The relationship between anger, level of impulsivity and self-destruction in atypical depression

Objective: Common feature of bulimia nervosa, binge eating and atypical depression is a change in body weight, appetite and eating habits. In bulimia, increase in impulsivity and aggression has been reported. In a self-destructive act, impulsivity is associated with aggressive behavior. In individuals feeling comfort in eating, a genetic predisposition towards impulsivity and reward sensitivity with resultant tendency to depression has been reported. We aimed to investigate whether impulsivity or anger in atypical depression is different from depressive disorder without atypical characteristics.

Method: Literate women who met diagnostic SCID-I criteria of major depressive disorder and aged over 18 years were included in the study. Excluding diagnosis of depressive disorder and binge eating, patients with other mental disease and depressive individuals with psychotic characteristics were not included in the study. 60 patients included in the study, 30 of which were atypical depression and 30 depression cases without atypical characteristics. Barratt Impulsivity Scale (BIS-11), Eating Attitude Test (EAT), Multidimensional Anger Inventory, Hamilton Depression Scale (HAM-D) and sociodemographic data forms were given to the patients. For the comparison of categorical variables chi-square test and for numerical variables Mann Whitney U test were used.

Results: Frequency of binge eating was 46.7% and 10% in depressive patients with or without atypical features, respectively, with a statistically significant difference between both groups (p=0.002). In patients with atypical depression, frequency of self-destruction (p=0.023) and ‘self-directed anger’ (p=0.002) was significantly higher. In the regression analysis, we detected that higher rates of ‘self-directed anger’ (p=0.050) and ‘anger directed at others’ (p=0.033) contributed to the increases in Eating Attitude Scale scores. When binge eaters were eliminated from comparator groups, rates of self –destruction were found to be higher in atypical depression (p=0.008) and ‘self-directed anger’ (p=0.012) was seen in significantly higher number of patients. Besides, total Barrat scores were higher in atypical depression (p=0.037).

Conclusion: In our study, higher rates of ‘self-directed anger’ and impulsivity in atypical depression comply with the results of the studies performed in patients with eating disorders. In the regression analysis, anger was a variable predicting eating attitude, which is compatible with similar results of other studies. Higher rates of impulsivity and anger in atypical depression and their association with eating attitudes indicate that they had common characteristics shared also by eating disorders.