In 2000, anger made headlines in newspapers all across America. Two drivers, caught on a crowded road had a small fender-bender. The driver of the car that was hit strode back to the other car, reached across the driver’s lap and tossed her tiny dog out of the car. According to CBS News, the man was eventually sentenced to three years in prison, and the man’s lawyer claimed that the media had biased the court against the man’s case. No matter how reprehensible the action, it’s possible the man’s lawyer was right. Perhaps the man needed anger management, as opposed to criminal retribution.
Anger disorders are real, and as this story demonstrates, they can have terrible consequences. People who have anger disorders simply cannot control their rage, and they may lash out in ways that others find inappropriate or even illegal. Anger disorders can arise from a variety of sources, but treatment can help people gain a sense of control over their overwhelming anger.
Describing an Anger Disorder
Anger is a common human emotion, and it serves a valuable purpose. A person flushed with anger has heightened senses, a pounding heart and an increased flow of blood to the extremities. This can help a person fight off an attacker, defend another person in distress or deflect an emotional assault. No therapist would suggest that all forms of anger should be eliminated. Anger is an important part of the human experience.
People with anger disorders, however, have an anger response that is out of control. They may feel simmering, low levels of anger all of the time, so mild insults become fuel for a fire that is already burning. Some people move from tiny levels of anger to huge levels of anger in a moment, with very little transition between the two states. Other people experience an outburst of anger on too-frequent a basis, screaming almost every day.
Intermittent explosive disorder is a particularly dangerous form of anger disorder, and according to the National Institute of Mental Health, as many as 11.6 million Americans struggle with the disorder during their lifetimes. People with this anger disorder experience overwhelming forms of anger and impulsiveness that are completely out of proportion to the situation the person is experiencing. During a violent outburst, the person may:
- Destroy property
- Injure other people
- Threaten to injure other people
- Persist in this behavior, even when told to stop
According to the Mayo Clinic, these episodes typically last for 15 to 20 minutes, and when the episode is over, the person may feel a significant amount of remorse. The behavior is compulsive, meaning that the person can’t stop or control it, but when the person reflects upon what he or she has done, the person might feel guilty, worthless or even frightened.
Causes and Risk Factors
Anger disorders can go hand in hand with a variety of other mental illnesses. For example, according to an article published in Bipolar Magazine, people with certain forms of bipolar disease often display symptoms of anger disorders. During the manic or depressive phases of bipolar disorders, the person might experience low levels of hostility or irritability that can quickly become episodes of rage. If these people abuse alcohol or other substances during their manic or depressive phases, the anger can grow worse. The substances reduce the ability of the person to control his or her emotions and behave appropriately, which could make an outburst of anger more likely.
An article published in the Journal of Traumatic Stress suggests that people who have post-traumatic stress syndrome often experience high levels of anger. In this study, the authors examined a group of people who had been diagnosed with post-traumatic stress disorder after enduring time in combat, and a specific subset of those people had such severe forms of anger disorders that the researchers referred to the group as a “ball of rage.” It’s clear that processing stress can lead to high levels of anger, and an inability to control those angry responses.It’s also possible that some forms of anger disorders develop in families. An article published in the Turkish journal Psikiyatride Guncel Yaklasimlar found that people with anger disorders have metabolic changes in their brains, specifically in the way their brains use specific neurotransmitters, but these people also tended to experience some sort of childhood trauma. It’s also possible that some people develop anger disorders because they grew up in households where exaggerated anger responses were both common and accepted. When they were children, they weren’t taught to manage their emotions, and they were surrounded by others who didn’t manage their emotions, and so they grew up to follow the same pattern.
Dangers of Anger Disorders
Obviously the main danger of an untreated anger disorder is sudden violence. A person in the throes of an outburst could kill someone, attack someone and get killed, or engage in a violent behavior and get arrested and incarcerated for that behavior. It might sound extreme, but people who live with anger disorders often claim that they felt “possessed,” “out of control” or “not really there.” The anger takes over and the person is unable to see what the end result will be.
People with anger disorders are often socially isolated. Their marriages can break down, they may lose custody of their children, they may behave badly at work and they may have few friends to socialize with. Those who behave in violent ways may be at particular risk of isolation, as their anger is simply frightening, and people may avoid them in order to protect themselves from physical harm.
In addition, according to the National Institutes of Mental Health, people who have anger disorders that are left untreated are at high risk for developing other mental illnesses, including bipolar disorder, depression, anxiety or addiction. The article states that treating anger disorders early in life, when symptoms begin, could help reduce that risk.
Who Needs Help?
If everyone experiences anger, and anger in and of itself isn’t considered unhealthy, it can be difficult to determine who needs to go through anger management therapy. In short, it can be hard to figure out when anger responses move from healthy and normal to dysfunctional and scary. According to the Mayo Clinic, people who do the following things may have an out-of-control anger response:
- Get in physical altercations
- Make physical or verbal threats
- Drive recklessly
- Getting arrested for behavior done while angry
- Feeling angry all the time and repressing those feelings
Sometimes, family members know when a loved one should see a professional for anger management. They’re living in fear, and they know that the anger problem has moved from tolerable to intolerable. Approaching someone with an anger problem is difficult, and sometimes, it can be dangerous. It’s best to talk to the person’s doctor, an intervention specialist or a mental health professional first, before opening up the floor to conversation, especially if the person has a tendency to become physically violent.
During an appointment with a mental health specialist, the person will be asked a variety of questions about the anger, and the problems the person has experienced as a result of that anger. In order to prepare for that appointment, the website Afterdeployment.org suggests that the person begin to think about his or her anger response and begin to take a series of notes to bring to that appointment. Good things to notice include:
- The physical symptoms that accompany an anger attack
- Triggers of an anger attack
- How quickly the person moves from annoyance to full-blown anger
- Actions the person takes while angry
- Thoughts that circle in the person’s mind during an anger episode
The person might have a physical exam with blood tests, just to ensure that a physical problem such as heart disease or a thyroid disorder isn’t causing the symptoms. The person might also be asked questions about family history of mental illness and anger disorders. Some people call their parents or their siblings to obtain this information, if they don’t already know it.
Some people with anger disorders and substance abuse issues benefit from a program much like the one we provide at Axis. Here, they can access intensive therapy techniques that can teach them how to identify anger and keep it from impacting their lives in such a serious and significant way. And, they can conquer the addictions that tend to keep an anger disorder firmly in place. Other people benefit from outpatient programs, where they meet with a counselor and discuss anger control techniques on a weekly or monthly basis. Either method can be beneficial in helping to raise awareness and increase anger-management skills. It’s a personal decision the person makes in consultation with the therapist.
In short, therapy can take many different courses, but the end goal is often much the same – that the person learns to control anger and move forward in a healthful and productive way. It’s hard work, but it’s work worth doing.