Validation of a Simplified Definition of Anger Attacks

Background: Anger attacks, sudden spells of anger with vegetative hyperarousal, are highly prevalent symptoms in depression. Assessment normally requires the use of specific instruments. The aim of this study was the validation of a simplified definition for anger attacks. Methods: Anger attacks were assessed in 203 patients suffering from major depression with the Anger Attacks Questionnaire. The first three items of the questionnaire (irritability, overreaction to minor annoyances, episodes with inappropriate anger or rage) were compared separately with the diagnosis, and their value as single screening questions to establish the diagnosis was assessed. Results: Irritability was only weakly associated with the diagnosis of anger attacks (Cohen’s kappa ĸ = 0.214 ± 0.058) and yielded a rather low specificity (0.302), while overreaction to minor annoyances (ĸ = 0.869 ± 0.037) and the question about episodes with inappropriate anger or rage (ĸ = 0.901 ± 0.032) had a high degree of agreement with the diagnosis of the questionnaire (specificity 0.918 and 0.935, respectively). The combination of the two later items resulted in an almost perfect reclassification of cases (ĸ = 0.955 ± 0.022; specificity = 0.971). Conclusions: As anger attacks are probably underdiagnosed in clinical practice, simplification of the diagnostic process is imperative. Our results demonstrate that asking one or two simple screening questions suffices to recognize the majority of patients with anger attacks.