Epilepsy Information

American Epilepsy Society (Abst. 3.293)

The experience of anger in patients with epileptic seizures: the state-trait anger expression inventory-2

Authors: K. I. Lebeau, L. Myers, M. Evans, M. Lancman, M. Lancman, B. Matzner

The relationship between epileptic seizures (ES) and aggressive behavior is a controversial issue that has been widely examined in the literature (Geschwind, 1975). While some studies have found an increased prevalence of aggression in patients with ES (Bach-Y-Rita et al., 1971; Elliott, 1982), others have not demonstrated this relationship (Kligman & Goldberg, 1975; Lishman, 1998). The purpose of this study was to determine the frequency of anger expression in ES and to examine differential aspects of anger in patients with ES. The study compared temporal lobe epilepsy (TLE) versus generalized epilepsy (GE) patients with regard to the following components: state versus trait anger and anger expression versus anger control.


All consecutive patients with ES who completed our standard epilepsy neuropsychological evaluation between January and May 15, 2012 were initially included (n=27). Three patients who had earned a Full Scale IQ of less than 70 (potentially impacting their ability to respond to the STAXI-2) were excluded (n=24). Patients had undergone video-EEG monitoring and had a confirmed diagnosis of TLE (n = 17) or GE (n = 7). The mean age of the sample was 44.54 (18.24), with a range of 17 to 71. The mean education level was 13.76 (2.81) years, with a range of 9 to 18 years. All subjects completed measures of State Trait Anger Expression Inventory-2 (STAXI-2) as part of a comprehensive neuropsychological battery. The STAXI-2 is a self-report questionnaire that assesses anger expression along four dimensions (state, trait, anger control and anger expression). Additional variables collected through chart review included epilepsy duration, lateralization, number of anti-epileptic drugs (AEDs) taken at the time of testing, and refractory epilepsy classification.

No significant correlation was found between anger scores and gender, epilepsy duration, refractoriness, number of AEDs or lateralization. However, in the combined sample of GE and TLE patients, 41.7% endorsed abnormally high Anger Expression Out (AX-O) ratings (T >70). AXO is defined as "anger expressed outwardly towards persons or objects in the environment." In addition, higher AXO scores correlated significantly with lower Full Scale IQ (p < 0.05).

The most obvious limitation in this study is that the sample size was small. However, the results suggest a possible trend towards increased symptoms of anger in epilepsy patients as a whole. The current report demonstrates a notable elevation of one STAXI-2 scale. This scale is an important one as it is an indicator of a tendency toward expression of anger directed at persons or objects in the environment. This finding has substantial implications for the mental health professionals who are part of the epilepsy treatment team. Anger can have a profound impact on interpersonal functioning and well-being. Therefore there is value to assessing this variable in ES. Future directions for research should include further exploring potential relations between anger and epilepsy variables in a larger sample.