Anger Disorders

What are anger disorders?

Anger disorders manifest when you struggle to control your anger, causing you to lash out verbally or physically at others or yourself. Anger becomes your go-to emotion, you regularly display harmful, destructive behaviors and your physical and mental health suffer as a result.

What is anger?

To understand anger disorders, we must first address anger itself. Anger is a normal emotion we may present when feeling attacked, insulted, frustrated, lied to, or disrespected. Anger isn’t a definitively harmful emotion, rather it can be useful in certain situations, for example:

• It can be used for self-motivation, inspiring us to change harmful behavioral patterns and accomplish more in our lives.
• It can be used to steel ourselves in dangerous situations by sparking adrenaline during our fight or flight response.
• It can lead to increased cooperation and mutual respect between people; if justified. Anger can tell others that you’re not being listened to, your needs aren’t being met, and that we need to work together to rectify that. The resulting solution can be mutually beneficial for all.

However, if anger rears its head regularly and begins to feel unmanageable, these could be signs of an anger disorder.

Types of anger

Anger can be presented in 3 different ways:

1. Passive anger is when you express discontent in an indirect manner. Whilst not directly confrontational, you may subtly appear passive-aggressive. For example, you may make sarcastic remarks about someone’s actions, give a partner the silent treatment to punish them, or offer others disingenuous compliments intended to imply contempt.
2. Inward anger is anger you direct toward yourself. It can involve constant blaming yourself for things going wrong, physical self-harm, and self-deprecating behavior. You may deny yourself activities or food you enjoy or force yourself to partake in things you hate or isolate yourself from people you love as a way of punishing yourself.
3. Outward anger refers to external, clearly observable ways of displaying anger. These include expletives, breaking things, physical violence, verbal abuse to others, and aggressive behavior.

Types of anger disorder

The Diagnostic and Statistical Manual of Mental Disorders (DSM) holds that anger is a core component in five diagnoses: borderline personality disorder, bipolar disorder, intermittent explosive disorder, oppositional defiant disorder, and disruptive mood dysregulation disorder.^[1]

Borderline personality disorder

Borderline personality disorder (BPD) is a mental health condition that causes emotional instability in sufferers. It is characterized by self-image issues, impulsive behaviors, unstable relationships with friends or family, and intense anger issues.^[2]

Sufferers are highly unpredictable, with moods shifting from one end of a spectrum to another suddenly. This can be problematic when it comes to surges of anger, as these can not only lead to harmful behaviors toward others, but also toward themselves. People with BPD have a far higher rate of self-harm and suicidal behaviors than the general population.^[2]

Bipolar Disorder

Bipolar disorder is a brain disorder that is marked by intense mood swings between mania and depression.

Whilst experiencing a manic episode, you may feel euphoric and inexplicably energized. During a depressive episode, you can feel desolate and inconsolable.

It is common for people with bipolar disorder to feel irritable during manic episodes, annoyed by others’ efforts to mollify or merely talk to them. In acute cases of bipolar disorder, this irritability can quickly turn to anger.

Research has found that people with bipolar disorder had an increased propensity for verbal and physical aggression, anger, and hostility than others.^[3]

Whilst anger isn’t a symptom of bipolar disorder, it is commonly experienced by sufferers and can impact their relationships, friendships, and work lives.

Intermittent explosive disorder

Intermittent explosive disorder (IED) is a condition characterized by volatile, aggressive outbursts and violent behavior.

People with IED exhibit myriad varieties of aggressive behavior including:

• Sudden, intense arguments
• Threats
• Punching walls
• Fights
• Domestic Violence
• Shouting
• Road rage
• Destroying public property

Sufferers experience intense anger, reactivity, and dyscontrol before and during an IED episode.^[4] People with IED are more likely to assault their partner, experience interpersonal difficulties and develop serious health problems such as coronary heart disease.^[4]

People with IED also reported feeling overwhelming regret in the aftermath of an IED episode.^[4] This may contribute to their increased risk of depression, anxiety, and substance misuse.

Oppositional defiant disorder

Oppositional defiant disorder (ODD) is a childhood mental condition involving recurring patterns of anger, confrontational behavior, and defiance in the face of authority figures. Diagnosis occurs if the above symptoms, along with irritability and vindictiveness, are displayed for more than 6 months.^[5]

Disruptive mood dysregulation disorder

Disruptive mood dysregulation disorder (DMDD) is a mood disorder that occurs in children and adolescents and is characterized by unshakeable feelings of anger, severe temper tantrums, and incessant irritability.

Closely related to ODD, the diagnostic criteria for DMDD includes behavioral outbursts over three times a week for more than one year. In between outbursts, a patient’s mood is observably negative.^[6]

Children with DMDD are diagnosed between the ages of 6 and 10.^[6] As they progress through adolescence and into adulthood, someone with DMDD may throw fewer tantrums, but instead display anxious or depressive symptoms.^[6]

Warning signs of anger disorders

Living with an anger disorder

Living with an anger disorder can feel frustrating and isolating. Uncontrolled anger can negatively impact your relationships, work life, and health. Here are some tips you can implement to better manage your anger disorder:

• Exercise regularly – physical activity helps relieve stress and improve your mood. Whether it be the gym, a sport, yoga, running, or long walks – regular exercise is a great option for tempering your anger and encouraging relaxation.
• Practice altering your perspective – attempt to think about how others may both your actions and other situations. Regularly doing so may cause you to empathize more with how people respond to potentially anger-inducing situations.
• Avoid drinking excessively and using recreational drugs – both make you lose your inhibitions and render you ill-equipped to manage your anger disorder.
• Humor – try and use humor to help you cope with triggering situations. Trying to find things to make you and others laugh can diffuse the tension in situations. Make sure it’s reciprocal laughter though and not done at someone else’s expense, as that can be counter-productive and hurtful.
• Think before speaking – Impulse control can be helpful when managing an anger disorder. When you are angry, it’s easy to blurt out something you later regret. Practice taking time to think through what you are about to say. Then, express your frustration in a composed manner, explain how your needs aren’t being met, and how you can collaborate to bring about a better situation for everyone involved.
• Take some time - if you feel anger swelling or you feel yourself getting stressed, take a short break from a situation. Leave the scene and get a few moments of peace to collect your thoughts. This may help you navigate through the rest of the day’s events without getting angry.

Living with someone with an anger disorder

It can feel troubling living with someone with an anger disorder. Whether they are a family member, partner, friend, or housemate, you may worry for both of your safety.

Whilst they bear sole responsibility for their actions, there are steps you can take to support them in the management of their anger:

• Listen – allow them the space to convey how they feel without interrupting or judging them. This may relax them, establish you as a confidante and be more responsive to your attempts to help them. Also, providing them with someone to vent to can be enough to abate their anger.
• Give them space – if you have argued or they have had a flare-up, allow them space to self-regulate and let them know that you are open to talking when they have calmed down.
• Avoid antagonizing – do not make accusatory statements such as ‘why are you being so…’. This can antagonize someone with an anger disorder. Instead, express how you would like to be treated going forward and frame this from a personal perspective. For example, ‘I believe I am being disrespected and I would like to feel more heard. Can you please help…’
• Create a safety plan – establish a plan for how you will act if you feel threatened. Have an emergency contact, a loved one or friend, and an exit plan lined up for this moment. Your safety is paramount and you need not bear the brunt of someone else’s anger.
• Set boundaries – this is about respect; being upfront about what behavior you will and will not tolerate can benefit relationships in the long term. Someone else’s anger problem need not jeopardize your sense of well-being or make anyone else in the home feel unsafe. Set limits and define consequences; communicate these clearly to the person with an anger disorder and if they cross the line – act on the consequences.
• Encourage professional help – provide contact details of medical professionals, therapists, support groups, and anger management groups. You may offer them lifts to and from appointments and debrief with them if they so choose.

Treatment for an anger disorder

Psychotherapy

Cognitive behavioral therapy and other talk therapies are the frontline treatments for IED. Together with a psychologist or therapist, patients will identify harmful thought patterns. You will learn how these thoughts trigger anger issues. Then, you will aim to replace these thoughts with healthier ones, leading to better anger management.

Treatment for ODD in children centers around psychosocial management, with parents and teachers tasked with providing care coordination to children that are afflicted. [5]. Both parents and teachers can receive training and children can be involved in peer group support.^[5]

Pharmacological treatment

Whilst not the first line of treatment for anger, medications can be used alongside psychotherapy in the management of anger issues.

There are numerous antidepressants used to treat depressive symptoms which may precipitate or accompany anger disorders. These include Prozac, Celexa, Zoloft, and Lexapro.

There are pharmacological treatments aimed at the management of aggression with antipsychotics, risperidone, and then aripiprazole, showing the best results.^[5]

It is important to discuss your personal circumstances with your doctor or other medical professionals before undergoing any pharmacological treatment. They can help to minimize the risk of side effects or negative implications from any course of medication.