Sweetened blood cools hot tempers: physiological self-control and aggression

Alcohol use, civilian interference, and other possible risk factors for death during restraint

Physical restraint is usually used when trying to control and terminate a violent episode. Many causes are possible behind aggressive, agitated, and violent behavior. Some of these are such factors that can either be detected in forensic autopsies or can be evident from the person's medical records. Various causes for deaths during physical restraint have been suggested. In this study, we wanted to review all incidents in which physical restraint was employed, ending in death of the restrained person, whether the restraint was applied by police officers, security guards, police custody personnel, health care personnel or ordinary civilians. The main aim was to see if this new kind of study design would increase our knowledge in circumstances and causes leading to death in restraint situations. Data was collected retrospectively from all forensic autopsies performed in the Southern Finland area during 2010-2015. We went through 21,036 forensic autopsy cases and found 12 cases (0.06 %) in which a physical restraint was employed before death. Police officers were involved in the physical restraint in 7/12 of the cases: in two of these cases, police alone; in three cases, police and guards; and in two cases, police and health care personnel. Civilians carried out the restraint in 5/12 cases. With civilians responsible for the restraint, the cause of death was more likely considered to be a result of the restraint itself than in cases where police and other authorities were responsible for the restraint. This could be because civilians aren't educated about safe restraint methods, and they might themselves be intoxicated. Alcohol was the most common psychoactive substance found in this study and could be a risk factor for not only aggressive behavior but also death, since alcohol use can provoke cardiac arrhythmias and even sudden death. Based on this study, and previously published studies, we see restraint deaths as a varying spectrum of deaths, in which the death is often possibly a result of many factors, including the effects of agitation and restraint, intoxication, and cardiac and other illnesses.

Lived Experience of People with Type 1 Diabetes in North East Ethiopia; Psycho-Social and Economical Perspective, a Phenomenological Study

Objective

To explore lived experience of people with type 1 diabetes in North East Ethiopia; psycho-social and economical perspective.

Methods

A descriptive phenomenological study was conducted to explore the lived experience of people with type 1 diabetes in North East Ethiopia; psycho-social and economical perspective from March 02 to March 25, 2020. A heterogeneous purposive sample method was used to choose the participants. The lead investigator used an in-depth interview to collect data, using an audio recorder and an interview guide. The data were analysed using the thematic analysis method. Atlas. ti software version 7 was used to facilitate the data analysis process.

Results

A total of 13 participants were enrolled in this study. The participants age range were 14 to 70 years and their duration of diabetes since diagnosis were from 8 months to 16 years. The three interconnected themes that emerged from the analysis are: (1) psychological experience with two sub-themes (psychological problems due to diabetes including fear and coping strategies for psychological problems), (2) social experience, which has five categories (influence on intimate relationships, influence on social participation, disclosure status, social isolation and stigma, social support, and influence on education); and (3) economic experience.

Conclusion

Fear was one of the psychological experiences felt by people with type 1 diabetes. Although type 1 diabetes is a biomedical problem, it is also accompanied by other psychological and socio-economic issues, that require a holistic approach to address it. So, health professionals should strengthen health information dissemination programs.

Does crime trigger genetic risk for type 2 diabetes in young adults? A G x E interaction study using national data

BACKGROUND

Living in neighborhoods perceived as disordered exacerbates genetic risk for type 2 diabetes (T2D) among older adults. It is unknown whether this gene-neighborhood interaction extends to younger adults. The present study aims to investigate whether crime, an objectively measured indicator of neighborhood disorder, triggers genetic risk for T2D among younger adults, and whether this hypothesized triggering occurs through exposure to obesity.

METHODS

Data were from the Wave I (2008) National Longitudinal Study of Adolescent to Adult Health. A standardized T2D polygenic score was created using 2014 GWAS meta-analysis results. Weighted mediation analyses using generalized structural equation models were conducted in a final sample of 7606 adults (age range: 25-34) to test the overall association of T2D polygenic scores with T2D, and the mediating path through obesity exposure in low, moderate, and high county crime-rate groups. Age, sex, ancestry, educational degree, household income, five genetic principal components, and county-level concentrated advantage and population density were adjusted.

RESULTS

The overall association between T2D polygenic score and T2D was not significant in low-crime areas (p = 0.453), marginally significant in moderate-crime areas (p = 0.064), and statistically significant in high-crime areas (p = 0.007). The mediating path through obesity was not significant in low or moderate crime areas (ps = 0.560 and 0.261, respectively), but was statistically significant in high-crime areas (p = 0.023). The indirect path through obesity accounted for 12% of the overall association in high-crime area.

CONCLUSION

A gene-crime interaction in T2D was observed among younger adults, and this association was partially explained by exposure to obesity.

Hangry in the field: An experience sampling study on the impact of hunger on anger, irritability, and affect

The colloquial term “hangry” refers to the notion that people become angry when hungry, but very little research has directly determined the extent to which the relationship between hunger and negative emotions is robust. Here, we examined associations between everyday experiences of hunger and negative emotions using an experience sampling method. Sixty-four participants from Central Europe completed a 21-day experience sampling phase in which they reported their hunger, anger, irritability, pleasure, and arousal at five time-points each day (total = 9,142 responses). Results indicated that greater levels of self-reported hunger were associated with greater feelings of anger and irritability, and with lower pleasure. These findings remained significant after accounting for participant sex, age, body mass index, dietary behaviours, and trait anger. In contrast, associations with arousal were not significant. These results provide evidence that everyday levels of hunger are associated with negative emotionality and supports the notion of being “hangry”.

Converging vulnerability factors for compulsive food and drug use

Highly palatable foods and substance of abuse have intersecting neurobiological, metabolic and behavioral effects relevant for understanding vulnerability to conditions related to food (e.g., obesity, binge eating disorder) and drug (e.g., substance use disorder) misuse. Here, we review data from animal models, clinical populations and epidemiological evidence in behavioral, genetic, pathophysiologic and therapeutic domains. Results suggest that consumption of highly palatable food and drugs of abuse both impact and conversely are regulated by metabolic hormones and metabolic status. Palatable foods high in fat and/or sugar can elicit adaptation in brain reward and withdrawal circuitry akin to substances of abuse. Intake of or withdrawal from palatable food can impact behavioral sensitivity to drugs of abuse and vice versa. A robust literature suggests common substrates and roles for negative reinforcement, negative affect, negative urgency, and impulse control deficits, with both highly palatable foods and substances of abuse. Candidate genetic risk loci shared by obesity and alcohol use disorders have been identified in molecules classically associated with both metabolic and motivational functions. Finally, certain drugs may have overlapping therapeutic potential to treat obesity, diabetes, binge-related eating disorders and substance use disorders. Taken together, data are consistent with the hypotheses that compulsive food and substance use share overlapping, interacting substrates at neurobiological and metabolic levels and that motivated behavior associated with feeding or substance use might constitute vulnerability factors for one another. This article is part of the special issue on 'Vulnerabilities to Substance Abuse'.

Investigating Self-Control Resource Depletion as a Situational Risk Factor for Aversive Interpartner Communication by Young Adults With ADHD

Objective: Adults with attention-deficit hyperactivity disorder (ADHD) have more conflictual relations with their romantic partners than adults without ADHD. This study investigated whether adults with ADHD are differentially susceptible to conflict when self-control resources are depleted. Method: Heterosexual adult couples (20 including at least one adult with ADHD; 12 including no adults with ADHD) were randomly assigned to have resources temporarily depleted or not. Positive and negative communication was assessed during a subsequent problem-solving task with their partners. Results: Adults with ADHD whose self-control resources were depleted communicated less positively and more negatively with their romantic partners than adults without ADHD whose resources were depleted. Conclusion: Adults with ADHD appear to have a differential susceptibility to interpartner discord when their self-control resources have been depleted. Clinicians seeking to remediate discordant romantic relationships of adults with ADHD should consider evaluating how often their resources needed to manage their impulses are depleted.

Relationship between county-level crime and diabetes: Mediating effect of physical inactivity

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High crime rates are associated with increased rates of type 2 diabetes.

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Area physical inactivity is an important mediator in this process.

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Over 60% of the relation between crime and diabetes was mediated by physical inactivity.

This paper assessed the extent to which physical inactivity accounts for the relationship between the crime rate and prevalence of type 2 diabetes in the United States. Using 2018 US county-level data, we compared unadjusted and adjusted prevalence of type 2 diabetes between high and low crime counties for 2,966 US counties. Average causal mediating effects of residents’ reported physical inactivity were estimated for each comparison. Counties with a higher crime rate were more likely to have higher percentages of people with type 2 diabetes than counties with a lower crime rate, even after adjusting for potential confounding factors such as racial distribution, income level, food insecurity, and neighborhood walkability (adjusted coefficient for top 40% vs. bottom 40% of crime rate distribution = 0.36; p < 0.001). Over 60% of the adjusted relationship between county-level rate of crime and type 2 diabetes was found to be mediated by physical inactivity. This study reinforces potentially overlooked public health benefits of effective anti-crime measures via improved physical activity.

Socioeconomic inequality in the risk of intentional injuries among adolescents: a cross-sectional analysis of 89 countries

INTRODUCTION

In 2015, the elimination of hunger worldwide by 2030 was declared by the United Nations as a Sustainable Development Goal. However, food insecurity remains pervasive, contributing to socioeconomic health inequalities. The overall objective was to investigate the relationship between food insecurity and intentional injuries among adolescents.

METHODS

Individual-level data from the Global School-based Student Health Survey from 89 countries were used (370 719 adolescents, aged 12-17 years). Multilevel logistic regressions were used to examine the sex-specific association between the level of food insecurity (none, medium and high) and intentional injuries (interpersonal violence and suicide attempts), accounting for the clustering of observations within surveys. Random-effects meta-analyses were used to analyse dose-response relationships.

RESULTS

Medium and high food insecurity were associated with increased odds of reporting an injury from interpersonal violence among both sexes. A positive dose-response relationship was found, where each level increase in food insecurity was associated with a 30% increase in the odds of an injury due to interpersonal violence among boys (1.30; 95% CI 1.26 to 1.34) and a 50% increase among girls (1.53; 95% CI 1.46-1.62). The odds for suicide attempts increased by 30% for both sexes with each level increase in food insecurity (boys: 1.29; 95% CI 1.25-1.32; girls: 1.29; 95% CI 1.25-1.32).

DISCUSSION

The findings indicate that socioeconomic inequalities exist in the risk of intentional injuries among adolescents. Although additional studies are needed to establish causality, the present study suggests that the amelioration of food insecurity could have implications beyond the prevention of its direct consequences.

Sexual behavior in rodents: Where do we go from here?

Hormones and Behavior was first published 50 years ago including some articles related to the hormonal regulation of sexual behavior in different species. Since then, this research field has produced outstanding discoveries that have contributed to our understanding of the control of sexual behavior. The refinement of classical techniques and the development of new experimental tools has opened the door to a new era of research that will allow us to understand different aspects of sexual behavior. It would also expand the possible extrapolation from animal models to understand human sexuality and its dysfunctions. In this review, we summarize some of the most recent findings about sexual behavior in both sexes including the refinement of classical methods of study with new approaches and questions as well as the development of new methods trying to explain mechanisms of action on motivational and consummatory elements of mating behavior. We also reviewed other aspects that modulate sexual behavior such as attractivity, olfactory signals and learning which model mate selection. Additionally, we described studies demonstrating that sexual behavior induces permanent brain modifications in neuronal circuits. Finally, we briefly describe recent contributions on animal models of human sexuality dysfunctions which, although with their own limitations, are under continuous refining.

Objective Physiological Measurements but Not Subjective Reports Moderate the Effect of Hunger on Choice Behavior

Hunger is a powerful driver of human behavior, and is therefore of great interest to the study of psychology, economics, and consumer behavior. Assessing hunger levels in experiments is often biased, when using self-report methods, or complex, when using blood tests. We propose a novel way of objectively measuring subjects' levels of hunger by identifying levels of alpha-amylase (AA) enzyme in their saliva samples. We used this measure to uncover the effect of hunger on different types of choice behaviors. We found that hunger increases risk-seeking behavior in a lottery-choice task, modifies levels of vindictiveness in a social decision-making task, but does not have a detectible effect on economic inconsistency in a budget-set choice task. Importantly, these findings were moderated by AA levels and not by self-report measures. We demonstrate the effects hunger has on choice behavior and the problematic nature of subjective measures of physiological states, and propose to use reliable and valid biologically based methods to overcome these problems.

Self-Regulation Facilitates Meaning in Life

Meaning is a central feature of human life. Our overarching proposition is that self-regulation helps facilitate meaning in life. We propose that purposeful, effortful, and directive actions that regulate selfish impulses are necessary to continually develop a sense of meaning in life. We explain how self-regulatory processes map onto this process: the drive for meaning is governed by internalized standards of meaning, people monitor their experiences to ensure a fit between their experiences and standards of meaning, and strength is required for deliberative behaviors aimed at reaffirming and regaining meaning. Moreover, we outline various self-regulatory pathways to gain meaning via coherence, significance, and purpose. Finally, we suggest various ways to test and expand our model and hypotheses.

Examination of the validity and reliability of the French version of the Brief Self-Control Scale

This study aims to develop and to validate a French version of the Brief Self-Control Scale (BSCS; Tangney et al., 2004). This instrument is usually applied as a unidimensional self-report measure for assessing trait self-control, which captures one's dispositional ability to resist short-term temptation in order to reach more valuable long-term goals. Data were collected from two independent samples of French-speaking individuals (n₁ = 287; n₂ = 160). Results indicated that the French version of the BSCS can be treated as unidimensional, like the original questionnaire. Data also showed consistent acceptable reliability and reasonable test-retest stability. Acceptable external validity of constructs was supported by relationships with self-reported measures of impulsivity (UPPS), including urgency, lack of premeditation, and lack of perseverance. Overall, the findings suggest that the average score of the French version of the BSCS is a viable option for assessing trait self-control in French speaking populations.

Perinatal Exposure to a Diet High in Saturated Fat, Refined Sugar and Cholesterol Affects Behaviour, Growth, and Feed Intake in Weaned Piglets

The increased consumption of diets high in saturated fats and refined sugars is a major public health concern in Western human societies. Recent studies suggest that perinatal exposure to dietary fat and/or sugar may affect behavioural development. We thus investigated the effects of perinatal exposure to a high-fat high-sugar diet (HFS) on behavioural development and production performance of piglets. Thirty-two non-obese sows and their piglets were allocated to 1 of 4 treatments in a 2 × 2 factorial design, with 8-week prenatal (gestation) and 8-week postnatal (lactation and post-weaning) exposure to a HFS diet (12% saturated fat, 18.5% sucrose, 1% cholesterol) or control low-fat low-sugar high-starch diets as factors. From weaning onwards (4 weeks of age), piglets were housed in group of 3 littermates (n = 8 groups/treatment) and fed ad libitum. After the end of the dietary intervention (8 weeks of age), all the piglets were fed a standard commercial diet. Piglet behaviours in the home pens were scored, and skin lesions, growth, feed intake and feed efficiency were measured up to 8 weeks after the end of the dietary treatment, i.e. until 16 weeks of age. At the end of the dietary treatment (8 weeks of age), response to novelty was assessed in a combined open field and novel object test (OFT/NOT). During the weeks following weaning, piglets fed the postnatal HFS diet tended to be less aggressive (p = 0.06), but exhibited more oral manipulation of pen mates (p = 0.05) than controls. Compared to controls, piglets fed the prenatal or postnatal HFS diet walked more in the home pen (p ≤ 0.05), and tended to have fewer skin lesions (p < 0.10). Several behavioural effects of the postnatal HFS diet depended on the prenatal diet, with piglets subjected to a switch of diet at birth being more active, and exploring feeding materials, pen mates, and the environment more than piglets that remained on the same diet. Behaviours during the OFT/NOT were not affected by the diet. The intake of the postnatal HFS diet drastically reduced feed intake, but improved feed efficiency up to 8 weeks after the end of the dietary intervention, i.e. 16 weeks of age (p < 0.0001 for both). Our study highlights the key role of prenatal and postnatal nutritional interactions for early behavioural development, and reveals programming effects of early life nutrition on voluntary feed intake of piglets later in life.

Childhood Reports of Food Neglect and Impulse Control Problems and Violence in Adulthood

Food insecurity and hunger during childhood are associated with an array of developmental problems in multiple domains, including impulse control problems and violence. Unfortunately, extant research is based primarily on small convenience samples and an epidemiological assessment of the hunger-violence link is lacking. The current study employed data from Wave 1 (2001-2002) and Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). The NESARC is a nationally representative sample of non-institutionalized U.S. residents aged 18 years and older. Participants who experienced frequent hunger during childhood had significantly greater impulsivity, worse self-control, and greater involvement in several forms of interpersonal violence. These effects were stronger among whites, Hispanics, and males. The findings support general theoretical models implicating impulse control problems as a key correlate of crime and violence and add another facet to the importance of ameliorating food neglect in the United States.

Trait anger but not anxiety predicts incident type 2 diabetes: The Multi-Ethnic Study of Atherosclerosis (MESA)

OBJECTIVE

Prior studies have shown a bidirectional association between depression and type 2 diabetes mellitus (T2DM); however, the prospective associations of anger and anxiety with T2DM have not been established. We hypothesized that trait anger and anxiety would predict incident T2DM, independently of depressive symptoms.

RESEARCH DESIGN AND METHODS

In the Multi-ethnic Study of Atherosclerosis (MESA), we prospectively examined the association of trait anger and trait anxiety (assessed via the Spielberger Trait Anger and Anxiety Scales, respectively) with incident T2DM over 11.4 years in 5598 White, Black, Hispanic, and Chinese participants (53.2% women, mean age 61.6 years) at baseline without prevalent T2DM or cardiovascular disease. We used Cox proportional hazards models to calculate the hazard ratios (HR) of incident T2DM by previously defined anger category (low, moderate, high), and anxiety quartile, as there were no previously defined categories.

RESULTS

High total trait anger was associated with incident T2DM (HR 1.50; 95% CI 1.08-2.07) relative to low total trait anger. The association was attenuated following adjustment for waist circumference (HR 1.32; 95% CI 0.94-1.86). Higher anger reaction was also associated with incident T2DM (HR=1.07; 95% CI 1.03-1.11) that remained significant after adjusting for potential confounders/explanatory factors. In contrast, trait anxiety did not predict incident T2DM.

CONCLUSIONS

High total trait anger and anger reaction are potential modifiable risk factors for T2DM. Further research is needed to explore the mechanisms of the anger-diabetes relationship and to develop preventive interventions.

Bitter Taste Causes Hostility

The present research tested the novel hypothesis that bitter taste increases hostility. Theoretical background formed the intimate link of the taste-sensory system to the visceral system, with bitter intake typically eliciting a strong aversion response. Three experiments using differential bitter and control stimuli showed that hostile affect and behavior is increased by bitter taste experiences. Specifically, participants who consumed a bitter (vs. control) drink showed an increase in self-reported current hostility (Experiment 1), in hypothetical aggressive affect and hypothetical aggressive behavior (Experiment 2) and in actual hostile behavior assessed using a well-established method for non-physical laboratory aggression (Experiment 3). Furthermore, the effect occurred not only when participants were previously provoked (Experiments 2 and 3) but also when no provocation preceded (Experiment 1 and 3). Importantly, stimulus aversiveness and intensity did not influence the effects observed, ruling them out as explanations. Alternative interpretative frameworks and limitations are discussed.

High fat, low carbohydrate diet limit fear and aggression in Göttingen minipigs

High fat, low carbohydrate diets have become popular, as short-term studies show that such diets are effective for reducing body weight, and lowering the risk of diabetes and cardiovascular disease. There is growing evidence from both humans and other animals that diet affects behaviour and intake of fat has been linked, positively and negatively, with traits such as exploration, social interaction, anxiety and fear. Animal models with high translational value can help provide relevant and important information in elucidating potential effects of high fat, low carbohydrate diets on human behaviour. Twenty four young, male Göttingen minipigs were fed either a high fat/cholesterol, low carbohydrate diet or a low fat, high carbohydrate/sucrose diet in contrast to a standard low fat, high carbohydrate minipig diet. Spontaneous behaviour was observed through video recordings of home pens and test-related behaviours were recorded during tests involving animal-human contact and reaction towards a novel object. We showed that the minipigs fed a high fat/cholesterol, low carbohydrate diet were less aggressive, showed more non-agonistic social contact and had fewer and less severe skin lesions and were less fearful of a novel object than minipigs fed low fat, high carbohydrate diets. These results found in a porcine model could have important implications for general health and wellbeing of humans and show the potential for using dietary manipulations to reduce aggression in human society.

Low glucose relates to greater aggression in married couples

Intimate partner violence affects millions of people globally. One possible contributing factor is poor self-control. Self-control requires energy, part of which is provided by glucose. For 21 days, glucose levels were measured in 107 married couples. To measure aggressive impulses, each evening participants stuck between 0 and 51 pins into a voodoo doll that represented their spouse, depending how angry they were with their spouse. To measure aggression, participants competed against their spouse on a 25-trial task in which the winner blasted the loser with loud noise through headphones. As expected, the lower the level of glucose in the blood, the greater number of pins participants stuck into the voodoo doll, and the higher intensity and longer duration of noise participants set for their spouse.

Interactive Effect of Moral Disengagement and Violent Video Games on Self-Control, Cheating, and Aggression

Violent video games glorify and reward immoral behaviors (e.g., murder, assault, rape, robbery, arson, motor vehicle theft). Based on the moral disengagement theory, we predicted that violent games would increase multiple immoral behaviors (i.e., lack of self-control, cheating, aggression), especially for people high in moral disengagement. High school students ( N = 172) who had completed a measure of moral disengagement were randomly assigned to play one of the Grand Theft Auto (GTA) violent video games, or a nonviolent game. Self-control was measured using the weight of uneaten chocolates (i.e., M&M’s) in a bowl by the computer. After gameplay, participants could cheat on a test to win raffle tickets for attractive prizes (e.g., iPad). Aggression was measured using a competitive task in which participants could give an ostensible partner unpleasant noise blasts through headphones. Results showed that violent video games decreased self-control and increased cheating and aggression, especially for people high in moral disengagement.

Hunger Games

Social-welfare policies are a modern instantiation of a phenomenon that has pervaded human evolutionary history: resource sharing. Ancestrally, food was a key shared resource in situations of temporary hunger. If evolved human psychology continues to shape how individuals think about current, evolutionarily novel conditions, this invites the prediction that attitudes regarding welfare politics are influenced by short-term fluctuations in hunger. Using blood glucose levels as a physiological indicator of hunger, we tested this prediction in a study in which participants were randomly assigned to conditions in which they consumed soft drinks containing either carbohydrates or an artificial sweetener. Analyses showed that participants with experimentally induced low blood glucose levels expressed stronger support for social welfare. Using an incentivized measure of actual sharing behavior (the dictator game), we further demonstrated that this increased support for social welfare does not translate into genuinely increased sharing motivations. Rather, we suggest that it is “cheap talk” aimed at increasing the sharing efforts of other individuals.

The multiple systems model of angry rumination

Angry rumination is perseverative thinking about a personally meaningful anger-inducing event and is a risk factor for aggression. This article presents a new model for understanding angry rumination across five levels of analysis: cognitive, neurobiological, affective, executive control, and behavioral. The type of rumination that occurs at the cognitive level moderates affective responding and neurobiological activation, which influences executive control and aggression. Angry rumination recruits brain regions implicated in cognitive control, emotion regulation, negative affect, physiological arousal, social cognition, and self-reflection on emotional states. Moreover, angry rumination temporarily reduces self-control, which can increase aggression. The article suggests a functional account of angry rumination, identifies gaps in our knowledge, and proposes future research directions based on hypotheses derived from the model.

Adding insult to injury: effects of interpersonal rejection types, rejection sensitivity, and self-regulation on obsessive relational intrusion

This study tested the I(3) model [Finkel, 2007; 2008] of intimate partner violence as applied to obsessive relational intrusion (ORI) to assess the relation among self-regulation, rejection, rejection sensitivity (RS), and stalking-related aggression. In Study 1, participants (N=221) read one of three vignettes: no relationship termination, an "internal" rejection (involves an internal attribution to the rejected as cause of relationship ending), or an "external" rejection (external attributions for relationship demise). Next, participants experienced one of two conditions manipulating self-regulation (no depletion vs. depletion). Finally, participants rated their likelihood of engaging in ORI (e.g. unwanted pursuit and/or aggression). Consistent with predictions, participants receiving an internal rejection reported higher aggression than participants experiencing an external rejection, especially when depleted of self-regulation. Study 2 extended the design of Study 1 by adding in a screening survey of RS. Internal rejections still yielded more aggression than other conditions, but this was especially so when rejection-sensitive persons were depleted of self-regulation. In addition to providing support for the I(3) model of aggression, this research shows that not all types of rejection are created equal.