Revealing the Mechanisms That Contribute to Anger Expression Proneness in Patients with Brain Damage: The Importance of Executive Dysfunctions and Alexithymia

Abstract

Background: The ability of scientists and clinicians to detect the therapeutic needs of patients with brain damage has increased in recent years. In this sense, many studies have signaled that individuals tend to experience an increase in irritability after suffering brain damage, with some patients even showing sudden aggressive outbursts. This increase in anger expression in these patients could be explained by executive functioning alterations (or executive dysfunctions), given their role in goal-oriented behaviors, along with emotional dysregulations such as alexithymia (e.g., difficulties recognizing and verbalizing feelings) and anger rumination (e.g., tendency to recall thoughts regarding experiences of frustration or anger). Therefore, it is essential to understand the mechanisms that contribute to and/or facilitate anger expression in patients with brain damage. Methods: In this regard, the main objective of this study is to assess whether executive dysfunctions (assessed with the Frontal Systems Behavior Scale) would explain anger expression (measured with the Reactive and Proactive Aggression Questionnaire) in patients with brain damage (n = 23; mean age: 56.61 ± 10.68; 57% men) compared to controls (n = 24; mean age: 60.96 ± 9.25; 33% men), paying special attention to potential moderators of this association such as alexithymia (analyzed with the Toronto Alexithymia Scale-20) and anger rumination (assessed with the Anger Rumination Scale). Results: The results of the current investigation led us to conclude that anger expression in patients with brain damage was partly explained by executive dysfunction, especially in those patients who scored high in alexithymia. This model was not significant among controls. Conclusions: Thus, we highlight the importance of targeting certain psychological alterations, such as alexithymia, when implementing psychotherapeutic programs as an adjuvant to cognitive training focused on cognitive deficits (e.g., executive dysfunctions). This, in turn, would support the full recovery of individuals who have experienced brain damage.