The feeling of anger: From brain networks to linguistic expressions

Perceived Injustice and Anger in Fibromyalgia With and Without Comorbid Mental Health Conditions: A Hebrew Validation of the Injustice Experience Questionnaire

OBJECTIVES

Perceived injustice (PI), assessed by the Injustice Experience Questionnaire (IEQ), is an important trigger of anger. Both PI and anger are associated with adverse chronic pain outcomes, and with comorbid mental health severity. We aimed examined the roles of PI and anger in mediating pain across Fibromyalgia patients, with and without comorbid anxiety/depression (FM+A/D, FM-A/D, respectively), as well as rheumatoid arthritis (RA), and pain-free controls (PFC). We hypothesized the highest levels of PI, anger, and pain in FM+A/D patients, followed by FM-A/D, RA, and PFC, thus also validating a Hebrew version of the IEQ.

METHODS

We translated the IEQ using the forward-backward method and collected data online. Based on self-reported anxiety/depression, the sample comprised 66 FM+A/D patients, 64 FM-A/D, 34 RA, and 32 PFCs. Assessments included the IEQ, state and trait anger, pain intensity, anxiety, depression, and pain catastrophizing. The structure and reliability of the Hebrew IEQ were examined using factor analysis and Cronbach alpha. Bootstrapped-based modeling was used to test the roles of state and trait anger in mediating and moderating the relationship between PI and pain intensity.

RESULTS

We confirmed a one-factor structure of the IEQ, with excellent reliability. FM+A/D patients demonstrated the highest scores in all measures. Within this group, trait anger moderated the mediating effect of state anger in the relationship between PI and pain intensity.

DISCUSSION

Our findings validate a Hebrew IEQ and highlight the importance of PI and state and trait anger in the differential manifestation of mental health comorbidity in FM.

Neural responses to facial emotions and subsequent clinical outcomes in difficult-to-treat depression

BACKGROUND

Amygdala and dorsal anterior cingulate cortex responses to facial emotions have shown promise in predicting treatment response in medication-free major depressive disorder (MDD). Here, we examined their role in the pathophysiology of clinical outcomes in more chronic, difficult-to-treat forms of MDD.

METHODS

Forty-five people with current MDD who had not responded to ⩾2 serotonergic antidepressants (n = 42, meeting pre-defined fMRI minimum quality thresholds) were enrolled and followed up over four months of standard primary care. Prior to medication review, subliminal facial emotion fMRI was used to extract blood-oxygen level-dependent effects for sad v. happy faces from two pre-registered a priori defined regions: bilateral amygdala and dorsal/pregenual anterior cingulate cortex. Clinical outcome was the percentage change on the self-reported Quick Inventory of Depressive Symptomatology (16-item).

RESULTS

We corroborated our pre-registered hypothesis (NCT04342299) that lower bilateral amygdala activation for sad v. happy faces predicted favorable clinical outcomes (rs[38] = 0.40, p = 0.01). In contrast, there was no effect for dorsal/pregenual anterior cingulate cortex activation (rs[38] = 0.18, p = 0.29), nor when using voxel-based whole-brain analyses (voxel-based Family-Wise Error-corrected p < 0.05). Predictive effects were mainly driven by the right amygdala whose response to happy faces was reduced in patients with higher anxiety levels.

CONCLUSIONS

We confirmed the prediction that a lower amygdala response to negative v. positive facial expressions might be an adaptive neural signature, which predicts subsequent symptom improvement also in difficult-to-treat MDD. Anxiety reduced adaptive amygdala responses.

The contribution of brain volume to explain autonomous imbalance during recovery from acute stress in batterers

AIM

Many authors have suggested that intimate partner violence (IPV) perpetrators present an imbalance between both branches of the autonomous nervous system when coping with acute stress. Concretely, there is a predominance of the sympathetic branches over the parasympathetic ones when recovering from stress. This imbalance can be explained by their tendency toward anger rumination, and more concretely, by their focus on thoughts of revenge during this period. Unfortunately, there is a gap in the scientific literature in terms of using magnetic resonance imaging (MRI) techniques to assess which brain structures would explain this tendency of IPV perpetrators when coping with acute stress.

METHOD

The main objective of this study was to assess whether the gray matter volume (GMV) of relevant brain structures, signaled in previous scientific literature, moderates the association between thoughts of revenge and sympathetic activation during the recovery period, based on skin conductance levels (SCL) after being exposed to stress, in a group of IPV perpetrators (n = 58) and non-violent men (n = 61).

RESULTS

This study highlighted that the GMV of the left nucleus accumbens, right lobules of the cerebellum, and inferior temporal gyrus in IPV perpetrators moderated the association between thoughts of revenge and SCL during the recovery period. Accordingly, the higher the thoughts of revenge, the higher the sympathetic predominance (or higher SCL levels), especially among IPV perpetrators with the lowest GMV of these brain structures. Nonetheless, those variables were unrelated in the control group.

CONCLUSIONS

Our study highlights the involvement of certain brain structures and how they explain the tendency of some IPV perpetrators to ruminate anger or, more precisely, to focus on thoughts of revenge when they recover from acute stress. These results reinforce the need to incorporate neuroimaging techniques during screening processes to properly understand how IPV perpetrators deal with stress, which in turn helps target their needs and design concrete intervention modules.

The link between anger and reactive aggression: Insights into anger rumination

This study examined the mediating role of anger rumination in the relationship between anger and reactive aggression and the potential of adaptive anger rumination in reducing reactive aggression. Study 1, a two-wave longitudinal survey of 177 Chinese adolescents, showed that anger rumination mediated the relationship between anger and reactive aggression. Study 2, an experimental study with 160 university students, showed that the self-distanced group had lower aggression than the self-immersed group, and anger rumination mediated the impact of anger on reactive aggression in only the self-immersed group. These findings clarify the role of anger rumination concerning the relationship between anger and reactive-aggression and highlight the importance of self-distanced anger rumination in preventing reactive aggression among adolescents and young adults.

Affective dysfunction mediates the link between neuroimmune markers and the default mode network functional connectivity, and the somatic symptoms in somatic symptom disorder

OBJECTIVE

Somatic symptom disorder (SSD) is characterized by physical symptoms and associated functional impairments that are often comorbid with depression and anxiety disorders. In this study, we explored relationships between affective symptoms and the functional connectivity of the default mode network (DMN) in SSD patients, as well as the impact of peripheral inflammation. We employed mediation analyses to investigate the potential pathways between these factors.

METHODS

We recruited a total of 119 individuals (74 unmedicated SSD patients and 45 healthy controls), who were subjected to comprehensive psychiatric and clinical evaluations, blood tests, and resting-state functional magnetic resonance imaging scanning. We assessed neuroimmune markers (interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), tryptophan, serotonin, and 5-hydroxyindoleacetic acid (5-HIAA)), clinical indicators of somatic symptoms, depression, anxiety, anger, alexithymia, and functional connectivity (FC) within the DMN regions. Data were analyzed using correlation and mediation analysis, with a focus on exploring potential relations between clinical symptoms, blood indices, and DMN FCs.

RESULTS

Patients with SSD had higher clinical scores as well as IL-6 and TNF-α levels compared with those in the control group (P < 0.05). The SSD group exhibited lower FC strength between the left inferior parietal lobule and left prefrontal cortex (Pfalse discovery rate (FDR) < 0.05). Exploratory correlation analysis revealed that somatic symptom scores were positively correlated with affective symptom scores, negatively correlated with the FC strength between the intra prefrontal cortex regions, and correlated with levels of IL-6, TNF- α, and tryptophan (uncorrected P < 0.01). Mediation analysis showed that levels of anxiety and trait anger significantly mediated the relations between DMN FC strength and somatic symptoms. In addition, the DMN FC mediated the level of trait anger with respect to somatic symptoms (all PFDR < 0.05). The levels of depression and trait anger exhibited significant mediating effects as suppressors of the relations between the level of 5-HIAA and somatic symptom score (all PFDR < 0.05). Further, the level of 5-HIAA had a mediating effect as a suppressor on the relation between DMN FC and state anger. Meanwhile, the levels of hs-CRP and IL-6 had full mediating effects as suppressors when explaining the relations of DMN FC strengths with the level of depression (all PFDR < 0.05). The patterns of valid mediation pathways were different in the control group.

CONCLUSIONS

Affective symptoms may indirectly mediate the associations between DMN connectivity, somatic symptoms, and neuroimmune markers. Inflammatory markers may also mediate the impact of DMN connectivity on affective symptoms. These results emphasize the importance of affective dysregulation in understanding the mechanisms of SSD and have potential implications for the development of tailored therapeutic approaches for SSD patients with affective symptoms. Furthermore, in SSD research using DMN FC or neuroimmune markers, considering and incorporating such mediating effects of affective symptoms suggests the possibility of more accurate prediction and explanation.

The Human Affectome

Over the last decades, theoretical perspectives in the interdisciplinary field of the affective sciences have proliferated rather than converged due to differing assumptions about what human affective phenomena are and how they work. These metaphysical and mechanistic assumptions, shaped by academic context and values, have dictated affective constructs and operationalizations. However, an assumption about the purpose of affective phenomena can guide us to a common set of metaphysical and mechanistic assumptions. In this capstone paper, we home in on a nested teleological principle for human affective phenomena in order to synthesize metaphysical and mechanistic assumptions. Under this framework, human affective phenomena can collectively be considered algorithms that either adjust based on the human comfort zone (affective concerns) or monitor those adaptive processes (affective features). This teleologically-grounded framework offers a principled agenda and launchpad for both organizing existing perspectives and generating new ones. Ultimately, we hope the Human Affectome brings us a step closer to not only an integrated understanding of human affective phenomena, but an integrated field for affective research.

Probing neurodynamics of experienced emotions-a Hitchhiker's guide to film fMRI

Film functional magnetic resonance imaging (fMRI) has gained tremendous popularity in many areas of neuroscience. However, affective neuroscience remains somewhat behind in embracing this approach, even though films lend themselves to study how brain function gives rise to complex, dynamic and multivariate emotions. Here, we discuss the unique capabilities of film fMRI for emotion research, while providing a general guide of conducting such research. We first give a brief overview of emotion theories as these inform important design choices. Next, we discuss films as experimental paradigms for emotion elicitation and address the process of annotating them. We then situate film fMRI in the context of other fMRI approaches, and present an overview of results from extant studies so far with regard to advantages of film fMRI. We also give an overview of state-of-the-art analysis techniques including methods that probe neurodynamics. Finally, we convey limitations of using film fMRI to study emotion. In sum, this review offers a practitioners' guide to the emerging field of film fMRI and underscores how it can advance affective neuroscience.

The mediating role of attachment and anger: exploring the impact of maternal early-life maltreatment on child abuse potential

Background

Maternal early-life maltreatment (ELM) increases the risk of subsequent child maltreatment, but the underlying mechanisms of these intergenerational effects remain largely unknown. Identifying these mechanisms is crucial for developing preventive interventions that can break the cycle of abuse. Notably, previous research has shown that ELM often results in attachment insecurity and altered anger characteristics. Therefore, this study determines whether these characteristics mediate the relationship between maternal history of ELM and child abuse potential.

Methods

The study sample included 254 mothers, of whom 149 had experienced ELM to at least a moderate degree. Maternal ELM was assessed using the Childhood Experience of Care and Abuse (CECA) interview. Attachment insecurity, trait anger and anger expression, and maternal abuse potential were assessed using the Vulnerable Attachment Questionnaire (VASQ), State-Trait Anger Expression Inventory (STAXI), and Child Abuse Potential Inventory (CAPI), respectively.

Results

The severity of maternal ELM predicted higher child abuse potential, with attachment insecurity and anger suppression mediating this effect. Specifically, higher levels of maternal ELM were associated with greater attachment insecurity and increased anger suppression, resulting in a higher child abuse potential. Although higher levels of trait anger were directly associated with higher child abuse potential, this parameter did not mediate the relationship with ELM. In addition, no significant associations were observed between outwardly expressed anger and ELM or child abuse potential. All analyses were adjusted for maternal mental disorders, years of education, and relationship status.

Discussion

Attachment insecurity and anger suppression may serve as pathways linking the maternal history of ELM to the risk of child abuse, even when considering maternal psychopathology. Overall, our findings indicate that interventions aimed at strengthening attachment and improving anger suppression may be beneficial for all mothers with ELM history and high child abuse potential, not just those who suffer from mental illness.

On reliability of annotations in contextual emotion imagery

We documented the relabeling process for a subset of a renowned database for emotion-in-context recognition, with the aim of promoting reliability in final labels. To this end, emotion categories were organized into eight groups, while a large number of participants was requested for tagging. A strict control strategy was performed along the experiments, whose duration was 13.45 minutes average per day. Annotators were free to participate in any of the daily experiments (the average number of participants was 28), and a Z-Score filtering technique was implemented to keep trustworthiness of annotations. As a result, the value of the agreement parameter Fleiss' Kapa increasingly varied from slight to almost perfect, revealing a coherent diversity of the experiments. Our results support the hypothesis that a small number of categories and a large number of voters benefit reliability of annotations in contextual emotion imagery.

Father trait anger and associations with father-infant bonding and caregiving: The mediating role of mentalizing

Trait anger reflects a tendency to feel irritation, annoyance, and rage, and involves a narrowing of cognition and attention. This narrowed scope may impact the capacity to understand the mental states of oneself and others (mentalizing), which for fathers of infants may compromise bonding and caregiving involvement. Here, we investigated the extent to which mentalizing mediated the relationship between father trait anger and both father-infant bonding and father involvement in infant caregiving. Data were from 168 fathers (M = 30.04 years of age, SD = 1.36) of 190 infants (M = 7.58 months of age, SD = 5.06) in the longitudinal Men and Parenting Pathways (MAPP) study. We assessed fathers' preconception trait anger at Wave 1 and their mentalizing 2 years later at Wave 3. At Waves 3, 4, and/or 5, we assessed father-infant bonding and father involvement in infant caregiving when men had an infant younger than 18 months of age. Associations were examined using path analysis. Poorer mentalizing fully mediated the relationship between preconception trait anger and father-infant bonding (total score), but not involvement in infant caregiving. Further, poorer mentalizing fully mediated the relationships between trait anger and each component of the father-infant bond (i.e., patience and tolerance, affection and pride, and pleasure in interactions). Findings suggest that for men high on trait anger, targeted interventions that facilitate mentalizing capacities may help to develop a foundation for a strong father-infant bond. Interventions may be offered on becoming a father (perinatal), or prior to becoming a father (preconception) to prevent future bonding problems.

The distinction between irritability and anger and their associations with impulsivity and subjective wellbeing

Irritability, anger, and impulsivity have important associations with psychological well-being. However, studying the internal relationships between such emotional constructs is challenging, largely because of the lack of precise operational definitions and extensively validated measurement tools. The aim of this study was to examine relationships between the above emotional constructs and how they relate to satisfaction with life and perceived negative impact on different life domains. Participants (N = 471) completed a self-report questionnaire online. Correlational analyses showed that higher levels of irritability and trait anger were associated with lower life satisfaction. Impulsivity displayed complex relationships with life satisfaction, with some aspects (sensation seeking) showing a positive relationship and others (urgency, lack of perseverance) showing a negative relationship. A two-factor Confirmatory Factor Analysis treating irritability and anger as separate constructs showed a better fit compared with a one-factor model, indicating that irritability and anger should be treated as separate constructs. An exploratory moderation analysis showed that higher irritability predicted increased anger only for participants scoring average to high on urgency (a facet of impulsivity). Our findings increase the understanding of the relationship between these dispositional constructs and supports the conceptualization of irritability and anger as related but distinct constructs.

White matter microstructure predicts individual differences in infant fear (But not anger and sadness)

We examine neural correlates of discrete expressions of negative emotionality in infants to determine whether the microstructure of white matter tracts at 1 month of age foreshadows the expression of specific negative emotions later in infancy. Infants (n = 103) underwent neuroimaging at 1-month, and mothers reported on infant fear, sadness, and anger at 6, 12, and 18 months using the Infant Behavior Questionnaire-Revised. Levels and developmental change in fear, sadness, and anger were estimated from mother reports. Relations between MRI and infant emotion indicated that 1-month white matter microstructure was differentially associated with level and change in infant fear, but not anger or sadness, in the left stria terminalis (p < 0.05, corrected), a tract that connects frontal and tempo-parietal regions and has been implicated in emerging psychopathology in adults. More relaxed constraints on significance (p < 0.10, corrected) revealed that fear was associated with lower white matter microstructure bilaterally in the inferior portion of the stria terminalis and regions within the sagittal stratum. Results suggest the neurobehavioral uniqueness of fear as early as 1 month of age in regions that are associated with potential longer-term outcomes. This work highlights the early neural precursors of fearfulness, adding to literature explaining the psychobiological accounts of affective development. HIGHLIGHTS: Expressions of infant fear and anger, but not sadness, increase from 6 to 18 months of age. Early neural architecture in the stria terminalis is related to higher initial levels and increasing fear in infancy. After accounting for fear, anger and sadness do not appear to be associated with differences in early white matter microstructure. This work identifies early neural precursors of fearfulness as early as 1-month of age.

Non-angry aggressive arousal and angriffsberietschaft: A narrative review of the phenomenology and physiology of proactive/offensive aggression motivation and escalation in people and other animals

Human aggression typologies largely correspond with those for other animals. While there may be no non-human equivalent of angry reactive aggression, we propose that human proactive aggression is similar to offense in other animals' dominance contests for territory or social status. Like predation/hunting, but unlike defense, offense and proactive aggression are positively reinforcing, involving dopamine release in accumbens. The drive these motivational states provide must suffice to overcome fear associated with initiating risky fights. We term the neural activity motivating proactive aggression "non-angry aggressive arousal", but use "angriffsberietschaft" for offense motivation in other animals to acknowledge possible differences. Temporal variation in angriffsberietschaft partitions fights into bouts; engendering reduced anti-predator vigilance, redirected aggression and motivational over-ride. Increased aggressive arousal drives threat-to-attack transitions, as in verbal-to-physical escalation and beyond that, into hyper-aggression. Proactive aggression and offense involve related neural activity states. Cingulate, insular and prefrontal cortices energize/modulate aggression through a subcortical core containing subnuclei for each aggression type. These proposals will deepen understanding of aggression across taxa, guiding prevention/intervention for human violence.

Decoding individual differences in expressing and suppressing anger from structural brain networks: A supervised machine learning approach

Anger can be broken down into different elements: a transitory state (state anger), a stable personality feature (trait anger), a tendency to express it (anger-out), or to suppress it (anger-in), and the ability to regulate it (anger control). These elements are characterized by individual differences that vary across a continuum. Among them, the abilities to express and suppress anger are of particular relevance as they determine outcomes and enable successful anger management in daily situations. The aim of this study was to demonstrate that anger suppression and expression can be decoded by patterns of grey matter of specific well-known brain networks. To this aim, a supervised machine learning technique, known as Kernel Ridge Regression, was used to predict anger expression and suppression scores of 212 healthy subjects from the grey matter concentration. Results show that individual differences in anger suppression were predicted by two grey matter patterns associated with the Default-Mode Network and the Salience Network. Additionally, individual differences in anger expression were predicted by a circuit mainly involving subcortical and fronto-temporal regions when considering whole brain grey matter features. These results expand previous findings regarding the neural bases of anger by showing that individual differences in specific anger-related components can be predicted by the grey matter features of specific networks.

Trait anger and negative interpretation bias in neutral face perception

Introduction

Anger is a basic emotion helping people to achieve goals by preparing the body for action and prompting others to change their behavior but is also associated with health issues and risks. Trait anger, the disposition to experience angry feelings, goes along with an attribution of hostile traits to others. Negative distortions in the interpretation of social information have also been observed in anxiety and depression. The present study examined the associations between components of anger and negative interpretation tendencies in the perception of ambiguous and neutral schematic faces controlling for anxiety, depressed mood, and other variables.

Methods

A sample of 150 young adults performed a computer-based perception of facial expressions task and completed the State-Trait Anger Expression Inventory (STAXI-2) along with other self-report measures and tests.

Results

Trait anger and anger expression correlated with the perception of negative affects in neutral but not in ambiguous faces. More specifically, trait anger was linked to the attribution of anger, sadness, and anxiety to neutral faces. Trait anger predicted perceived negative affects in neutral faces when adjusting for anxiety, depression, and state anger.

Discussion

For neutral schematic faces, the present data support an association between trait anger and negatively biased interpretation of facial expression, which is independent of anxiety and depressed mood. The negative interpretation of neutral schematic faces in trait angry individuals seems not only to comprise the attribution of anger but also of negative emotions signaling weakness. Neutral schematic facial expressions might be useful stimuli in the future study of anger-related interpretation biases.

Effects of a nonviolent communication-based anger management program on psychiatric inpatients

This quasi-experimental study aimed to determine the effects of a nonviolent communication-based anger management program on self-esteem, anger expression, and aggression in 44 psychiatric inpatients (experimental group: n = 21; control group: n = 24). The program consisted of six sessions of 60 min each, using a non-equivalent control group pretest-posttest design, and thereafter analyzing the intervention effects. Results showed statistically significant differences between the experimental and control groups in anger expression and anger suppression. There were positive, though not statistically significant, changes in self-esteem and aggression. The findings indicated a decreasing effect of anger expression and anger suppression.

HTR1B genotype and psychopathy: Main effect and interaction with paternal maltreatment

Psychopathy is a condition characterized by atypical emotions and socially maladaptive behavioral patterns. Among incarcerated people, psychopathy has been associated with higher rates of crimes, recidivism, and resistance to treatment. Many studies have indicated significant heritability of psychopathic traits, but little is known about the specific contribution of genes and their interaction with adverse experiences in life. Considering the primary role that serotonin plays in cognition and emotion, we investigated TPH2-rs4570625, 5-HTTLPR, MAOA-uVNTR, HTR1B-rs13212041 and HTR2A-rs6314 as risk factors for psychopathy in the largest sample of institutionalized individuals studied so far, consisting of 793 US White male incarcerated adults, and in a replication sample of 168 US White male incarcerated adolescents. In a subgroup of the adult sample, the interaction between genetics and parenting style, assessed by the Measure of Parental Style (MOPS) questionnaire, was also evaluated. The HTR1B-rs13212041-T/T genotype, as compared to HTR1B-rs13212041-C allele, predicted higher psychopathy scores in both the adult and the adolescent samples. The interaction between HTR1B-rs13212041-T/T genotype and paternal MOPS scores, investigated in a subgroup of the adult sample, was an even stronger predictor of higher levels of psychopathy than either the genetics or the environment taken individually. Overall, these data, obtained in two independent samples, shed new light on neurobiological correlates of psychopathy with promising implications both at a clinical and forensic level.

Personal insult disrupts regulatory brain networks in violent offenders

The failure to adequately regulate negative emotions represents a prominent characteristic of violent offenders. In this functional magnetic resonance imaging study, we used technical, nonsocial frustration to elicit anger in violent offenders (n = 19) and then increased the provocation by adding personal insults (social provocation). The aim was to investigate neural connectivity patterns involved in anger processing, to detect the effect of increasing provocation by personal insult, and to compare anger-related connectivity patterns between offenders and noncriminal controls (n = 12). During technical frustration, the offenders showed increased neural connectivity between the amygdala and prefrontal cortex compared to the controls. Conversely, personal insults, and thus increased levels of provocation, resulted in a significant reduction of neural connectivity between regions involved in cognitive control in the offenders but not controls. We conclude that, when (nonsocially) frustrated, offenders were able to employ regulatory brain networks by displaying stronger connectivity between regulatory prefrontal and limbic regions than noncriminal controls. In addition, offenders seemed particularly sensitive to personal insults, which led to increased implicit aggression (by means of motoric responses) and reduced connectivity in networks involved in cognitive control (including dorsomedial prefrontal cortex, precuneus, middle/superior temporal regions).

Evidence for lateralized functional connectivity patterns at rest related to the tendency of externalizing or internalizing anger

Previous electroencephalographic and brain stimulation studies have shown that anger responses may be differently lateralized in the prefrontal cortex, with outward-oriented responses (externalized anger) linked to left prefrontal activity, and inward-oriented responses (internalized anger) linked to right prefrontal activity. However, the specific neural structures involved in this asymmetry, and how they interact to produce individual differences, remain unexplored. Furthermore, it is unclear whether such asymmetry may be explained by general behavioral tendencies, known as Behavioral Activation and Behavioral Inhibition Systems (BIS/BAS). Therefore, we analyzed the tendency of externalizing and internalizing anger, respectively measured by the Anger-Out and Anger-In subscales of the State-Trait Anger Expression Inventory, with the patterns of functional connectivity at rest of 71 participants. A left, prefrontal, resting-state, functional connectivity pattern was found for externalizing anger (Anger-Out), including the left inferior frontal gyrus and the left frontal eye fields. By contrast, a right, prefrontal, resting-state, functional connectivity pattern was found for internalizing anger (Anger-In), including the rostral and lateral prefrontal cortex, the orbitofrontal cortex, the frontal pole, the superior, middle and inferior frontal gyri, and the anterior cingulate. Notably, these patterns were not associated with the BIS/BAS scores. In this study, for the first time, we provide evidence using fMRI functional connectivity for two specific lateralized circuits contributing to individual differences in externalizing and internalizing anger. These results confirm and extend the asymmetry hypothesis for anger and have notable implications in the treatment of anger-related problems.

A psychodynamic contribution to the understanding of anger - The importance of diagnosis before treatment

This paper starts from the claim that a shared understanding of anger, in both its normal and psychopathological dimensions, is missing and that there are various therapeutic paths that seem to be less effective than those related to other pathologies. A major limitation of anger research and of its treatments lies in the lack of precise clinical diagnoses to inform therapy. For this reason, the first aim of our work is to survey critical literature in order to find useful elements to differentiate anger, starting from the evidence of negative and positive outcomes of treatments. Such evidence will then be enhanced in our proposal of interpretation and intervention, within a dynamic framework and with particular reference to Orefice’s thought. The core focus is to explore the different functions that anger has for the patient and to investigate the elementary functioning of the self. Our reading of the phenomena related to anger will provide useful tools both for understanding the dynamics underlying anger and as a guide for clinical intervention.

A systematic review of neural, cognitive, and clinical studies of anger and aggression

Anger and aggression have large impact on people's safety and the society at large. In order to provide an intervention to minimise aggressive behaviours, it is important to understand the neural and cognitive aspects of anger and aggression. In this systematic review, we investigate the cognitive and neural aspects of anger-related processes, including anger-related behaviours and anger reduction. Using this information, we then review prior existing methods on the treatment of anger-related disorders as well as anger management, including mindfulness and cognitive behavioural therapy. At the cognitive level, our review that anger is associated with excessive attention to anger-related stimuli and impulsivity. At the neural level, anger is associated with abnormal functioning of the amygdala and ventromedial prefrontal cortex. In conclusions, based on cognitive and neural studies, we here argue that mindfulness based cognitive behavioural therapy may be better at reducing anger and aggression than other behavioural treatments, such as cognitive behavioural therapy or mindfulness alone. We provide key information on future research work and best ways to manage anger and reduce aggression. Importantly, future research should investigate how anger related behaviours is acquired and how stress impacts the development of anger.

Mapping the brain basis of feelings, emotions and much more: A special issue focused on 'The Human Affectome'

The Human Affectome Project was launched by the non-profit organization Neuroqualia (www.neuroqualia.org) in 2015 with the seemingly impossible goal: To map a psychological process and form possible definitions and working models for affective states and related emotions. Twelve reviews based on emotions, feelings and motivation were written dedicated to mapping the brain basis of affect. A capstone piece 'The Human Affectome' provides a foundation for the special issue by giving detailed up-to-date definitions for key terms including feeling, affect, emotion and mood. Critically, the piece offers an overall model synthesizing three main features of affect: valence, motivation, and arousal. Affect itself is explored as the main umbrella function capturing all feeling states and related processes. Overall, the project and the special issue has been a highly successful interdisciplinary effort producing a novel approach that can be used to understand, guide and revise contemporary research on the brain basis of feeling and how diverse feeling states interact with each other in typical and atypical fashions.

Neural Correlates of Reactive Aggression in Adult Attention-Deficit/Hyperactivity Disorder

Despite not being part of the core diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD), emotion dysregulation is a highly prevalent and clinically important component of (adult) ADHD. Emotionally dysregulated behaviors such as reactive aggression have a significant impact on the functional outcome in ADHD. However, little is known about the mechanisms underlying reactive aggression in ADHD. In this study, we aimed to identify the neural correlates of reactive aggression as a measure of emotionally dysregulated behavior in adults with persistent ADHD during implicit emotion regulation processes. We analyzed associations of magnetic resonance imaging-based whole-brain activity during a dynamic facial expression task with levels of reactive aggression in 78 adults with and 78 adults without ADHD, and also investigated relationships of reactive aggression with symptoms and impairments. While participants with ADHD had higher reactive aggression scores than controls, the neural activation patterns of both groups to processing of emotional faces were similar. However, investigating the brain activities associated with reactive aggression in individuals with and without ADHD showed an interaction of diagnosis and reactive aggression scores. We found high levels of activity in the right insula, the hippocampus, and middle and superior frontal areas to be particularly associated with high reactive aggression scores within the ADHD group. Furthermore, the limbic activity was associated with more hyperactivity/impulsivity symptoms. These results suggest a partly differential mechanism associated with reactive aggression in ADHD as compared to controls. Emotional hyper-reactivity in the salience network as well as more effortful top-down regulation from the self-regulation network might contribute to emotionally dysregulated behavior as measured by reactive aggression.

Attachment styles and their association with aggression, hostility, and anger in Lebanese adolescents: a national study

Background

The idea that attachment styles can affect the level of anger in an individual educes a reason why people develop anger issues and behavioral problems in adolescence that escalate into adulthood. Lebanon suffers from a shortage of data pertaining to insecure attachment styles and the affective and cognitive aspects of anger and behavioral anger expression among the Lebanese youth population. This study aimed to investigate the association between attachment dimensions and anger expression (trait anger, hostility, physical aggression, and verbal aggression) among a sample of Lebanese adolescent participants.

Methods

This cross-sectional study was performed between January and May 2019 among 1810 Lebanese high-school students aged 12–18 and used two validated measures, the Adolescent-Relationship Questionnaire (A-RQ) and The Buss-Perry Aggression Questionnaire (BPAQ). The A-RQ assessed attachment behaviors, while the BPAQ evaluated aggression.

Results

Higher fearful and dismissing attachment styles, and higher physical activity index were significantly associated with higher physical and verbal aggression. A higher fearful attachment style was significantly associated with more anger. A higher secure attachment style was significantly associated with less anger. Higher preoccupied and dismissing attachment styles were significantly associated with higher hostility.

Conclusion

Our findings revealed a significant relationship between both insecure attachment dimensions and the tripartite model of anger expression. This study adds to the anger literature by providing a more informed understanding of how variations in anger expression are linked to the processing of interpersonal interactions, which are the hidden facets of attachment systems.

Association Between Polymorphism (5-HTTLPR) of the Serotonin Transporter Gene and Behavioral Response to Unfair Distribution

Behavioral responses to unfair distribution have been measured mainly using the Ultimatum Game (UG). Recent studies examining the biological basis of behavioral responses to unfair distribution have focused attention on the role of the serotonin transporter gene. However, studies, to date, have been conducted on non-Asians, and it has not been confirmed whether similar results can be seen in other ethnic groups. It has also been shown that behavioral responses to unfair distribution are not only seen in the case of victims themselves but also in the case of third parties not directly affected. This study aimed to determine whether the results of the previous study would be replicated in an Asian population and whether the serotonin transporter gene would also be associated with behavior toward unfair distribution by third parties. We examined the association between polymorphisms (5-HTTLPR) of the serotonin transporter gene and participants’ behavior in the UG and the third-party punishment game (TPPG). The results did not show an association between punishment for unfair proposals in the TPPG and genetic polymorphisms, while participants with the SL/LL genotype were more likely to reject unfair offers in the UG than those with the SS genotype. These results indicate that 5-HTTLPR is associated with behavior when unfair intentions are directed at oneself.

The Link between Fibromyalgia Syndrome and Anger: A Systematic Review Revealing Research Gaps

Anger has been associated with increased pain perception, but its specific connection with Fibromyalgia Syndrome (FMS) has not yet been established in an integrated approach. Therefore, the present systematic review focuses on exploring this connection, and based on this connection, delimiting possible gaps in the research, altogether aimed at improving FMS clinical intervention and guiding future research lines. Anger is considered a basic negative emotion that can be divided into two dimensions: anger-in (the tendency to repress anger when it is experienced) and anger-out (the leaning to express anger through verbal or physical means). The current systematic review was performed based on the guidelines of the PRISMA and Cochrane Collaborations. The Prospective Register of Systematic Reviews (PROSPERO) international database was forehand used to register the review protocol. The quality of chosen articles was assessed and the main limitations and research gaps resulting from each scientific article were discussed. The search included PubMed, Scopus, and Web of Science databases. The literature search identified 13 studies eligible for the systematic review. Levels of anger-in have been shown to be higher in FMS patients compared to healthy participants, as well as patients suffering from other pain conditions (e.g., rheumatoid arthritis). FMS patients had also showed higher levels of state and trait anxiety, worry and angry rumination than other chronic pain patients. Anger seems to amplify pain especially in women regardless FMS condition but with a particularly greater health-related quality of life´s impact in FMS patients. In spite of the relevance of emotions in the treatment of chronic pain, including FMS, only two studies have proposed intervention programs focus on anger treatment. These two studies have observed a positive reduction in anger levels through mindfulness and a strength training program. In conclusion, anger might be a meaningful therapeutic target in the attenuation of pain sensitivity, and the improvement of the general treatment effects and health-related quality of life in FMS patients. More intervention programs directed to reduce anger and contribute to improve well-being in FMS patients are needed.

To Blame or Not? Modulating Third-Party Punishment with the Framing Effect

People as third-party observers, without direct self-interest, may punish norm violators to maintain social norms. However, third-party judgment and the follow-up punishment might be susceptible to the way we frame (i.e., verbally describe) a norm violation. We conducted a behavioral and a neuroimaging experiment to investigate the above phenomenon, which we call the "third-party framing effect". In these experiments, participants observed an anonymous perpetrator deciding whether to keep her/his economic benefit while exposing a victim to a risk of physical pain (described as "harming others" in one condition and "not helping others" in the other condition), then they had a chance to punish that perpetrator at their own cost. Our results showed that the participants were more willing to execute third-party punishment under the harm frame compared to the help frame, manifesting a framing effect. Self-reported anger toward perpetrators mediated the relationship between empathy toward victims and the framing effect. Meanwhile, activation of the insula mediated the relationship between mid-cingulate cortex activation and the framing effect; the functional connectivity between these regions significantly predicted the size of the framing effect. These findings shed light on the psychological and neural mechanisms of the third-party framing effect.

Structural and functional brain networks of individual differences in trait anger and anger control: An unsupervised machine learning study

The ability to experience, use and eventually control anger is crucial to maintain well-being and build healthy relationships. Despite its relevance, the neural mechanisms behind individual differences in experiencing and controlling anger are poorly understood. To elucidate these points, we employed an unsupervised machine learning approach based on independent component analysis to test the hypothesis that specific functional and structural networks are associated with individual differences in trait anger and anger control. Structural and functional resting state images of 71 subjects as well as their scores from the State-Trait Anger Expression Inventory entered the analyses. At a structural level, the concentration of grey matter in a network including ventromedial temporal areas, posterior cingulate, fusiform gyrus and cerebellum was associated with trait anger. The higher the concentration, the higher the proneness to experience anger in daily life due to the greater tendency to orient attention towards aversive events and interpret them with higher hostility. At a functional level, the activity of the default mode network (DMN) was associated with anger control. The higher the DMN temporal frequency, the stronger the exerted control over anger, thus extending previous evidence on the role of the DMN in regulating cognitive and emotional functions in the domain of anger. Taken together, these results show, for the first time, two specialized brain networks for encoding individual differences in trait anger and anger control.

Trends of Anger and Physical Aggression in Russian Women During COVID-19 Lockdown

The effect of social lockdown during the COVID-19 outbreak on female aggressiveness is not well known. The strict measures of lockdown have resulted in millions of people, worldwide, confined to their homes during the pandemic. However, the consequence of lockdown strategies on females' psychological status including aggressiveness has not yet been investigated. We conducted a cross-sectional study on 31 Russian females' homemakers who are participants in an online fitness platform to investigate the immediate anxiety, depression, and aggression experienced under strict lockdown measures. The participants were surveyed using the hospital anxiety depression scale (HADS) and the Buss-Perry Aggression Questionnaire. We used descriptive and statistical methods to investigate the prevalence of these emotions among two age groups (20-35 and 36-65 years). We found that moderate anxiety prevalence was 77.4% in the entire group while mild depression was 54.8%. Interestingly, the whole sample showed a high level of angriness (p = 0.0002) and physical aggression (p = 0.019). These two emotions seem to be more prevalent than other negative emotions such as hostility, verbal aggression. This relationship was not dependent on age. Overall, there is a significant worsening in female aggression that could lead to higher chances of female victimization and being subjected to partner violence. Future policies designing lockdown strategies should consider this effect on active female homemakers. Due to the small size of our cohort, our results are only indicative of data trends. Larger studies are still needed to confirm the current findings.

The Modulatory Role of Serotonin on Human Impulsive Aggression

The hypothesis of chronically low brain serotonin levels as pathophysiologically linked to impulsive aggression has been around for several decades. Whereas the theory was initially based on indirect methods to probe serotonin function, our understanding of the neural mechanisms involved in impulsive aggression has progressed with recent advances in neuroimaging. The review integrates evidence based on data from several neuroimaging domains in humans. In vivo molecular neuroimaging findings demonstrate associations between impulsive aggression and high serotonin 1B and serotonin 4 receptor binding, high serotonin transporter levels, and low monoamine oxidase A levels, suggesting that low interstitial serotonin levels are a neurobiological risk factor for impulsive aggressive behavior. Imaging genetics suggests that serotonergic-related genetic polymorphisms associate with antisocial behavior, and some evidence indicates that the low-expressing monoamine oxidase A genotype specifically predisposes to impulsive aggression, which may be mediated by effects on corticolimbic function. Interventions that (presumably) alter serotonin levels have effects on brain activity within brain regions involved in impulsive aggression, notably the amygdala, dorsal striatum, anterior cingulate, insula, and prefrontal cortex. Based on these findings, we propose a model for the modulatory role of serotonin in impulsive aggression. Future studies should ensure that clinical features unique for impulsive aggression are appropriately assessed, and we propose investigations of knowledge gaps that can help confirm, refute, or modify our proposed model of impulsive aggression.

Emotional imagination of negative situations: Functional neuroimaging in anorexia and bulimia

Aim

The present study aims to extend the knowledge of the neural correlates of emotion processing in first episode subjects affected by anorexia nervosa (AN) or bulimia nervosa (BN). We applied an emotional distress paradigm targeting negative emotions thought to be relevant for interpersonal difficulties and therapeutic resistance mechanisms.

Methods

The current study applied to 44 female participants with newly diagnosed AN or BN and 20 matched controls a neuroimaging paradigm eliciting affective responses. The measurements also included an extensive assessment comprising clinical scales, neuropsychological tests, measures of emotion processing and empathy.

Results

AN and BN did not differ from controls in terms of emotional response, emotion matching, self-reported empathy and cognitive performance. However, eating disorder and psychopathological clinical scores, as well as alexithymia levels, were increased in AN and BN. On a neural level, no significant group differences emerged, even when focusing on a region of interest selected a priori: the amygdala. Some interesting findings put in relation the hippocampal activity with the level of Body Dissatisfaction of the participants, the relative importance of the key nodes for the common network in the decoding of different emotions (BN = right amygdala, AN = anterior cingulate area), and the qualitative profile of the deactivations.

Conclusions

Our data do not support the hypothesis that participants with AN or BN display reduced emotional responsiveness. However, peculiar characteristics in emotion processing could be associated to the three different groups. Therefore, relational difficulties in eating disorders, as well as therapeutic resistance, could be not secondary to a simple difficulty in feeling and identifying basic negative emotions in AN and BN participants.

The neuroscience of positive emotions and affect: Implications for cultivating happiness and wellbeing

This review paper provides an integrative account regarding neurophysiological correlates of positive emotions and affect that cumulatively contribute to the scaffolding for happiness and wellbeing in humans and other animals. This paper reviews the associations among neurotransmitters, hormones, brain networks, and cognitive functions in the context of positive emotions and affect. Consideration of lifespan developmental perspectives are incorporated, and we also examine the impact of healthy social relationships and environmental contexts on the modulation of positive emotions and affect. The neurophysiological processes that implement positive emotions are dynamic and modifiable, and meditative practices as well as flow states that change patterns of brain function and ultimately support wellbeing are also discussed. This review is part of "The Human Affectome Project" (http://neuroqualia.org/background.php), and in order to advance a primary aim of the Human Affectome Project, we also reviewed relevant linguistic dimensions and terminology that characterizes positive emotions and wellbeing. These linguistic dimensions are discussed within the context of the neuroscience literature with the overarching goal of generating novel recommendations for advancing neuroscience research on positive emotions and wellbeing.

Do anger perception and the experience of anger share common neural mechanisms? Coordinate-based meta-analytic evidence of similar and different mechanisms from functional neuroimaging studies

The neural bases of anger are still a matter of debate. In particular we do not know whether anger perception and anger experience rely on similar or different neural mechanisms. To study this topic, we performed activation-likelihood-estimation meta-analyses of human neuroimaging studies on 61 previous studies on anger perception and experience. Anger perception analysis resulted in significant activation in the amygdala, the right superior temporal gyrus, the right fusiform gyrus and the right IFG, thus revealing the role of perceptual temporal areas for perceiving angry stimuli. Anger experience analysis resulted in the bilateral activations of the insula and the ventrolateral prefrontal cortex, thus revealing a role for these areas in the subjective experience of anger and, possibly, in a subsequent evaluation of the situation. Conjunction analyses revealed a common area localized in the right inferior frontal gyrus, probably involved in the conceptualization of anger for both perception and experience. Altogether these results provide new insights on the functional architecture underlying the neural processing of anger that involves separate and joint mechanisms. According to our tentative model, angry stimuli are processed by temporal areas, such as the superior temporal gyrus, the fusiform gyrus and the amygdala; on the other hand, the subjective experience of anger mainly relies on the anterior insula; finally, this pattern of activations converges in the right IFG. This region seems to play a key role in the elaboration of a general meaning of this emotion, when anger is perceived or experienced.

Functional topography of anger and aggression in the human cerebellum

New insights into the functional neuroanatomic correlates of emotions point toward the involvement of the cerebellum in anger and aggression. To identify cerebellar regions commonly activated in tasks examining the experience of anger and threat as well as exerting an aggressive response, two coordinate-based activation likelihood estimation meta-analyses reporting a total of 57 cerebellar activation foci from 819 participants were performed. For anger processing (18 studies), results showed significant clusters in the bilateral posterior cerebellum, overlapping with results from previous meta-analyses on emotion processing, and implying functional connectivity to cognitive, limbic, and social canonic networks in the cerebral cortex. By contrast, active aggression expression (10 studies) was associated with significant clusters in more anterior regions of the cerebellum, overlapping with cerebellar somatosensory and motor regions and displaying functional connectivity with the somatomotor and default mode network. This study not only strengthens the notion that the cerebellum is involved in emotion processing, but also provides the first quantitative evidence for distinct cerebellar functional activation patterns related to anger and aggression.

Prescription and dispensing guidelines in Lebanon: initiative of the Order of Pharmacists of Lebanon

Background

In Lebanon, difficulties in accessing medications are due to two main barriers, mainly: high cost and the lack of medication safety, related to poor-quality (irrational) prescription and use. The objective of this work is to suggest guidelines to implement a unified medical prescription in Lebanon. These guidelines are expected to promote medication safety and decrease pharmaceutical expenditures in the Lebanese context.

Methods

The Order of Pharmacists of Lebanon (OPL) developed a comprehensive set of guidelines for physicians and pharmacists, including a detailed workflow process to improve the use of the unified medical prescription. The guidelines were presented to the Lebanese Ministry of Public Health (MOPH).

Results

The project covered prescription guidelines to physicians (handwritten and electronic-prescriptions), and medication dispensing and generic substitution guidelines to pharmacists. Prescription guidelines included all required information about both the prescribing physician and the patient with the maximum of details, comprehensibility, and caution regarding specific populations/co-morbidities/co-prescriptions. Dispensing guidelines included details for safe and appropriate treatment dispensing, pearls for medications’ counseling and generic substitution, as well as specific consideration for at-risk populations or those with concomitant medications and co-morbidities. Finally, a suggested workflow clarified the process for improving the unified medical prescription.

Conclusions

The implementation of the guidelines should now be formally evaluated, to assess if they achieve the aims to reduce prescribing and dispensing errors, to improve the quality of medicines' prescription and use, the patient care, and the interaction between all stakeholders

The impact of self-control training on neural responses following anger provocation

Self-control training (SCT) is one way to enhance self-controlled behavior. We conducted a novel and exploratory functional magnetic resonance imaging experiment to examine how SCT affects neural responses in a situation that elicits a self-control response: anger provocation. Forty-five healthy young men and women completed two-weeks of SCT or a behavioral monitoring task and were then insulted during scanning. We found significant changes in functional activation and connectivity using a lenient error threshold, which were not observed using a stricter threshold. Activation in the posterior insula was greater for the control compared to the SCT group at post-provocation, trait aggression correlated with neural responses to SCT, and SCT was associated with specific amygdala-cortical connections. Neural changes occurred even though SCT did not affect participants' performance on an inhibition task, reports of trying to control their anger, or their experience of anger. This dissociation prevented clear interpretation about whether the neural changes were indicative of specific anger or anger control processes. Although replication with high-powered studies is needed, we provide evidence that SCT affects neural responses in the context of anger provocation.

Pain and Evil: From Local Nociception to Misery Following Social Harm

Experiencing pain, especially when chronic, is an excruciating condition that should be regarded as a syndrome, if not a disease. People suffering from chronic pain tend to develop psychological discomfort mostly due to lack of acceptance, disbelief, blame. The complexity of pain pathophysiology, plus a wide range of negative psychosocial factors, leads to a more complex suffering that deserves attention and multidisciplinary treatments. The possibility that chronic pain may occur following physical aggression, torture, or persecution raises the issue of evil as a major contributor to pain in its worst representation - when individuals or groups are attacked based on racial, social, gender, religious, political, or other grounds. To explore the complex issue of chronic pain following physical or psychological harm, and to underscore the need for a multidisciplinary approach to reduce the burden of chronic pain, we discuss the biological mechanisms underlying pain state. We seek to clarify those factors leading to pain chronification, as well as personal and social attitudes that confound patients with chronic pain. The importance of family and social environment is also investigated, as well as personality traits of chronic pain patients that may further hamper successful treatment. The presence of chronic pain, modulated by, for example, acceptance of being a victim of premeditated physical and social violence, makes the issue more difficult to comprehend.