Hostility conflict and the effect of chlordiazepoxide on change in hostility level

Abstract

Dimascio, Shader, Salzman and their colleagues 1–5 conducted a series of experiments providing evidence that chlordiazepoxide produced a significantly greater increment in self-reported and behaviorally expressed hostility over a 1-week interval than did placebo in groups of college age normal male volunteers. Rickels and Downing 6 presented data indicating that a group of anxious, nonpsychotic outpatients treated with chlordiazepoxide in 4-week double-blind drug trials showed greater decrements in physician rated irritability and hostility and in self-assessed anger-hostility than did placebo treated patients. These latter findings were considered to strongly suggest that caution be exercised in generalizing results obtained in samples of asymptomatic volunteers to psychiatric patient groups. Kochansky et al. 3 have suggested that the ratings employed by Rickels and Downing to assess clinical hostility may focus upon “manifest angry affects” rather than hostility as “inner motivational or arousal level;” Kochansky et al. employed the Buss Durkee Hostility Inventory (BDHI) to assess such arousal level. The present study examines 4-week changes in hostility in anxious neurotic outpatients treated with either chlordiazepoxide (CDZ) or placebo using four scales from the BHDI (verbal hostility, indirect hostility, irritability, and resentment) in an effort to assess hostility as an inner motivational level. An Hostility Conflict Scale 7 intended to assess the level of conflict or guilt about the expression of hostility was also administered. It was felt that the potential for CDZ-facilitated hostility increase might be greater among patients with greater amounts of conflict associated with hostility expression since the drug might be expected to allay anxiety associated with such conflict.