Martijn van Teffelen

Chapter 7 164 Explosive disorder are verbal- and physical. For post-traumatic stress disorder, borderline personality disorder, antisocial personality disorder, and disruptive mood dysregulation disorder, criteria are based on affective and behavioral dimensions of hostility. For paranoid personality disorder, criteria are mostly related to cognitive or affective aspects of hostility. For bipolar disorder, criteria are mostly related to affective aspects of hostility. These DSM-5 criteria may provide a first quick-and-dirty indication of which intervention to select. For example, a person diagnosed with Intermittent Explosive Disorder may specifically benefit from interventions that are behavioral in nature, such as social skills training, or problem-solving skills training. Likewise, a clinician may opt for social skills training, or problem-solving skills training in combination with progressive relaxation for reducing hostility in a patient suffering from with PTSD. Similarly, a patient with paranoid personality traits may benefit from more cognitively based interventions, such as (I-)CR or CBM-I. Related to this, when hostility is a primary reason to seek help, it may be worthwhile to map a patient’s hostility profile and when this does not match the full clinical picture as described by current DSM-5 criteria, clinicians may want diagnose an ‘unspecified disruptive, impulse-control, and conduct disorder’, and tailor treatment base on a patients personality profile. In sum, hostility is a diagnostically challenging condition. Consequently, the effectiveness of hostility interventions may differ between nomological diagnostic classifications. Taken together, the clinical implications of the present dissertation suggest that hostility is a challenging construct in terms of measurement and diagnosis. In spite of its’ challenging nature, the cognitive dimension of hostility is an intervention target that appears to be sensitive for further efficacy optimization. Specifically, the present dissertation showed that CR procedures can be improved through the integration of mental imagery. Moreover, CBM-I may be a valuable, low-cost addition to current treatment options. Overall, the present dissertation showed that hostility is an unrecognized, but highly impairing condition that requires better diagnostic understanding and targeted clinical intervention. Findings revealed that hostility consists of multiple dimensions at different specificity levels and that these dimensions are differentially impacted by personality traits and interventions. Specifically, the integration of mental imagery techniques and implementation of cognitive bias modification provides exciting new avenues for advancing the treatability of hostility. Hopefully, the current work stimulates joint efforts in future research to further unravel the antecedents and consequences of hostility dimensions and how they relate to personality profiles. A better understanding of hostility may increase diagnostic precision and provide valuable insight into new (e.g., I-CR and CBM-I) and more personalized intervention strategies. Ultimately, following Aristotle’s words, this may help patients to become angry with the right person, to the right degree, for the right purpose, and in the right way.