Clinicians’ diagnosis of a case with anger problems

Psychiatrists and psychologists responded to case vignettes to assess the prevalence, severity, and diagnostic confidence clinicians had concerning treating anger disordered clients compared with clients with generalized anxiety disorder. Five hundred and forty-two clinicians (a response rate of 30%) assessed one of two matched case histories by mail. One described generalized anxiety disorder (GAD) and the other a case of anger disorder (AD). Cases were identical except for thoughts and affect relevant to the disorders. Both male and female versions were used. More than 95% of the participants viewed the cases they received as pathological. The disorders were rated as equally common. The clinicians reported treating equal numbers of patients with similar anger or anxiety symptoms in the past year. Although the case histories were alike in length and detail, AD participants rated their case as less complete and had lower confidence in their diagnoses. The diagnostic consensus was high for GAD clinicians, but low for AD. Forty-three percent of participants selected an Axis II diagnosis for AD, compared with 3% for GAD. Clinicians appeared to encounter patients with chronic anger about as frequently as they see GAD, but they displayed diagnostic confusion and bias toward personality disorder diagnoses when presented with the anger symptoms. The findings support the development of a diagnostic category for primary anger. The wide dispersion of diagnoses for anger underscores the need for focused differential assessment.