Citation
The Diagnosis and Treatment of Anger in Outpatient Medical Settings

Material Information

Title:
The Diagnosis and Treatment of Anger in Outpatient Medical Settings
Creator:
Ewigman, Nathan L
Place of Publication:
[Gainesville, Fla.]
Florida
Publisher:
University of Florida
Publication Date:
Language:
english
Physical Description:
1 online resource (226 p.)

Thesis/Dissertation Information

Degree:
Doctorate ( Ph.D.)
Degree Grantor:
University of Florida
Degree Disciplines:
Psychology
Clinical and Health Psychology
Committee Chair:
GYLYS II,JULIUS A
Committee Co-Chair:
HARMAN,JEFFREY SCOTT
Committee Members:
JANICKE,DAVID
ROZENSKY,RONALD HOWARD
COOK,ROBERT L
Graduation Date:
8/9/2014

Subjects

Subjects / Keywords:
African Americans ( jstor )
Anger ( jstor )
Hispanics ( jstor )
Insurance ( jstor )
Medications ( jstor )
Mood disorders ( jstor )
Physicians ( jstor )
Psychiatric diagnosis ( jstor )
Psychotherapy ( jstor )
Psychotic disorders ( jstor )
Clinical and Health Psychology -- Dissertations, Academic -- UF
anger -- diagnosis -- outpatient -- treatment
Genre:
bibliography ( marcgt )
theses ( marcgt )
government publication (state, provincial, terriorial, dependent) ( marcgt )
born-digital ( sobekcm )
Electronic Thesis or Dissertation
Psychology thesis, Ph.D.

Notes

Abstract:
Anger is a common and potentially pathological emotion and is a known correlate of poor interpersonal, intrapersonal and cardiovascular outcomes. However, anger has been relatively ignored by researchers and is not represented as a distinct psychiatric disorder in the DSM-IV. The diagnoses and treatments associated with individuals presenting with anger have not been documented. The current study aimed to determine the diagnoses and treatment associated with adults presenting with anger to office-based and outpatient department settings. To this end, the current study utilized 1998-2008 data from the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS). These datasets are nationally representative of visits to office-based (NAMCS) and hospital ambulatory care settings (NHAMCS). Visits by individuals who self-reported anger as their presenting problem were analyzed. Results indicated that nearly all visits in which individuals present with anger culminated in a psychiatric diagnosis while nearly all visits receive no treatments or were offered/delivered psychotherapy. The groups that were most likely to be offered/delivered psychotherapy were ironically those with the least resources to follow-up; i.e. younger and uninsured individuals. Specific diagnoses and treatments were more likely among visits with certain subgroups. The current study provides evidence of clinical uncertainty regarding the diagnosis and treatment of anger in medical settings. Potential implications of the current research involve the inclusion of anger disorders into the DSM and education of health care providers on pathological anger. ( en )
General Note:
In the series University of Florida Digital Collections.
General Note:
Includes vita.
Bibliography:
Includes bibliographical references.
Source of Description:
Description based on online resource; title from PDF title page.
Source of Description:
This bibliographic record is available under the Creative Commons CC0 public domain dedication. The University of Florida Libraries, as creator of this bibliographic record, has waived all rights to it worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law.
Thesis:
Thesis (Ph.D.)--University of Florida, 2014.
Local:
Adviser: GYLYS II,JULIUS A.
Local:
Co-adviser: HARMAN,JEFFREY SCOTT.
Electronic Access:
RESTRICTED TO UF STUDENTS, STAFF, FACULTY, AND ON-CAMPUS USE UNTIL 2015-02-28
Statement of Responsibility:
by Nathan L Ewigman.

Record Information

Source Institution:
UFRGP
Rights Management:
Copyright Ewigman, Nathan L. Permission granted to the University of Florida to digitize, archive and distribute this item for non-profit research and educational purposes. Any reuse of this item in excess of fair use or other copyright exemptions requires permission of the copyright holder.
Embargo Date:
2/28/2015
Classification:
LD1780 2014 ( lcc )

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Full Text

PAGE 24

Definition

PAGE 25

Related Constructs

PAGE 26

Prevalence

PAGE 29

Consequences

PAGE 30

Problems with the Conceptualization of Anger

PAGE 31

Current Conceptualizations of Pathological Anger Diagnosis of Pathological Anger

PAGE 32

Anger attacks, anger disorders & intermittent explosive disorder

PAGE 33

www.dsm5.org

PAGE 34

Anger related DSM diagnoses by category

PAGE 35

i

PAGE 37

Common diagnoses of patients presenting with anger

PAGE 40

Treatment of Pathological Anger Psychosocial T reatments

PAGE 41

d Pharmacological T reatments

PAGE 43

Physician Decision Making about Pathological Anger

PAGE 44

Existing Models of Ph ysician Decision Making

PAGE 48

Conceptual Model

PAGE 49

Step 1: Patient s ymptoms. Step 2: Diagnostic f it and c ommunication.

PAGE 51

Step 3: Clinical u ncertainty. Step 4: Cognitive dispositions to r espond (CDRs).

PAGE 54

Step 5: Patient level factors contribute to diagnostic disparities via cdrs.

PAGE 57

Step 6: Diagnost ic d ecision.

PAGE 59

Step 7: Patient level factors contribute to treatment disparities.

PAGE 62

Step 8: Treatment d ecision.

PAGE 63

Step 9: Clinical o utcome.

PAGE 65

Rationale for the Current Study

PAGE 66

Current Study

PAGE 67

Preliminary Aims Primary Aims: Diagnoses

PAGE 68

Aim 1. . . . Aim 2.

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Aim 3.

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Primary Aims: Treatment Aim 4.

PAGE 71

Aim 5.

PAGE 72

Aim 6. Aim 7.

PAGE 74

Data Source Variables Anger as a Reason for Visit

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Dependent Variables Presence of any psychiatric diagnosis

PAGE 80

Presence of NOS diagnosis

PAGE 82

Diagnostic categories

PAGE 84

Mo od Disorders.

PAGE 85

Anxiety d isorders. Psychotic disorders.

PAGE 86

Other psychiatric d isorders.

PAGE 92

Treatment Prescrip tions

PAGE 95

Psychotropic vers us nonpsychotropic medications Psychotherapy

PAGE 99

Overall Treatment Choice vice versa

PAGE 106

Predictor Variables

PAGE 107

Control Varia bles Presence of other psychiatric symptoms

PAGE 108

Non psychiatric u ses for psychotropic medications

PAGE 109

Medical comorbiditi es Sociodemographic aspects of the clinical practice Time

PAGE 110

Covariates Dropped Due to Missing Observations

PAGE 111

Statistical Analyses General A pproach p Primary Aims: Diagnoses Aim 1

PAGE 112

Aim 2

PAGE 113

Aim 3

PAGE 115

o o Primary Aims: Treatment Aim 4

PAGE 117

Aim 5

PAGE 118

Aim 6

PAGE 119

Aim 7

PAGE 120

v12 v13 v14 dn21dn31dn41 n n n4 v v = n

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p Anger as a Reason for Visit by Patient Level Factors Descriptive

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Multivariate p p p p p p p p

PAGE 125

p p Presence of Any Psychiatric Disorder by Patient Level Factors Descriptive

PAGE 128

Multivariate

PAGE 129

p

PAGE 130

Hypotheses from A im 1 p more

PAGE 131

Not Otherwi se Specified (NOS) Diagnoses by Patient Level Factors Descriptive

PAGE 132

Multivariate

PAGE 133

p

PAGE 134

Hypotheses from A im 2 p

PAGE 135

p Psychiatric Diagnoses by Patient Level Factors Descriptive

PAGE 142

Multivariate p

PAGE 143

p p p p p p

PAGE 144

p p p p p p p p p p

PAGE 145

p p p p p p p p p

PAGE 146

Hypotheses from A im 3 p p

PAGE 147

p Pr escription Categories by Patient Level Factors Descriptive Multivariate

PAGE 148

Psychotropic versus NonPsychotropic Medications by Patient Level Factors Receipt of Psychotherapeutic Intervention/Referral by Patient Level Factors Descriptive

PAGE 150

Multivariate

PAGE 151

p

PAGE 153

Hypotheses from A im 6 greater p Treatment Choices by Patient Level Factors Descriptive

PAGE 161

Multivariate

PAGE 162

p p

PAGE 163

p p p p p

PAGE 164

p p p p p

PAGE 165

p Hypotheses from A im 7 p

PAGE 167

Explanation of Results and Unifying Themes Subgroups Most Likely to Present with Anger

PAGE 168

Diagnoses When Anger i s the Presenting Problem

PAGE 174

Treatment When Anger i s the Presenting Problem

PAGE 178

Clinical and Policy Implications

PAGE 182

Research Implications and Future Research : The Case for DSM Anger Diagnoses

PAGE 186

Limitations

PAGE 188

Strengths

PAGE 189

Conclusions