Abstract: Objective: Anger attacks have been observed in patients with obsessive-compulsive disorder (OCD), often triggered by obsessional triggers. However, few studies have reported the clinical characteristics and correlates of anger attacks among Chinese patients with OCD. Methods: A total of 90 adults with a primary diagnosis of OCD, ranging from 15 to 78 years old, participated in the study. Participants were administered the Rage Outbursts and Anger Rating Scale (ROARS), Yale-Brown Obsessive-Compulsive Scale-Second Edition, and Brown Assessment of Beliefs Scale by a trained clinician. Patients completed the Obsessive-Compulsive Inventory-Revised and Depression Anxiety Stress Scale-21. Results: A total of 31.3% of participants reported anger outbursts in the past week, and ROARS scores had no significant correlation with age, duration of illness, OCD severity, depression, or stress. However, ROARS scores were negatively related to education level, and positively related to obsessing symptoms and anxiety. Conclusions: These data suggest that anger attacks are relatively common in Chinese patients with OCD. The severity of anger attacks is related to educational level, obsessing symptoms, and anxiety, which may be a latent variable reflecting executive functioning and emotion regulation skills.

中国强迫症患者愤怒发作的发生率及其临床相关因素

[1]Antony MM, Bieling PJ, Cox BJ, et al., 1998. Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychol Assess, 10(2):176-181.

[2]Budman C, Coffey BJ, Shechter R, et al., 2008. Aripiprazole in children and adolescents with Tourette disorder with and without explosive outbursts. J Child Adolesc Psychopharmacol, 18(5):509-515.

[3]Carlson GA, Potegal M, Margulies D, et al., 2009. Rages— what are they and who has them? J Child Adolesc Psychopharmacol, 19(3):281-288.

[4]Chan RCK, Xu T, Huang J, et al., 2012. Extending the utility of the Depression Anxiety Stress scale by examining its psychometric properties in Chinese settings. Psychiatry Res, 200(2-3):879-883.

[5]Eisen JL, Phillips KA, Baer L, et al., 1998. The Brown Assessment of Beliefs Scale: reliability and validity. Am J Psychiatry, 155(1):102-108.

[6]Foa EB, Huppert JD, Leiberg S, et al., 2002. The obsessive-compulsive inventory: development and validation of a short version. Psychol Assess, 14(4):485-496.

[7]Fraguas R Jr, Papakostas GI, Mischoulon D, et al., 2006. Anger attacks in major depressive disorder and serum levels of homocysteine. Biol Psychiatry, 60(3):270-274.

[8]Goodman WK, Price LH, Rasmussen SA, et al., 1989a. The Yale-Brown Obsessive Compulsive Scale: I. Development, use, and reliability. Arch Gen Psychiatry, 46(11):1006-1011.

[9]Goodman WK, Price LH, Rasmussen SA, et al., 1989b. The Yale-Brown Obsessive Compulsive Scale: II. Validity. Arch Gen Psychiatry, 46(11):1012-1016.

[10]Hirschtritt ME, Bloch MH, Mathews CA, 2017. Obsessive-compulsive disorder: advances in diagnosis and treatment. JAMA, 317(13):1358-1367.

[11]Johnco C, Salloum A, de Nadai AS, et al., 2015. Incidence, clinical correlates and treatment effect of rage in anxious children. Psychiatry Res, 229(1-2):63-69.

[12]Krebs G, Bolhuis K, Heyman I, et al., 2013. Temper outbursts in paediatric obsessive-compulsive disorder and their association with depressed mood and treatment outcome. J Child Psychol Psychiatry, 54(3):313-322.

[13]Moscovitch DA, McCabe RE, Antony MM, et al., 2008. Anger experience and expression across the anxiety disorders. Depress Anxiety, 25(2):107-113.

[14]Ng F, Trauer T, Dodd S, et al., 2007. The validity of the 21-item version of the Depression Anxiety Stress Scales as a routine clinical outcome measure. Acta Neuropsychiatr, 19(5):304-310.

[15]Niu CY, Liu WT, Lei H, et al., 2016. The Chinese version of the Brown Assessment of Beliefs Scale: psychometric properties and utility in obsessive compulsive disorder. J Obsess Compuls Relat Disord, 11:39-42.

[16]Painuly NP, Grover S, Mattoo S, et al., 2011a. Anger attacks in obsessive compulsive disorder. Ind Psychiatry J, 20(2):115-119.

[17]Painuly NP, Grover S, Gupta N, et al., 2011b. Prevalence of anger attacks in depressive and anxiety disorders: implications for their construct? Psychiatry Clin Neurosci, 65(2):165-174.

[18]Peng ZW, Yang WH, Miao GD, et al., 2011. The Chinese version of the Obsessive-Compulsive Inventory-Revised scale: replication and extension to non-clinical and clinical individuals with OCD symptoms. BMC Psychiatry, 11:129.

[19]Piacentino D, Pasquini M, Tarsitani L, et al., 2016. The association of anger with symptom subtypes in severe obsessive-compulsive disorder outpatients. Psychopathology, 49(1):40-46.

[20]Quek TC, Ho CSH, Choo CC, et al., 2018. Misophonia in Singaporean psychiatric patients: a cross-sectional study. Int J Environ Res Public Health, 15(7):1410.

[21]Radomsky AS, Ashbaugh AR, Gelfand LA, 2007. Relationships between anger, symptoms, and cognitive factors in OCD checkers. Behav Res Ther, 45(11):2712-2725.

[22]Storch EA, Rasmussen SA, Price LH, et al., 2010. Development and psychometric evaluation of the Yale-Brown Obsessive-Compulsive Scale-Second Edition. Psychol Assess, 22(2):223-232.

[23]Storch EA, Jones AM, Lack CW, et al., 2012. Rage attacks in pediatric obsessive-compulsive disorder: phenomenology and clinical correlates. J Am Acad Child Adolesc Psychiatry, 51(6):582-592.

[24]Weiss-Goldman N, Arditi B, Rice T, et al., 2018. Psychopharmacology of the rage attack phenomenon in a child with obsessive compulsive disorder. J Child Adolesc Psychopharmacol, 28(5):360-362.

[25]Whiteside SP, Abramowitz JS, 2004. Obsessive-compulsive symptoms and the expression of anger. Cogn Ther Res, 28(2):259-268.

[26]Whiteside SP, Abramowitz JS, 2005. The expression of anger and its relationship to symptoms and cognitions in obsessive-compulsive disorder. Depress Anxiety, 21(3):106-111.

[27]Wijaya CS, Lee JJZ, Husain SF, et al., 2018. Differentiating medicated patients suffering from major depressive disorder from healthy controls by spot urine measurement of monoamines and steroid hormones. Int J Environ Res Public Health, 15(5):865.

[28]Wu MS, Storch EA, 2015. Rage outbursts in adult obsessive-compulsive disorder. Ann Clin Psychiatry, 27(4):304-305.

[29]Yeo SN, Zainal H, Tang CS, et al., 2017. Success/failure condition influences attribution of control, negative affect, and shame among patients with depression in Singapore. BMC Psychiatry, 17:285.