investigate the link between childhood trauma and anger in adulthood, the researchers examined data on 2271 participants in the Netherlands Study of Depression and Anxiety (NESDA).
Childhood trauma was assessed at baselineusing the semistructured Childhood Trauma Interview. Anger was measured at a 4-year follow-up using the Spielberger Trait Anger Subscale, the Anger Attacks Questionnaire, and the borderline and antisocial subscales of the Personality Disorder Questionnaire 4 to identify cluster B personality traits.
Results showed that emotional neglect during childhood was significantly associated with trait anger in adulthood, at an adjusted odds ratio (OR) of 1.42 (P < .001), anger attacks (OR = 1.35; P = .004), and borderline (OR = 1.76; P < .001) and antisocial (OR = 1.88; P = .001) personality traits.
Childhood psychological abuse was also significantly associated with later trait anger (OR = 1.28; P = .002), anger attacks (OR = 1.31; P = .024), and borderline (OR = 1.77; P < .001) and antisocial (OR = 1.69; P = .011) traits.
There was also a significant association between childhood psychical abuse and trait anger in adulthood (OR = 1.37; P < .001), anger attacks (OR = 1.48; P = .004), and borderline (OR = 1.71; P < .001) and antisocial (OR = 1.98; P = .002) traits.
There was no significant association between sexual abuse experienced in childhood and later anger or personality traits.
De Bles said the findings suggest “there is indeed a relationship between childhood trauma and anger in adulthood, and this is something that might be interesting for clinicians, as anger could be a red flag for a history of childhood trauma.”
She told Medscape Medical News that anger is a “very normal human emotion” but that it has not been as widely studied as sadness and anxiety.
She suggested that future research could examine the use of trauma-based therapies for patients with a history of childhood trauma and anger.
Commenting on the findings for Medscape Medical News, Nur Hani Zainal, PhD, Department of Healthcare Policy, Harvard Medical School, Boston, Massachusetts, said the findings are “very consistent with the current biopsychosocial models in psychiatry and clinical psychology.”
Zainal, who was co-author of a recent study that showed that anger appears to mediate the relationship between childhood trauma and adult psychopathology, said the current study offers a “good, incremental contribution” to the literature.
She noted there are “good uses” for the emotion of anger, as “sometimes we need anger to set healthy boundaries for ourselves.” However, she agreed that as an aspect of depression, anxiety, and posttraumatic stress disorder, it is often “overlooked.”
Zainal said that the findings reinforce the importance of thoroughly evaluating adult patients’ experiences during childhood.
Julian Beezhold, MD, secretary general of the EPA and a consultant psychiatrist with the Norwich Medical School, University of East Anglia, Norwich, United Kingdom, commented in the release that anger is a “somewhat neglected symptom.”
“The findings are in line with what we see in day-to-day clinical practice and will hopefully help increase the awareness of the importance of both anger and associated childhood trauma.”
The infrastructure for the NESDA study is funded through the Geestkracht program of the Netherlands Organization for Health Research and Development and financial contributions by participating universities and mental health care organizations (VU University Medical Center, GGZ inGeest, Leiden University Medical Center, Leiden University, GGZ Rivierduinen, University Medical Center Groningen, University of Groningen, Lentis, GGZ Friesland, GGZ Drenthe, Dimence, Rob Giel Onderzoekscentrum). The authors have disclosed no relevant financial relationships.
European Psychiatric Association (EPA) 2023 Congress: Abstract O0065. Presented March 27, 2023.
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