Comparing Self-Reported and Clinician-Rated Anger Across Psychiatric Diagnoses in Partial Hospitalization

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Findings regarding anger’s diagnostic associations have also been inconsistent. The present study examined whether self-reported and clinician-rated anger showed overlapping versus distinct associations with psychiatric diagnoses in a heterogeneous partial hospitalization sample. A total of 727 patients completed a comprehensive diagnostic evaluation prior to admission, including clinician-rated anger items from the Schedule for Affective Disorders and Schizophrenia (SADS) and self-reported anger on the Clinically Useful Anger Outcome Scale (CUANGOS). We examined associations between each anger measure and a broad range of psychiatric diagnoses and compared the relative strength of those associations across assessment modalities. Both self-reported and clinician-rated anger were associated with major depressive disorder, generalized anxiety disorder, posttraumatic stress disorder, impulse control disorders, attention-deficit/hyperactivity disorder, borderline personality disorder, substance use disorders, and cannabis use disorder. However, only self-reported anger was associated with bipolar disorder during a current depressive episode and panic disorder. Self-reported anger was also more strongly associated than clinician-rated anger with bipolar depression and posttraumatic stress disorder. Overall, the findings suggest substantial overlap between self-reported and clinician-rated anger, while also indicating that self-report may capture somewhat broader diagnostic information in partial hospitalization settings. These results support the value of explicitly assessing anger during psychiatric intake, even when it is not the patient’s primary presenting complaint. anger irritability self-report clinician rating psychiatric assessment partial hospitalization Introduction Although afflictive emotions such as anxiety, depression, and anger appear across psychopathology, anger has been relatively less examined (Genovese et al., 2017 ). This relative neglect persists despite contemporary evidence that irritability and anger-related phenomena remain common and clinically consequential in adults, particularly in relation to depressive and anxious symptom burden (Perlis et al., 2024 ; Rizk et al., 2025 ). Capturing anger in psychological science is challenging because it is a multifaceted construct shaped by cultural, social, and historical influences. Cultural norms around emotional expression can influence whether anger is encouraged, suppressed, or interpreted as problematic, and social structures such as gender and power dynamics further shape how anger is expressed and evaluated (Matsumoto et al., 2008; Shields, 2002). These contextual dimensions underscore the need for nuanced and clinically useful methods of assessing anger in psychiatric samples. Anger comprises affective, cognitive, physiological, and behavioral components. It includes the subjective experience of irritation, frustration, or rage, appraisals of perceived injustice or threat, autonomic arousal, and behavioral expressions that may range from verbal outbursts to more overt aggressive responses (Averill, 1982, 1983; Izard, 1991; Lazarus, 1991; Levenson, 1992). Anger may function adaptively when it signals injustice or motivates corrective action, but maladaptively when it becomes chronic, excessive, or poorly regulated (Averill, 1982). Persistent or intense anger has been associated with negative psychological, physiological, and interpersonal consequences, including elevated stress responding, cardiovascular burden, and impaired relationships (Averill, 1982; Suls & Bunde, 2005). Unlike depression and anxiety, anger is not fully represented in a stand-alone diagnosis (Cassiello-Robbins & Barlow, 2016 ). Rather, one aspect of anger—behavioral or verbal aggression—is most closely represented in the Diagnostic and Statistical Manual (5th ed.; DSM-5; American Psychiatric Association [APA], 2013) by intermittent explosive disorder (IED), which involves recurrent outbursts that may result in harm to self or others. Aside from IED, anger and/or irritability (a lower-intensity form of anger; Brotman et al., 2007) appears as a diagnostic criterion in disorders such as manic or hypomanic episodes, posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and borderline personality disorder (BPD). However, it often remains unclear whether anger is a clinically meaningful presenting problem for patients with these diagnoses. For instance, a provider reviewing a patient’s chart with a GAD diagnosis would not be able to infer the presence or severity of the patient’s anger from the diagnosis alone. This limitation highlights the difficulty of capturing anger adequately within existing diagnostic frameworks. Prior work has begun to clarify associations between anger and psychiatric diagnoses. In a review, Cassiello-Robbins and Barlow ( 2016 ) concluded that anger was significantly associated with IED, BPD, PTSD, and GAD. Studies have also linked elevated anger with greater symptom severity in PTSD and GAD, and more recent symptom-level work suggests that irritability is meaningfully intertwined with PTSD and depression rather than merely representing a trivial peripheral feature (Zhan et al., 2024 ). In one large outpatient sample, bipolar I disorder, PTSD, IED, and cluster B personality disorders were associated with subjective anger, whereas GAD, IED, and cluster B personality disorders were associated with aggression (Genovese et al., 2017 ). Additional literature has identified significant associations between anger and diagnoses for which anger is not a formal diagnostic criterion. For example, obsessive-compulsive disorder (OCD), social anxiety disorder (SAD), and panic disorder have each been linked to elevated anger (Cassiello-Robbins & Barlow, 2016 ). In the same large outpatient sample, major depressive disorder (MDD), panic disorder with agoraphobia, and eating disorders were associated with subjective anger, while MDD was associated with aggression (Genovese et al., 2017 ). Elevated anger has also been associated with greater symptom severity in OCD (Barrett et al., 2013 ). Despite these findings, inconsistencies remain across studies. Within one research group, two studies drawing from the same outpatient population yielded conflicting findings regarding the association between aggression and several diagnoses (Genovese et al., 2017 ; Posternak & Zimmerman, 2002 ). Genovese et al. ( 2017 ) reported that panic disorder with agoraphobia, PTSD, and impulse control disorders were significantly associated with aggression, whereas Posternak and Zimmerman ( 2002 ) did not. In contrast, Posternak and Zimmerman ( 2002 ) reported significant associations between aggression and bipolar disorder as well as substance use disorders, whereas Genovese et al. ( 2017 ) did not. Mixed findings have also emerged for GAD, PTSD, panic disorder, OCD, and social phobia (e.g., Barrett et al., 2013 ; Corrigan & Watson, 2005 ; Hawkins & Cougle, 2017; Moscovitch et al., 2008 ; Pulay et al., 2008 ). Taken together, the literature suggests that the diagnostic correlates of anger may depend meaningfully on sample characteristics, clinical setting, and the way anger is measured. Clarifying diagnostic associations with anger is important because anger appears to have meaningful clinical consequences. Even mild or moderate levels of anger as measured by the Clinically Useful Anger Outcome Scale (CUANGOS) were associated with impairment in functioning and well-being, including lower life satisfaction, poorer daily functioning, lower quality of life, greater suicide attempts, and higher clinician-rated psychosocial morbidity (Levin-Aspenson, Diehl, Boyd, & Zimmerman, 2022 ). Elevated anger at intake has also been associated with worse depression and PTSD symptoms at discharge (Fava et al., 1991 ; Forbes et al., 2008 ). Anger has been shown to reduce therapeutic alliance and engagement in treatment (Morland et al., 2012 ), and from a clinician perspective may be among the most difficult emotions to address effectively in therapy (Boswell, 2016 ). Contemporary work in acute psychiatric settings further suggests that patients’ self-reported anger can be clinically informative, including for short-term aggressive behavior risk (Deptula et al., 2025 ). Together, these findings underscore the clinical importance of anger and the need to better understand its place within psychopathology. Few studies have examined anger in partial hospitalization programs, where patients typically present with greater clinical severity than patients in outpatient settings. In fact, despite the large number of registered partial hospitalization programs, relatively little research has been reported from these settings (Beard et al., 2016 ). The present study extends the literature by examining anger in a partial hospitalization program (PHP) sample characterized by both substantial symptom severity and diagnostic heterogeneity. Accordingly, an important clinical question is whether self-reported and clinician-rated anger provide similar versus distinct diagnostic information at intake. Few studies have directly compared self-reported and clinician-rated anger as indicators of clinical status. Evidence from adjacent assessment literatures suggests that self-report and clinician-rated measures can be strongly related overall while still diverging meaningfully in symptom estimates, severity ratings, and diagnostic classification (Kramer et al., 2023 ). Prior work on depression has likewise shown that self- and clinician-rated modes of assessment can make distinct contributions to psychopathology measurement (Cuijpers et al., 2010 ; Levin-Aspenson & Watson, 2018 ; Uher et al., 2012 ). In the same vein, it is important to determine whether self-reported and clinician-rated anger show similar diagnostic utility, as the answer could inform how anger is measured in routine clinical practice. The primary purpose of the present study was to examine whether self-reported and clinician-rated anger showed similar versus distinct associations with psychiatric diagnoses in a large, diagnostically heterogeneous PHP sample. We hypothesized that diagnoses that include anger or irritability in their diagnostic criteria (e.g., BPD, GAD, PTSD) would be associated with elevated self- and clinician-rated anger. Additionally, in line with prior findings from smaller and more specific samples summarized by Cassiello-Robbins and Barlow ( 2016 ), we hypothesized that both measures of anger would also be associated with greater odds of receiving other mood and anxiety disorder diagnoses, as well as attention-deficit/hyperactivity disorder (ADHD) and substance use disorders. Supplementary to this primary aim, we examined whether these diagnostic associations differed across self-reported and clinician-rated modes of assessment. Method Participants The sample used in this study ( N = 727) was drawn from a larger population of patients who were admitted to a PHP between April 2014 and August 2019. Included participants in this study were patients who completed a full initial diagnostic evaluation by semi-structured interview and completed demographic data and self-reported anger scores via the CUANGOS. The average age was 35.44 years (SD = 14.09, range = 18–77). The average length of stay for the sample was 7.70 days ( SD = 5.18; range = 0–35 days). The Rhode Island Hospital institutional review committee approved the research protocol, and all participants provided informed written consent. The first three authors, as employees of Rhode Island Hospital, had access to these data from June 2018 to June 2020, and the last author is the principal investigator of the study. All procedures performed in this study were in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments. Measures All included measures were administered at the same timepoint, except for treatment dropout. The patients included in this study received initial diagnostic evaluations by trained clinical interviewers using the Structured Clinical Interview for DSM-IV (SCID-IV; First et. al., 1994 ) for clinical disorders and the Structured Interview for DSM-IV Personality (SIDP-IV; Pfohl & Zimmerman, 1997) for BPD. We additionally assessed DSM-IV impulse control disorders (pyromania, kleptomania, pathological gambling, other-specified impulse control disorders, and unspecified impulse control disorders). Information about interviewer training and diagnostic reliability are available in other MIDAS project publications (see Zimmerman, 2016 ; Zimmerman et. al., 2015 ). These publications describe the rigorous training and reliability rating process interviewers go through before interviewing patients for the MIDAS project. Our analyses included only current diagnoses; diagnoses in full or partial remission were excluded as including them could skew results or complicate interpretation, as the outcomes may not accurately reflect full remission or active disorder states (Meinert et al., 2022). Some diagnoses were collapsed into diagnostic categories due to low sample size (e.g. a total of 14 patients in our sample were diagnosed with any psychotic disorder), or to examine a related group of diagnoses in addition to individual diagnoses (e.g. all substance use disorders [ASUDs] were included for analysis in addition to individually examining alcohol use disorder, cannabis use disorder, and all other substance use disorders. While interviewers administered the full Schedule for Affective Disorders and Schizophrenia (SADS; Endicott & Spitzer, 1978 ), we used the two items within the SADS that assess levels of subjective anger and overt irritability during the preceding week. They explicitly assess: 1) severity of subjective anger during the preceding week and 2) severity of overt expression of anger during the preceding week. Each item was rated on a scale from 0 (“not at all”) to 5 (“extreme”). The two items were significantly correlated ( r = .66, p < .001) and thus were combined to make a dimensional clinician rating of overall anger. The Clinically Useful Anger Outcome Scale (CUANGOS) is a 5-item measure from our research group that assesses symptoms of anger in the past week including subjective feelings of anger and overt displays of anger and irritability (Levin-Aspenson, Boyd, Diehl, & Zimmerman, 2021 ). Items are rated on a scale from 0 (“not at all”) to 4 (“extremely”), with total scores ranging from 0 to 20 and higher scores indicating the presence of increased symptoms. The internal consistency of the CUANGOS in the present study was strong (Cronbach’s α = .86). The items can be viewed in the supplement in Table S2. Analyses All analyses were conducted using SPSS version 25 and the CorrToolBox package in R. We first performed regressions and ANOVA procedures to test whether SADS scores and CUANGOS scores varied by race, age, gender identity, level of education, and total DSM diagnoses. We next standardized all continuous variables and running bivariate correlations between the different measures of anger used in this study. We then used logistic regression to determine the extent to which self- or clinician-rated anger was associated with increased odds of receiving a given diagnosis. To compare the strength of associations, we calculated biserial correlations between self- and clinician-rated anger scores with each diagnosis. Biserial correlations are recommended for this procedure because the anger scores are continuous, and each diagnosis is dichotomous but are assumed to represent an underlying construct with a continuous distribution (Tate, 1955). From these results, we calculated Fischer’s r -to- z transformation to test whether the strength of diagnostic associations differed by mode of assessment (Lee & Preacher, 2013). This method is well-supported across samples of normal distributions, skewed distributions, and various other specific applications (e.g., Silver, 1987; Shohoji, 1981; and Hjelm, 1962). Results Demographic information for this sample can be found in Table 1 . The sample was predominately female (69.4%), white (71.7%), and well educated (77.5% completed at least some college). CUANGOS scores correlated strongly with subjective feelings of anger ( r =.59, p <.001), overt irritability ( r =.60, p <.001), and the combined SADS anger score ( r = 66., p <.001). The only demographic variable significantly associated with different anger scores was age; as age increased, both SADS and CUANGOS scores decreased (see Supplement Paragraph 1 for further details). Table 1 Demographic Characteristics of the Sample (n = 727) Gender N % Male 202 27.8 Female 506 69.6 Transgender and/or nonbinary Education 19 2.6 Less than high school 40 5.6 Graduated high school 449 61.8 Graduated college or greater 238 32.6 Marital status Married/living together 283 38.9 Divorced/separated 102 14.0 Widowed 10 1.4 Never married 332 45.7 Ethnicity White 523 71.8 African American/Black 40 5.5 Hispanic/Latinx 81 11.1 Asian 31 4.3 Other 53 7.3 Self- and clinician-rated anger scores both were significantly associated with increased likelihood of being diagnosed with MDD, GAD, PTSD, impulse control disorders, ADHD, BPD, substance use disorders in general, and cannabis use disorder in particular (Table 2 ). Diagnoses of bipolar disorder (current episode depressed) and panic disorder were significantly were significantly associated only with self-report anger scores. There were no diagnoses predicted only by clinician-rated anger. Finally, anger was significantly associated with reduced likelihood of receiving a diagnosis of adjustment disorder. Mean CUANGOS and SADS scores for each diagnostic group are presented in Supplemental Table 1. Anger’s diagnostic associations largely did not differ across self- or clinician-rated modes of assessment with a few exceptions. PTSD and bipolar disorder (currently depressed were more strongly correlated with CUANGOS scores while bipolar disorder (currently manic or hypomanic) was more strongly associated with SADS scores (Table 3 ). Table 2 Odds Ratios of Diagnoses of Clinician-rated and Self-report Anger Patient Group SADS anger items Z-score Odds-ratio (95% CI) CUANGOS Z-score Odds-ratio (95% CI) Major depressive disorder 1.17* (1.00, 1.36) 1.23* (1.04, 1.45) Dysthymia 1.07 (0.89, 1.28) 1.14 (0.94, 1.37) Any bipolar I disorder 1.14 (0.83, 1.58) 1.25 (0.91 to 1.72) Any bipolar II disorder 1.37 (0.97, 1.91) 1.37 (1.00 to 1.89) Bipolar I and II disorder, depressed 1.26 (0.97, 1.63) 1.45** (1.13 to 1.86) Bipolar I and II disorder, (Hypo)manic 1.39 (0.62, 3.15) 0.66 (0.25 to 1.73) Panic disorder 1.17 (1.00, 1.37) 1.31*** (1.12 to 1.54) Agoraphobia 1.09 (0.91, 1.29) 1.14 (0.95 to 1.36) Generalized anxiety disorder 1.25** (1.08, 1.44) 1.32*** (1.13, 1.54) Social Phobia 1.04 (0.90, 1.21) 1.14 (0.97, 1.33) Specific Phobia 0.95 (0.73, 1.22) 1.02 (0.78, 1.33) Posttraumatic stress disorder 1.46*** (1.24, 1.72) 1.71*** (1.45, 2.01) Obsessive-compulsive disorder 1.09 (0.82, 1.44) 1.15 (0.87, 1.53) Any adjustment disorder 0.72* (0.53, 0.98) .57** (0.39, .84) Any psychotic disorder 0.98 (0.58, 1.67) 1.06 (0.62, 1.81) Any impulse control disorder 1.43*** (1.28, 1.57) 1.23* (1.06, 1.41) Any Eating Disorder 1.07 (0.83, 1.37) 1.21 (0.94, 1.56) Any Somatoform Disorder 1.15 (0.79, 1.66) 1.24 (0.86, 1.79) Attention-Deficit / hyperactivity disorder 1.27** (1.06, 1.51) 1.29** (1.08, 1.54) Borderline personality disorder 2.22*** (1.79, 2.65) 2.15*** (1.78, 2.58) All substance use disorders 1.33** (1.11, 1.59) 1.34** (1.12, 1.60) Alcohol use disorder 1.16 (0.91, 1.49) 1.17 (0.91, 1.51) Cannabis use disorder 1.57*** (1.24, 2.00) 1.56*** (1.24, 2.00) Other Drug Use Disorder 1.03 (0.68, 1.56) 1.17 (0.98, 1.05) * p < .05, ** p < .01, *** p < .001; significantly-predicted disorders are noted in bold Table 3 Significant differences between biserial correlations Patient Group SADS anger items Biserial correlation CUANGOS Biserial correlation Fischer’s r to z transformation MDD .098* .129** -1.012 Dysthymia .037 .072 -1.135 Bipolar I Disorder .067 .077 -0.325 Bipolar II Disorder .141 .161 -0.656 Bipolar Disorder, Depressed .113 .173** -1.968* Bipolar Disorder, (Hypo)manic .119 − .102 7.220*** Panic Disorder .095* .133** -1.240 Agoraphobia .043 .095 -1.689 GAD .131*** .154*** − .0754 Social Phobia .031 .060 -0.940 Specific Phobia − .040 .012 -1.685 PTSD .217*** .300*** -2.804** OCD .042 .069 -0.876 Any Adjustment Disorder − .152* − .177* 0.823 Any Psychotic Disorder .002 − .048 1.62 Any Impulse Control Disorder .225*** .166* 1.956 Any Eating Disorder .043 .070 -0.876 Any Somatoform Disorder .061 .121 -1.95 ADHD .138** .137** 0.033 BPD .414*** .395*** 0.685 All SUDs .188*** .177** 0.363 AUD .081 .084 -0.098 Cannabis Use Disorder .229 .206 0.766 * p < .05, ** p < .01, *** p < .001; significant differences between self-reported and clinician-rated anger are noted in bold Discussion This study examined associations between baseline self-reported and clinician-rated anger and a range of psychiatric diagnoses in a diagnostically heterogeneous sample of partial hospitalization patients. Prior work has found significant associations between anger and multiple diagnoses (e.g., Genovese et al., 2017 ; Posternak & Zimmerman, 2002 ), but the present study extends that literature to a relatively large partial hospitalization sample. To our knowledge, it is also among the first studies to compare self-reported and clinician-rated anger across a broad range of diagnoses in this setting. Importantly, both measures used here—the CUANGOS and the SADS anger items—capture both subjective feelings of anger and overt displays of anger. Taken together, these findings support the assessment of anger as a clinically useful complementary indicator in psychiatric intake, in addition to its relevance for psychosocial functioning and morbidity (e.g., Levin-Aspenson et al., 2022 ). Contemporary adult work likewise suggests that irritability and anger-related phenomena remain clinically meaningful across psychopathology (Perlis et al., 2024 ; Rizk et al., 2025 ). These findings support the significance of anger as a transdiagnostic symptom dimension. Notably, both SADS anger-item scores and CUANGOS scores were significantly associated with myriad diagnoses, including MDD, GAD, PTSD, impulse control disorders, ADHD, BPD, substance use disorders, and cannabis use disorder. These results build on prior literature by suggesting that anger is broadly relevant across multiple forms of psychopathology, although self-reported anger was associated with more diagnoses than clinician-rated anger in the present sample. It is not surprising that anger was associated with GAD, PTSD, and BPD, as these diagnoses include irritability and/or anger-related behavior in their diagnostic criteria. It is more notable that several diagnoses for which anger is not a formal criterion were also associated with anger, which further underscores its broader clinical importance. This pattern is broadly consistent with newer adult literature indicating that irritability and related anger phenomena track substantial affective burden and psychiatric comorbidity rather than a single narrow diagnosis (Perlis et al., 2024 ; Rizk et al., 2025 ). Clinically, these findings reinforce the value of assessing anger even when it is not the patient’s primary presenting complaint. CUANGOS scores were more strongly associated with PTSD than were SADS anger-item scores. Although direct comparisons of self-report versus clinician-rated anger in PTSD remain limited, more recent work suggests that irritability is closely tied to PTSD and depressive symptom structure (Zhan et al., 2024 ). In adjacent PTSD assessment research, self-report and clinician-rated measures appear capable of aligning globally while still differing in clinically meaningful ways at the level of severity estimates and symptom patterns (Kramer et al., 2023 ). Future research should therefore continue to examine whether mode of assessment meaningfully shapes how anger is captured in PTSD and related conditions. Anger was associated with a significantly lower likelihood of receiving an adjustment disorder diagnosis. In the present sample, patients diagnosed with adjustment disorder were being compared with patients who met criteria for other psychiatric disorders, many of which were characterized by greater anger-related burden. In a higher-severity setting such as partial hospitalization, adjustment disorder may function largely as a diagnosis of exclusion, applied when clinically meaningful distress is present but criteria are not met for another disorder. Consequently, patients diagnosed with adjustment disorder may exhibit comparatively lower overall severity, such that higher anger levels increase the likelihood of an alternative diagnosis. This pattern is also broadly consistent with the outpatient findings reported by Genovese et al. ( 2017 ). Anger was also associated with greater odds of receiving an ADHD diagnosis. Prior studies have reported significant associations between ADHD and anger (e.g., Ramirez et al., 1997 ; Lubke et al., 2015 ), but the present study extends this work to a clinically diverse, higher-acuity sample. One possible explanation is that anger and ADHD partly reflect shared difficulties involving impulse control or self-restraint (Ramirez et al., 1997 ). This interpretation is also broadly consistent with anger’s significant associations in the present sample with other disorders characterized by disinhibition or impaired behavioral control. Anger was similarly associated with greater odds of substance use disorders overall. These findings are consistent with prior work showing strong links between anger, aggression-related psychopathology, and substance use disorders (Coccaro et al., 2016 ). Our results extend that literature by suggesting that anger in general, rather than only more overtly aggressive syndromes, is associated with substance use pathology in this sample. Within the substance use category, however, only cannabis use disorder was significantly associated with elevated anger. One possible reason is that relations between anger and substance use may have been attenuated by this program’s policy of not admitting patients whose primary diagnosis was alcohol or another substance use disorder, instead referring them to dual-diagnosis programs. Given the many links between alcohol use disorder and anger in prior work (e.g., Lubke et al., 2015 ), future research should examine the unique relationships between anger and specific forms of substance misuse in both non-specialized samples and settings that do not exclude primary substance use presentations. It is also possible that some individuals experiencing elevated anger turn to cannabis in an effort to cope with internal distress rather than as part of a more overt externalizing pattern. Another possibility is that both heightened anger and cannabis use are partly accounted for by broader externalizing liability (Krueger et al., 2007 ). Notably, only self-reported anger was significantly associated with bipolar disorder, and only for patients currently in a major depressive episode. This pattern is somewhat surprising given prior evidence that anger attacks may be more common during bipolar depression than unipolar depression (Perlis et al., 2004 ). One likely explanation is sample size. Far more patients in the present sample were diagnosed with MDD than with current mania or hypomania, and the very small number of manic or hypomanic cases makes those findings difficult to interpret with confidence. The same limitation applies to the apparent discrepancy in the strength of associations between self- and clinician-rated anger and current manic or hypomanic episodes. Future research should revisit these outcomes in larger samples with better representation of bipolar spectrum states. Similarly, panic disorder was significantly associated with self-reported anger, but not clinician-rated anger. Although prior research supports links between panic disorder and anger, the findings have been mixed (e.g., Baker et al., 2004 ; Hawkins & Cougle, 2010; Moscovitch et al., 2008 ). Cassiello-Robbins and Barlow ( 2016 ) proposed that individuals may experience overlapping physiological and psychological features in “fight” and “flight” states, which may contribute to complexity in how anger and panic are reported. Mixed findings in the broader literature, together with the present difference between CUANGOS and SADS anger-item scores, suggest that relations between anger and panic merit further clarification. At the same time, the SADS association approached significance and the magnitude of the correlations did not differ dramatically, so these results should be interpreted cautiously. Fear-based disorders aside from panic disorder, including agoraphobia, OCD, social phobia, and specific phobia, were not significantly associated with anger in the present study. This is particularly interesting in the case of OCD, as prior work has reported independent associations between anger expression and OCD even after accounting for psychiatric comorbidity (Barrett et al., 2013 ). Mixed results have also been reported for other fear-based disorders (e.g., Moscovitch et al., 2008 ). One possible explanation is that some fear-based disorders may be characterized less by high outward anger expression than by suppression of anger or distress related to anger-related states. For example, patients with OCD may be more likely to inhibit anger expression while also feeling less control over it (Whiteside & Abramowitz, 2004 ). More broadly, some anger measures emphasize expression more than internal anger experience (Barrett et al., 2013 ; Erwin et al., 2003). Although both measures in the present study assessed subjective irritability and overt anger, it remains possible that the aspects of anger most relevant to fear-based disorders were not captured optimally here. Future work should continue to examine anger in fear-based disorders using a wider range of anger measures and samples. Several limitations qualify the present findings. First, because the data were cross-sectional, causal conclusions cannot be drawn. Second, diagnoses were analyzed categorically, which prevented examination of symptom severity within disorders. Third, although the sample was large and diagnostically heterogeneous, it was drawn from a single geographic area and included relatively few patients with psychotic disorders. The sample was also predominantly White and female, and most participants had attended at least some college, which limits generalizability. In addition, substance use disorders were likely underrepresented due to program admission practices. Finally, although the comparison of self- and clinician-rated anger is a strength of the study, these findings should still be viewed as preliminary and in need of replication. In conclusion, the present findings highlight the importance of anger as a clinically meaningful correlate of many common psychiatric disorders in a heterogeneous partial hospitalization sample. Although clinicians may address anger when it is an obvious presenting problem, they may be less likely to assess it directly when it is embedded within other forms of distress. The current results suggest that clinicians treating higher-acuity patients with distress disorders (e.g., MDD, GAD, PTSD) and/or more externalizing presentations (e.g., impulse control disorders, ADHD, BPD, substance use disorders, and cannabis use disorder) may benefit from assessing anger more explicitly as part of routine case formulation and treatment planning. Beyond diagnosis, future work should examine how anger relates to other clinically relevant variables such as therapeutic alliance, treatment-interfering behaviors, and non-specific treatment factors. It also remains important to determine whether addressing anger more directly improves outcomes in other domains, or vice versa. This possibility is plausible given newer meta-analytic evidence linking anger to greater avoidance, rumination, and suppression, and to lower acceptance and reappraisal, all of which overlap conceptually with treatment targets emphasized in CBT-, DBT-, and ACT-informed approaches (Pop et al., 2025 ). Declarations Author Contribution JD: designed and executed the study, conducted the data analyses, and wrote the paper. HF: assisted with study design, assisted with the data analyses, and contributed to writing and editing the manuscript. SB: assisted with the data analyses and contributed to writing and editing the manuscript. MZ: collaborated with the design and writing of the study. All authors approved the final version of the manuscript for submission. Data Availability Restrictions apply to the availability of these data due to sensitive patient information. The data are, however, available upon request to the study's senior author. References Baker, R., Holloway, J., Thomas, P. W., Thomas, S., & Owens, M. (2004). Emotional processing and panic. Behaviour Research and Therapy, 42 (11), 1271–1287. Barrett, E. L., Mills, K. L., & Teesson, M. (2013). Mental health correlates of anger in the general population: Findings from the 2007 National Survey of Mental Health and Wellbeing. Australian & New Zealand Journal of Psychiatry, 47 (5), 470–476. Beard, C., Stein, A. T., Hearon, B. A., Lee, J., Hsu, K. J., & Bjorgvinsson, T. (2016). Predictors of depression treatment response in an intensive CBT partial hospital. Journal of Clinical Psychology, 72 , 297–310. https://doi.org/10.1002/jclp.22269 Boswell, J. F. (2016). Recognizing anger in clinical research and practice. Clinical Psychology: Science and Practice, 23 (1), 86–89. Cassiello-Robbins, C., & Barlow, D. H. (2016). Anger: The unrecognized emotion in emotional disorders. Clinical Psychology: Science and Practice, 23 (1), 66–85. Coccaro, E. F., Fridberg, D. J., Fanning, J. R., Grant, J. E., King, A. C., & Lee, R. (2016). Substance use disorders: Relationship with intermittent explosive disorder and with aggression, anger, and impulsivity. Journal of Psychiatric Research, 81 , 127–132. Corrigan, P. W., & Watson, A. C. (2005). Findings from the National Comorbidity Survey on the frequency of violent behavior in individuals with psychiatric disorders. Psychiatry Research, 136 (2–3), 153–162. Cuijpers, P., Li, J., Hofmann, S. G., & Andersson, G. (2010). Self-reported versus clinician-rated symptoms of depression as outcome measures in psychotherapy research on depression: A meta-analysis. Clinical Psychology Review, 30 (6), 768–778. Deptula, A., Lerman, M., & Novaco, R. W. (2025). Anger predictors of aggressive behavior on an acute inpatient psychiatric unit. Journal of the American Psychiatric Nurses Association, 31 (5), 498–512. https://doi.org/10.1177/10783903251359704 Endicott, J., & Spitzer, R. L. (1978). A diagnostic interview: The Schedule for Affective Disorders and Schizophrenia. Archives of General Psychiatry, 35 (7), 837–844. Fava, M., Rosenbaum, J. F., McCarthy, M., Pava, J., Steingard, R., & Bless, E. (1991). Anger attacks in depressed outpatients and their response to fluoxetine. Psychopharmacology Bulletin . First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1994). Structured clinical interview for Axis I DSM-IV disorders (SCID). Patient ed., version 2. Forbes, D., Parslow, R., Creamer, M., Allen, N., McHugh, T., & Hopwood, M. (2008). Mechanisms of anger and treatment outcome in combat veterans with posttraumatic stress disorder. Journal of Traumatic Stress, 21 (2), 142–149. Genovese, T., Dalrymple, K., Chelminski, I., & Zimmerman, M. (2017). Subjective anger and overt aggression in psychiatric outpatients. Comprehensive Psychiatry, 73 , 23–30. Gould, R. A., Ball, S., Kaspi, S. P., Otto, M. W., Pollack, M. H., Shekhar, A., & Fava, M. (1996). Prevalence and correlates of anger attacks: A two site study. Journal of Affective Disorders, 39 (1), 31–38. Hawkins, K. A., & Cougle, J. R. (2011). Anger problems across the anxiety disorders: Findings from a population-based study. Depression and Anxiety, 28 (2), 145–152. Kramer, L. B., Whiteman, S. E., Petri, J. M., Spitzer, E. G., & Weathers, F. W. (2023). Self-rated versus clinician-rated assessment of posttraumatic stress disorder: An evaluation of discrepancies between the PTSD Checklist for DSM-5 and the Clinician-Administered PTSD Scale for DSM-5. Assessment, 30 (5), 1590–1605. Krueger, R. F., Markon, K. E., Patrick, C. J., Benning, S. D., & Kramer, M. D. (2007). Linking antisocial behavior, substance use, and personality: An integrative quantitative model of the adult externalizing spectrum. Journal of Abnormal Psychology, 116 (4), 645–666. Levin-Aspenson, H. F., & Watson, D. (2018). Mode of administration effects in psychopathology assessment: Analyses of gender, age, and education differences in self- rated versus interview-based depression. Psychological Assessment, 30 (3), 287–295. Levin-Aspenson, H. F., Boyd, S. I., Diehl, J. M., & Zimmerman, M. (2021). A Clinically Useful Anger Outcome Scale. Journal of Psychiatric Research . Levin-Aspenson, H., Diehl, J. M., Boyd, S. I., & Zimmerman, M. (2022). Levels of anger severity in psychiatric patients. Journal of Nervous and Mental Disease . Lee, I. A., & Preacher, K. J. (2013, September). Calculation for the test of the difference between two dependent correlations with one variable in common [Computer software]. Lubke, G. H., Ouwens, K. G., de Moor, M. H., Trull, T. J., & Boomsma, D. I. (2015). Population heterogeneity of trait anger and differential associations of trait anger facets with borderline personality features, neuroticism, depression, attention deficit hyperactivity disorder (ADHD), and alcohol problems. Psychiatry Research, 230 (2), 553–560. Morland, L. A., Love, A. R., Mackintosh, M. A., Greene, C. J., & Rosen, C. S. (2012). Treating anger and aggression in military populations: Research updates and clinical implications. Clinical Psychology: Science and Practice, 19 (3), 305–322. Moscovitch, D. A., McCabe, R. E., Antony, M. M., Rocca, L., & Swinson, R. P. (2008). Anger experience and expression across the anxiety disorders. Depression and Anxiety, 25 (2), 107–113. Perlis, R. H., Smoller, J. W., Fava, M., Rosenbaum, J. F., Nierenberg, A. A., & Sachs, G. S. (2004). The prevalence and clinical correlates of anger attacks during depressive episodes in bipolar disorder. Journal of Affective Disorders, 79 (1–3), 291–295. Perlis, R. H., Uslu, A., Schulman, J., Himelfarb, A., Gunning, F. M., Solomonov, N., Santillana, M., Baum, M. A., Druckman, J. N., Ognyanova, K., & Lazer, D. (2024). Prevalence and correlates of irritability among U.S. adults. Neuropsychopharmacology, 49 (13), 2052– 2059. https://doi.org/10.1038/s41386-024-01959-3 Pfohl, B., Blum, N., & Zimmerman, M. (1997). Structured interview for DSM-IV personality: SIDP-IV. American Psychiatric Publishing. Pop, G. V., Nechita, D.-M., Miu, A. C., & Szentágotai-Tătar, A. (2025). Anger and emotion regulation strategies: A meta-analysis. Scientific Reports, 15 , 6931. https://doi.org/10.1038/s41598-025-91646-0 Posternak, M. A., & Zimmerman, M. (2002). Anger and aggression in psychiatric outpatients. Journal of Clinical Psychiatry . Pulay, A. J., Dawson, D. A., Hasin, D. S., Goldstein, R. B., Ruan, W. J., Pickering, R. P., & Grant, B. F. (2008). Violent behavior and DSM-IV psychiatric disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 69 (1), 12–22. Ramirez, C. A., Rosén, L. A., Deffenbacher, J. L., Hurst, H., Nicoletta, C., Rosencranz, T., & Smith, K. (1997). Anger and anger expression in adults with high ADHD symptoms. Journal of Attention Disorders, 2 (2), 115–128. Rizk, M., Tebeka, S., Dubertret, C., & Le Strat, Y. (2025). Prevalence, correlates and comorbidity of irritability in adults with major depressive episode in the U.S. population (2012–2013). Journal of Psychiatric Research, 181 , 517–522. https://doi.org/10.1016/j.jpsychires.2024.11.074 Uher, R., Perlis, R. H., Placentino, A., Dernovšek, M. Z., Henigsberg, N., Mors, O., & Farmer, A. (2012). Self-report and clinician-rated measures of depression severity: Can one replace the other? Depression and Anxiety, 29 (12), 1043–1049. Whiteside, S. P., & Abramowitz, J. S. (2004). Obsessive-compulsive symptoms and the expression of anger. Cognitive Therapy and Research, 28 (2), 259–268. Zhan, N., Li, F., Fung, H. W., Zhang, K., Wang, J., & Geng, F. (2024). A symptom-level perspective on irritability, PTSD, and depression in children and adults. Journal of Affective Disorders, 367 , 606–616. https://doi.org/10.1016/j.jad.2024.08.213 Zimmerman, M. (2016). A review of 20 years of research on overdiagnosis and underdiagnosis in the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project. Canadian Journal of Psychiatry, 61 (2), 71–79. Zimmerman, M., Ellison, W., Young, D., Chelminski, I., & Dalrymple, K. (2015). How many different ways do patients meet the diagnostic criteria for major depressive disorder? Comprehensive Psychiatry, 56 , 29–34. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9487881","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":634210739,"identity":"588b6902-5256-42d9-af1e-3e1123b6b6e6","order_by":0,"name":"Joseph Diehl","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/ElEQVRIiWNgGAWjYBACxgYYwZDYwMxQYAPiNh4gQYtBGpiLVwtCH0MCA1DLYbAAXi3M7e0PHxfuYIhmYE9ufFxgcN5ubfthoC01NtE4Leg5Y2w88wxDbgPPw2bjGQa3k7edSQRqOZaW24BLy4wcNmneNqAWicQ2aR6gFrMDQC2MDYfxaEl//huqpf03j8G5ZLPzDwlpSTBjhtnCzGNwwM7sBiFbgH6RntkmkdsG9AvQYckJZjeAtiTg8YshMMQ+F7bZ5Pazpz/8zFNhZ292Pv3hgw81Nri1ACWYGRgkGNigAolglQk4lIOAPANYCwLY41E8CkbBKBgFIxQAAAV+YOwhstdnAAAAAElFTkSuQmCC","orcid":"","institution":"Duke University","correspondingAuthor":true,"prefix":"","firstName":"Joseph","middleName":"","lastName":"Diehl","suffix":""},{"id":634210740,"identity":"ec07d87a-db67-4362-8570-1457188aff4f","order_by":1,"name":"Holly Levin-Aspenson","email":"","orcid":"","institution":"University of North Texas","correspondingAuthor":false,"prefix":"","firstName":"Holly","middleName":"","lastName":"Levin-Aspenson","suffix":""},{"id":634210741,"identity":"51d3e3d5-ac2c-44e5-8009-1debc86064b1","order_by":2,"name":"Simone Boyd","email":"","orcid":"","institution":"Rutgers, The State University of New Jersey","correspondingAuthor":false,"prefix":"","firstName":"Simone","middleName":"","lastName":"Boyd","suffix":""},{"id":634210742,"identity":"77ff05b5-a666-4ee9-8e76-afacbb0a2738","order_by":3,"name":"Mark Zimmerman","email":"","orcid":"","institution":"South County Psychiatry","correspondingAuthor":false,"prefix":"","firstName":"Mark","middleName":"","lastName":"Zimmerman","suffix":""}],"badges":[],"createdAt":"2026-04-21 18:38:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9487881/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9487881/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108805068,"identity":"628add49-fa2b-43ae-a124-49ea03ff9f05","added_by":"auto","created_at":"2026-05-08 15:24:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":386316,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9487881/v1/ba8cce49-7c20-4207-8cb9-805061c1b05c.pdf"},{"id":108518929,"identity":"9ffe9e31-1766-426e-976c-700d1ccbb93b","added_by":"auto","created_at":"2026-05-05 13:57:24","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":19148,"visible":true,"origin":"","legend":"","description":"","filename":"PQsupplement.docx","url":"https://assets-eu.researchsquare.com/files/rs-9487881/v1/733ce6344a0db1d9591042a0.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparing Self-Reported and Clinician-Rated Anger Across Psychiatric Diagnoses in Partial Hospitalization","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAlthough afflictive emotions such as anxiety, depression, and anger appear across psychopathology, anger has been relatively less examined (Genovese et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). This relative neglect persists despite contemporary evidence that irritability and anger-related phenomena remain common and clinically consequential in adults, particularly in relation to depressive and anxious symptom burden (Perlis et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Rizk et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Capturing anger in psychological science is challenging because it is a multifaceted construct shaped by cultural, social, and historical influences. Cultural norms around emotional expression can influence whether anger is encouraged, suppressed, or interpreted as problematic, and social structures such as gender and power dynamics further shape how anger is expressed and evaluated (Matsumoto et al., 2008; Shields, 2002). These contextual dimensions underscore the need for nuanced and clinically useful methods of assessing anger in psychiatric samples.\u003c/p\u003e \u003cp\u003eAnger comprises affective, cognitive, physiological, and behavioral components. It includes the subjective experience of irritation, frustration, or rage, appraisals of perceived injustice or threat, autonomic arousal, and behavioral expressions that may range from verbal outbursts to more overt aggressive responses (Averill, 1982, 1983; Izard, 1991; Lazarus, 1991; Levenson, 1992). Anger may function adaptively when it signals injustice or motivates corrective action, but maladaptively when it becomes chronic, excessive, or poorly regulated (Averill, 1982). Persistent or intense anger has been associated with negative psychological, physiological, and interpersonal consequences, including elevated stress responding, cardiovascular burden, and impaired relationships (Averill, 1982; Suls \u0026amp; Bunde, 2005).\u003c/p\u003e \u003cp\u003eUnlike depression and anxiety, anger is not fully represented in a stand-alone diagnosis (Cassiello-Robbins \u0026amp; Barlow, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Rather, one aspect of anger\u0026mdash;behavioral or verbal aggression\u0026mdash;is most closely represented in the Diagnostic and Statistical Manual (5th ed.; DSM-5; American Psychiatric Association [APA], 2013) by intermittent explosive disorder (IED), which involves recurrent outbursts that may result in harm to self or others. Aside from IED, anger and/or irritability (a lower-intensity form of anger; Brotman et al., 2007) appears as a diagnostic criterion in disorders such as manic or hypomanic episodes, posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and borderline personality disorder (BPD). However, it often remains unclear whether anger is a clinically meaningful presenting problem for patients with these diagnoses. For instance, a provider reviewing a patient\u0026rsquo;s chart with a GAD diagnosis would not be able to infer the presence or severity of the patient\u0026rsquo;s anger from the diagnosis alone. This limitation highlights the difficulty of capturing anger adequately within existing diagnostic frameworks.\u003c/p\u003e \u003cp\u003ePrior work has begun to clarify associations between anger and psychiatric diagnoses. In a review, Cassiello-Robbins and Barlow (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) concluded that anger was significantly associated with IED, BPD, PTSD, and GAD. Studies have also linked elevated anger with greater symptom severity in PTSD and GAD, and more recent symptom-level work suggests that irritability is meaningfully intertwined with PTSD and depression rather than merely representing a trivial peripheral feature (Zhan et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). In one large outpatient sample, bipolar I disorder, PTSD, IED, and cluster B personality disorders were associated with subjective anger, whereas GAD, IED, and cluster B personality disorders were associated with aggression (Genovese et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Additional literature has identified significant associations between anger and diagnoses for which anger is not a formal diagnostic criterion. For example, obsessive-compulsive disorder (OCD), social anxiety disorder (SAD), and panic disorder have each been linked to elevated anger (Cassiello-Robbins \u0026amp; Barlow, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). In the same large outpatient sample, major depressive disorder (MDD), panic disorder with agoraphobia, and eating disorders were associated with subjective anger, while MDD was associated with aggression (Genovese et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2017\u003c/span\u003e). Elevated anger has also been associated with greater symptom severity in OCD (Barrett et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2013\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite these findings, inconsistencies remain across studies. Within one research group, two studies drawing from the same outpatient population yielded conflicting findings regarding the association between aggression and several diagnoses (Genovese et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Posternak \u0026amp; Zimmerman, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2002\u003c/span\u003e). Genovese et al. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) reported that panic disorder with agoraphobia, PTSD, and impulse control disorders were significantly associated with aggression, whereas Posternak and Zimmerman (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2002\u003c/span\u003e) did not. In contrast, Posternak and Zimmerman (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2002\u003c/span\u003e) reported significant associations between aggression and bipolar disorder as well as substance use disorders, whereas Genovese et al. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2017\u003c/span\u003e) did not. Mixed findings have also emerged for GAD, PTSD, panic disorder, OCD, and social phobia (e.g., Barrett et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Corrigan \u0026amp; Watson, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e2005\u003c/span\u003e; Hawkins \u0026amp; Cougle, 2017; Moscovitch et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2008\u003c/span\u003e; Pulay et al., \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). Taken together, the literature suggests that the diagnostic correlates of anger may depend meaningfully on sample characteristics, clinical setting, and the way anger is measured.\u003c/p\u003e \u003cp\u003eClarifying diagnostic associations with anger is important because anger appears to have meaningful clinical consequences. Even mild or moderate levels of anger as measured by the Clinically Useful Anger Outcome Scale (CUANGOS) were associated with impairment in functioning and well-being, including lower life satisfaction, poorer daily functioning, lower quality of life, greater suicide attempts, and higher clinician-rated psychosocial morbidity (Levin-Aspenson, Diehl, Boyd, \u0026amp; Zimmerman, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Elevated anger at intake has also been associated with worse depression and PTSD symptoms at discharge (Fava et al., \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e1991\u003c/span\u003e; Forbes et al., \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). Anger has been shown to reduce therapeutic alliance and engagement in treatment (Morland et al., \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e2012\u003c/span\u003e), and from a clinician perspective may be among the most difficult emotions to address effectively in therapy (Boswell, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Contemporary work in acute psychiatric settings further suggests that patients\u0026rsquo; self-reported anger can be clinically informative, including for short-term aggressive behavior risk (Deptula et al., \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Together, these findings underscore the clinical importance of anger and the need to better understand its place within psychopathology.\u003c/p\u003e \u003cp\u003eFew studies have examined anger in partial hospitalization programs, where patients typically present with greater clinical severity than patients in outpatient settings. In fact, despite the large number of registered partial hospitalization programs, relatively little research has been reported from these settings (Beard et al., \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). The present study extends the literature by examining anger in a partial hospitalization program (PHP) sample characterized by both substantial symptom severity and diagnostic heterogeneity. Accordingly, an important clinical question is whether self-reported and clinician-rated anger provide similar versus distinct diagnostic information at intake.\u003c/p\u003e \u003cp\u003eFew studies have directly compared self-reported and clinician-rated anger as indicators of clinical status. Evidence from adjacent assessment literatures suggests that self-report and clinician-rated measures can be strongly related overall while still diverging meaningfully in symptom estimates, severity ratings, and diagnostic classification (Kramer et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Prior work on depression has likewise shown that self- and clinician-rated modes of assessment can make distinct contributions to psychopathology measurement (Cuijpers et al., \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e2010\u003c/span\u003e; Levin-Aspenson \u0026amp; Watson, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e2018\u003c/span\u003e; Uher et al., \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e2012\u003c/span\u003e). In the same vein, it is important to determine whether self-reported and clinician-rated anger show similar diagnostic utility, as the answer could inform how anger is measured in routine clinical practice.\u003c/p\u003e \u003cp\u003eThe primary purpose of the present study was to examine whether self-reported and clinician-rated anger showed similar versus distinct associations with psychiatric diagnoses in a large, diagnostically heterogeneous PHP sample. We hypothesized that diagnoses that include anger or irritability in their diagnostic criteria (e.g., BPD, GAD, PTSD) would be associated with elevated self- and clinician-rated anger. Additionally, in line with prior findings from smaller and more specific samples summarized by Cassiello-Robbins and Barlow (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2016\u003c/span\u003e), we hypothesized that both measures of anger would also be associated with greater odds of receiving other mood and anxiety disorder diagnoses, as well as attention-deficit/hyperactivity disorder (ADHD) and substance use disorders. Supplementary to this primary aim, we examined whether these diagnostic associations differed across self-reported and clinician-rated modes of assessment.\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eThe sample used in this study (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;727) was drawn from a larger population of patients who were admitted to a PHP between April 2014 and August 2019. Included participants in this study were patients who completed a full initial diagnostic evaluation by semi-structured interview and completed demographic data and self-reported anger scores via the CUANGOS. The average age was 35.44 years (SD\u0026thinsp;=\u0026thinsp;14.09, range\u0026thinsp;=\u0026thinsp;18\u0026ndash;77). The average length of stay for the sample was 7.70 days (\u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;5.18; range\u0026thinsp;=\u0026thinsp;0\u0026ndash;35 days). The Rhode Island Hospital institutional review committee approved the research protocol, and all participants provided informed written consent. The first three authors, as employees of Rhode Island Hospital, had access to these data from June 2018 to June 2020, and the last author is the principal investigator of the study. All procedures performed in this study were in accordance with the ethical standards of the 1964 Declaration of Helsinki and its later amendments.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cp\u003eAll included measures were administered at the same timepoint, except for treatment dropout. The patients included in this study received initial diagnostic evaluations by trained clinical interviewers using the Structured Clinical Interview for DSM-IV (SCID-IV; First et. al., \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e1994\u003c/span\u003e) for clinical disorders and the Structured Interview for \u003cem\u003eDSM-IV\u003c/em\u003e Personality (SIDP-IV; Pfohl \u0026amp; Zimmerman, 1997) for BPD. We additionally assessed DSM-IV impulse control disorders (pyromania, kleptomania, pathological gambling, other-specified impulse control disorders, and unspecified impulse control disorders). Information about interviewer training and diagnostic reliability are available in other MIDAS project publications (see Zimmerman, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e2016\u003c/span\u003e; Zimmerman et. al., \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e2015\u003c/span\u003e). These publications describe the rigorous training and reliability rating process interviewers go through before interviewing patients for the MIDAS project. Our analyses included only current diagnoses; diagnoses in full or partial remission were excluded as including them could skew results or complicate interpretation, as the outcomes may not accurately reflect full remission or active disorder states (Meinert et al., 2022). Some diagnoses were collapsed into diagnostic categories due to low sample size (e.g. a total of 14 patients in our sample were diagnosed with any psychotic disorder), or to examine a related group of diagnoses in addition to individual diagnoses (e.g. all substance use disorders [ASUDs] were included for analysis in addition to individually examining alcohol use disorder, cannabis use disorder, and all other substance use disorders.\u003c/p\u003e \u003cp\u003eWhile interviewers administered the full Schedule for Affective Disorders and Schizophrenia (SADS; Endicott \u0026amp; Spitzer, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e1978\u003c/span\u003e), we used the two items within the SADS that assess levels of subjective anger and overt irritability during the preceding week. They explicitly assess: 1) severity of subjective anger during the preceding week and 2) severity of overt expression of anger during the preceding week. Each item was rated on a scale from 0 (\u0026ldquo;not at all\u0026rdquo;) to 5 (\u0026ldquo;extreme\u0026rdquo;). The two items were significantly correlated (\u003cem\u003er\u003c/em\u003e = .66, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001) and thus were combined to make a dimensional clinician rating of overall anger.\u003c/p\u003e \u003cp\u003eThe Clinically Useful Anger Outcome Scale (CUANGOS) is a 5-item measure from our research group that assesses symptoms of anger in the past week including subjective feelings of anger and overt displays of anger and irritability (Levin-Aspenson, Boyd, Diehl, \u0026amp; Zimmerman, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e2021\u003c/span\u003e). Items are rated on a scale from 0 (\u0026ldquo;not at all\u0026rdquo;) to 4 (\u0026ldquo;extremely\u0026rdquo;), with total scores ranging from 0 to 20 and higher scores indicating the presence of increased symptoms. The internal consistency of the CUANGOS in the present study was strong (Cronbach\u0026rsquo;s \u003cem\u003eα\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.86). The items can be viewed in the supplement in Table S2.\u003c/p\u003e\n\u003ch3\u003eAnalyses\u003c/h3\u003e\n\u003cp\u003eAll analyses were conducted using SPSS version 25 and the CorrToolBox package in R. We first performed regressions and ANOVA procedures to test whether SADS scores and CUANGOS scores varied by race, age, gender identity, level of education, and total DSM diagnoses. We next standardized all continuous variables and running bivariate correlations between the different measures of anger used in this study. We then used logistic regression to determine the extent to which self- or clinician-rated anger was associated with increased odds of receiving a given diagnosis. To compare the strength of associations, we calculated biserial correlations between self- and clinician-rated anger scores with each diagnosis. Biserial correlations are recommended for this procedure because the anger scores are continuous, and each diagnosis is dichotomous but are assumed to represent an underlying construct with a continuous distribution (Tate, 1955). From these results, we calculated Fischer\u0026rsquo;s \u003cem\u003er\u003c/em\u003e-to-\u003cem\u003ez\u003c/em\u003e transformation to test whether the strength of diagnostic associations differed by mode of assessment (Lee \u0026amp; Preacher, 2013). This method is well-supported across samples of normal distributions, skewed distributions, and various other specific applications (e.g., Silver, 1987; Shohoji, 1981; and Hjelm, 1962).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eDemographic information for this sample can be found in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The sample was predominately female (69.4%), white (71.7%), and well educated (77.5% completed at least some college). CUANGOS scores correlated strongly with subjective feelings of anger (\u003cem\u003er\u003c/em\u003e=.59, \u003cem\u003ep\u003c/em\u003e\u0026lt;.001), overt irritability (\u003cem\u003er\u003c/em\u003e=.60, \u003cem\u003ep\u003c/em\u003e\u0026lt;.001), and the combined SADS anger score (\u003cem\u003er\u0026thinsp;=\u003c/em\u003e\u0026thinsp;66., \u003cem\u003ep\u003c/em\u003e\u0026lt;.001). The only demographic variable significantly associated with different anger scores was age; as age increased, both SADS and CUANGOS scores decreased (see Supplement Paragraph 1 for further details).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eDemographic Characteristics of the Sample (n\u0026thinsp;=\u0026thinsp;727)\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e506\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e69.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransgender and/or nonbinary\u003c/p\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than high school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGraduated high school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e449\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e61.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGraduated college or greater\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e238\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried/living together\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e283\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced/separated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever married\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e332\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEthnicity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e523\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e71.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAfrican American/Black\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHispanic/Latinx\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAsian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSelf- and clinician-rated anger scores both were significantly associated with increased likelihood of being diagnosed with MDD, GAD, PTSD, impulse control disorders, ADHD, BPD, substance use disorders in general, and cannabis use disorder in particular (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Diagnoses of bipolar disorder (current episode depressed) and panic disorder were significantly were significantly associated only with self-report anger scores. There were no diagnoses predicted only by clinician-rated anger. Finally, anger was significantly associated with \u003cem\u003ereduced\u003c/em\u003e likelihood of receiving a diagnosis of adjustment disorder. Mean CUANGOS and SADS scores for each diagnostic group are presented in Supplemental Table\u0026nbsp;1. Anger\u0026rsquo;s diagnostic associations largely did not differ across self- or clinician-rated modes of assessment with a few exceptions. PTSD and bipolar disorder (currently depressed were more strongly correlated with CUANGOS scores while bipolar disorder (currently manic or hypomanic) was more strongly associated with SADS scores (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eOdds Ratios of Diagnoses of Clinician-rated and Self-report Anger\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSADS anger items Z-score Odds-ratio (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCUANGOS Z-score Odds-ratio (95% CI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMajor depressive disorder\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.17* (1.00, 1.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.23* (1.04, 1.45)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDysthymia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.07 (0.89, 1.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.14 (0.94, 1.37)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny bipolar I disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.14 (0.83, 1.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.25 (0.91 to 1.72)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny bipolar II disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.37 (0.97, 1.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.37 (1.00 to 1.89)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBipolar I and II disorder, depressed\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.26 (0.97, 1.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.45** (1.13 to 1.86)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBipolar I and II disorder, (Hypo)manic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.39 (0.62, 3.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.66 (0.25 to 1.73)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePanic disorder\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.17 (1.00, 1.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.31*** (1.12 to 1.54)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAgoraphobia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.09 (0.91, 1.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.14 (0.95 to 1.36)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGeneralized anxiety disorder\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.25** (1.08, 1.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.32*** (1.13, 1.54)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial Phobia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.04 (0.90, 1.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.14 (0.97, 1.33)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpecific Phobia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.95 (0.73, 1.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.02 (0.78, 1.33)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePosttraumatic stress disorder\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.46*** (1.24, 1.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.71*** (1.45, 2.01)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObsessive-compulsive disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.09 (0.82, 1.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.15 (0.87, 1.53)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAny adjustment disorder\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.72* (0.53, 0.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.57** (0.39, .84)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny psychotic disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.98 (0.58, 1.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.06 (0.62, 1.81)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAny impulse control disorder\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.43*** (1.28, 1.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.23* (1.06, 1.41)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny Eating Disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.07 (0.83, 1.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.21 (0.94, 1.56)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny Somatoform Disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.15 (0.79, 1.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.24 (0.86, 1.79)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAttention-Deficit / hyperactivity disorder\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.27** (1.06, 1.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.29** (1.08, 1.54)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBorderline personality disorder\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.22*** (1.79, 2.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.15*** (1.78, 2.58)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAll substance use disorders\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.33** (1.11, 1.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.34** (1.12, 1.60)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol use disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.16 (0.91, 1.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.17 (0.91, 1.51)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCannabis use disorder\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.57*** (1.24, 2.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.56*** (1.24, 2.00)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther Drug Use Disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.03 (0.68, 1.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.17 (0.98, 1.05)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e*\u003cem\u003ep\u003c/em\u003e \u0026lt; .05, **\u003cem\u003ep\u003c/em\u003e \u0026lt; .01, ***\u003cem\u003ep\u003c/em\u003e \u0026lt; .001; \u003cem\u003esignificantly-predicted disorders are noted in bold\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eSignificant differences between biserial correlations\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePatient Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSADS anger items Biserial correlation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCUANGOS Biserial correlation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFischer\u0026rsquo;s r to z transformation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMDD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.098*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.129**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-1.012\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDysthymia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.037\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.072\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-1.135\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBipolar I Disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.067\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.077\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.325\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBipolar II Disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.656\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBipolar Disorder, Depressed\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.173**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-1.968*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBipolar Disorder, (Hypo)manic\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e7.220***\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePanic Disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.095*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.133**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-1.240\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAgoraphobia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-1.689\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGAD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.131***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.154***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.0754\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial Phobia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.060\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.940\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpecific Phobia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.040\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-1.685\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePTSD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.217***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.300***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-2.804**\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOCD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.069\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.876\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny Adjustment Disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.152*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.177*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.823\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny Psychotic Disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny Impulse Control Disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.225***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.166*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.956\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny Eating Disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.070\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.876\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny Somatoform Disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.061\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-1.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eADHD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.138**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.137**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBPD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.414***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.395***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.685\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAll SUDs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.188***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.177**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.363\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAUD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.081\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.084\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.098\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCannabis Use Disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.206\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.766\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e*\u003cem\u003ep\u003c/em\u003e \u0026lt; .05, **\u003cem\u003ep\u003c/em\u003e \u0026lt; .01, ***\u003cem\u003ep\u003c/em\u003e \u0026lt; .001; \u003cem\u003esignificant differences between self-reported and clinician-rated anger are noted in bold\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study examined associations between baseline self-reported and clinician-rated anger and a range of psychiatric diagnoses in a diagnostically heterogeneous sample of partial hospitalization patients. Prior work has found significant associations between anger and multiple diagnoses (e.g., Genovese et al., \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2017\u003c/span\u003e; Posternak \u0026amp; Zimmerman, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e2002\u003c/span\u003e), but the present study extends that literature to a relatively large partial hospitalization sample. To our knowledge, it is also among the first studies to compare self-reported and clinician-rated anger across a broad range of diagnoses in this setting. Importantly, both measures used here\u0026mdash;the CUANGOS and the SADS anger items\u0026mdash;capture both subjective feelings of anger and overt displays of anger. Taken together, these findings support the assessment of anger as a clinically useful complementary indicator in psychiatric intake, in addition to its relevance for psychosocial functioning and morbidity (e.g., Levin-Aspenson et al., \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e2022\u003c/span\u003e). Contemporary adult work likewise suggests that irritability and anger-related phenomena remain clinically meaningful across psychopathology (Perlis et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Rizk et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThese findings support the significance of anger as a transdiagnostic symptom dimension. Notably, both SADS anger-item scores and CUANGOS scores were significantly associated with myriad diagnoses, including MDD, GAD, PTSD, impulse control disorders, ADHD, BPD, substance use disorders, and cannabis use disorder. These results build on prior literature by suggesting that anger is broadly relevant across multiple forms of psychopathology, although self-reported anger was associated with more diagnoses than clinician-rated anger in the present sample. It is not surprising that anger was associated with GAD, PTSD, and BPD, as these diagnoses include irritability and/or anger-related behavior in their diagnostic criteria. It is more notable that several diagnoses for which anger is not a formal criterion were also associated with anger, which further underscores its broader clinical importance. This pattern is broadly consistent with newer adult literature indicating that irritability and related anger phenomena track substantial affective burden and psychiatric comorbidity rather than a single narrow diagnosis (Perlis et al., \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e2024\u003c/span\u003e; Rizk et al., \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e2025\u003c/span\u003e). Clinically, these findings reinforce the value of assessing anger even when it is not the patient\u0026rsquo;s primary presenting complaint.\u003c/p\u003e \u003cp\u003eCUANGOS scores were more strongly associated with PTSD than were SADS anger-item scores. Although direct comparisons of self-report versus clinician-rated anger in PTSD remain limited, more recent work suggests that irritability is closely tied to PTSD and depressive symptom structure (Zhan et al., \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e2024\u003c/span\u003e). In adjacent PTSD assessment research, self-report and clinician-rated measures appear capable of aligning globally while still differing in clinically meaningful ways at the level of severity estimates and symptom patterns (Kramer et al., \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e2023\u003c/span\u003e). Future research should therefore continue to examine whether mode of assessment meaningfully shapes how anger is captured in PTSD and related conditions.\u003c/p\u003e \u003cp\u003eAnger was associated with a significantly lower likelihood of receiving an adjustment disorder diagnosis. In the present sample, patients diagnosed with adjustment disorder were being compared with patients who met criteria for other psychiatric disorders, many of which were characterized by greater anger-related burden. In a higher-severity setting such as partial hospitalization, adjustment disorder may function largely as a diagnosis of exclusion, applied when clinically meaningful distress is present but criteria are not met for another disorder. Consequently, patients diagnosed with adjustment disorder may exhibit comparatively lower overall severity, such that higher anger levels increase the likelihood of an alternative diagnosis. This pattern is also broadly consistent with the outpatient findings reported by Genovese et al. (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e2017\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAnger was also associated with greater odds of receiving an ADHD diagnosis. Prior studies have reported significant associations between ADHD and anger (e.g., Ramirez et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e1997\u003c/span\u003e; Lubke et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), but the present study extends this work to a clinically diverse, higher-acuity sample. One possible explanation is that anger and ADHD partly reflect shared difficulties involving impulse control or self-restraint (Ramirez et al., \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e1997\u003c/span\u003e). This interpretation is also broadly consistent with anger\u0026rsquo;s significant associations in the present sample with other disorders characterized by disinhibition or impaired behavioral control.\u003c/p\u003e \u003cp\u003eAnger was similarly associated with greater odds of substance use disorders overall. These findings are consistent with prior work showing strong links between anger, aggression-related psychopathology, and substance use disorders (Coccaro et al., \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e2016\u003c/span\u003e). Our results extend that literature by suggesting that anger in general, rather than only more overtly aggressive syndromes, is associated with substance use pathology in this sample.\u003c/p\u003e \u003cp\u003eWithin the substance use category, however, only cannabis use disorder was significantly associated with elevated anger. One possible reason is that relations between anger and substance use may have been attenuated by this program\u0026rsquo;s policy of not admitting patients whose primary diagnosis was alcohol or another substance use disorder, instead referring them to dual-diagnosis programs. Given the many links between alcohol use disorder and anger in prior work (e.g., Lubke et al., \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e2015\u003c/span\u003e), future research should examine the unique relationships between anger and specific forms of substance misuse in both non-specialized samples and settings that do not exclude primary substance use presentations. It is also possible that some individuals experiencing elevated anger turn to cannabis in an effort to cope with internal distress rather than as part of a more overt externalizing pattern. Another possibility is that both heightened anger and cannabis use are partly accounted for by broader externalizing liability (Krueger et al., \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e2007\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNotably, only self-reported anger was significantly associated with bipolar disorder, and only for patients currently in a major depressive episode. This pattern is somewhat surprising given prior evidence that anger attacks may be more common during bipolar depression than unipolar depression (Perlis et al., \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). One likely explanation is sample size. Far more patients in the present sample were diagnosed with MDD than with current mania or hypomania, and the very small number of manic or hypomanic cases makes those findings difficult to interpret with confidence. The same limitation applies to the apparent discrepancy in the strength of associations between self- and clinician-rated anger and current manic or hypomanic episodes. Future research should revisit these outcomes in larger samples with better representation of bipolar spectrum states.\u003c/p\u003e \u003cp\u003eSimilarly, panic disorder was significantly associated with self-reported anger, but not clinician-rated anger. Although prior research supports links between panic disorder and anger, the findings have been mixed (e.g., Baker et al., \u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e2004\u003c/span\u003e; Hawkins \u0026amp; Cougle, 2010; Moscovitch et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). Cassiello-Robbins and Barlow (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e2016\u003c/span\u003e) proposed that individuals may experience overlapping physiological and psychological features in \u0026ldquo;fight\u0026rdquo; and \u0026ldquo;flight\u0026rdquo; states, which may contribute to complexity in how anger and panic are reported. Mixed findings in the broader literature, together with the present difference between CUANGOS and SADS anger-item scores, suggest that relations between anger and panic merit further clarification. At the same time, the SADS association approached significance and the magnitude of the correlations did not differ dramatically, so these results should be interpreted cautiously.\u003c/p\u003e \u003cp\u003eFear-based disorders aside from panic disorder, including agoraphobia, OCD, social phobia, and specific phobia, were not significantly associated with anger in the present study. This is particularly interesting in the case of OCD, as prior work has reported independent associations between anger expression and OCD even after accounting for psychiatric comorbidity (Barrett et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2013\u003c/span\u003e). Mixed results have also been reported for other fear-based disorders (e.g., Moscovitch et al., \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e2008\u003c/span\u003e). One possible explanation is that some fear-based disorders may be characterized less by high outward anger expression than by suppression of anger or distress related to anger-related states. For example, patients with OCD may be more likely to inhibit anger expression while also feeling less control over it (Whiteside \u0026amp; Abramowitz, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e2004\u003c/span\u003e). More broadly, some anger measures emphasize expression more than internal anger experience (Barrett et al., \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2013\u003c/span\u003e; Erwin et al., 2003). Although both measures in the present study assessed subjective irritability and overt anger, it remains possible that the aspects of anger most relevant to fear-based disorders were not captured optimally here. Future work should continue to examine anger in fear-based disorders using a wider range of anger measures and samples.\u003c/p\u003e \u003cp\u003eSeveral limitations qualify the present findings. First, because the data were cross-sectional, causal conclusions cannot be drawn. Second, diagnoses were analyzed categorically, which prevented examination of symptom severity within disorders. Third, although the sample was large and diagnostically heterogeneous, it was drawn from a single geographic area and included relatively few patients with psychotic disorders. The sample was also predominantly White and female, and most participants had attended at least some college, which limits generalizability. In addition, substance use disorders were likely underrepresented due to program admission practices. Finally, although the comparison of self- and clinician-rated anger is a strength of the study, these findings should still be viewed as preliminary and in need of replication.\u003c/p\u003e \u003cp\u003eIn conclusion, the present findings highlight the importance of anger as a clinically meaningful correlate of many common psychiatric disorders in a heterogeneous partial hospitalization sample. Although clinicians may address anger when it is an obvious presenting problem, they may be less likely to assess it directly when it is embedded within other forms of distress. The current results suggest that clinicians treating higher-acuity patients with distress disorders (e.g., MDD, GAD, PTSD) and/or more externalizing presentations (e.g., impulse control disorders, ADHD, BPD, substance use disorders, and cannabis use disorder) may benefit from assessing anger more explicitly as part of routine case formulation and treatment planning. Beyond diagnosis, future work should examine how anger relates to other clinically relevant variables such as therapeutic alliance, treatment-interfering behaviors, and non-specific treatment factors. It also remains important to determine whether addressing anger more directly improves outcomes in other domains, or vice versa. This possibility is plausible given newer meta-analytic evidence linking anger to greater avoidance, rumination, and suppression, and to lower acceptance and reappraisal, all of which overlap conceptually with treatment targets emphasized in CBT-, DBT-, and ACT-informed approaches (Pop et al., \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e2025\u003c/span\u003e).\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eJD: designed and executed the study, conducted the data analyses, and wrote the paper. HF: assisted with study design, assisted with the data analyses, and contributed to writing and editing the manuscript. SB: assisted with the data analyses and contributed to writing and editing the manuscript. MZ: collaborated with the design and writing of the study. All authors approved the final version of the manuscript for submission.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eRestrictions apply to the availability of these data due to sensitive patient information. The data are, however, available upon request to the study's senior author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBaker, R., Holloway, J., Thomas, P. W., Thomas, S., \u0026amp; Owens, M. (2004). Emotional processing and panic. \u003cem\u003eBehaviour Research and Therapy, 42\u003c/em\u003e(11), 1271\u0026ndash;1287.\u003c/li\u003e\n\u003cli\u003eBarrett, E. L., Mills, K. L., \u0026amp; Teesson, M. (2013). Mental health correlates of anger in the general population: Findings from the 2007 National Survey of Mental Health and Wellbeing. \u003cem\u003eAustralian \u0026amp; New Zealand Journal of Psychiatry, 47\u003c/em\u003e(5), 470\u0026ndash;476.\u003c/li\u003e\n\u003cli\u003eBeard, C., Stein, A. T., Hearon, B. A., Lee, J., Hsu, K. J., \u0026amp; Bjorgvinsson, T. (2016). Predictors of depression treatment response in an intensive CBT partial hospital. \u003cem\u003eJournal of Clinical Psychology, 72\u003c/em\u003e, 297\u0026ndash;310. https://doi.org/10.1002/jclp.22269\u003c/li\u003e\n\u003cli\u003eBoswell, J. F. (2016). Recognizing anger in clinical research and practice. \u003cem\u003eClinical Psychology: Science and Practice, 23\u003c/em\u003e(1), 86\u0026ndash;89.\u003c/li\u003e\n\u003cli\u003eCassiello-Robbins, C., \u0026amp; Barlow, D. H. (2016). Anger: The unrecognized emotion in emotional disorders. \u003cem\u003eClinical Psychology: Science and Practice, 23\u003c/em\u003e(1), 66\u0026ndash;85.\u003c/li\u003e\n\u003cli\u003eCoccaro, E. F., Fridberg, D. J., Fanning, J. R., Grant, J. E., King, A. C., \u0026amp; Lee, R. (2016). Substance use disorders: Relationship with intermittent explosive disorder and with aggression, anger, and impulsivity. \u003cem\u003eJournal of Psychiatric Research, 81\u003c/em\u003e, 127\u0026ndash;132.\u003c/li\u003e\n\u003cli\u003eCorrigan, P. W., \u0026amp; Watson, A. C. (2005). Findings from the National Comorbidity Survey on the frequency of violent behavior in individuals with psychiatric disorders. \u003cem\u003ePsychiatry Research, 136\u003c/em\u003e(2\u0026ndash;3), 153\u0026ndash;162.\u003c/li\u003e\n\u003cli\u003eCuijpers, P., Li, J., Hofmann, S. G., \u0026amp; Andersson, G. (2010). 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Anger attacks in depressed outpatients and their response to fluoxetine. \u003cem\u003ePsychopharmacology Bulletin\u003c/em\u003e.\u003c/li\u003e\n\u003cli\u003eFirst, M. B., Spitzer, R. L., Gibbon, M., \u0026amp; Williams, J. B. W. (1994). \u003cem\u003eStructured clinical interview for Axis I DSM-IV disorders (SCID).\u003c/em\u003e Patient ed., version 2.\u003c/li\u003e\n\u003cli\u003eForbes, D., Parslow, R., Creamer, M., Allen, N., McHugh, T., \u0026amp; Hopwood, M. (2008). Mechanisms of anger and treatment outcome in combat veterans with posttraumatic stress disorder. \u003cem\u003eJournal of Traumatic Stress, 21\u003c/em\u003e(2), 142\u0026ndash;149.\u003c/li\u003e\n\u003cli\u003eGenovese, T., Dalrymple, K., Chelminski, I., \u0026amp; Zimmerman, M. (2017). Subjective anger and overt aggression in psychiatric outpatients. \u003cem\u003eComprehensive Psychiatry, 73\u003c/em\u003e, 23\u0026ndash;30.\u003c/li\u003e\n\u003cli\u003eGould, R. A., Ball, S., Kaspi, S. P., Otto, M. 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How many different ways do patients meet the diagnostic criteria for major depressive disorder? \u003cem\u003eComprehensive Psychiatry, 56\u003c/em\u003e, 29\u0026ndash;34.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"anger, irritability, self-report, clinician rating, psychiatric assessment, partial hospitalization","lastPublishedDoi":"10.21203/rs.3.rs-9487881/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9487881/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAnger is clinically important across psychiatric disorders, yet it remains unclear whether self-reported and clinician-rated anger provide similar clinical information in higher-acuity settings. Findings regarding anger\u0026rsquo;s diagnostic associations have also been inconsistent. The present study examined whether self-reported and clinician-rated anger showed overlapping versus distinct associations with psychiatric diagnoses in a heterogeneous partial hospitalization sample.\u003c/p\u003e \u003cp\u003eA total of 727 patients completed a comprehensive diagnostic evaluation prior to admission, including clinician-rated anger items from the Schedule for Affective Disorders and Schizophrenia (SADS) and self-reported anger on the Clinically Useful Anger Outcome Scale (CUANGOS). We examined associations between each anger measure and a broad range of psychiatric diagnoses and compared the relative strength of those associations across assessment modalities.\u003c/p\u003e \u003cp\u003eBoth self-reported and clinician-rated anger were associated with major depressive disorder, generalized anxiety disorder, posttraumatic stress disorder, impulse control disorders, attention-deficit/hyperactivity disorder, borderline personality disorder, substance use disorders, and cannabis use disorder. However, only self-reported anger was associated with bipolar disorder during a current depressive episode and panic disorder. Self-reported anger was also more strongly associated than clinician-rated anger with bipolar depression and posttraumatic stress disorder. Overall, the findings suggest substantial overlap between self-reported and clinician-rated anger, while also indicating that self-report may capture somewhat broader diagnostic information in partial hospitalization settings. These results support the value of explicitly assessing anger during psychiatric intake, even when it is not the patient\u0026rsquo;s primary presenting complaint.\u003c/p\u003e","manuscriptTitle":"Comparing Self-Reported and Clinician-Rated Anger Across Psychiatric Diagnoses in Partial Hospitalization","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-05 13:57:17","doi":"10.21203/rs.3.rs-9487881/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"66174563-bf22-42b3-b3b2-3529eb156093","owner":[],"postedDate":"May 5th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-05T13:57:17+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-05 13:57:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9487881","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9487881","identity":"rs-9487881","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}