The *European Journal of Neurology* issued the following news release:
High unexpressed anger in MS patients linked to nervous system damage,
not disease severity
People with Multiple Sclerosis (MS) feel more than twice as much
withheld anger as the general population and this could have an adverse
effect on their relationships and health, according to a study published
in the December issue of the European Journal of Neurology.
Italian researchers assessed 195 patients with MS, using a range of
scales that measure anger, depression and anxiety, and then compared
them with the general population.
They were surprised by the results, which showed that while patients
experienced almost twice the normal level of withheld anger and exerted
low levels of control on their anger, their expressed anger levels were
similar to the general population.
This, together with the fact that the elevated withheld anger levels
were not related to the severity of the patients’ MS, suggests that
these inconsistent changes were caused by nervous system damage, rather
than an emotional reaction to the stress of the disease.
“We believe that the higher levels of withheld anger shown by the study
subjects is due to demyelination, loss of the substance in the white
matter that insulates the nerve endings and helps people receive and
interpret messages from the brain” explains lead researcher Dr Ugo
Nocentini from the IRCCS S Lucia Foundation in Rome.
“The way we process anger is controlled by complex interconnections
between the subcortical and cortical systems, notably the amygdale and
basal ganglia and the medial prefrontal cortex. We believe that the
demyelination process that causes the root symptoms of MS also disrupts
the pathways that control how we deal with withheld anger.”
The patients who took part in the study comprised 150 with relapsing-
remitting MS and 45 with progressive MS. More than two-thirds (68 per
cent) were women, the average age of the participants was 40 and the
average time since diagnosis was 11 years.
Researchers evaluated the participants using the State Trait Anger
Expression Inventory, the Chicago Multiscale Depression Inventory and
the State Trait Anxiety Inventory.
The researchers then looked at age and sex-matched subjects in the
general population and identified the levels of anger experienced by the
25 per cent of people with the highest scores.
They found that MS patients:
* Were more than twice as likely to experience high levels of withheld
anger, with 60 per cent of patients recording the same high levels as
the top 25 per cent of the general population.
* Exerted a low level of control on their anger, with just 11 per cent
of patients reporting the same high levels of control compared to the
top 25 per cent of the general population.
* Were about the same as non MS patients when it came to expressed
anger, with 30 per cent of patients reporting the same high levels as
the top 25 per cent of the general population.
During the study the authors also compared the anger scores against
selected demographic and clinical characteristics and found they were
independent of age, education, disease duration and course, disability
and fatigue severity. The only notable difference was that women
reported higher levels of current anxiety.
“Our findings clearly show that anger characteristics in MS patients
differ from those observed in the general population and the overall
results surprised the research team” concludes Dr Nocentini.
“For example, patients reported low levels of anger control and high
levels of withheld anger, yet the scores for expressed anger were
similar to those of the general population.
“We would have expected greater consistency between withheld and
expressed anger and higher levels of expressed anger as a consequence of
low anger control.”
The authors conclude that damage to the fibres in the areas of the brain
where anger issues are processed is the most logical explanation. They
also say the findings have important implications for clinical practice.
“Anger disrupts interpersonal relationships and this is particularly
true for withheld anger, which might go unrecognised by other people”
says Dr Nocentini. “Witheld anger has been reported to be associated
with physical problems, in particular high blood pressure and vascular
disorders, and may have a negative effect on the general health of MS
“Because withheld anger has no, or few, overt manifestations, and is
unlikely to be recognised by clinicians or reported by patients, it is
important that MS patients are asked if they experience abnormal anger.”
Notes to editors: An exploration of anger phenomenology in multiple
sclerosis. Nocentini et al. European Journal of Neurology. 16,
1312-1317. (December 2009)