Boiling at a different degree: an investigation of trait and state anger in remitted bipolar I disorder.

BACKGROUND Elevated anger is a prominent clinical feature of bipolar disorder (BD). However, it is unclear whether this feature is characterized by elevated trait anger (i.e., how much anger one experiences in general) and/or state anger (i.e., how much anger one experiences when provoked), how stable anger elevations are (i.e., whether they appear during remission), and whether they have prognostic significance. METHODS The present study assessed trait anger as well as state anger during a neutral baseline and a validated laboratory anger provocation among adults with remitted bipolar I disorder (BD; n=27) and healthy controls (CTL; n=29). To examine prognostic significance, we assessed manic and depressive symptom severity one year later in a subsample of BD participants (n=18). RESULTS Results revealed greater trait anger as well as state anger experience at baseline for the BD compared to the CTL group. No group differences emerged in anger during the provocation. Anger did not predict symptom severity, but greater positive emotion during the provocation predicted mania (but not depression) symptom severity. LIMITATIONS We utilized a relatively high functioning sample of remitted BD patients. Future studies should include BD patients with current mood episodes and more diverse functioning, to ensure generalizability of our results. CONCLUSIONS These findings suggest that BD is characterized by elevated trait and baseline state anger, but not greater responding to anger provocation. Persistently elevated anger may represent a marker of BD, and context-inappropriate positive emotion experience during anger provocation may constitute a vulnerability factor for mania severity.