Epilepsy Information

American Epilepsy Society Poster 2.210

Anger expression and how it relates to mood and coping strategies in patients with epilepsy

Authors: K. Lebeau, L. Myers, M. Evans, J. Politsky, M. Lancman, M. E. Lancman, M. Fleming

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 examine anger expression in patients with ES and how it relates to other variables such as mood and coping strategies. 


All consecutive patients with ES who completed our standard epilepsy neuropsychological evaluation between January 2012 and May 2013 were initially included (n=125). Seven patients who earned a Full Scale IQ of < 70 (potentially impacting their ability to respond to the STAXI-2) were excluded and the final sample size was reduced to 118. Patients had undergone video-EEG monitoring and had a confirmed diagnosis of epilepsy. The mean age of the sample was 37.51 (14.51) and the mean education level was 13.54 (2.80) years. All subjects completed measures of State Trait Anger Expression Inventory-2 (STAXI-2), Stait Trait Anxiety Inventory (STAI), Center for Epidemiological Studies—Depression (CES-D), and Coping Inventory for Stressful Situations (CISS) as part of a comprehensive neuropsychological battery. The STAXI-2 is a self-report questionnaire that provides a global anger expression index, the CES-D is a self-report measure of depression, the STAI measures state and trait anxiety, and the CISS assesses typical coping strategies used when faced with a stressful situation. Additional variables collected through chart review included epilepsy duration, epilepsy type, lateralization, and refractory epilepsy classification.

Findings indicate that 16 patients endorsed a clinically elevated Anger Index Score (T>65). Those tended to have an earlier seizure onset (p = .054). Lateralization, etiology, handedness, and epilepsy type were not significantly correlated with anger. As for emotional variables, those who scored in the clinical ranges on the anger index, also reported significant trait anxiety (p = .002) and depression (p = .000) and reported using significantly elevated emotionally-based coping strategies (p = .028) and significantly reduced task-oriented coping strategies (p = .000).

The current study identified a subgroup of epilepsy patients with what appears to be problematic levels of anger. Moreover, these patients tended to use the less effective emotionally-based coping strategies as opposed to the more effective task-oriented strategies, reported elevated levels of depression and trait anxiety. These findings have 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 specific aspects of anger and quality of life.