CHAPTER 23: New Prospects for Alleviation of Anger in the Context of Chronic Pain

CONCEPTUALIZATION OF ANGER

WHAT IS ANGER?

Anger has been defined with different shades of emphasis, but in psychology, there is general agreement that anger is a subjective feeling rooted in an attribution or appraisal of wrongdoing and coupled with an action tendency to undo that wrongdoing in ways that may range from resistance to retaliation. This is consistent with the cognitive-motivational view of all emotions.¹ It also reflects Smedslund's² depiction of the lay perspective on anger.

Similar to fear and sadness, anger can assume any one of three forms: emotion, mood, or temperament.³ Emotion is a momentary episode, mood is relatively prolonged in duration, and temperament is a proneness to the particular feeling or emotion so that it recurs. These three forms are reflected in the varied and nuanced vocabulary of anger. As an emotion, anger can range in intensity from annoyance to rage; as a mood, it is tonic rather than phasic as implied by the words irritability or irascibility; as temperament, it is a propensity to frequent anger as captured in the word hostility, which, in affect science, is reserved for dispositional or attitudinal rather than situational anger.^4,5

Some of these lexical boundaries may be ignored in common parlance. However, for scientists and professionals, proper classification and terminology facilitate comparisons across studies, integration of findings, and scholarly discourse. Hence, there is interest in choosing the right words and (when necessary) coining new terms for different phenomena. Along such lines, anger is further distinguishable from two other terms, aggression and violence. Aggression, in social psychology, refers to behavior (physical or verbal) that is intended to hurt. Violence is behavior that intentionally and actually culminates in physical injury or damage.

WHEN IS ANGER A PROBLEM?

According to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5),⁶ a mental disorder is “a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning” (p. 20). A conspicuous departure from the earlier version of the DSM has been the omission of the statement about significantly increased risk of “pain, disability, death, or important loss of freedom”⁷ (p. xxxi). By the new rule, a heightened risk of pain or other catastrophic consequences does not signal a mental disorder. However, aggressive or violent anger would almost certainly be regarded as a disorder inasmuch as it represents a marked disturbance in actions, thoughts, or emotional control. Yet, at present there are no DSM diagnostic labels for anger disorders. One exception is intermittent explosive disorder (IED), which is grouped under “Disruptive, Impulse-Control and Conduct Disorders” along with conditions such as pyromania, kleptomania, and oppositional defiant disorder. A diagnosis of IED refers to recurrently uncontrolled anger culminating in physical ...