Journal of Zhejiang University-SCIENCE B

, Volume 20, Issue 4, pp 363–370 | Cite as

Incidence and clinical correlates of anger attacks in Chinese patients with obsessive-compulsive disorder

  • Ying-ying Zhang
  • Heng-fen Gong
  • Xiao-li Zhang
  • Wen-juan Liu
  • Hai-yan Jin
  • Fang Fang
  • Sophie Schneider
  • Elizabeth McIngvale
  • Chen-cheng Zhang
  • Wayne K. Goodman
  • Xi-rong SunEmail author
  • Eric A. StorchEmail author



Anger attacks have been observed in patients with obsessive-compulsive disorder (OCD), often triggered by obsessional triggers. However, few studies have reported the clinical characteristics and correlates of anger attacks among Chinese patients with OCD.


A total of 90 adults with a primary diagnosis of OCD, ranging from 15 to 78 years old, participated in the study. Participants were administered the Rage Outbursts and Anger Rating Scale (ROARS), Yale-Brown Obsessive-Compulsive Scale-Second Edition, and Brown Assessment of Beliefs Scale by a trained clinician. Patients completed the Obsessive-Compulsive Inventory-Revised and Depression Anxiety Stress Scale-21.


A total of 31.3% of participants reported anger outbursts in the past week, and ROARS scores had no significant correlation with age, duration of illness, OCD severity, depression, or stress. However, ROARS scores were negatively related to education level, and positively related to obsessing symptoms and anxiety.


These data suggest that anger attacks are relatively common in Chinese patients with OCD. The severity of anger attacks is related to educational level, obsessing symptoms, and anxiety, which may be a latent variable reflecting executive functioning and emotion regulation skills.

Key words

Obsessive-compulsive disorder Anger attacks Assessment China 


概 要

目 的

强迫症患者的愤怒发作通常由强迫症状触发。然而, 中国强迫症患者愤怒发作临床特征的相关研究报道较少。本研究主要探讨中国强迫症患者愤怒发作的发生率及其临床相关因素。



方 法

九十例 15~78 岁的原发性强迫症患者参与了本研究。研究人员对患者进行了以下量表的评估:愤 怒发作和愤怒严重程度量表 (ROARS)、耶鲁-布朗强迫量表第二版 (Y-BOCS-II) 和布朗信念评估量表 (BABS)。强迫症患者完成了改良强迫问卷-修订版 (OCI-R) 和抑郁焦虑应激量表 (DASS-12)。

结 论

31.3%的强迫症患者在过去一周内有愤怒发作, ROARS 的得分与年龄、疾病病程、强迫症严重程度、抑郁和压力没有显著相关性。ROARS 得分与教育程度呈负相关, 与强迫思维和焦虑程度呈正相关。


强迫症 愤怒发作 评估 中国 

CLC number



Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.



The authors thank all participants and Tessa M. H. NEDERPE (as an internship in Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China) who gave useful suggestions and language modification.


  1. Antony MM, Bieling PJ, Cox BJ, et al., 1998. Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychol Assess, 10(2):176–181. CrossRefGoogle Scholar
  2. Budman C, Coffey BJ, Shechter R, et al., 2008. Aripiprazole in children and adolescents with Tourette disorder with and without explosive outbursts. J Child Adolesc Psychopharmacol, 18(5):509–515. CrossRefGoogle Scholar
  3. Carlson GA, Potegal M, Margulies D, et al., 2009. Rages—what are they and who has them? J Child Adolesc Psychopharmacol, 19(3):281–288. CrossRefGoogle Scholar
  4. Chan RCK, Xu T, Huang J, et al., 2012. Extending the utility of the Depression Anxiety Stress scale by examining its psychometric properties in Chinese settings. Psychiatry Res, 200(2–3):879–883. CrossRefGoogle Scholar
  5. Eisen JL, Phillips KA, Baer L, et al., 1998. The Brown Assessment of Beliefs Scale: reliability and validity. Am J Psychiatry, 155(1):102–108. CrossRefGoogle Scholar
  6. Foa EB, Huppert JD, Leiberg S, et al., 2002. The obsessive-compulsive inventory: development and validation of a short version. Psychol Assess, 14(4):485–496. CrossRefGoogle Scholar
  7. Fraguas R Jr, Papakostas GI, Mischoulon D, et al., 2006. Anger attacks in major depressive disorder and serum levels of homocysteine. Biol Psychiatry, 60(3):270–274. CrossRefGoogle Scholar
  8. Goodman WK, Price LH, Rasmussen SA, et al., 1989a. The Yale-Brown Obsessive Compulsive Scale: I. Development, use, and reliability. Arch Gen Psychiatry, 46(11):1006–1011. CrossRefGoogle Scholar
  9. Goodman WK, Price LH, Rasmussen SA, et al., 1989b. The Yale-Brown Obsessive Compulsive Scale: II. Validity. Arch Gen Psychiatry, 46(11):1012–1016. CrossRefGoogle Scholar
  10. Hirschtritt ME, Bloch MH, Mathews CA, 2017. Obsessive-compulsive disorder: advances in diagnosis and treatment. JAMA, 317(13):1358–1367. CrossRefGoogle Scholar
  11. Johnco C, Salloum A, de Nadai AS, et al., 2015. Incidence, clinical correlates and treatment effect of rage in anxious children. Psychiatry Res, 229(1–2):63–69. CrossRefGoogle Scholar
  12. Krebs G, Bolhuis K, Heyman I, et al., 2013. Temper outbursts in paediatric obsessive-compulsive disorder and their association with depressed mood and treatment outcome. J Child Psychol Psychiatry, 54(3):313–322. CrossRefGoogle Scholar
  13. Moscovitch DA, McCabe RE, Antony MM, et al., 2008. Anger experience and expression across the anxiety disorders. Depress Anxiety, 25(2):107–113. CrossRefGoogle Scholar
  14. Ng F, Trauer T, Dodd S, et al., 2007. The validity of the 21-item version of the Depression Anxiety Stress Scales as a routine clinical outcome measure. Acta Neuropsychiatr, 19(5):304–310. CrossRefGoogle Scholar
  15. Niu CY, Liu WT, Lei H, et al., 2016. The Chinese version of the Brown Assessment of Beliefs Scale: psychometric properties and utility in obsessive compulsive disorder. J Obsess Compuls Relat Disord, 11:39–42. CrossRefGoogle Scholar
  16. Painuly NP, Grover S, Mattoo S, et al., 2011a. Anger attacks in obsessive compulsive disorder. Ind Psychiatry J, 20(2): 115–119. CrossRefGoogle Scholar
  17. Painuly NP, Grover S, Gupta N, et al., 2011b. Prevalence of anger attacks in depressive and anxiety disorders: implications for their construct? Psychiatry Clin Neurosci, 65(2):165–174. CrossRefGoogle Scholar
  18. Peng ZW, Yang WH, Miao GD, et al., 2011. The Chinese version of the Obsessive-Compulsive Inventory-Revised scale: replication and extension to non-clinical and clinical individuals with OCD symptoms. BMC Psychiatry, 11:129. CrossRefGoogle Scholar
  19. Piacentino D, Pasquini M, Tarsitani L, et al., 2016. The association of anger with symptom subtypes in severe obsessive-compulsive disorder outpatients. Psychopathology, 49(1): 40–46. CrossRefGoogle Scholar
  20. Quek TC, Ho CSH, Choo CC, et al., 2018. Misophonia in Singaporean psychiatric patients: a cross-sectional study. Int J Environ Res Public Health, 15(7):1410. CrossRefGoogle Scholar
  21. Radomsky AS, Ashbaugh AR, Gelfand LA, 2007. Relationships between anger, symptoms, and cognitive factors in OCD checkers. Behav Res Ther, 45(11):2712–2725. CrossRefGoogle Scholar
  22. Storch EA, Rasmussen SA, Price LH, et al., 2010. Development and psychometric evaluation of the Yale-Brown Obsessive-Compulsive Scale-Second Edition. Psychol Assess, 22(2):223–232. CrossRefGoogle Scholar
  23. Storch EA, Jones AM, Lack CW, et al., 2012. Rage attacks in pediatric obsessive-compulsive disorder: phenomenology and clinical correlates. J Am Acad Child Adolesc Psychiatry, 51(6):582–592. CrossRefGoogle Scholar
  24. Weiss-Goldman N, Arditi B, Rice T, et al., 2018. Psychopharmacology of the rage attack phenomenon in a child with obsessive compulsive disorder. J Child Adolesc Psychopharmacol, 28(5):360–362. CrossRefGoogle Scholar
  25. Whiteside SP, Abramowitz JS, 2004. Obsessive-compulsive symptoms and the expression of anger. Cogn Ther Res, 28(2):259–268. CrossRefGoogle Scholar
  26. Whiteside SP, Abramowitz JS, 2005. The expression of anger and its relationship to symptoms and cognitions in obsessive-compulsive disorder. Depress Anxiety, 21(3): 106–111. CrossRefGoogle Scholar
  27. Wijaya CS, Lee JJZ, Husain SF, et al., 2018. Differentiating medicated patients suffering from major depressive disorder from healthy controls by spot urine measurement of monoamines and steroid hormones. Int J Environ Res Public Health, 15(5):865. CrossRefGoogle Scholar
  28. Wu MS, Storch EA, 2015. Rage outbursts in adult obsessive-compulsive disorder. Ann Clin Psychiatry, 27(4):304–305.Google Scholar
  29. Yeo SN, Zainal H, Tang CS, et al., 2017. Success/failure condition influences attribution of control, negative affect, and shame among patients with depression in Singapore. BMC Psychiatry, 17:285. CrossRefGoogle Scholar

Copyright information

© Zhejiang University and Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Functional Neurosurgery, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
  2. 2.Department of PsychiatryPudong New District Mental Health CenterShanghaiChina
  3. 3.The People’s Hospital of LeshanSichuanChina
  4. 4.Department of Psychological Medicine, Zhongshan HospitalFudan UniversityShanghaiChina
  5. 5.Department of Psychiatry, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
  6. 6.Department of PsychotherapyShanghai Hongkou Mental Health CenterShanghaiChina
  7. 7.Menninger Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonUSA

Personalised recommendations