The Assessment, Diagnosis, and Treatment of Anger Disorders with Ray DiGiuseppe

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This Masterclass explores anger as a clinical problem and reviews research on the assessment, diagnosis, and treatments of patients with anger problems.

Clinical models of anger often borrow from the models of other emotional disorders and fail to identify how anger differs from fear, anxiety, and depressive disorders. This course will focus on the characteristics of anger and anger disorders.

Research on the comorbidity of anger in psychiatric samples reveals that anger is not a depression, manic, impulse, or personality disorders as suggested by many theorists but remains a separate clinical entity. This course will review how anger symptoms are comorbid with other disorders and how this comorbidity negatively influences the clinical presentation and prognosis of the primary disorders. Attention will focus on how anger is portrayed in the present taxonomic systems, e.g., DSM-5 and ICD- ICD-10-CM. It will also specify how anger can be conceptualised as an independent syndrome and what categories of anger patients have been derived from latent class analysis.

The lack of clear definitions for what constitutes clinically dysfunctional anger has also led to disagreement in how anger is represented in psychological tests. We will review the common problems in anger assessment instruments and structured interviews. A model for assessing anger that can be used to individualise treatment will be presented.

Research on effective anger treatment models will be presented. Anger treatments usually employ one manual for all participants. Most researchers fail to identify different types of anger problems that may require various interventions. Such models do not help clinicians assess essential aspects of the anger experience and use their assessment to construct an individualised case conceptualisation.

Most anger treatments rely on Cognitive-Behavioural Therapies. However, we have little research identifying which CBT constructs are most related to anger and should be targeted in treatment. Data on the attitudes that most likely lead to clinical anger are reviewed, along with suggestions for targeting them. This Masterclass will propose a model of anger characteristics that informs assessment that will help clinicians build case conceptualisations and individual treatment plans based on empirically based interventions.

Implication for everyday clinical practice

Participants will learn how to best assess anger problems and how and when to implement the following interventions:

• motivational enhancement strategies,
• strategies for establishing a therapeutic alliance with angry patients,
• strategies for challenging anger eliciting cognitions,
• exposure interventions,
• the rehearsal of new assertive behaviours,
• relevant homework assignments.

Key learning objectives:

Participants who attend this workshop will be able to:

• Describe how anger symptoms are presented in DSM 5 & ICD-11-CM.
• Explain how excessive anger a harmful and dysfunctional form of psychopathology is.
• Explain how anger and aggressive symptoms are comorbid with other disorders.
• Describe what characteristics of anger leads to resistance to change.
• Design assessment strategies reveal anger and aggression problems for children, adolescents, and adults.
• Implement a comprehensive model of anger assessment
• Explain the cognitive behaviour treatments of anger.
• Design treatment plans based on empirically supported interventions for angry patients.