Clinical Anger 1

Clinical Anger: Construct, Measurement, Reliability, and Validity

William E. Snell, Jr.

Scott Gum, Roger L. Shuck, Jo A. Mosley, and Tamara L. Hite

Southeast Missouri State University

Running head: CLINICAL ANGER

DATE: February 27, 2025

Portions of this research were presented at the 34th annual meeting of the

Southwestern Psychological Association, Tulsa, Oklahoma.

Address all correspondence to William E. Snell, Jr., Department of Psychology,

Southeast Missouri State University, One University Plaza, Cape Girardeau, Missouri

63701. E-MAIL addresses are: (INTERNET) C779EDP@SEMOVM.SEMO.EDU and

(BITNET) C779EDP@SEMOVM.
 Clinical Anger 2

Abstract

The purpose of the present investigation was to develop and validate an objective self-

report instrument, the Clinical Anger Scale (CAS), designed to measure the syndrome

of clinical anger. Factor analysis of the Clinical Anger Scale confirmed essentially a

unidimensional item structure; reliability analyses also demonstrated adequate alphas

(i.e., internal consistency) and test-retest coefficients (i.e., stability) for the CAS; and

other results indicated that the CAS was unrelated to social desirability influences.

Additional findings indicated that clinical anger was positively associated with several

anger-related concepts (e.g., trait anger, state anger, anger-in, anger-out, anger-

control). Other results showed that the Clinical Anger Scale was related in predictable

ways to men's and women's psychological symptoms, personality traits, and early family

environments. These results are discussed in terms of the need to distinguish and to

investigate the concept of clinical anger and its therapeutic treatment.

 Clinical Anger 3

Clinical Anger: Construct, Measurement, Reliability, and Validity

During the course of the past several years a number of professionals have

investigated the phenomena of anger (e.g., Averill, 1983; Biaggio & Maiuro, 1985;

Feshbach, 1986; Rubin, 1986; Spielberger, Jacobs, Russell, & Crane, 1983). Most of

this work has been conducted within the context of hostility and aggression (see Geen,

1990, for an overview) and a variety of important conceptual distinctions have been

made between anger and both hostility and aggression. Some work has also

distinguished anger from anger-provoking events and experiences (e.g., Ben-Zur &

Breznitz, 1991; Snell, McDonald, & Koch, 1991). Other distinctions have been

addressed in research that has developed and used such standardized instruments as

the Buss-Durkee Hostility Inventory (Buss & Durkee, 1957; Buss, 1961), the Reaction

Inventory (Evans & Stangeland, 1971), the Anger Self-Report Scale (Zelin, Adler, &

Myerson, 1972), the Anger Inventory (Novaco, 1975), the Multidimensional Anger

Inventory (Siegel, 1985), the Subjective Anger Scale (Knight, Ross, Collins, &

Paramenter, 1985), the Anger Expression Scale (Spielberger, Johnson, Russell, Crane,

Jacobs, & Worden, 1985), the State-Trait Anger Scale (Spielberger et al., 1983), and

the Awareness and Expression of Anger Indicator (Catchlove & Braha, 1985). This

literature, with the distinctions emphasized by each respective instrument, has

contributed to greater understanding of the phenomena of anger.

Interestingly enough, none of the extant instruments concerned with measuring

anger directly assesses clinical anger. By contrast, practitioners have for some time

discussed the importance of the concept of clinical anger from a therapeutic perspective

(Alschuler & Alschuler, 1984; Rubin, 1986; Sharkin, 1988). Sharkin (1988), for
 Clinical Anger 4

example, has described the need for a reliable and valid measure to help in the effective

treatment of clients suffering from clinical anger. Although the therapy literature on

client anger makes reference to the importance of measuring and treating clinical anger,

no research instrument currently exists that would directly facilitate this line of

investigation. Thus, an instrument specifically designed to measure clinical anger was

needed. It was anticipated that the development of such a clinical tool might lead to

greater insight into the nature of clinical anger, by helping professionals study the extent

to which their clients may be influenced by the various symptoms of clinical anger. The

purpose of the present investigation was to develop and validate an objective and

reliable instrument designed to measure the syndrome of clinical anger.

As a first step in the construction of the Clinical Anger Scale, it was recognized that

clinical anger is a syndrome consisting of symptoms that can vary in their intensity and

strength (cf. Biaggio & Maiuro, 1985; Spielberger et al., 1983; Spielberger et al., 1985).

Given the potential for severe health risks associated with intense anger (Hardy &

Smith, 1988; Spielberger et al., 1985), it was decided to design the Clinical Anger Scale

so that it assessed the chronic, pervasive aspects of clinical anger (i.e., clinical anger

symptomatology). As a second step in the construction of the Clinical Anger Scale,

items were written to assess the affective, cognitive, physiological, motoric, and

behavioral symptoms of clinical anger (e.g., fatigue, irritability, rage). Previous research

associated with other clinical-related instruments was consulted in the preparation of

these items (e.g., Beck, Epstein, Brown, & Steer, 1988; Beck, Ward, Mendelson, Mock,

& Erbaugh, 1961). The initial items were reviewed and discussed not only with

professional psychology instructors but also with a group of undergraduate psychology

 Clinical Anger 5

majors and graduate counseling students. Then, after revision of several items, the

final version of the Clinical Anger Scale was prepared and administered to several

samples of males and females.

Several specific analyses were conducted to examine the psychometric properties

of the Clinical Anger Scale. Factor analysis was conducted to examine the factorial

validity of the instrument, and reliability coefficients were computed to examine the

internal consistency and stability of the CAS. Also, in addition to providing evidence for

the convergent and divergent validity of the CAS, an ancillary purpose of the present

study was to provide preliminary evidence for its validity by examining some personality,

psychopathological symptomology, behavioral, and family environmental correlates of

clinical anger.

Method

Subjects

Data was collected from 6 samples (each sample is described below). In

exchange for their participation, the subjects received either extra-credit points in their

course or else partially fulfilled a course requirement. The number of subjects in the

analyses reported below occasionally varies, since not all subjects in each sample

completed every item on all of the instruments.

Sample I. During the Fall of 1986, a sample of 177 subjects (43 males, 112

females, 22 gender-unspecified) volunteered to participate in a research study on

psychology. These individuals averaged 23.93 years of age (SD = 6.5). This sample

completed the CAS and a measure of acting-out behaviors, neurotic behaviors, and

psychological defensiveness (described below).

 Clinical Anger 6

Sample II. In the Fall of 1990, a sample of 183 subjects (67 males, 114 females, 2

gender-unspecified) participated in an investigation concerned with individual

tendencies. These individuals were 22.99 years of age (SD = 6.56), with approximately

equal representations of freshmen, sophomores, juniors, and seniors. Only about 10%

of the sample was non-Caucasian, and about 22% of the sample was (or had been)

married. This sample completed the CAS, the Eysenck Personality Inventory, the

Goldberg Big-5 Scale, the State-Trait Anger Inventory, the Anger Expression Scale, the

Symptom Checklist-90 (Revised), and a measure of social desirability (described

below).

Sample III. During the Spring of 1991, 131 subjects (49 males, 81 females, 1

gender-unspecified) volunteered to participate in a research study on anger as one way

of fulfilling a course requirement. These subjects were was 21.17 years of age (SD =

5.03), 77% were freshmen and sophomores, only 14 were married, and only 20 were

non-Caucasian. This sample completed the CAS, the Family Environment Scale, the

State-Trait Anger Inventory, and the Anger Expression Scale (described below).

Sample IV. During the Spring and Fall of 1987, four-hundred and five subjects

(104 males and 301 females) volunteered to participate in a research study on anger

and personality. This was the largest of the CAS samples and thus was used to

examine the internal consistency and factor structure of the CAS items. These subjects

averaged 24.13 years of age (SD = 6.08), and approximately 22% of the sample was

married.

Sample V. During the Fall of 1987, 235 individuals (55 males, 165 females, and

15 who chose not to identify their gender) volunteered to complete the CAS (and
 Clinical Anger 7

several other questionnaires unrelated to the present investigation) as one way of

fulfilling a course requirement. They averaged 24.59 years of age (SD = 6.58), and

25% of the sample was married.

Sample VI. During the Spring of 1991, thirty-nine (31 females, 8 males) subjects

in an undergraduate psychology course volunteered to participate in a psychology study

on individual tendencies (average age = 24.79, SD = 7.01). These individuals

completed the Clinical Anger Scale during the second week of the semester and then

were retested 3 weeks later.

Procedure

As soon as they arrived at the testing room, all subjects were asked to read an

informed consent form. Those who volunteered to participate (all subjects did so) were

then asked to complete several assessment instruments (discussed below). The

subjects completed the experimental material during either a single one-hour or two-

hour session. All subject were thanked for their participation and then were later

debriefed.

Instruments

Clinical Anger Scale (CAS). An objective self-report instrument was designed to

measure the psychological symptoms presumed to have relevance in the understanding

and treatment of clinical anger. Twenty-one sets of statements were prepared for this

purpose. In writing these groups of items, the format from one of Beck's early

instruments was used to design the Clinical Anger Scale (Beck et al., 1961; Beck, 1963,

1967). The following symptoms of anger were measured by the CAS items: anger

now, anger about the future, anger about failure, anger about things, angry-hostile
 Clinical Anger 8

feelings, annoying others, angry about self, angry misery, wanting to hurt others,

shouting at people, irritated now, social interference, decision interference, alienating

others, work interference, sleep interference, fatigue, appetite interference, health

interference, thinking interference, and sexual interference. Subjects were asked to

read each of the 21 groups of statements (4 statements per group) and to select the

single statement that best described how they felt (e.g., item 1: A = I do not feel angry,

B = I feel angry, C = I am angry most of the time now, and D = I am so angry all the time

that I can't stand it). The four statements in each cluster varied in symptom intensity,

with more intense clinical anger being associated with statement "D." Each cluster of

statements was scored on a 4-point Likert scale, with A = 0, B = 1, C = 2, and D = 3.

Subjects' responses on the CAS were summed so that higher scores corresponded to

greater clinical anger (21 items; range 0 - 63).

State-Trait Anger Scale. The State-Trait Anger Scale (STAS; Spielberger,

Jacobs, Russell, & Crane, 1983) contains of two separate subscales, each consisting of

15 items. The state anger scale measures the amount of anger a person is feeling at

the time of the administration of the STAS (i.e., general and immediate feelings of

anger), and the trait anger subscale measures any enduring, chronic feelings of anger

(i.e., dispositional feelings of anger). Higher scores corresponded to greater state and

trait anger, respectively.

Anger Expression Scale. The Anger Expression Scale (AES; Spielberger et al,

1985) was designed to measure how people express anger when they are provoked.

This 20-item scale consists of the following subscales: anger-in, in which the feelings of

anger are experienced but held in (i.e., suppressed); anger-out, in which anger is
 Clinical Anger 9

expressed outwardly toward other people and the environment; and anger-control, in

which people control the experience and expression of anger. Higher scores

corresponded to greater amounts of anger-in, anger-out, and anger-control,

respectively.

Social Desirability. The Crowne-Marlow Social Desirability Scale (Crowne &

Marlow, 1964) measures the extent to which people's responses to self-report

instruments are influenced by the tendency to respond in a socially desirable fashion.

Higher scores corresponded to a greater tendency to make socially desirable responses

on instruments.

Acting Out and Neurotic Behaviors. A measure of acting-out and neurotic

behaviors (Spence, Helmreich, & Holahan, 1979) was also used in the present

investigation. This instrument was designed to measure (1) acting out or sociopathic

behavior, consisting of several items concerned with such behaviors as alcohol and

other drug use, misdemeanors, lying, verbal and physical fights, and school

misbehavior; and (2) emotional distress of a more neurotic behavioral nature, consisting

of items concerned with the frequency of feeling nervous, tense, fearful and anxious;

and other items concern with feeling depressed, the certainty of life goals, satisfaction

with one's social life, general life satisfaction, and voluntary seeking of professional help

for psychological problems. For both the measure of acting-out and neurotic behaviors,

higher scores indicated greater amounts of each respective behavioral tendency.

Eysenck Personality Inventory. The Eysenck Personality Inventory (EPI;

Eysenck & Eysenck, 1968) includes two major scales: the N scale measures neurotic

tendencies such as anxiousness, tenseness, guilt feelings, and depression; and the E
 Clinical Anger 10

scale measures extraverted tendencies such as sociability, activity, liveliness, and

sensation seeking. The EPI also includes a lie scale which is intended to assess the

propensity to "fake good" (cf. Haapasalo, 1990). Evidence for the EPI's reliability and

validity is summarized in Eysenck and Eysenck (1968, 1969). Higher scores indicated

greater neuroticism, extraversion, and impression management (i.e., lying) tendencies.

Interpersonal Defensiveness Scale. The Interpersonal Defensiveness Scale

(IDS; Snell & Finney, 1991) was designed to measure interpersonal defensive

tendencies, defined as an exaggerated concern with protecting one's social image,

misinterpreting reactions from others as a personal affront, and rationalizing as well as

justifying one's own actions (e.g., If others find fault with me, they better be prepared to

argue.). Cronbach alpha for this instrument was .89 (n=132). The IDS was scored so

that higher scores corresponded to greater interpersonal defensiveness.

Symptom Checklist 90 (Revised). The SCL-90-R was developed by Derogatis

(1983) as a multidimensional self-report measure of the symptoms of clinical

psychopathology. As such, it reflects a person's current psychological symptoms and

yields separate scores for the following indexes: somatization, interpersonal sensitivity,

obsessive symptoms, depression, anxiety, hostility, paranoid ideation, phobic anxiety,

psychosis, and a global severity index (GSI). Derogatis describes the GSI as the best

single SCL-90-R measure of a person's current level of psychological disturbance, since

it consists of the total of all the other symptom dimensions on the SCL-90-R. Higher

scores on the GSI and the other SCL-90-R subscales corresponded to greater amounts

of each symptomology.

Family Environment Scale. The Family Environment Scale (FES; Moos & Moos,
 Clinical Anger 11

1981; Billings & Moos, 1983) is a self-report inventory designed to measure several

aspects of family environment. It consists of 90 true-false questions divided into 10

subscales. Three of the FES subscales concern internal aspects of the family's

interpersonal relationship (i.e., cohesion, expression, and conflict), and in this sense

they assess the degree of commitment, openness, support and conflictive interactions

among family members. Another group of 5 subscales reflects a family emphasis on

developmental directions and is thus concerned with goal orientation and personal

growth (independence, achievement orientation, intellectual-cultural orientation, active-

recreational orientation, and moral-religious emphasis). The two remaining subscales

(i.e., organization and control) are related to system maintenance; they measure

aspects of family structure such as planning family activities and the rules-regulations

used to run the family (Moos & Moos, 1981). Higher scores on each of the 10 FES

subscales corresponded to a stronger family emphasis or orientation for each

respective subscale.

Goldberg Big-5 Scale. The Goldberg Big-5 instrument (Goldberg, in press, 1990)

includes five scales designed to assess the following personality attributes (each with

10 items): (1) extraversion-introversion measured by tendencies such as forcefulness,

spontaneity, and sociability; (2) agreeableness-pleasantness measured by tendencies

like politeness, cooperation, and flexibility; (3) conscientiousness measure by

tendencies such as reliability, responsibility, and organization; (4) emotional stability

measured by attributes such as security, contentedness, and stability; and (5) intellect-

sophistication measured by traits such as reflectiveness, curiosity, and perceptiveness.

Higher scores corresponded to greater extraversion, agreeableness, conscientiousness,

 Clinical Anger 12

emotional stability, and intellect-sophistication, respectively.

Results

These results are presented in several major sections. The first section presents

the psychometric analyses of the Clinical Anger Scale. Included in this section are the

factor analysis results, the reliability results, and other scale validity results. Section two

then presents the gender norms and the ANOVA analyses conducted to examine the

effect of gender on the CAS. The third section reports the research evidence for the

convergent validity of both the CAS. This section presents the correlations between the

CAS and Speilberger's anger-related instruments. Section fourth includes the results of

the analyses conducted to examine the relationship between the CAS and the

measures of psychological symptoms, personality traits, and unhealthy behaviors (i.e.,

acting out and neuroticism indexes). The fifth and final section describes the

relationship between the CAS and the measure of early family atmosphere, the Family

Environment Scale.

Psychometric Results for the CAS

To examine the psychometric properties of the Clinical Anger Scale, a series of

factor analyses (principal axis with varimax rotation) were conducted for males and

females separately and in combination (using Sample IV). The results are shown in

Table 1.

_________________

Insert Table 1 about here

________________

An inspection of Table 1 indicates that for the combined group of both males and
 Clinical Anger 13

females, all of the CAS statements (except for item 3) loaded above |.30| on a single

factor solution (the eigenvalue for Solution I was 9.53 with 45.4% of the variance being

explained). No other factor solution had an eigenvalue greater than 1 (see Table 1).

The CAS items were then analyzed for males and females separately. The resulting

factor loadings are also shown in Table 1. Again, for both the male and the female

analyses, only one factor solution with an eigenvalue greater than 1 was found (for

males, the eigenvalue for Solution I was 11.33 and it accounted for 54% of the variance;

for females, the eigenvalue for Solution I was 8.71 and it accounted for 41.5% of the

variance). Although neither the male nor the female analyses produced more than one

factor solution with an eigenvalue greater than 1, it is apparent from Table 1 that some

of the secondary solutions were associated with the attitudinal, physiological, and

performance manifestations of clinical anger.

The internal consistency of the 21 items on the Clinical Anger Scale was analyzed

by means of Cronbach alpha, and yielded reliability coefficients of .94 (males and

females together), .95 (males only), and .92 (females only). The item-total correlations

for these alphas are presented in Table 1. All the item-total correlations exceeded |.30|,

except for item 3 (anger about failure) which had item-total coefficients of .13, .19,

and .11, respectively, for the total sample, males only, and females only. [Although the

item-total coefficient for item 3 was low, it was decided nonetheless to retain this item in

the computation of the total CAS score, pending the results of additional investigations

on other older samples.] In addition to conducting internal reliability analyses, test-

retest analyses were also performed (see Table 2). The correlations between the two

administrations of the CAS were .85 (males), .77 (females), and .78 (both males and
 Clinical Anger 14

females). Finally, to determine whether people's scores on the Clinical Anger Scale

were contaminated by some type of response bias, the CAS was correlated with a

measure of social desirability and with the EPI Lie Scale. The results, shown in Table 2,

indicate that the CAS was independent of the tendency to respond in a socially

desirable fashion and was largely independent of the EPI Lie scores (the only exception

was the Lie scale for females, but this correlation only accounted for 4% of the overall

variability in the scores).

In brief, this information indicates that the CAS was largely unifactorial in nature,

highly reliable, and essentially uncontaminated by social desirable and lying tendencies.

________________

Insert Table 2 about here

_________________

Gender Effects and Norms for the CAS

According to social stereotypes about gender, anger is an affect that characterizes

men more than women. A series of ANOVAs for Samples I, II, III, IV, and V was thus

conducted on the CAS to examine whether men and women would report different

degrees of clinical anger. In these analyses, gender was treated as the independent

variable and the CAS was regarded as dependent variable. The results are presented

in Table 2, and reveal no evidence that males and females differ in terms of the

syndrome of clinical anger (all ps > .05). This table also presents normative data (i.e.,

means and standard deviations) for males and females in each of the major samples

(Samples I-V).

Convergent Validity Findings for the CAS

 Clinical Anger 15

Preliminary evidence for the validity of the Clinical Anger Scale was determined by

examining the correlations between the CAS and the scores on Spielberger's anger-

related instruments. These correlations are shown in the bottom half of Table 2. As

expected, the scores on the Clinical Anger Scale were positively and strongly correlated

with the two subscales on the State-Trait Anger Scale. Moreover, the Clinical Anger

Scale was positively correlated with the subscales on the Anger Expression Scale,

although the relationships were not always as strong nor as significant as for the State-

Trait Anger Scale. These findings thus provide support for the convergent validity of the

Clinical Anger Scale.

Additional Validity Findings for the CAS

This section presents the results of analyses conducted to examine the

relationship between the CAS and the measures of psychological symptoms,

personality traits, and other unhealthy behaviors (i.e., acting out and neuroticism

indexes). The results are shown in Table 3.

________________

Insert Table 3 about here

________________

Psychological Symptoms. As an inspection of Table 3 indicates, the Clinical

Anger Scale was positively correlated with the full range of psychological symptoms

measured by the SCL-90-R. Also, as one might expect, males and females who

reported greater clinical anger reported an elevated number of psychological symptoms

associated with hostility. In brief, clinical anger was positively associated with a broad

array of psychopathological symptoms.

 Clinical Anger 16

Personality Traits. The Clinical Anger Scale was also correlated with two

personality instruments, the Eysenck Personality Inventory and the Goldberg Big-5

Scale. As can be seen in Table 3 (for the combined sample of males and females),

clinical anger was positively correlated with Eysenck's neuroticism scale and negatively

correlated with Eysenck's extraversion scale, and negatively correlated with the Big-5

measure of extraversion, pleasantness-agreeableness, and emotional stability. Thus,

feelings of clinical anger were associated in a predictable pattern with measures of

dispositional personality attributes.

Unhealthy Behaviors. Table 3 also shows the correlations between the Clinical

Anger Scale and the measures of acting-out behaviors, neurotic behaviors, and

interpersonal defensiveness. As expected, among the combined sample of males and

females, clinical anger was positively associated with all three measures of

psychologically unhealthy behaviors (although the pattern of results did vary somewhat

among males and females). Thus, people who were characterized by more intense

clinical angry reported engaging in a greater number of misdirected and inappropriate

behaviors (e.g., lying, fighting, thefts, drug use); as being more uncertain and

dissatisfied with their social and personal life; and as acting in a more suspicious and

defensive manner about the intentions of others.

Family Environments and the CAS

The relationship between the Clinical Anger Scale and a measure of early family

environment, as assessed by the Family Environment Scale, was also examined.

These correlations were computed for both males and females separately, but only the

results for the combined sample will be interpreted (see Table 3). An inspection of this
 Clinical Anger 17

table reveals that clinical anger was negatively associated with a family history of

cohesion, expressiveness, and shared recreational activities, but was positively related

to an earlier history of family conflict and exaggerated family control (but see the gender

specific correlations). No other correlations were statistically significant.

Discussion

The need for a reliable and valid instrument capable of assessing the symptoms of

clinical anger led to the present research on the construction and preliminary validation

of the Clinical Anger Scale. The Clinical Anger Scale was specifically designed to

measure the array of psychological, physiological, affective, cognitive, motoric, and

behavioral symptoms constituting clinical anger. Preliminary evidence for the validity of

the CAS was demonstrated in a series of analyses showing that clinical anger was

related in a systematic and interpretable manner with measures of state anger, trait

anger, anger control, and anger expressed inwardly and outwardly. Moreover, other

findings revealed that men's and women's feelings of clinical anger were predictably

associated with a number of distinct personality characteristics, psychopathological

symptoms, and inappropriate as well as problematic interpersonal behaviors.

The reliability and validity findings presented in the present investigation would

seem to provide substantial preliminary evidence encouraging the use of the Clinical

Anger Scale among both researchers and mental health practitioners. This assessment

instrument could, for example, be used in the context of a stress inoculation approach to

anger (Novaco, 1975, 1977), research on the interpersonal expression of anger (Holt,

1970; Spielberger et al., 1985), an examination of the role of anger in hypertension and

coronary heart disease (Yuen & Kuiper, 1991; Diamond, 1982; Musante, MacDougall,
 Clinical Anger 18

Dembroski, & Costa, 1989; Spielberger et al., 1985), therapeutic work concerned with

violent behavior (Rothenberg, 1971), the therapeutic treatment of clinical anger

(Deffenbacher, McNamara, Stark, & Sabadell, 1990; Deffenbacher, Story, Start, Hogg,

& Brandon, 1987; Hazaleus & Deffenbacher, 1986), and the study of gender-related

aggressiveness and anger (Frodi, Macaulay, & Thome, 1977; Smith, Ulch, Cameron,

Cumberland, Musgrave & Tremblay, 1989).

In addition, the Clinical Anger Scale provides a way for studying the role of clinical

anger among both clients and nonclients (Rubin, 1986; Tavris, 1982). In clinical

settings, the CAS could provide information helpful in understanding angry clients, the

planning of treatment, and the assessment of therapeutic progress. Client scores on

the CAS could, for example, be compared with non-clinical groups (or against CAS

norms, once they are established). By being administered at several points in time, the

Clinical Anger Scale may also provide valuable information about clinical status and

treatment response. Moreover, in non-clinical settings, the CAS may prove useful in

identifying individuals who have "clinical" levels of anger or those who at risk for

developing clinical anger. Additionally, the CAS can be easily administered in mental

health, prison, educational, and other types of settings to screen for anger

symptomatology. In this sense, the CAS may prove to be useful to employ in applied

settings where the measurement of clinical anger is deemed necessary and helpful

(Sharkin, 1988).

An important caveat is in order here. It is vital to make the distinction between the

assessment of the severity of clinical anger symptomatology and any formal diagnosis

of clinical anger. Clearly it would be improper to diagnose a clinical anger disorder with
 Clinical Anger 19

the CAS or any other self-report instrument. The most appropriate method for deriving

a diagnosis is a clinical interview designed to determine if individuals meet the criteria

specified by some nosological system (e.g., the DSM-III-R). The problem with most

currently recognized classification systems is that they lack a diagnostic class for clinical

anger (cf. clinical depression). Nonetheless, although the CAS was not designed to

yield a diagnosis, it may nonetheless provide a standardized assessment of the severity

of symptomatology which are clinically relevant to anger. The present research

represents an initial step toward the study of these and other important topics

associated with clinical anger.

 Clinical Anger 20

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 Clinical Anger 22

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 Clinical Anger 26

Table 1

Psychometric Properties of the Clinical Anger Scale (CAS)

____________________________________________________________________________________________

Clinical Item-Total Factor Analysis Loadings

Anger Correlations Both Males Females

Scale ______________ ________ _____________ _____________

Item-Labels B M F I II I II III I II III

____________________________________________________________________________________________

1.Angry now .74 .83 .68 .76 .23 .59 .55 .31 .75 .22 .19

2.Angry About Future .70 .74 .65 .60 .37 .36 .77 .24 .55 .20 .41

3.Angry About Failure .13 .19 .11 .01 .23 .20 .12 .00 -.00 .02 .23

4.Angry About Things .75 .83 .70 .77 .25 .59 .47 .37 .77 .26 .17

5.Angry-Hostile Feelings .79 .88 .72 .85 .21 .68 .52 .31 .69 .51 .03

6.Annoying Others .54 .53 .52 .48 .26 .12 .29 .65 .37 .43 .11

7.Angry About Self .62 .58 .64 .54 .33 .26 .34 .50 .61 .15 .36

8.Others Cause My Misery .56 .59 .53 .48 .30 .30 .60 .15 .32 .37 .28

9.Want to Hurt Others .60 .68 .55 .53 .32 .40 .53 .30 .21 .61 .18

10.Shout At People .66 .79 .57 .68 .24 .76 .26 .32 .50 .45 .04

11.Irritated Now .67 .76 .60 .58 .36 .58 .46 .27 .48 .28 .28

12.Social Interference .57 .58 .59 .46 .38 .24 .35 .48 .31 .55 .20

13.Decisioning Interference .73 .80 .68 .52 .55 .60 .36 .43 .30 .51 .44

14.Alienating Others .76 .83 .70 .73 .31 .77 .31 .32 .58 .45 .17

15.Work Interference .68 .72 .64 .49 .51 .64 .42 .17 .29 .45 .46

16.Sleep Interference .69 .76 .63 .42 .63 .51 .36 .47 .33 .25 .63

17.Fatigue .74 .78 .73 .65 .41 .65 .34 .35 .55 .45 .29

18.Appetite Interference .59 .65 .58 .34 .59 .66 .14 .29 .26 .24 .60

19.Health Interference .71 .83 .63 .54 .51 .62 .39 .43 .31 .44 .42

20.Thinking Interference .63 .76 .56 .41 .54 .54 .38 .40 .14 .52 .40
 Clinical Anger 27

21.Sexual Interference .60 .55 .65 .44 .44 .29 -.05 .84 .41 .33 .42

Alpha .94 .95 .92 .-- .-- .-- .-- .-- .-- .-- .--

Standardized Item Alpha .94 .96 .93 .-- .-- .-- .-- .-- .-- .-- .--

Eigenvalue .-- .-- .-- 9.53 .59 11.33 .93 .60 8.71 .88 .57

Percent of Variance .-- .-- .-- 45.40 2.80 54.00 4.40 2.80 41.50 4.20 2.70

____________________________________________________________________________________________

Note. N for both males and females = 379; n for males = 95; n for females = 280. B = both males and females; M =

males; F = females. Loading greater than |.50| are underlined.

 Clinical Anger 28

Table 2

Gender, Validity, and Reliability Results for the Clinical Anger Scale (CAS)

____________________________________________________________________________________________

Results Gender Other Information

____________________________________________________________________________________________

Gender Results: Males Females Fs

Sample I 10.47 8.98 F(1, 132) = 1.49

(6.68) (5.95)

(34) (99)

Sample II 8.20 8.68 F(1, 111) < 1

(4.93) (5.43)

(35) (77)

Sample III 10.46 8.96 F(1, 122) = 1.31

(8.70) (5.86)

(48) (76)

Sample IV 10.80 9.41 F(1, 375) = 1.58

(11.66) (8.39)

(95) (281)

Sample V 12.04 9.83 F(1, 210) = 1.55

(12.86) (10.37)

(51) (160)

Reliability and Social Desirability Results: Males Females Both

Test-retest Reliability (Sample VI) .85a .77d .78d

(6) (28) (34)

Social Desirability (Sample II) -.08 -.15 -.11

(34) (68) (110)

EPI Lie Scale (Sample II) -.11 -.20a -.09

(34) (69) (111)

Validity Results: Males Females Both

STAS State Anger (Sample III) .63d .57d .61d

(47) (75) (122)

STAS Trait Anger (Sample III) .64d .44d .55d

(48) (75) (125)

STAS State Anger (Sample II) .71d .46d .56d

 Clinical Anger 29

(35) (71) (114)

STAS Trait Anger (Sample II) .37a .63d .55d

(35) (71) (114)

Anger Expression-out (Sample III) .55d .27a .44d

(47) (76) (125)

Anger Expression-in (Sample III) .41c .50d .45d

(47) (76) (125)

Anger Expression-control (Sample III) -.39c -.16 -.27d

(47) (76) (125)

Anger Expression-out (Sample II) .08 .42d .36d

(35) (71) (114)

Anger Expression-in (Sample II) .43c .29b .41d

(35) (70) (113)

Anger Expression-control (Sample II) -.25 -.27a -.23b

(35) (71) (114)

____________________________________________________________________________________________

Note. Higher scores correspond to greater amounts of each respective tendency. For the gender ANOVAs, the standard deviations are enclosed

in parentheses and then the group size; otherwise, the number of subjects is shown in parentheses.

a p < .05. b p < .01. c p < .005. d p < .001.

 Clinical Anger 30

Table 3

Correlations Between the the Clinical Anger Scale and Several Other Validity-Related Tendencies

____________________________________________________________________________________________

Results Males Females Both

____________________________________________________________________________________________

Symptom Checklist 90-Revised: (Sample II) (n=35) (n=71) (n=114)

Somatization .34a .27a .39d

Obsessive Symptoms .30a .37d .40d

Interpersonal Sensitivity .40b .53d .53d

Depression .54d .55d .56d

Anxiety .66d .48d .52d

Hostility .65d .74d .68d

Phobic Anxiety .30a .45d .45d

Paranoid Ideation .41b .40d .50d

Psychosis .31a .47d .51d

Global Severity Index .58d .60d .63d

Acting Out: (Sample I) .40a .07 .36d

(30) (89) (124)

Neuroticism: (Sample I) .59d .50d .35d

(30) (86) (123)

Interpersonal Defensiveness: (Sample I) .28+ .32d .17a

(31) (86) (124)

Family Environment Scale: (Sample III) (n=47-48) (n=75-76) (n=123-125)

Cohesion -.45d -.26a -.33d

Expression -.31a -.39d -.35d

Conflict .39c .18 .27d

Independence -.16 -.05 -.12

Achievement Orientation .04 -.01 .02

Intellectual-Cultural Orientation .13 -.16 -.03

Active Recreational Orientation -.15 -.19 -.16a

Moral-Religious Emphasis -.20 .06 -.07

Organization -.06 .00 -.02

Control .22 .41d .32d

Eysenck Personality Inventory: (Sample II) (n=34-35) (n=67-68) (n=110-111)

Extraversion-Introversion -.32a -.21a -.29d

 Clinical Anger 31

Neuroticism .29 .34c .28c

BIG-5 Personality Traits: (Sample II) (n=34-35) (n=67-69) (n=110-112)

Extraversion-Introversion -.27 -.11 -.19a

Pleasantness-Agreeableness -.29a -.20 -.19a

Conscientiousness -.08 -.07 .03

Emotional Stability -.46c -.12 -.25c

Intellect-Sophistication -.26 -.07 -.07

____________________________________________________________________________________________

Note. Ns are enclosed in parentheses. Higher scores indicate a greater intensity of clinical anger, and greater amounts of each of the other

respective tendencies.

a p < .05. b p < .01. c p < .005. d p < .001.