A psychodynamic contribution to the understanding of anger - The importance of diagnosis before treatment

Submitted: September 21, 2021
Accepted: May 16, 2022
Published: June 30, 2022
Abstract Views: 2691
PDF: 1410
HTML: 218
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.


This paper starts from the claim that a shared understanding of anger, in both its normal and psychopathological dimensions, is missing and that there are various therapeutic paths that seem to be less effective than those related to other pathologies. A major limitation of anger research and of its treatments lies in the lack of precise clinical diagnoses to inform therapy. For this reason, the first aim of our work is to survey critical literature in order to find useful elements to differentiate anger, starting from the evidence of negative and positive outcomes of treatments. Such evidence will then be enhanced in our proposal of interpretation and intervention, within a dynamic framework and with particular reference to Orefice’s thought. The core focus is to explore the different functions that anger has for the patient and to investigate the elementary functioning of the self. Our reading of the phenomena related to anger will provide useful tools both for understanding the dynamics underlying anger and as a guide for clinical intervention.



PlumX Metrics


Download data is not yet available.


Alia-Klein, N., Gan, G., Bezek, J., Bruno, A., Denson, T.F., Hendler, T., Lowe, L., Mariotti, V., Muscatello, M.R., Palumbo, S., Pellegrini, S., Pietrino. P., Rizzo, A., & Verona, E. (2020). The feeling of anger: From brain network to linguistic expression. Neuroscience and Behavioral Reviews, 108, 480-497. doi:10.1016/j.neubiorev.2019.12.002.
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders. (5th Ed.).
Anderson, C. A., & Bushman, B. J. (2002). Human aggression. Annual Review of Psychology, 53, 27-51. doi:10.1146/annurev.psych.53.100901.135231.
Bankart, C.P. (2006). Trating anger with wisdom and compassion: a buddhist approach. In Anger-Related Disorders: A Practitioner’s Guide to Comparative Treatments Edited by Feindler, E.V. New York: Springer Publishing Company.
Bateman, A., O’Connell, J., Lorenzini, N., Gardner, T., & Fonagy, P. (2016). A randomised controlled trial of mentalization-based treatment versus structured clinical management for patients with comorbid borderline personality disorder and antisocial personality disorder. BMC psychiatry, 16(1), 304. doi:10.1186/s12888-016-1000-9.
Berkowitz, L. (1989). Frustration-aggression hypothesis: Examination and reformulation. Psychological Bulletin, 106, 59-73. doi:10.1037/0033‐2909.106.1.59.
Bernstein, D. P., Arntz, A., & de Vos, M. (2007). Schema focused therapy in forensic settings: Theoretical model and recommendations for best clinical practice. International Journal of Forensic Mental Health, 6, 169-183. doi:10.1080/14999013.2007.10471261.
Berta, M., Zarling, A. (2019). A preliminary examination of an acceptance and commitment therapy-based- program for incarcerated domestic violence offenders. Violence and victims, 34(2), 213-228. doi:10.1891/0886-6708.VV-D-17-00106.
Byrne, G., & Ghráda, Á. N. (2019). The application and adoption of four ‘third wave’ psychotherapies for mental health difficulties and aggression within correctional and forensic settings: A systematic review. Aggression and violent behavior, 46, 45-55.
Bushman, B. J., Baumeister, R. F., & Stack, A. D. (1999). Catharsis, aggression, and persuasive influence: Self-fulfilling or self-defeating prophecies? Journal of personality and social psychology, 76(3), 367.
Bushman, B. J., Baumeister, R. F., & Phillips, C. M. (2001). Do people aggress to improve their mood? Catharsis beliefs, affect regulation opportunity, and aggressive responding. Journal of personality and social psychology, 81(1), 17.
Bushman, B. J. (2002). Does Venting Anger Feed or Extinguish the Flame? Catharsis, Rumination, Distraction, Anger, and Aggressive Responding. Personality and social psychology bulletin, 28(6), 724-731.
Condino, V., Tanzilli, A., Speranza, A.M., & Lingiardi, V. (2016). Therapeutic interventions in intimate partner violence: an overview. Research in Psychotherapy: Psychopathology, Process and Outcome, 19(2), 79-88. doi:10.4081/ripppo.2016.241.
Daly,J.E., & Pelowski, S. (2000). Predictors of dropout among men who batter: A review of studies with implications for research and practice. Violence and Victims,15(2), 137-160.
Deffenbacher, J. L. (2006). Evidence for effective treatment of anger‐related disorders. In E. L. Feindler (Ed.), Anger related disorders: A practitioner’s guide to comparative treatments (pp. 43-69). New York: Springer.
Deffenbacher, J. L. (2011) Cognitive-Behavioral Conceptualization and Treatment of Anger. Cognitive and Behavioral Practice, 18(2), 212-221. doi:10.1016/j.cbpra.2009.12.004.
de la Parra, G., Dagnino, P., Valdés, C., & Krause, M. (2017). Beyond Self-Criticism and Dependency: Structural Functioning of Depressive Patients and Its Treatment. Research in psychotherapy, 20(1), 236. doi:10.4081/ripppo.2017.236.
Del Corno F., Lang M., Colson D. (2013). Il processo diagnostico con i ‘casi difficili’ dal disturbo dell’alleanza al concetto di organizzatore. In (a cura di) Del Corno F., Lang M. Elementi di psicologia clinica. Milano: Franco Angeli Editore.
Deffenbacher, J. L., Demm, P. M., Brandon, A. D. (1986). High general anger: correlates and treatment. Behaviour research and therapy, 24(4), 481-489.
Diamond, G.M., Shahar, B., Sabo, D., & Tsvieli, N. (2016). Attachment-based family therapy and emotion-focused therapy for unresolved anger: The role of productive emotional processing. Psychotherapy, 53(1), 34-44.
DiGiuseppe, R., Tafrate, R.C. (2003). Anger treatment for adults: A meta-analytic review Clinical Psychology: Science and Practice, 10(1), 70-84. doi:10.1093/clipsy/10.1.70.
Donahue, J.J., Santanello, A., Marsiglio, M.C., Van Maschio, L.M. (2017). Acceptance and Commitment Therapy for Anger Dysregulation with Military Veterans: A Pilot Study. J Contemp Psychother, 47, 233-241. doi:10.1007/s10879-017-9361-z.
Echeburúa, E., & Fernández-Montalvo, J. (2009). Evaluación de un programa de tratamiento en prisión de hombres condenados por violencia grave contra la pareja. International Journal of Clinical and Health Psychology, 9(1), 5-20.
Ecstein, D., Milliren, A., Rasmussen, P.R., Willhite. R. (1996). An Adlerian approach to the treatment of anger disorders. In Anger-Related Disorders: A Practitioner’s Guide to Comparative Treatments Edited by Feindler, E.V. New York: Springer Publishing Company.
Edwards, H. (2006). Psychopharmacological considerations in anger management In Anger-Related Disorders: A Practitioner’s Guide to Comparative Treatments (Edited by Feindler, E.V.). New York: Springer Publishing Company.
Eifert, G.H., Forsyth, J.P. (2011). The Application of Acceptance and Commitment to Problem Anger. Cognitive and Behavioral Practice, 241-250.
Eher, R., Hofer, S., Buchgeher, A., Domany, S., Turner, D., Olver, M. (2020). The Predictive Properties of Psychiatric Diagnoses, Dynamic Risk and Dynamic Risk Change Assessed by the VRS-SO in Forensically Admitted and Released Sexual Offenders. Frontiers in Psychiatry, 10. doi:10.3389/fpsyt.2019.00922.
Feindler, E.V. and Byers, A. (2006). Multiple perspective on the conceptualization and treatment of anger-related disorders. In Anger-Related Disorders: A Practitioner’s Guide to Comparative Treatments (Edited by Feindler, E.V.) New York : Springer Publishing Company.
Fernandez, E, & Johnson, S.L. (2016). Anger in psychological disorders: Prevalence, presentation, etiology and prognostic implications. Clinical Psychology Review, 46, 124-135. doi:10.1016/j.cpr.2016.04.012.
Fonagy, P. (2004). The developmental roots of violence in the failure of mentalization. In A Matter of Security. The Application of Attachment Theory to Forensic Psychiatry and Psychotherapy Edited by Friedemann Pfäfflin and Gwen Adshead - Jessica Kingsley Publishers London and New York.
Frazier, S. N., & Vela, J. (2014). Dialectical behavior therapy for the treatment of anger and aggressive behavior: A review. Aggression and Violent Behaviour, 19(2), 156-163.
Gagliardini, G., Gullo, S., Caverzasi, E., Boldrini, A., Blasi, S., & Colli, A. (2018). Assessing mentalization in psychotherapy: first validation of the Mentalization Imbalances Scale. Research in psychotherapy , 21(3), 339. doi:10.4081/ripppo.2018.339.
Galovski, T. E., Malta, L. S., & Blanchard, E. B. (2006). Road rage: Assessment and treatment of the angry, aggressive driver. American Psychological Association, pp. 101-122.
Garaigordobil, M. (2014). Psychology of hatred and violence: Definition, explanatory theories, cognitive-emotional factors and prevention strategies. In A. M. Columbus (Ed.). Advances in psychology research (p. 47-69). Nova Science Publishers.
Gold, J. (2006). Assimilative psychodynamic psychotherapy: an integrative approach to anger disorders. In Anger-Related Disorders: A Practitioner’s Guide to Comparative Treatments (Edited by Feindler, E.V.). New York: Springer Publishing Company.
Hamelin, J., Travis, R., Sturmey, P. (2013). Anger Management and Intellectual Disabilities: A Systematic Review. Journal of Mental Health Research in Intellectual Disabilities, 6(1), 60-70. doi:10.1080/19315864.2011.637661.
Hatcher, R.M., Palmer, E.J., McGuire, J., Hounsome, J.C., Bilby, C.A.L., & Hollin, C.R. (2008). Aggression replacement training with adult male offenders within community settings: A reconviction analysis. The Journal of Forensic Psychiatry & Psychology, 19(4), 517-532.
Holdsworth, E., Bowen, E. Brown, S., Howat, D. (2014). Offender engagement in group programs and associations with offender characteristics and treatment factors: A review. Aggression and Violent Behavior, 19(2), 102-121. doi:10.1016/j.avb.2014.01.004.
Howells, K., Day, A. (2003). Readiness for anger management: clinical and theoretical issues. Clinical Psychology Review, 23(2), 319-337. doi:10.1016/S0272-7358(02)00228-3.
Jarry, J. L., & Paivio, S. C. (2006). Emotion-focused therapy for anger. In Anger-related disorders: A practitioner’s guide to comparative treatments (pp. 203-230), Edited by Feindler, E. L.. New York: NY Springer.
Jinkerson, J., Masila, A., & Hawkins, R.C. (2015). Can Myers-Briggs dimensions predict therapy outcome? Differences in the Thinking-Feeling function pair in cognitive therapy for depression/anxiety. Research in Psychotherapy: Psychopathology, Process and Outcome, 18(1), 21-31. doi:10.7411/RP.2014.022.
Josephs, L., & McLeod, B.A. (2014). A theory of mind–focused approach to anger management. Psychoanalytic Psychology, 31, 68-83.
Kassinove, H., & Tafrate, R. C. (2010). Anger. In D. McKay, J. S. Abramowitz, & S. Taylor (Eds.). Cognitive-behavioral therapy for refractory cases: Turning failure into success (pp. 297-323). American Psychological Association. doi:10.1037/12070-014.
Kennedy, H.G. (1992). Anger and Irritability. The British Journal of Psychiatry, 161(2), 145-153. doi:10.1192/bjp.161.2.145.
Keulen‐de Vos, M., Bernstein, D. P., & Arntz, A. (2014). Schema therapy for aggressive offenders with personality disorders. In R. C. Tafrate, & D. Mitchell (Eds.), Forensic CBT: A handbook for clinical practice (pp. 66-83). Oxford, UK: John Wiley & Sons. doi:10.1002/9781118589878.ch4.
Keulen‐de Vos, M. E., Bernstein, D. P., Vanstipelen, S., de Vogel, V., Lucker, T. P. C., Slaats, M., & Arntz, A. (2016). Schema modes in criminal and violent behavior of forensic cluster B PD patients: A retrospective and prospective study. Legal and Criminological Psychology, 21, 56-76. doi:10.1111/lcrp.12047.
Kernberg, O.F. (1994). Aggression, trauma, and hatred in the treatment of borderline patients. The psychiatric clinics of North America, 17(4), 701-714.
Kernberg, O. F. (2018). (Ed.) Treatment of Severe Personality Disorders: Resolution of Aggression and Recovery of Eroticism (322 p.). Arlington, Virginia: American Psychiatric Association Publishing.
Knafo, D., & Moscovitz, S. (2006). Psychoanalytic treatment of anger and aggression. In Anger-Related Disorders: A Practitioner’s Guide to Comparative Treatments (Edited by Feindler, E.V.) New York : Springer Publishing Company.
Kohut, H. (1971). The Analysis of the Self. NY: International Universities Press.
Kohut, H. (1978). Thoughts on Narcissism and Narcissistic Rage. In The Search for The Self, Vol. 2. Edited by Ornstein P. NY: International Universities Press.
Kramer, U., Pascual-Leone, A., Despland, J. N., & de Roten, Y. (2015). One minute of grief: Emotional processing in short-term dynamic psychotherapy for adjustment disorder. Journal of Consulting and Clinical Psychology, 83(1), 187.
Kramer, U., Pascual‐Leone, A., Berthoud, L., de Roten, Y., Marquet, P., Kolly, S., Despland, J‐N., Page, D. (2016). Assertive Anger Mediates Effects of Dialectical Behaviour‐informed Skills Training for Borderline Personality Disorder: A Randomized Controlled Trial. Clinical Psychology Psychotherapy, 23, 189-202. doi:10.1002/cpp.1956.
Kulesza, M., & Copeland, A. L. (2009). Cognitive‐behavioral treatment for anger problems: A review of the literature. Behaviour Therapist, 32, 102-108.
Locati, F., De Carli, P., Tarasconi, E., Lang, M., Parolin, L. (2016). Ruptures and transference in a single-case study. Research in Psychotherapy: Psychopathology, Process and Outcome, 19, 89-10.
Lee, A.H., DiGiuseppe R. (2018). Anger and aggression treatments: a review of meta-analyses. Current Opinion in Psychology, 19, 65-74. doi:10.1016/j.copsyc.2017.04.004.
Lewis, M. (1993). The development of anger and rage. In R. A. Glick & S. P. Roose (Eds.). Rage, Power and Aggression: The Role of Affect in Motivation, Development, and Adaptation, New Haven & London: Yale University Press.
Lochman, J. E., Whidby, J. M., & FitzGerald, D. P. (2000) Cognitive-behavioral assessment and treatment with aggressive children. In P. C. Kendall (Ed.), Child & adolescent therapy: Cognitive-behavioral procedures (p. 31-87). Guilford Press.
Marshall, W. L. (1999). Current Status of North American Assessment and Treatment Programs for Sexual Offenders. Journal of Interpersonal Violence, 14(3), 221-239. doi:10.1177/088626099014003002.
Mary McMurran, M. & Theodosi, E. (2007). Is treatment non-completion associated with increased reconviction over no treatment? Psychology, Crime & Law, 13(4), 333-343. doi:10.1080/10683160601060374.
Megargee, E.I. (1984, 2012). Aggression and Violence. In: H.E. Adams, P.B. Sutker (Eds.). Comprehensive Handbook of Psychopathology. Springer, Boston, MA. doi:10.1007/978-1-4615-6681-6_19.
Menninger, W. (2007). Bulletin of the Menninger Clinic. Guilford Publications, 71(2), 115-131.
Moeller, S.B., Kvist, V., Jansen, J.E., & Watkins, E.R. (2021). Clinical Case of a Schizotypal Personality Disorder: Rumination-Focused CBT for Anger Rumination. Journal of Contemporary Psychotherapy, 51, 311-321. doi:10.1007/s10879-021-09501-y.
Moscosa, M.S., & Spielberg, C.D. (2011). Cross-cultural assessment of emotions: The expression of anger. Revista de Psicología, 29(2), 243-360. doi:19.18800/PSICO.201102.007
Neacsiu, A. D., Rizvi, S.L., & Linehan, M. M. (2010). Dialectical behaviour therapy skills use as a mediator and outcome of treatment for borderline personality disorder. Behaviour Research and Therapy, 48, 832-839.
Nicoll, M., Beail, N., Saxon, D. (2013). Cognitive behavioural treatment for anger in adults with intellectual disabilities: a systematic review and meta-analysis. Journal of Applied Research in Intellectual Disabilities, 26, 47-62. doi:10.1111/jar.12013.
Novaco, R.W. (1994) Anger as risk factor for violence among the mentally disordered. In J. Monahan, & H. J. Steadman (Eds.). Violence and Mental Disorder: Developments in Risk Assessment. The University of Chicago Press/ Chicago and London.
Novaco, R.W.; Welsh, W. N. (1989). Anger Disturbances: Cognitive Mediation and Clinical Prescriptions. In K. Howells, & C.V. Hollin (Eds.). Clinical Approaches to Violence (pp. 39-60). NCJ-125629.
Olver, M.E., Kingston, Drew, A., Nicholaichuk, T.P., & Wong, S.C.P. (2014). A psychometric examination of treatment change in a multisite sample of treated Canadian federal sexual offenders. Law and Human Behaviour, 38(6), 544-559.
Olver, M. E., Nicholaichuk, T. P., Kingston, D. A., & Wong, S. (2020). A prospective multisite examination of dynamic sexual violence risk: Extension and update to Olver, Nicholaichuk, Kingston, and Wong (2014). Journal of consulting and clinical psychology, 88(4), 362-371. doi:10.1037/ccp0000478.
Orefice, S. (2002). La sfiducia e la diffidenza. Metodologia clinica per i casi difficili. Milano: Raffaello Cortina Editore.
Orefice, S. (2013). Seminario ‘Psicopatologie e efficacia clinica’ organizzato da ARP, Associazione per la Ricerca in Psicologia Clinica, 16 novembre, Milano.
Paivio,S. C., & Carriere, M. (2007). Contributions of emotion-focused therapy to the understanding and treatment of anger and aggression. In T. A., Cavell, & K., Malcolm (Eds.). Anger, aggression, and interventions for interpersonal violence (pp. 143-164). Mahwah, NJ: Lawrence Erlbaum Associates.
O’Reilly, G., Carr, A., Murphy, P., Cotter, A. (2010). A Controlled Evaluation of a Prison-Based Sexual Offender Intervention Program. Sexual Abuse: Journal of Research and Treatment, 22(1), 95-111.
Ornstein, P.H. (1999). Conceptualization and treatment of rage in self psychology. Journal of Clinical Psychology, 55, 283-293.
Panksepp, J., & Biven, L. (2012). The Archaeology of Mind: Neuroevolutionary Origins of Human Emotion. New York: W. W. Norton & Company.
Pascual‐Leone, A., & Paivio, S. C. (2013). Emotion‐focused therapy for anger in complex trauma. In E. Fernandez (Ed.), Treatments for anger in specific populations. Theory, application and outcome (pp. 33-51). New York: Oxford University Press.
Pascual‐Leone, A., Gillis, S., Singh, T., & Andreescu, C. (2013). Problem anger in psychotherapy: An emotion‐focused perspective on hate, rage and rejecting anger. Journal of Contemporary Psychotherapy, 43(2), 83-92.
Pascual‐Leone, A., & Kramer, U. (2017). Developing emotion‐based case formulations: A research‐informed method. Clinical Psychology & Psychotherapy, 24(1), 212-225.
Pelin, D., Timo, L., Türker, O., & Esma, G. (2021). Masculinity, femininity, and angry drivers: Masculinity and femininity as moderators between driver anger and anger expression style among young drivers. Accident Analysis and Prevention, 161, 106347. doi:10.1016/j.aap.2021.106347.
Polaschek, D.L.L. (2010). High-Intensity rehabilitation for violent offenders in New Zealand: Reconviction outcomes for high and medium-risk prisoners. Journal of Interpersonal Violence Available from: http://jiv.sagepub.com/content/early/2010/05/26/ 0886260510365854
Robinson, M.D, Traurig, E., & Klein, R.J. (2020). On looking versus leaping: A situated multilevel approach to trait anger and the anger-aggression relationship. Personality and Individual Differences, 164, 110130. doi:10.1016/j.paid.2020.110130.
Rogier, G., Garofalo, C., & Velotti, P. (2019). Is emotional suppression always bad? A matter of flexibility and gender differences. Current Psychology, 38(2), 411-420. doi:10.1007/s12144-017-9623-7.
Rudge, S., Feigenbaum, J.D., & Fonagy, P. (2020). Mechanisms of change in dialectical behaviour therapy and cognitive behaviour therapy for borderline personality disorder: a critical review of the literature. Journal of Mental Health, 29(1), 92-102. doi:10.1080/09638237.2017.1322185.
Serin, R.C., Gobeil, R., & Preston, D.L. (2009). Evaluation of the persistently violent offender treatment program. International Journal of Offender Therapy and Comparative Criminology, 53(1), 57-73.
Sell, A. N. (2011). The recalibrational theory and violent anger. Aggression and violent behavior, 16(5), 381-389.
Spielberger, C.D. (1999). State-Trait Anger Expression Inventory (STAXI) -2. Psychological Assessment Resource Inc., Odessa, FL.
Stefanska, E.B., Higgs, T., Carter, A.J., & Beech, A.R. (2017). ‘We boil at different degrees’: factors associated with Severity of attack in sexual killing. Journal of Criminal Justice, 50, 53-61. doi:10.1177/0886260518758333.
Steinmann, R., Gat, I., Nir-Gottlieb, O., Shahar, B., & Diamond, G.M. (2017). Attachment-based family therapy and individual emotion-focused therapy for unresolved anger: Qualitative analysis of treatment outcomes and change processes. Psychotherapy, 54(3), 281-291.
Tavris, C. (2017). Anger: The misunderstood emotion. Touchstone.
Tivis, L.J., Parsons, O.A. & Nixon, S.J. (1998). Anger in an Inpatient Treatment Sample of Chronic Alcoholics. Alcoholism. Clinical and Experimental Research, 22, 902-907. doi:10.1111/j.1530-0277.1998.tb03887.x.
Geffner, R., Franey, K.C., Arnold, T.G., & Falconer, R. (2013). Identifying and Treating Sex Offenders: Current Approaches, Research, and Techniques (pp. 1-292). Taylor and Francis. doi:10.4324/9780203824443.
Wiener, J. (1998). Under the volcano: varieties of anger and their transformation. Journal of Analytical Psychology, 43(4), 493-508.
Winnicott, D. W. (1971). Playing and Reality. London & New York: Routledge.

How to Cite

Manfredi, P., & Taglietti, C. . (2022). A psychodynamic contribution to the understanding of anger - The importance of diagnosis before treatment. Research in Psychotherapy: Psychopathology, Process and Outcome, 25(2). https://doi.org/10.4081/ripppo.2022.587

Similar Articles

1 2 > >> 

You may also start an advanced similarity search for this article.