A Model of Anger in Multiple Sclerosis Patients

Abstract

Anger in Multiple Sclerosis (MS) is an acknowledged clinical problem; however research is limited and mainly focuses on depression and does not study anger as an individual entity. The current studies, using both quantitative and qualitative approaches, investigated possible vulnerability factors and triggers which could be possibly associated with anger expression in MS participants. Additionally, a descriptive model of anger in MS was developed. Study 1 investigated emotional, social and cognitive vulnerability factors in MS participants and a control group. Multiple regressions revealed that five factors accounted for 41% of anger variance in MS participants (anger ruminations, anxiety state, anxiety trait, depression and social support). Three factors accounted for 43% of anger variance in control participants (anger ruminations, trait anxiety and fatigue). Studies 2 and 3 investigated the possible effect of health care professionals’ (HCPs) response and communication styles in healthcare contexts on anger. A methodology for developing and validating vignettes was reported. ANOVAs revealed that HCPs and MS patients identified styles that were low in empathy and low in attending to patients’ needs, as likely to provoke anger. HCPs significantly underestimated provoked levels of anger, compared to MS participants. Studies 4 and 5 used a qualitative approach (content analysis) to elucidate MS patients’ and HCPs’ perceptions of anger. HCPs identified communication styles as a category which could increase anger in MS patients. Patients’ behaviour also emerged as a category which could contribute to HCPs’ levels of anger. Training was also identified as a category which could help to manage patient anger. MS participants identified four main categories. MS participants identified the categories of HCPs’ behaviour and unpredictability of MS as possibly contributing to anger levels. The category of ‘effects on health’ emerged as a possible consequence of anger. The category of ‘anger frequency’ highlighted the variations in how often MS participants experienced anger. A model of anger expression in MS was proposed which incorporated vulnerability factors associated with anger, communication styles and response styles from HCPs. The model was discussed in the context of past literature. Interestingly, it was concluded that factors associated with anger levels in MS participants are not disease factors unique to MS. Strengths and limitations of the studies, implications for clinical practice and future research were outlined.