Self-Reported Dysfunctional Anger in Men and Women at a Psychiatric Outpatient Clinic

  • Lindsay V. HealeyEmail author
  • Vanessa Holmes
  • Susan Curry
  • Michael C. Seto
  • Adekunle G. Ahmed


Gender differences in anger and aggression are disputed in the literature. This study examined self-reported gender differences in a clinical sample of individuals referred for concerns about dysfunctional anger on measures of anger and aggression. The sample consisted of adults aged 18 years or over (N = 543; 90 [17%] women and 453 [83%] men) who presented at an outpatient anger clinic for treatment of their dysfunctional anger between 2003 and 2014. We found that women in the psychiatric outpatient sample significantly outscored men on many of the anger variables and reported similar levels of aggression, which contradicts previous reports in nonclinical populations. These results are of clinical importance because women’s dysfunctional anger may be under-reported. Dysfunctional anger screening and treatment may need to be adjusted accordingly based on gender.


Gender differences Anger Aggression Expression Suppression 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

As this was a retrospective study, formal consent was not required from participants. However, informed consent was still obtained from all participants at intake and in the case that they did not consent—their data was not used for this study.


  1. Abraham, S., Shah, N. G., Roux, A. D., Hill-Briggs, F., Seeman, T., Szklo, M., et al. (2015). Trait anger but not anxiety predicts incident type 2 diabetes: The Multi-Ethnic Study of Atherosclerosis (MESA). Psychoneuroendocrinology, 60, 105–113. Scholar
  2. Affleck, W., Glass, K. C., & MacDonald, M. (2013). The limitations of language: Male participants, stoicism, and the qualitative research interview. American Journal of Men’s Health, 7, 155–162. Scholar
  3. Ahmed, A. G., Kingston, D. A., DiGiuseppe, R., Bradford, J. M., & Seto, M. C. (2012). Developing a clinical typology of dysfunctional anger. Journal of Affective Disorders, 136, 139–148. Scholar
  4. Archer, J. (2004). Sex differences in aggression in real-world settings: A meta-analytic review. Review of General Psychology, 8, 291–322. Scholar
  5. Archer, J. (2009). Does sexual selection explain human sex differences in aggression? Behavioral and Brain Sciences, 32, 249–266. Scholar
  6. Archer, J., & Haigh, A. (1997). Beliefs about aggression among male and female prisoners. Aggressive Behavior, 23, 405–415. Scholar
  7. Baker, M. T., Van Hasselt, V. B., & Sellers, A. H. (2008). Validation of the Novaco Anger Scale in an incarcerated offender population. Criminal Justice and Behavior, 35, 741–754. Scholar
  8. Birkley, E. L., & Eckhardt, C. I. (2015). Anger, hostility, internalizing negative emotions, and intimate partner violence perpetration: A meta-analytic review. Clinical Psychology Review, 37, 40–56. Scholar
  9. Boggs, C. D., Morey, L. C., Skodol, A. E., Shea, M. T., Sanislow, C. A., Grilo, C. M., et al. (2005). Differential impairment as an indicator of sex bias in DSM-IV criteria for four personality disorders. Psychological Assessment, 17, 492–496. Scholar
  10. Buss, A. H., & Perry, M. (1992). The aggression questionnaire. Journal of Personality and Social Psychology, 63, 452–459. Scholar
  11. Campbell, A. (2006). Sex differences in direct aggression: What are the psychological mediators? Aggression and Violent Behavior, 11, 237–264. Scholar
  12. Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155–159. Scholar
  13. DiGiuseppe, R., & Tafrate, R. C. (2004). Anger Disorders Scale (ADS): Technical manual. Toronto, ON: Multi-Health Systems.Google Scholar
  14. DiGiuseppe, R., & Tafrate, R. C. (2007). Understanding anger disorders. England, UK: Oxford University Press.Google Scholar
  15. Eagly, A. H., Wood, W., & Diekman, A. B. (2000). Social role theory of sex differences and similarities: A current appraisal. In T. Eckes & H. M. Trautner (Eds.), The developmental social psychology of gender (pp. 123–174). Mahwah, NJ: Erlbaum.Google Scholar
  16. Ellis, A. (2001). Overcoming destructive beliefs, feelings, and behaviors: New directions for Rational Emotive Behavior Therapy. New York, NY: Prometheus Books.Google Scholar
  17. Fischer, A. H., & Evers, C. (2011). The social costs and benefits of anger as a function of gender and relationship context. Sex Roles, 65, 23–34. Scholar
  18. Garb, H. N. (1997). Race bias, social class bias, and gender bias in clinical judgment. Clinical Psychology: Science and Practice, 4, 99–120. Scholar
  19. Kemp, S., & Strongman, K. T. (1995). Anger theory and management: A historical analysis. The American Journal of Psychology, 108, 397–417.CrossRefGoogle Scholar
  20. Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 62, 617–627. Scholar
  21. Lachmund, E., DiGiuseppe, R., & Fuller, J. R. (2005). Clinicians’ diagnosis of a case with anger problems. Journal of Psychiatric Research, 39, 439–447. Scholar
  22. Lee, A. H., & DiGiuseppe, R. (2018). Anger and aggression treatments: A review of meta-analyses. Current Opinion in Psychology, 19, 65–74. Scholar
  23. Lench, H. C. (2004). Anger management: Diagnostic differences and treatment implications. Journal of Social and Clinical Psychology, 23, 512–531. Scholar
  24. McCann, J. T., & Biaggio, M. K. (1989). Narcissistic personality features and self-reported anger. Psychological Reports, 64, 55–58. Scholar
  25. McDermut, W., Fuller, J. R., DiGiuseppe, R., Chelminski, I., & Zimmerman, M. (2009). Trait anger and Axis I disorders: Implications for REBT. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 27, 121–135. Scholar
  26. Novaco, R. W. (1994). Anger as a risk factor for violence among the mentally disordered. In J. Monahan & H. J. Steadman (Eds.), Violence and mental disorder: Developments in risk assessment (pp. 21–59). Chicago, IL: The University of Chicago Press.Google Scholar
  27. Paulhus, D. (1998). Paulhus Deception Scales (PDS): The balanced inventory of desirable responding—7: User’s manual. North Tanawanda, NY: Multi-Health Systems.Google Scholar
  28. Praill, N., González-Prendes, A. A., & Kernsmith, P. (2015). An exploration of the relationships between attitudes towards anger expression and personal style of anger expression in women in the USA and Canada. Issues in Mental Health Nursing, 36, 397–406. Scholar
  29. Ruddle, A., Pina, A., & Vasquez, E. (2017). Domestic violence offending behaviors: A review of the literature examining childhood exposure, implicit theories, trait aggression and anger rumination as predictive factors. Aggression and Violent Behavior, 34, 154–165. Scholar
  30. Seidlitz, L., & Diener, E. (1998). Sex differences in the recall of affective experiences. Journal of Personality and Social Psychology, 74, 262–271. Scholar
  31. Serota, K. B., Levine, T. R., & Boster, F. J. (2010). The prevalence of lying in America: Three studies of self-reported lies. Human Communication Research, 36, 2–25. Scholar
  32. Sloan, M. M. (2012). Controlling anger and happiness at work: An examination of gender differences. Gender, Work and Organization, 19, 370–391. Scholar
  33. Smith, P., & Waterman, M. (2006). Self-reported aggression and impulsivity in forensic and non-forensic populations: The role of gender and experience. Journal of Family Violence, 21, 425–437. Scholar
  34. Spielberger, C. D. (1999). Manual for the state-trait anger expression inventory-2. Odessa, FL: Psychological Assessment Resources.Google Scholar
  35. Stith, S. M., Smith, D. B., Penn, C. E., Ward, D. B., & Tritt, D. (2004). Intimate partner physical abuse perpetration and victimization risk factors: A meta-analytic review. Aggression and Violent Behavior, 10, 65–98. Scholar
  36. Sullivan, G. M., & Feinn, R. (2012). Using effect size—or why the P value is not enough. Journal of Graduate Medical Education, 4, 279–282. Scholar
  37. Suls, J., & Bunde, J. (2005). Anger, anxiety, and depression as risk factors for cardiovascular disease: The problems and implications of overlapping affective dispositions. Psychological Bulletin, 131, 260–300. Scholar
  38. Suter, J. M., Byrne, M. K., Byrne, S., Howells, K., & Day, A. (2002). Anger in prisoners: Women are different from men. Personality and Individual Differences, 32, 1087–1100. Scholar
  39. Tafrate, R. C., Kassinove, H., & Dundin, L. (2002). Anger episodes in high-and low-trait-anger community adults. Journal of Clinical Psychology, 58, 1573–1590. Scholar
  40. Taylor, J. L., & Novaco, R. W. (2005). Anger treatment for people with developmental disabilities: A theory, evidence and manual based approach. West Sussex: Wiley.CrossRefGoogle Scholar
  41. Toohey, M. J., Tirnady, R., McCabe, J., & Kassinove, H. (2016). Underreporting of anger in men on probation. Journal of Offender Rehabilitation, 55, 39–50. Scholar
  42. Young, K. D., Bellgowan, P. S., Bodurka, J., & Drevets, W. C. (2013). Functional neuroimaging of sex differences in autobiographical memory recall. Human Brain Mapping, 34, 3320–3332. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Royal Ottawa Health Care Group, Integrated Forensic ProgramOttawaCanada
  2. 2.University of Ottawa Institute of Mental Health ResearchOttawaCanada

Personalised recommendations