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Neuroendocrine and Behavioral Mechanisms Mediating the Relationship between Anger Expression and Cardiovascular Risk: Assessment Considerations and Improvements

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The hypothesis that intense anger experience may increase risk for or exacerbate cardiovascular diseases has been under active theoretical and empirical interest for decades. Biopsychological models of disease suggest that persons displaying exaggerated physiological responses to acute emotional or stressful states are at a greater risk to develop cardiovascular disorders. The last two decades have witnessed active work to refine means by which anger expression can be assessed, and laboratory research has produced evidence suggesting that certain expression styles may predict enhanced physiological responses to acute stress. In this paper, we review methodological and definition issues related to the assessment of anger, and we summarize recent improvements on the assessment of anger expression. We also review recent studies addressing the association between anger and cardiovascular diseases, and we present potential neuroendocrine and behavioral mechanisms through which anger expression may increase risk for cardiovascular disease.

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REFERENCES

  • Abel J. L., Larkin, K. T., and Edens, J. L. (1995). Women, anger, and cardiovascular responses to stress. J. Psychosom. Res. 39: 251–259.

    PubMed  Google Scholar 

  • al’Absi, M., and Arnett, D. K. (2000). Adrenocortical responses to psychological stress and risk for hypertension. Biomed. Pharmacother. 54: 234–244.

    PubMed  Google Scholar 

  • al’Absi, M., Bongard, S., Buchanan, T., Pincomb, G. A., Licinio, J., and Lovallo, W. R. (1997). Cardiovascular and neuroendocrine adjustment to public speaking and mental arithmetic stressors. Psychophysiology 34: 266–275.

    PubMed  Google Scholar 

  • al’Absi, M., Bongard, S., and Lovallo, W. R. (2000). Adrenocorticotropin responses to interpersonal stress: effects of overt anger expression style and defensiveness. Int. J. Psychophysiol. 37: 257–265.

    PubMed  Google Scholar 

  • al’Absi, M., France, C., Harju, A., France, J., and Wittmers, L. (2006). Adrenocortical and nociceptive responses to oploid blockade in hypertension prone men and women. Psychosom Med 68: 292–298.

    PubMed  Google Scholar 

  • al’Absi, M., Wittmers, L. E., Ellestad, D., Nordehn, G., Kim, S. W., Kirschbaum, C., and Grant, J. E. (2004). Sex differences in pain and hypothalamic-pituitary-adrenocortical responses to opioid blockade. Psychosom. Med. 66: 198–206.

    PubMed  Google Scholar 

  • Alexander, F. (1939). Emotional factor in essential hypertention. Psycosom. Med. 1: 173–179.

    Google Scholar 

  • Aston-Jones, G., Ennis, M., Pieribone, V. A., Nickell, W. T., and Shipley, M. T. (1986). The brain nucleus locus coeruleus: Restricted afferent control of a broad efferent network. Science 234: 734–737.

    PubMed  Google Scholar 

  • Baker, T. B., Brandon, T. H., and Chassin, L. (2004). Motivational influences on cigarette smoking. Annu. Rev. Psychol. 55: 463–491.

    PubMed  Google Scholar 

  • Barefoot, J. C., and Lipkus, I. M. (1994). The assessment of anger and hostility. In Siegman, A. W., and Smith, T. W. (Eds.), Anger, Hostility, and the Heart. Lawrence Erlbaum Ass., Hillsdale, NJ, pp. 43–66.

    Google Scholar 

  • Biaggio, M. K. (1980). Assessment of anger arousal. J. Pers. Assess. 44: 289–298.

    PubMed  Google Scholar 

  • Biaggio, M. K., Supplee, K., and Curtis, N. (1981). Reliability and validity of four anger scales. J. Pers. Assess. 45: 639–648.

    PubMed  Google Scholar 

  • Boltwood, M. D., Taylor, C. B., Burke, M. B., Grogin, H., and Giacomini, J. (1993). Anger report predicts coronary artery vasomotor response to mental stress in atherosclerotic segments. Am. J. Cardiol. 72: 1361–1365.

    PubMed  Google Scholar 

  • Bongard, S. (2000). Anger expression behavior in different domains and associated cardiovascular loads. Unpublished habilitation-thesis, Johann Wolfgang Goethe-University Frankfurt am Main, Germany.

  • Bongard, S., and al’Absi, M. (1999). Open anger expression at work is associated with elevated blood pressure. J. Psychophysiol. 13: 132.

    Google Scholar 

  • Bongard, S., and al’Absi, M. (2003). Domain-specific anger expression assessment and blood pressure during rest and acute stress. Pers. Individ. Diff. 34: 1381–1402.

    Google Scholar 

  • Bongard, S., and al’Absi, M. (2005). Domain specific anger expression and blood pressure in an occupational setting. J. Psychosom. Res. 58: 43–49.

    PubMed  Google Scholar 

  • Bongard, S., Martin, N. M., and al’Absi, M. (2006). Validation of a Domain Specific Anger Expression Assessment. In preparation.

  • Böddeker, I., and Stemmler, G. (2000). Who responds how and when to anger? The assessment of actual anger response styles and their relation to personality. Cognition & Emotion 14: 737–762.

    Google Scholar 

  • Brady, K. T., and Sonne, S. C. (1999). The role of stress in alcohol use, alcoholism treatment, and relapse. Alcohol. Res. Health 23: 263–271.

    PubMed  Google Scholar 

  • Brindley, D., and Rolland, Y. (1989). Possible connections between stress, diabetes, obesity, hypertension, and adrenal lipoprotein metabolism that may result in artherosclerosis. Clin. Sci. 49: 282–291.

    Google Scholar 

  • Bruehl, S., Burns, J. W., Chung, O. Y., Ward, P., and Johnson, B. (2002). Anger and pain sensitivity in chronic low back pain patients and pain-free controls: the role of endogenous opioids. Pain 99: 223–233.

    PubMed  Google Scholar 

  • Burnett, F. E., Scott, L. V., Weaver, M. G., Medbak, S. H., and Dinan, T. G. (1999). The effect of naloxone on adrenocorticotropin and cortisol release: evidence for a reduced response in depression. J. Affect Disord. 53: 263–268.

    PubMed  Google Scholar 

  • Buss, A. (1961). The Psychology of Aggression. John Wiley, New York.

    Google Scholar 

  • Buss, A., and Durkee, A. (1957). An inventory for assessing different kinds of hostility. J. Consult. Psychol. 21: 343–349.

    PubMed  Google Scholar 

  • Chang, P. P., Ford, D. E., Meoni, L. A., Wang, N. Y., and Klag, M. J. (2002). Anger in young men and subsequent premature cardiovascular disease: The precursors study. Arch. Intern. Med. 162: 901–906.

    PubMed  Google Scholar 

  • Cherek, D. R., Bennett, R. H., and Grabowski, J. (1991). Human aggressive responding during acute tobacco abstinence: Effects of nicotine and placebo gum. Psychopharmacology (Berl.) 104: 317–322.

    Google Scholar 

  • Chrousos, G. P., and Gold, P. W. (1992). The concepts of stress and stress system disorders. Overview of physical and behavioral homeostasis. JAMA 267: 1244–1252.

    PubMed  Google Scholar 

  • Costa, P. T., and McCrae, R. R. (1992). Revised NEO Personality Inventory (NEO-PI-RT) and NEO Five-Factor Inventory (NEO-FFI) professional manual. Psychological Assessment Resources, Odessa, FL.

    Google Scholar 

  • Cook, W. W., Medley, D. M., and Diamond, E. L. (1954). Proposed hostility and pharisaic-virtue scales for the MMPI: the role of anger and hostility in essential hypertension and coronary heart disease. J. Appl. Psychol. 38: 414–418.

    Google Scholar 

  • Crowne, D., and Marlowe, D. (1960). A new scale of social desirability independent of psychopathology. J. Consult Psychol. 24: 329–354.

    Google Scholar 

  • Cunningham, E. T. J., Bohn, M. C., and Sawchenko, P. E. (1990). Organization of adrenergic inputs to the paraventricular and supraoptic nuclei of the hypothalamus in the rat. J. Comp. Neurol. 292: 651–667.

    PubMed  Google Scholar 

  • Dallman, M. (1993). Stress update: adaptation of the hypothalamic-pituitary-adrenal axis to chronic stress. Trends Endocrinol. Metab. 4: 62–69.

    PubMed  Google Scholar 

  • Delitala, G., Trainer, P. J., Oliva, O., Fanciulli, G., and Grossman, A. B. (1994). Opioid peptide and alpha-adrenoceptor pathways in the regulation of the pituitary-adrenal axis in man. J. Endocrinol. 141: 163–168.

    PubMed  Google Scholar 

  • Dembroski, T. M., MacDougall, J. M., Williams, R. B., Haney, T. L., and Blumenthal, J. A. (1985). Components of Type A, hostility, and anger-in: Relationship to angiographic findings. Psychosom. Med. 47: 219–233.

    PubMed  Google Scholar 

  • Diamond, E. (1982). The role of anger and hostility in essential hypertension and coronary heart disease. Psychol. Bull. 92: 410–433.

    PubMed  Google Scholar 

  • Dimsdale, J. E., Pierce, C., Schoenfeld, D., Brown, A., Zusman, R., and Graham, R. (1986). Suppressed anger and blood pressure: The effects of race, sex, social class, obesity, and age. Psychosom. Med. 48: 430–435.

    PubMed  Google Scholar 

  • Dinan, T. G. (1996). Serotonin and the regulation of hypothalamic-pituitary-adrenal axis function. Life Sci. 58: 1683–1694.

    PubMed  Google Scholar 

  • Diorio, D., Viau, V., and Meaney, M. (1993). The role of the medial prefrontal cortex (cingulate gyrus) in the regulation of hypothalamic-pituitary-adrenal responses to stress. J. Neurosci. 13: 3839–3847.

    PubMed  Google Scholar 

  • Drouin, J., Sun, Y. L., Chamberland, M., Gauthier, Y., De Lean, A., Nemer, M., and Schmidt, T. J. (1993). Novel glucocorticoid receptor complex with DNA element of the hormone- repressed POMC gene. EMBO J. 12: 145–156.

    PubMed  Google Scholar 

  • Ekman, P. (1984). Expression and the nature of emotion. In Scherer, K. R., and Ekman, P. (Eds.), Approaches to Emotion. Erlbaum, Hillsdale, NJ, pp. 319–344.

    Google Scholar 

  • Engebretson, T. O., Matthews, K. A., and Scheier, M. F. (1989). Relations between anger expression and cardiovascular reactivity: Reconciling inconsistent findings through a matching hypothesis. J. Consult Clin. Psychol. 57: 513–521.

    Google Scholar 

  • Engebretson, T. O., and Stoney, C. M. (1995). Anger expression and lipid concentrations. Int. J. Behav. Med. 2: 281–298.

    PubMed  Google Scholar 

  • Everson, S. A., Goldberg, D. E., Kaplan, G. A., Julkunen, J., and Salonen, J. T. (1998). Anger expression and incident hypertension. Psychosom. Med. 60: 730–735.

    PubMed  Google Scholar 

  • Everson, S. A., Kaplan, G. A., Goldberg, D. E., Lakka, T. A., Sivenius, J., and Salonen, J. T. (1999). Anger expression and incident stroke: Prospective evidence from the Kuopio ischemic heart disease study. Stroke 30: 523–528.

    PubMed  Google Scholar 

  • Everson, S. A., McKey, B. S., and Lovallo, W. R. (1995). Effect of trait hostility on cardiovascular responses to harassment in young men. Int. J. Behav. Med. 2: 172–191.

    PubMed  Google Scholar 

  • Fields, H. L. (2000). Pain modulation: Expectation, opioid analgesia and virtual pain. Prog. Brain Res. 122: 245–253.

    PubMed  Google Scholar 

  • Fink, G., Robinson, I. C., and Tannahill, L. A. (1988). Effects of adrenalectomy and glucocorticoids on the peptides CRF-41, AVP and oxytocin in rat hypophysial portal blood. J. Physiol. (Lond.) 401: 329–345.

    Google Scholar 

  • Fontana, F., Bernardi, P., Merlo, P. E., Boschi, S., De Iasio, R., Capelli, M., Carboni, L., and Spampinato, S. (1994). Endogenous opioid system and atrial natriuretic factor in normotensive offspring of hypertensive parents at rest and during exercise test. J. Hypertens 12: 1285–1290.

    PubMed  Google Scholar 

  • Funkenstein, D. H., King, S. H., and Drolette, M. (1954). The direction of anger during a laboratory stress-inducing situation. Psychosom. Med. 16: 404–413.

    PubMed  Google Scholar 

  • Gabbay, F. H., Krantz, D. S., Kop, W. J., Hedges, S. M., Klein, J., Gottdiener, J. S., and Rozanski, A. (1996). Triggers of myocardial ischemia during daily life in patients with coronary artery disease: physical and mental activities, anger and smoking. J. Am. Coll. Cardiol. 27: 585–592.

    PubMed  Google Scholar 

  • Gallacher, J. E., Yarnell, J. W., Sweetnam, P. M., Elwood, P. C., and Stansfeld, S. A. (1999). Anger and incident heart disease in the Caerphilly study. Psychosom. Med. 61: 446–453.

    PubMed  Google Scholar 

  • Gallo, L. C., and Smith, T. W. (1998). Construct validation of health-relevant personality traits: Interpersonal circumplex and five-factor model analyses of the Aggression Questionnaire. Int. J. Behav. Med. 5: 129–147.

    PubMed  Google Scholar 

  • Gentry, W. D., Chesney, A. P., Gary, H. E., Jr., Hall, R. P., and Harburg, E. (1982). Habitual anger-coping styles: I. Effect on mean blood pressure and risk for essential hypertension. Psychosom. Med. 44: 195–202.

    PubMed  Google Scholar 

  • Gilbert, D. G., and Gilbert, B. O. (1995). Personality, psychopathology, and nicotine response as mediators of the genetics of smoking. Behav. Genet. 25: 133–147.

    PubMed  Google Scholar 

  • Gregg, T. R., and Siegel, A. (2001). Brain structures and neurotransmitters regulating aggression in cats: implications for human aggression. Prog. Neuropsychopharmacol. Biol. Psychiatry 25: 91–140.

    PubMed  Google Scholar 

  • Hadcock, J. R., and Malbon, C. C. (1988). Regulation of beta-adrenergic receptors by “permissive” hormones: Glucocorticoids increase steady-state levels of receptor mRNA. Proc. Natl. Acad. Sci. USA 85: 8415–8419.

    PubMed  Google Scholar 

  • Harburg, E., Erfurt, J. C., Hauenstein, L. S., Chape, C., Schull, W. J., and Schork, M. A. (1973). Socio-ecological stress, suppressed hostility, skin color, and black-white male blood pressure: Detroit. Psychosom. Med. 35: 276–296.

    PubMed  Google Scholar 

  • Harburg, E., Gleiberman, L., Russell, M., and Cooper, M. L. (1991). Anger-coping styles and blood pressure in black and white males: Buffalo, New York. Psychosom. Med. 53: 153–164.

    PubMed  Google Scholar 

  • Haynes, S. G., Feinleib, M., and Kannel, W.B (1980). The relationship of psychosocial factors to coronary heart disease in the Framingham Study III. Eight-year incidence of coronary heart disease. Am. J. Epidemiol. 111: 37–58.

    PubMed  Google Scholar 

  • Haynes, S. G., Levine, S., Scotch, N., Feinleib, M., and Kannel, W. B. (1978). The relationship of psychosocial factors to coronary heart disease in the Framingham Study I: methods and risk factors. Am. J. Epidemiol. 107: 362–383.

    PubMed  Google Scholar 

  • Hogan. B. E., and Linden, W. (2005). Curvelinear relationship of expressed anger and blood pressure in women but not in men: evidence from two samples. J. Psychosom. Res. 59: 97–102.

    PubMed  Google Scholar 

  • Houston, B. K. (1994). Anger, hostlity, and psychophysiological reactivity. In Siegman, A. W., and Smith, T. W. (Eds.), Anger, Hostility, and the Heart. Lawrence Erlbaum, Hillsdale, pp. 97–115.

    Google Scholar 

  • Iyengar, S., Kim, H. S., and Wood, P. L. (1987). Mu-, delta-, kappa- and epsilon-opioid receptor modulation of the hypothalamic-pituitary-adrenocortical (HPA) axis: subchronic tolerance studies of endogenous opioid peptides. Brain Res. 435: 220–226.

    PubMed  Google Scholar 

  • Jamner, L. D., Shapiro, D., Goldstein, I. B., and Hug, R. (1991). Ambulatory blood pressure and heart rate in paramedics: effects of cynical hostility and defensiveness. Psychosom. Med. 53: 393–406.

    PubMed  Google Scholar 

  • Jamner, L. D., Shapiro, D., and Jarvik, M. E. (1999). Nicotine reduces the frequency of anger reports in smokers and nonsmokers with high but not low hostility: An ambulatory study. Exp. Clin. Psychopharmacol. 7: 454–463.

    PubMed  Google Scholar 

  • Johnson, E. H. (1990). The Deadly Emotions: The Role of Anger, Hostility, and Aggression in Health and Emotional Well-Being. Praeger, New York.

    Google Scholar 

  • Jorgensen, R. S., Johnson, B. T., Kolodziej, M. E., and Schreer, G. E. (1996). Elevated blood pressure and personality: a meta-analytic review. Psychol. Bull. 120: 293–320.

    PubMed  Google Scholar 

  • Kamarck, T. W., Peterman, A. H., and Raynor, D. A. (1998). The effects of the social environment on stress-related cardiovascular activation: current findings, prospects, and implications. Ann. Behav. Med. 20: 247–256.

    Article  PubMed  Google Scholar 

  • Kawachi, I., Sparrow, D., Spiro, A., III, Vokonas, P., and Weiss, S. T. (1996). A prospective study of anger and coronary heart disease. The Normative Aging Study. Circulation 94: 2090–2095.

    PubMed  Google Scholar 

  • King, A. C., Taylor, C. B., and Haskell, W. L. (1990). Smoking in older women. Is being female a ‘risk factor’ for continued cigarette use? Arch. Intern. Med. 150: 1841–1846.

    PubMed  Google Scholar 

  • King, L. A., and Emmons, R. A. (1990). Conflict over emotional expression: psychological and physical correlates. J. Pers. Soc. Psychol. 58: 864–877.

    PubMed  Google Scholar 

  • Kirschbaum, C., and Hellhammer, D. (1992). Methodological aspects of salivary cortisol measurement. In Kirschbaum, C., Read, G. F., and Hellhammer, D. (Eds.), Assessment of Hormones and Drug in Saliva in Biobehavioral Research. Hogrefe & Huber, Seattle, pp. 19–32.

    Google Scholar 

  • Knight, R. G., Ross, R. A., Collins, J. I., and Parmenter, S. A. (1985). Some norms, reliability and preliminary validity data for an S-R inventory of anger: The Subjective Anger Scale (SAS). Person Individ. Diff. 6: 31–339.

    Google Scholar 

  • Koskenvuo, M., Kaprio, J., Rose, R. J., Kesaniemi, A., Sarna, S., Heikkila, K., and Langinvainio, H. (1988). Hostility as a risk factor for mortality and ischemic heart disease in men. Psychosom. Med. 50: 330–340.

    PubMed  Google Scholar 

  • Krantz, D. S., and Manuck, S. B. (1984). Acute psychological reactivity and risk of cardiovascular disease: a review and methodologic critique. Psychol. Bull. 96: 435–464.

    PubMed  Google Scholar 

  • Kubzansky, L. D., and Kawachi, I. (2000). Going to the heart of the matter: do negative emotions cause coronary heart disease? J. Psychosom. Res. 48: 323–337.

    PubMed  Google Scholar 

  • Larson, M. R., and Langer, A. W. (1997). Defensive hostility and anger expression: relationship to additional heart rate reactivity during active coping. Psychophysiology 34: 177–184.

    PubMed  Google Scholar 

  • Linden, W., Hogan, B. E., Rutledge, T., Chawla, A., Lenz, J. W., and Leung, D. (2003). There is more to anger coping than “in” or “out.” Emotion 3: 12–29.

    PubMed  Google Scholar 

  • Linden, W., and Lamensdorf, A. M. (1990). Hostile affect and casual blood pressure. Psychol. Health 4: 343–349.

    Google Scholar 

  • Linden, W., Leung, D., Chawla, A., Stossel, C., Rutledge, T., and Tanco, S. A. (1997). Social determinants of experienced anger. J. Behav. Med. 20: 415–432.

    PubMed  Google Scholar 

  • Lipkus, I. M., Barefoot, J. C., Williams, R. B., and Siegler, I. C. (1994). Personality measures as predictors of smoking initiation and cessation in the UNC Alumni Heart Study. Health Psychol. 13: 149–155.

    PubMed  Google Scholar 

  • Lovallo, W. R. (2004). Stress & Health: Biological and Psychological Interactions. Sage, Thousand Oaks, CA.

    Google Scholar 

  • Lovallo, W. R., and Wilson, M. F. (1992). A biobehavioral model of hypertension development. In Turner, J. R., Sherwood, A., and Light, K. C. (Eds.), Individual Differences in Cardiovascular Response to Stress. Plenum Press, New York, pp. 265–280.

    Google Scholar 

  • Markovitz, J. H. (1998). Cardiovascular risk factors in rapidly developing countries. Ann. Epidemiol. 8: 1–2.

    PubMed  Google Scholar 

  • Martin del Campo, A. F., Dowson, J. H., Herbert, J., and Paykel, E. S. (1994). Effects of naloxone on diurnal rhythms in mood and endocrine function: A dose-response study in man. Psychopharmacology (Berl.) 114: 583–590.

    Google Scholar 

  • Matsumoto, D. (1990). Cultural similarities and differences in display rules. Motivation and Emotion 14: 195–214.

    Google Scholar 

  • Matthews, K. A., Owens, J. F., Kuller, L. H., Sutton-Tyrrell, K., and Jansen-McWilliams, L. (1998). Are hostility and anxiety associated with carotid atherosclerosis in healthy postmenopausal women? Psychosom. Med. 60: 633–638.

    PubMed  Google Scholar 

  • McCubbin, J. A. (1993). Stress induced endogenous opioids: behavioral and circulatory interactions. Biol. Psychol. 35: 91–122.

    PubMed  Google Scholar 

  • McCubbin, J. A., Surwit, R. S., Williams, R. B., Nemeroff, C. B., and McNeilly, M. (1989). Altered pituitary hormone response to naloxone in hypertension development. Hypertension 14: 636–644.

    PubMed  Google Scholar 

  • McEwen, B. S. (1998). Protective and damaging effects of stress mediators. N. Engl. J. Med. 338: 171–179.

    PubMed  Google Scholar 

  • McEwen, B. S., and Stellar, E. (1993). Stress and the individual: mechanisms leading to disease. Arch. Intern. Med. 153: 2093–2101.

    PubMed  Google Scholar 

  • Miller, S. B. (1993). Cardiovascular reactivity in anger-defensive individuals: the influence of task demands. Psychosom. Med. 55: 75–85.

    Google Scholar 

  • Mills, P. J., Schneider, R. H., and Dimsdale, J. E. (1989). Anger assessment and reactivity to stress. J. Psychosom. Res. 33: 379–382.

    PubMed  Google Scholar 

  • Munck, A., Guyre, P. M., and Holbrook, N. J. (1984). Physiological functions of glucocorticoids in stress and their relation to pharmacological actions. Endocrinol. Rev. 5: 25–44.

    Article  Google Scholar 

  • Novaco, R. W. (1975). Anger Control: The Development and Evaluation of An Experimental Treatment. Lexington Books, Lexington, Mass.

    Google Scholar 

  • Novaco, R. W. (1977). Stress inoculation: a cognitive therapy for anger and its application to a case of depression. J. Consult Clin. Psychol. 45: 600–608.

    PubMed  Google Scholar 

  • Paulhus, D. L. (1984). Two-component models of social desirable responding. J. Pers. Soc. Psychol. 46: 598–609.

    Google Scholar 

  • Pearlin, L. I., and Schooler, C. (1978). The structure of coping. J. Health Soc. Beh. 19: 2–21.

    Google Scholar 

  • Pennebaker, J. W. (1985). Traumatic experience and psychosomatic disease: exploring the roles of behavioral inhibition, obsession, and confiding. Can. Psychol. 26: 82–95.

    Google Scholar 

  • Pennebaker, J. W., Highes, C. F., and O’heeron, R. C. (1987). The psychophysiology of confession: Linking inhibitory and psychosomatic processes. J. Pers. Soc. Psychol. 52: 781–793.

    PubMed  Google Scholar 

  • Petermann, F., and Petermann, U. (1996). Assessment form for Aggressive Behavior in Concrete Situations. Hogrefe, Göttingen.

    Google Scholar 

  • Plutchik, R. (1994). The Psychology and Biology of Emotion. Harper, New York.

    Google Scholar 

  • Porter, L. S., Stone, A. A., and Schwartz, J. E. (1999). Anger expression and ambulatory blood pressure: A comparison of state and trait measures. Psychosom. Med. 61: 454–463.

    PubMed  Google Scholar 

  • Redmond, D. E. J., and Huang, Y. H. (1979). Current concepts. II. New evidence for a locus coeruleus-norepinephrine connection with anxiety. Life Sci. 25: 2149–2162.

    PubMed  Google Scholar 

  • Rivier, C., and Vale, W. (1983). Modulation of stress-induced ACTH release by corticotropin-releasing factor, catecholamines and vasopressin. Nature 305: 325–327.

    PubMed  Google Scholar 

  • Rosenzweig, S. (1945). The picture-association method and its application in a study of reactions to frustration. J. Pers. 14: 3–23.

    Google Scholar 

  • Rosenzweig, S., and Adelman, S. (1977). Construct validity of the Rosenzweig Picture-Frustration Study. J. Pers. Assess. 41: 578–588.

    PubMed  Google Scholar 

  • Rosenzweig, S., Ludwig, D. J., and Adelman, S. (1975). Retest reliability of the Rosenzweig Picture-Frustration Study and similar semiprojective techniques. J. Pers. Assess. 39: 2–12.

    Google Scholar 

  • Sacco, R. L. (1997). Risk factors, outcomes, and stroke subtypes for ischemic stroke. Neurology 49: S39–S44.

    PubMed  Google Scholar 

  • Saper, C. B., Swanson, L. W., and Cowan, W. M. (1979). An autoradiographic study of the efferent connections of the lateral hypothalamic area in the rat. J. Comp. Neurol. 183: 689–706.

    PubMed  Google Scholar 

  • Schluger, J. H., Ho, A., Borg, L., Porter, M., Maniar, S., Gunduz, M., Perret, G., King, A., and Kreek, M. J. (1998). Nalmefene causes greater hypothalamic-pituitary-adrenal axis activation than naloxone in normal volunteers: implications for the treatment of alcoholism. Alcohol. Clin. Exp. Res. 22: 1430–1436.

    PubMed  Google Scholar 

  • Schneider, R. H., Egan, B. M., Johnson, E. H., Drobny H., and Julius, S. (1986). Anger and anxiety in borderline hypertension. Psychosom. Med. 48: 242–248.

    PubMed  Google Scholar 

  • Schum, J. L., Jorgensen, R. S., Verhaeghen, P., Sauro, M., and Thibodeau, R. (2003). Trait anger, anger expression, and ambulatory blood pressure: A meta-analytic review. J. Behav. Med. 26: 395–415.

    PubMed  Google Scholar 

  • Shapiro, D., Goldstein, I. B., and Jamner, L. D. (1995). Effects of anger/hostility, defensiveness, gender, and family history of hypertension on cardiovascular reactivity. Psychophysiology 32: 425–435.

    PubMed  Google Scholar 

  • Shapiro, D., Jamner, L. D., and Goldstein, I. B. (1993). Ambulatory stress psychophysiology: the study of “compensatory and defensive counterforces” and conflict in a natural setting. Psychosom. Med. 55: 309–323.

    PubMed  Google Scholar 

  • Siegel, J. M. (1986). The multidimensional anger inventory. J. Pers. Soc. Psychol. 51: 191–200.

    PubMed  Google Scholar 

  • Siegman, A. W. (1992). Cardiovascular consequences of expressing, experiencing, and repressing anger. J. Behav. Med. 16: 539–569.

    Google Scholar 

  • Siegman, A. W. (1994). Cardiovascular consequences of expressing and repressing anger. In Siegman, A. W., and Smith, T. W. (Eds.), Anger, Hostility, and the Heart. Lawrence Erlbaum Ass., Hillsdale, NJ, pp. 173–198.

    Google Scholar 

  • Smith, T. W., Pope, M. K., Sanders, J. D., Allred, K. D., and Keeffe, J. L. (1988). Cynical hostility at home and work: Psychosocial vulnerability across domains. J. Res. Pers. 22: 525–548.

    Google Scholar 

  • Spielberger, C. (1988). State-Trait Anger Expression Inventory. Professional manual. Psychological Assessment Resources, Odessa, FL.

    Google Scholar 

  • Spielberger, C. D., Johnson, E. H., Russell, S. F., Crane, R. J., Jacobs, G. A., and de Worn, T. I. (1985). The experience and expression of anger: construction and validation of an anger expression scale. In Chesney, M. A., and Rosenman, R. H. (Eds.), Anger and Hostility in Cardiovascular and Behavioral Disorders. Hemisphere/McGraw-Hill, New York.

    Google Scholar 

  • Stemmler, G. (2004). Physiological processes during emotion. In Philippot, P., and Feldman, R. S. (Eds.), The Regulation of Emotion. Lawrence Erlbaum Ass., Mahwah, NJ, pp. 33–70.

    Google Scholar 

  • Stemmler, G., Schäfer, H., and Marwitz, M. (1993). Concept and operationalizations of styles of anger processing. In Hodapp, V., and Schwenkmezger, P. (Eds.), Ärger und Ärgerausdruck. Hans Huber, Bern.

    Google Scholar 

  • Steptoe, A., Cropley, M., Griffith, J., and Kirschbaum, C. (2000). Job strain and anger expression predict early morning elevations in salivary cortisol. Psychosom. Med. 62: 286–292.

    PubMed  Google Scholar 

  • Strike, P. C., Magid, K., Whitehead, D. L., Brydon, L., Bhattacharyya, M. R., and Steptoe, A. (2006). Pathophysiological processes underlying emotional triggering of acute cardiac events. Proc. Natl. Acad. Sci. USA 103: 4322–4327.

    PubMed  Google Scholar 

  • Strike, P. C., and Steptoe, A. (2005). Behavioral and emotional triggers of acute coronary syndromes: A systematic review and critique. Psychosom. Med. 67: 179–186.

    PubMed  Google Scholar 

  • Suarez, E. C., and Williams, R. B. (1989). Situational determinants of cardiovascular and emotional reactivity in high and low hostile men. Psychosom. Med. 51: 404–418.

    PubMed  Google Scholar 

  • Suarez, E. C., and Williams, R. B. (1990). The relationship between dimensions of hostility and cardiovascular reactivity as a function of task characteristics. Psychosom. Med. 52: 558–570.

    PubMed  Google Scholar 

  • Suchday, S., and Larkin, K. T. (2001). Biobehavioral responses to interpersonal conflict during anger expression among anger-in and anger-out men. Ann. Behav. Med. 23: 282–290.

    PubMed  Google Scholar 

  • Suls, J., and Wan, C. K. (1993). The relationship between trait hostility and cardiovascular reactivity: A quantitative review and analysis. Psychophysiology 30: 615–626.

    PubMed  Google Scholar 

  • Swanson, L. W., and Simmons, D. M. (1989). Differential steroid hormone and neural influences on peptide mRNA levels in CRH cells of the paraventricular nucleus: A hybridization histochemical study in the rat. J. Comp. Neurol. 285: 413–435.

    PubMed  Google Scholar 

  • Szafarczyk, A., Guillaume, V., Conte-Devolx, B., Alonso, G., Malaval, F., Pares-Herbute, N., Oliver, C., and Assenmacher, I. (1988). Central catecholaminergic system stimulates secretion of CRH at different sites. Am. J. Physiol. 255: E463–E468.

    PubMed  Google Scholar 

  • Tavris, C. (1984). On the wisdom of counting to ten: Personal and social dangers of anger expression. Rev. Pers. Soc. Psychol. 5: 170–191.

    Google Scholar 

  • Tilders, F. J., Berkenbosch, F., Vermes, I., Linton, E. A., and Smelik, P. G. (1985). Role of epinephrine and vasopressin in the control of the pituitary- adrenal response to stress. Fed. Proc. 44: 155–160.

    PubMed  Google Scholar 

  • Underwood, M. K., Coie, J. D., and Herbsman, C. R. (1992). Display rules for anger and aggression in school-age children. Child Dev. 63: 366–380.

    PubMed  Google Scholar 

  • Valentino, R. J., and Foote, S. L. (1988). Corticotropin-releasing hormone increases tonic but not sensory-evoked activity of noradrenergic locus coeruleus neurons in unanesthetized rats. J. Neurosci. 8: 1016–1025.

    PubMed  Google Scholar 

  • van de Kar, L. D., and Blair, M. L. (1999). Forebrain pathways mediating stress-induced hormone secretion. Front Neuroendocrinol. 20: 1–48.

    PubMed  Google Scholar 

  • Vander, A. J., Sherman, J. H., and Luciano, D. S. (1994). Human Physiology. McGraw-Hill, New York.

    Google Scholar 

  • Wand, G. S., and Schumann, H. (1998). Relationship between plasma adrenocorticotropin, hypothalamic opioid tone, and plasma leptin. J. Clin. Endocrinol. Metab. 83: 2138–2142.

    PubMed  Google Scholar 

  • Weinberger, D. A., Schwartz, G. E., and Davidson, R. J. (1979). Low-anxious, high-anxious, and repressive coping styles: psychometric patterns and behavioral and physiological responses to stress. J. Abnorm. Psychol. 88: 369–380.

    PubMed  Google Scholar 

  • Whalen, C. K., Jamner, L. D., Henker, B., and Delfino, R. J. (2001). Smoking and moods in adolescents with depressive and aggressive dispositions: Evidence from surveys and electronic diaries. Health Psychol. 20: 99–111.

    PubMed  Google Scholar 

  • Williams, J. E., Paton, C. C., Siegler, I. C., Eigenbrodt, M. L., Nieto, F. J., and Tyroler, H. A. (2000). Anger proneness predicts coronary heart disease risk: Prospective analysis from the atherosclerosis risk in communities (ARIC) study. Circulation 101: 2034–2039.

    PubMed  Google Scholar 

  • Wilson, J. D., and Foster, D. W. (1992). Williams Textbook of Endocrinology. Saunders, Pheladelphia.

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al’Absi, M., Bongard, S. Neuroendocrine and Behavioral Mechanisms Mediating the Relationship between Anger Expression and Cardiovascular Risk: Assessment Considerations and Improvements. J Behav Med 29, 573–591 (2006). https://doi.org/10.1007/s10865-006-9077-0

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