Building Personal Resilience

When Anger Becomes a Disorder

BY CHAI KARYEN

15 March 2021  |   7 min read

You feel your muscles tightening. Your jaw clenches. Your fingers itch to grab a pillow and hurl it across the room. These are common ways that we experience anger internally. Most of us, if not everyone, have felt angry at some point in our lives. We feel angry when we perceive that an injustice has been done. We feel angry when something does not go our way. Some of us even feel “hangry”, an amalgam of hungry and angry, a negative emotion brought on by the release of stress hormones when we are hungry.

Anger is a naturally evolved phenomenon that allows humans to respond to threats. From fending off attackers to encountering terrible drivers on the way to work, unpleasant situations can trigger the release of stress hormones such as adrenaline and norepinephrine in our body, causing our muscles to twitch, our brows to wrinkle and our heart to beat faster (the Incredible Hulk, anyone?).

Anger is a natural emotion but it can also be destructive. People who are angry may display observable aggressive behaviour such as punching and kicking. Non-physical aggressive behaviour like verbal or passive-aggression are no less damaging and can affect quality of life for the aggresser and people around. Anger can occur in any environment containing threats or stressors – in the workplace, during gameplay, even in the home.

While there is no specific diagnosis for anger and aggression, they are commonly listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the International Statistical Classification of Diseases and Related Health Problems (ICD-10) as symptoms of more than 30 disorders, among them being Intermittent Explosive Disorder (IED).

Intermittent Explosive Disorder

IED is an impulse-control disorder characterised by a pattern of sudden, impulsive, aggressive and violent behaviour, or explosive outbursts of anger and/or violence that are disproportionate to the situation at hand. Common behavioural manifestations of IED are road rage, property damage and domestic abuse.

Intermittent explosive disorder frequently occurs alongside other mood disorders like depression and anxiety disorders, and can often be linked to alcohol and other substance use.

While anger and aggression are within the normal spectrum of feelings and most people lose their temper occasionally, someone with IED will likely display a pattern of frequent and extreme outburst of anger or aggression.

While anger and aggression are within the normal spectrum of feelings and most people lose their temper occasionally, someone with IED will likely display a pattern of frequent and extreme outburst of anger or aggression.

Negative impacts of frequent and disproportionate anger and aggression include:

  • Impaired interpersonal relationships. Being perceived as always angry can be an obstacle to building strong relationships with others, leading to dysfunctional family, friend or romantic relationships.
  • Constant troubles. Job loss, legal trouble, impulsive behaviours, financial problems are some possible consequences of IED if the condition goes unmanaged.
  • Substance abuse. Persons with IED are at risk of developing self-soothing behaviours that are harmful, for example alcohol or drug abuse.
  • Physical health problems. IED may be a risk factor for negative health outcomes like muscle tension, heart disease, stroke, high blood pressure, ulcers and chronic pain.
  • Self-harm. A person with IED may direct the aggression towards themselves instead of inflicting harm on others.

Good news! There are constructive ways to manage and channel anger

If left undiagnosed and unmanaged, IED can have destructive long-term effects on a person’s quality of life. There are coping techniques and methods to help persons with IED recognise and manage their patterns of anger and aggression. Here are some simple ways to help break the cycle of feeling angry and hostile:

Resist the impulse

IED is often associated with poor impulse control where, in the heat of the moment, we may say or do things that we later regret. Instead of giving in to the impulse, step back from the situation in your mind or even physically (if in a physical confrontation) to think about how you want to respond.

Take a breather

When you feel yourself getting tense and agitated, use relaxation strategies like deep breathing to help yourself calm down. Repeat the following breathing exercise five to eight times:

Breathe in and out deeply. Breathe in for four to five seconds. Breathe out for six to seven seconds.

Taking a moment for slow, deep breathing can help to decrease heart rate, lower your blood pressure, and cool down the body and mind, which can greatly reduce the likelihood of impulsive aggression.

Express your anger in a non-confrontational way

Anger can muddle your thoughts and dent your ability to communicate clearly. After you have achieved a state of calm, clearly state – or even write down – your concerns about the situation. Foster positive communication by using “I” statements (focusing on your feelings or beliefs) rather than “You” statements that tend to shift blame to the other person. For example, instead of saying “You never do the dishes”, say “I am upset that you forgot to do the dishes last week”.

Be a problem solver (or let it go)

So you have a problem and feel yourself getting upset. Instead of staying angry and focusing on the problem and nothing else, focus instead on goals and the steps you can take to achieve them. Are you feeling angry because noisy neighbours are keeping you up at night? Are you feeling frustrated that your spouse has forgotten to do the dishes again? If you have raised the noise issue to your neighbour and the noise continues, use sleep aids like white-noise machines or earplugs. If your spouse forgets his household chores, leave him reminder notes where he can see them. If the problems persists despite your best efforts, learn to let them go.

Redirect constructively

Repressing negative energy is like vigorously shaking a bottle of soda – you will eventually pop. Instead, redirect that energy to something constructive (or at least, not destructive). Exercise is not only beneficial for physical health, it also releases endorphins which make us feel good.

Use humour, but hold the sarcasm!

Humour offers relief in tense situations by lifting the mood and easing resentment. Humour can also fuel creative thinking by creating a psychological and emotional distance whereby we can envision alternative approaches to the situation. Remember to avoid sarcasm though. Sarcasm can hurt and exacerbate vulnerable feelings that are already present.

You don’t have to do this alone 

IED can be hard to manage alone, as it is often coupled with impulsivity and the feeling of being “possessed” by a powerful emotion. When the need arises, seek the help of professionals to guide you to adopt healthier coping strategies. Find registered therapists here: https://singaporepsychologicalsociety.org/srp-membership-directory/

The contributor is the Communications Chair of Singapore Psychological Society and an Associate at Work & Health Psychologists (WHP).

References

Coccaro, E. F., & McCloskey, M. S. (2019). Intermittent Explosive Disorder. London, United Kingdom: Academic Press

Coccaro, E. F., Berman, M. E., & Mccloskey, M. S. (2019). Aggression and Intermittent Explosive Disorder: Medical and Lifestyle Correlates. Intermittent Explosive Disorder, 131-143. doi:10.1016/b978-0-12-813858-8.00007-3

Coccaro, E. F., Fridberg, D. J., Fanning, J. R., Grant, J. E., King, A. C., & Lee, R. (2016). Substance use disorders: Relationship with intermittent explosive disorder and with aggression, anger, and impulsivity. Journal of Psychiatric Research, 81, 127-132. doi:10.1016/j.jpsychires.2016.06.011

Galbraith, T., Carliner, H., Keyes, K. M., Mclaughlin, K. A., Mccloskey, M. S., & Heimberg, R. G. (2018). The co-occurrence and correlates of anxiety disorders among adolescents with intermittent explosive disorder. Aggressive Behavior, 44(6), 581-590. doi:10.1002/ab.21783

Medeiros, G. C., Seger, L., Grant, J. E., & Tavares, H. (2018). Major depressive disorder and depressive symptoms in intermittent explosive disorder. Psychiatry Research, 262, 209-212. doi:10.1016/j.psychres.2018.02.001