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The Clinical Anger Scale (CAS)
by
Dr. William E. Snell, Jr.

This page shows a copy of the Clinical Anger Scale (CAS).


CAS
FEELINGS INVENTORY INSTRUCTIONS: The group of items below inquire about the types of feelings you have. Each of the 21 groups of items has four options.
 
For example, ITEM 99 ....... A. I feel fine.
           B. I don't feel all that well.
           C. I feel somewhat miserable.
           D. I feel completely miserable.
 
For each cluster of items, read and identify the statement that best reflects how you feel. For example, you might choose A in the above example. If so, then you would darken in the letter (A) on the answer sheet next to the item number associated with that group of statements. In this example, that item number would have been "99."
 
     Now go ahead and answer the questions on the answer sheet. Be sure to answer every question, even if you're not sure, and use a #2 pencil. Make sure you select only one statement from each of the 21 clusters of statements.

PLEASE BE HONEST IN RESPONDING TO THE STATEMENTS.

1. ..... A. I do not feel angry.
B. I feel angry.
C. I am angry most of the time now.
D. I am so angry and hostile all the time that I can't stand it.
2. ..... A. I am not particularly angry about my future.
B. When I think about my future, I feel angry.
C. I feel angry about what I have to look forward to.
D. I feel intensely angry about my future, since it cannot be improved.
3. ..... A. It makes me angry that I feel like such a failure.
B. It makes me angry that I have failed more than the average person.
C. As I look back on my life, I feel angry about my failures.
D. It makes me angry to feel like a complete failure as a person.
4. ..... A. I am not all that angry about things.
B. I am becoming more hostile about things than I used to be.
C. I am pretty angry about things these days.
D. I am angry and hostile about everything.
5. ..... A. I don't feel particularly hostile at others.
B. I feel hostile a good deal of the time.
C. I feel quite hostile most of the time.
D. I feel hostile all of the time.
6. ..... A. I don't feel that others are trying to annoy me.
B. At times I think people are trying to annoy me.
C. More people than usual are beginning to make me feel angry.
D. I feel that others are constantly and intentionally making me angry.
7. ..... A. I don't feel angry when I think about myself.
B. I feel more angry about myself these days than I used to.
C. I feel angry about myself a good deal of the time.
D. When I think about myself, I feel intense anger.
8. ..... A. I don't have angry feelings about others having screwed up my life.
B. It's beginning to make me angry that others are screwing up my life.
C. I feel angry that others prevent me from having a good life.
D. I am constantly angry because others have made my life totally miserable.
9. ..... A. I don't feel angry enough to hurt someone.
B. Sometimes I am so angry that I feel like hurting others, but I would not really do it.
C. My anger is so intense that I sometimes feel like hurting others.
D. I'm so angry that I would like to hurt someone.
10. .....A. I don't shout at people any more than usual.
B. I shout at others more now than I used to.
C. I shout at people all the time now.
D. I shout at others so often that sometimes I just can't stop.
11. .....A. Things are not more irritating to me now than usual.
B. I feel slightly more irritated now than usual.
C. I feel irritated a good deal of the time.
D. I'm irritated all the time now.
12. .....A. My anger does not interfere with my interest in other people.
B. My anger sometimes interferes with my interest in others.
C. I am becoming so angry that I don't want to be around others.
D. I'm so angry that I can't stand being around people.
13. .....A. I don't have any persistent angry feelings that influence my ability to make decisions.
B. My feelings of anger occasionally undermine my ability to make decisions.
C. I am angry to the extent that it interferes with my making good decisions.
D. I'm so angry that I can't make good decisions anymore.
14. .....A. I'm not so angry and hostile that others dislike me.
B. People sometimes dislike being around me since I become angry.
C. More often than not, people stay away from me because I'm so hostile and angry.
D. People don't like me anymore because I'm constantly angry all the time.
15. .....A. My feelings of anger do not interfere with my work.
B. From time to time my feelings of anger interfere with my work.
C. I feel so angry that it interferes with my capacity to work.
D. My feelings of anger prevent me from doing any work at all.
16. .....A. My anger does not interfere with my sleep.
B. Sometimes I don't sleep very well because I'm feeling angry.
C. My anger is so great that I stay awake 1—2 hours later than usual.
D. I am so intensely angry that I can't get much sleep during the night.
17. .....A. My anger does not make me feel anymore tired than usual.
B. My feelings of anger are beginning to tire me out.
C. My anger is intense enough that it makes me feel very tired.
D. My feelings of anger leave me too tired to do anything.
18. .....A. My appetite does not suffer because of my feelings of anger.
B. My feelings of anger are beginning to affect my appetite.
C. My feelings of anger leave me without much of an appetite.
D. My anger is so intense that it has taken away my appetite.
19. .....A. My feelings of anger don't interfere with my health.
B. My feelings of anger are beginning to interfere with my health.
C. My anger prevents me from devoting much time and attention to my health.
D. I'm so angry at everything these days that I pay no attention to my health and well-being.
20. .....A. My ability to think clearly is unaffected by my feelings of anger.
B. Sometimes my feelings of anger prevent me from thinking in a clear-headed way.
C. My anger makes it hard for me to think of anything else.
D. I'm so intensely angry and hostile that it completely interferes with my thinking.
21. .....A. I don't feel so angry that it interferes with my interest in sex.
           B. My feelings of anger leave me less interested in sex than I used to be.
           C. My current feelings of anger undermine my interest in sex.
           D. I'm so angry about my life that I've completely lost interest in sex.
Copyright - 1995

Scoring Instructions for the Clinical Anger Scale (CAS):

The Clinical Anger Scale: Construct, Measurement, Reliability, and Validity.
William E. Snell, Jr., Scott Gum, Roger L. Shuck, Jo A. Mosley, and Tamara L. Hite
Southeast Missouri State University

Abstract
          The purpose of the present investigation was to develop and validate an objective self-report instrument, the Clinical Anger Scale (CAS), designed to measure the syndrome of clinical anger. Several specific analyses were conducted to examine the psychometric properties of the Clinical Anger Scale (CAS). Factor analysis was conducted to examine the factorial validity of the instrument, and reliability coefficients were computed to examine the internal consistency and stability of the CAS. Also, in addition to providing evidence for the convergent and divergent validity of the CAS, an ancillary purpose of the present study was to provide preliminary evidence for its validity by examining some personality, psychopathological symptomology, behavioral, and family environmental correlates of clinical anger. Factor analysis of the Clinical Anger Scale confirmed essentially a unidimensional item structure; reliability analyses also demonstrated adequate alphas (i.e., internal consistency) and test-retest coefficients (i.e., stability) for the CAS; and other results indicated that the CAS was unrelated to social desirability influences. Additional findings indicated that clinical anger was positively associated with several anger-related concepts (e.g., trait anger, state anger, anger-in, anger-out, anger-control). Other results showed that the Clinical Anger Scale was related in predictable ways to men's and women's psychological symptoms, personality traits, and early family environments. These results are discussed in terms of the need to distinguish and to investigate the concept of clinical anger and its therapeutic treatment.
Method
          An objective self-report instrument--the Clinical Anger Scale (CAS)--was designed to measure the psychological symptoms presumed to have relevance in the understanding and treatment of clinical anger. Twenty-one sets of statements were prepared for this purpose. In writing these groups of items, the format from one of Beck's early instruments was used to design the Clinical Anger Scale (Beck et al., 1961; Beck, 1963, 1967). The following symptoms of anger were measured by the CAS items: anger now, anger about the future, anger about failure, anger about things, angry-hostile feelings, annoying others, angry about self, angry misery, wanting to hurt others, shouting at people, irritated now, social interference, decision interference, alienating others, work interference, sleep interference, fatigue, appetite interference, health interference, thinking interference, and sexual interference. Subjects were asked to read each of the 21 groups of statements (4 statements per group) and to select the single statement that best described how they felt (e.g., item 1: A = I do not feel angry, B = I feel angry, C = I am angry most of the time now, and D = I am so angry all the time that I can't stand it). The four statements in each cluster varied in symptom intensity, with more intense clinical anger being associated with statement "D." Each cluster of statements was scored on a 4-point Likert scale, with A = 0, B = 1, C = 2, and D = 3. Subjects' responses on the CAS were summed so that higher scores corresponded to greater clinical anger (21 items; range 0 - 63).
       A scoring procedure similar to Beck's (Beck et al., 1996). is used with the Clinical Anger Scale (CAS)--where a clinical anger score in a particular range is labeled in a manner similar to Beck's procedure.  That is, clinical interpretation of the CAS scores is accomplished through the following interpretive ranges:  0-13 - minimal clinical anger; 14-19 - mild clinical anger; 20-28 - moderate clinical anger; and 29-63 - severe clinical anger.
 
Results
           These results are presented in several major sections. The first section presents the psychometric analyses of the Clinical Anger Scale. Included in this section are the factor analysis results, the reliability results, and other scale validity results. Section two then presents the gender norms and the ANOVA analyses conducted to examine the effect of gender on the CAS. The third section reports the research evidence for the convergent validity of both the CAS. This section presents the correlations between the CAS and Speilberger's anger-related instruments. Section fourth includes the results of the analyses conducted to examine the relationship between the CAS and the measures of psychological symptoms, personality traits, and unhealthy behaviors (i.e., acting out and neuroticism indexes). The fifth and final section describes the relationship between the CAS and the measure of early family atmosphere, the Family Environment Scale.
 
Factor Analysis Results
          To examine the psychometric properties of the Clinical Anger Scale, a series of factor analyses (principal axis with varimax rotation) were conducted for males and females separately and in combination (using Sample IV). The results are shown in Table 1. An inspection of Table 1 indicates that for the combined group of both males and females, all of the CAS statements (except for item 3) loaded above |.30| on a single factor solution (the eigenvalue for Solution I was 9.53 with 45.4% of the variance being explained). No other factor solution had an eigenvalue greater than 1 (see Table 1). The CAS items were then analyzed for males and females separately. The resulting factor loadings are also shown in Table 1. Again, for both the male and the female analyses, only one factor solution with an eigenvalue greater than 1 was found (for males, the eigenvalue for Solution I was 11.33 and it accounted for 54% of the variance; for females, the eigenvalue for Solution I was 8.71 and it accounted for 41.5% of the variance). Although neither the male nor the female analyses produced more than one factor solution with an eigenvalue greater than 1, it is apparent from Table 1 that some of the secondary solutions were associated with the attitudinal, physiological, and performance manifestations of clinical anger.
 
Reliability
          The internal consistency of the 21 items on the Clinical Anger Scale was analyzed by means of Cronbach alpha, and yielded reliability coefficients of .94 (males and females together), .95 (males only), and .92 (females only). The item-total correlations for these alphas are presented in Table 1. All the item-total correlations exceeded |.30|, except for item 3 (anger about failure) which had item-total coefficients of .13, .19, and .11, respectively, for the total sample, males only, and females only. [Although the item-total coefficient for item 3 was low, it was decided nonetheless to retain this item in the computation of the total CAS score, pending the results of additional investigations on other older samples.] In addition to conducting internal reliability analyses, test-retest analyses were also performed (see Table 2). The correlations between the two administrations of the CAS were .85 (males), .77 (females), and .78 (both males and females).
 
Social Desirability
           Finally, to determine whether people's scores on the Clinical Anger Scale were contaminated by some type of response bias, the CAS was correlated with a measure of social desirability and with the EPI Lie Scale. The results, shown in Table 2, indicate that the CAS was independent of the tendency to respond in a socially desirable fashion and was largely independent of the EPI Lie scores (the only exception was the Lie scale for females, but this correlation only accounted for 4% of the overall variability in the scores). In brief, this information indicates that the CAS was largely unifactorial in nature, highly reliable, and essentially uncontaminated by social desirable and lying tendencies.
 
Gender Effects and Norms for the CAS
           According to social stereotypes about gender, anger is an affect that characterizes men more than women. A series of ANOVAs for Samples I, II, III, IV, and V was thus conducted on the CAS to examine whether men and women would report different degrees of clinical anger. In these analyses, gender was treated as the independent variable and the CAS was regarded as dependent variable. The results are presented in Table 2, and reveal no evidence that males and females differ in terms of the syndrome of clinical anger (all ps > .05). This table also presents normative data (i.e., means and standard deviations) for males and females in each of the major samples (Samples I-V).
 
Convergent Validity Findings for the CAS
           Preliminary evidence for the validity of the Clinical Anger Scale was determined by examining the correlations between the CAS and the scores on Spielberger's anger-related instruments. These correlations are shown in the bottom half of Table 2. As expected, the scores on the Clinical Anger Scale were positively and strongly correlated with the two subscales on the State-Trait Anger Scale. Moreover, the Clinical Anger Scale was positively correlated with the subscales on the Anger Expression Scale, although the relationships were not always as strong nor as significant as for the State-Trait Anger Scale. These findings thus provide support for the convergent validity of the Clinical Anger Scale. Additional Validity Findings for the CAS This section presents the results of analyses conducted to examine the relationship between the CAS and the measures of psychological symptoms, personality traits, and other unhealthy behaviors (i.e., acting out and neuroticism indexes). The results are shown in Table 3.
 
Psychological Symptoms and the CAS.
          As an inspection of Table 3 indicates, the Clinical Anger Scale was positively correlated with the full range of psychological symptoms measured by the SCL-90-R. Also, as one might expect, males and females who reported greater clinical anger reported an elevated number of psychological symptoms associated with hostility. In brief, clinical anger was positively associated with a broad array of psychopathological symptoms.
 
Personality Traits and the CAS.
          The Clinical Anger Scale was also correlated with two personality instruments, the Eysenck Personality Inventory and the Goldberg Big-5 Scale. As can be seen in Table 3 (for the combined sample of males and females), clinical anger was positively correlated with Eysenck's neuroticism scale and negatively correlated with Eysenck's extraversion scale, and negatively correlated with the Big-5 measure of extraversion, pleasantness-agreeableness, and emotional stability. Thus, feelings of clinical anger were associated in a predictable pattern with measures of dispositional personality attributes.
 
Unhealthy Behaviors and the CAS.
           Table 3 (Snell et al., 1995) also shows the correlations between the Clinical Anger Scale and the measures of acting-out behaviors, neurotic behaviors, and interpersonal defensiveness. As expected, among the combined sample of males and females, clinical anger was positively associated with all three measures of psychologically unhealthy behaviors (although the pattern of results did vary somewhat among males and females). Thus, people who were characterized by more intense clinical angry reported engaging in a greater number of misdirected and inappropriate behaviors (e.g., lying, fighting, thefts, drug use); as being more uncertain and dissatisfied with their social and personal life; and as acting in a more suspicious and defensive manner about the intentions of others.
 
Family Environments and the CAS.
          The relationship between the Clinical Anger Scale and a measure of early family environment, as assessed by the Family Environment Scale, was also examined. These correlations were computed for both males and females separately, but only the results for the combined sample will be interpreted (see Table 3). An inspection of this table reveals that clinical anger was negatively associated with a family history of cohesion, expressiveness, and shared recreational activities, but was positively related to an earlier history of family conflict and exaggerated family control (but see the gender specific correlations). No other correlations were statistically significant.
Discussion
          The need for a reliable and valid instrument capable of assessing the symptoms of clinical anger led to the present research on the construction and preliminary validation of the Clinical Anger Scale. The Clinical Anger Scale was specifically designed to measure the array of psychological, physiological, affective, cognitive, motoric, and behavioral symptoms constituting clinical anger. Preliminary evidence for the validity of the CAS was demonstrated in a series of analyses showing that clinical anger was related in a systematic and interpretable manner with measures of state anger, trait anger, anger control, and anger expressed inwardly and outwardly. Moreover, other findings revealed that men's and women's feelings of clinical anger were predictably associated with a number of distinct personality characteristics, psychopathological symptoms, and inappropriate as well as problematic interpersonal behaviors.

         Snell, W. E., Jr., Gum, S., Shuck, R. L., Mosley, J. A., & Hite, T. L.  (1995). 
The Clinical Anger Scale:  Preliminary reliability and validity. Journal of Clinical
Psychology, 51, 215-226.

         Beck, A. T., Brown, G., & Steer, R. A. (1996). Beck Depression
Inventory II manual
. San Antonio, TX: The Psychological Corporation.


Explicit written permission is need from Dr. William E. Snell, Jr.,
in order for individuals to use the Clinical Anger Scale (CAS).
Address internet e-mail to: wesnell@semo.edu.

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