Do Anger Disorders Really Exist?

“Do anger disorders really exist?”

To answer the titular question posed by this article, we should, in all fairness, acknowledge that the classification of the various forms of mental illness is a human construct – a means to describe a nuanced condition that may or may not actually fit the description perfectly, and may or may not have a treatment solution.

So, the short answer is “Yes.” As described in the DSM-5, anger-related disorders most certainly do exist, though it might be more accurate to say that one disorder directly describes anger, while there are several for which anger may be or often is a significant component. Really, the more important questions are: “What do these disorders look like?” “How do I know if I have one?” and “What can I do about it?”

Anger has a Purpose

Many of us get the message in our family of origin that anger is bad. If we were lucky, our parents said things like, “It’s okay to be angry, but it’s not okay to hit your sister.” Some parents, however, can’t tolerate anger in their children, likely because their parents couldn’t tolerate it in them. In this case, we may have learned that anger makes us unwelcome, or gets us punished, or that it has to be suppressed at all costs.

Anger is useful and serves an important purpose, as is true of all of our “negative” emotions. Anger allows us to push back against inappropriate or unkind behavior, whether directed at us or at others. It allows us to be assertive where we might otherwise be passive. It can give us strength and energy for action when needed.

It is a natural response to stimuli that threaten us physically, emotionally or socially. It is valuable and a gift when used correctly. Only when we express anger in a way that causes harm is it truly negative in its effect. And even then, the anger itself is not the problem, but the expression of it – the lens we are shining it through.

Expressing Anger

You are entitled to your emotions, but there are legal, moral and social restrictions on how you express them. There are many gradations of anger. The fine folk at Dictionary.com list no less than 49 different words for anger, including annoyance, displeasure, exasperation, fury, hatred, indignation, irritation, outrage to name a few.

Typically, we don’t like feeling these things and may try to stuff the feelings, sweep them aside, or get them all out as quickly as possible. Unfortunately, the first two methods may eventually cause a problem for us, and the last one often causes a problem for the unlucky recipient of our uncontrolled release of emotion.

Interestingly, stuffing your anger (unprocessed anger) is more likely to cause some other disorder such as anxiety, depression or dissociation. The danger of stuffing your feelings is that it works for a while, but for most people, there comes a point when they can’t manage it anymore. A diagnosis of an anger-related disorder is more likely once you reach the point that you feel you can’t control or manage it.

Disorders with Anger Components

According to the Psychology Today website, the most commonly used psychiatric diagnoses for aggressive, angry, or violent behavior are:

• Oppositional Defiant Disorder
• Attention-Deficit/Hyperactivity Disorder (in children and adolescents)
• Conduct Disorder (in children and adolescents)
• Psychotic Disorders
• Bipolar Disorder
• Antisocial Personality Disorder
• Borderline Personality Disorder
• Paranoid Personality Disorder
• Narcissistic Personality Disorder
• Intermittent Explosive Disorder

This latter diagnosis is an impulse control disorder characterized by repeated “failure to resist aggressive impulses that result in serious assaultive acts or destruction of property.”

Of all the listed diagnoses, this one comes closest to accurately describing the escalating explosions of violence we are witnessing today. It is a classic anger disorder. Let’s take a closer look at these disorders and see where anger shows up.

Oppositional Defiant Disorder

This is characterized by a pathological resistance to obeying rules or instructions. Anger presents when this resistance is challenged. For example, a 10-year-old child is told to clean his room and he says “no” not only to the original request, but to every other attempt at compromise, threat of discipline, or actual discipline, and either flies off or descends into a rage at each step of the confrontation.

Attention Deficit/Hyperactivity Disorder (in children and adolescents)

This is characterized by an inability to quiet thoughts sufficiently to sit calmly and focus. Anger shows up when the child is frustrated by his or her inability to focus, which makes them feel broken and useless, and this shame, often amplified by pressure from well-meaning adults, triggers anger.

Conduct Disorder (in children and adolescents)

This is characterized by antisocial behavior, including aggression or cruelty toward people or animals, vandalism, lying, theft, violations of rules, without remorse, or without empathy, with no concern for performance, or with a flat effect (emotionless while acting out). Outside of the flat effect just mentioned, anger is the base emotion for most of the actions taken by an individual with this disorder. This is a precursor to adult antisocial disorder.

Psychotic Disorders

This would include Schizophrenia and other spectrum disorders. Anger most often shows up in these disorders when the person is paranoid or delusional, confronted or restrained because of their behavior, or for no apparent reason as a result of the chaotic shifts in their moods.

Bipolar Disorder

This is characterized by significant mood swings from positive to negative, not in response to any obvious stimulus. A bipolar person may work 14 hours a day for 3 months, then crash and be suicidal, unable to get out of bed for weeks or months, in severe cases. Anger can show up during their manic phase when others try to slow them down or do something irritating, or during the depressed phase because nothing sounds good or worthwhile.

Antisocial Disorder

This is the adult version of conduct disorder, and the same elements are in play, including aggression or cruelty toward people or animals, vandalism, lying, theft, violations of rules, lack of remorse, or lack of empathy, with no concern for performance, or with a flat effect (emotionless while acting out). As with conduct disorder, outside of the flat effect just mentioned, anger is the baseline emotion for most of the actions taken by an individual with this disorder.

Borderline Personality Disorder

This is characterized by deep feelings of fear about abandonment, oscillating between extreme idealization and devaluation (you’re an angel/you’re the devil), unstable sense of self, impulsivity, suicidal ideation, reactivity of mood, chronic feelings of emptiness, stress-related paranoid ideation or dissociation. Anger shows up in the form of repeated and/or uncontrollable anger, fighting, or displays of temper.

Paranoid Personality Disorder

This is characterized by four or more of the following: unfounded suspicions of others, preoccupation with unjustified doubts of friends or associates, unfounded reluctance to confide in others, reading hidden or threatening meanings into benign remarks or events, persistently bearing grudges (unforgiving of insults, injuries, slights), perceived attacks where there are none followed by aggressive counterattacks, or unfounded suspicions of infidelity. Anger shows up with all of these in the ways that you would expect since each is built on a sense of betrayal.

Narcissistic Personality Disorder

This is characterized by a pervasive pattern of grandiosity, with five or more of the following: a grandiose sense of self-importance, preoccupation with fantasies of unlimited success, power, brilliance, beauty, or ideal love, belief in special uniqueness and that only other special unique people should be allowed, requiring excessive admiration, a strong sense of entitlement, interpersonal exploitation, lack of empathy, envy of others and belief that others are envious in return, arrogant/haughty behaviors or attitudes. Anger shows up when the narcissistic wound is triggered.

Adjustment Disorders with Disturbance of Conduct

This is the disorder which most directly addresses raw anger, characterized by either:

• Verbal aggression (e. g., temper tantrums, tirades, verbal arguments or fights) or physical aggression toward property, animals, or other individuals, occurring twice weekly, on average, for a period of three months, but that does not result in either damage or destruction of property or physical injury to animals or people.
• Three behavioral outbursts involving damage or destruction of property and/or physical assault involving personal injury against animals or other individuals occurring within a 12-month period.

The magnitude of aggressiveness expressed during the recurrent outbursts is grossly out of proportion to the provocation or to any precipitating psychosocial stressors. The recurrent aggressive outbursts are not premeditated and are not committed to achieving some tangible objective.

The recurrent aggressive outbursts cause either marked distress in the individual or impairment in occupational or interpersonal functioning or are associated with financial or legal consequences. The recurrent aggressive outbursts are not better explained by another mental disorder or use of substances.

These descriptions are provided only to give you a snapshot and help you see how anger shows up in each disorder. If you suspect you have symptoms suggesting you may have one or more of these disorders, it is important not to self-diagnose. Schedule an appointment with a qualified mental health professional and get a proper diagnosis, so you can begin seeking the appropriate treatment.

Anger Management

Most anger management tools involve your ability to be introspective, to notice you are becoming angry, and take action to redirect or de-escalate the feelings before you have an issue. If you are unable to use these tools to effectively manage your anger, again it is important to seek the counsel of a mental health professional.

Understanding and making room for our pain is often the only way to begin to heal, and sometimes some healing is necessary before you are going to be able to use the tools that are available.

Here are some helpful suggestions from the Mayo Clinic website:

Think before you speak.

In the heat of the moment, it’s easy to say something you’ll later regret. Take a few moments to collect your thoughts before saying anything and allow others involved in the situation to do the same.

Once you’re calm, express your anger.

As soon as you’re thinking clearly, express your frustration in an assertive but non-confrontational way. State your concerns and needs clearly and directly, without hurting others or trying to control them.

Get some exercise.

Physical activity can help reduce stress that can cause you to become angry. If you feel your anger escalating, go for a brisk walk or run, or spend some time doing other enjoyable physical activities.

Take a timeout.

Timeouts aren’t just for kids. Give yourself short breaks during times of the day that tend to be stressful. A few moments of quiet time might help you feel better prepared to handle what’s ahead without getting irritated or angry.

Identify possible solutions.

Instead of focusing on what made you mad, work on resolving the issue at hand. Be creative. Remind yourself that anger won’t fix anything and might only make it worse.

Avoid criticizing or placing blame.

Use “I” statements to describe the problem. Be respectful and specific. For example, say, “I’m upset that you left the table without offering to help with the dishes” instead of “You never do any housework.”

Don’t hold a grudge.

Forgiveness is a powerful tool. If you allow anger and other negative feelings to crowd out positive feelings, you might find yourself swallowed up by your own bitterness or sense of injustice. But if you can forgive someone who angered you, you might both learn from the situation and strengthen your relationship.

Practice relaxation skills.

When your temper flares, put relaxation skills to work. Practice deep-breathing exercises, imagine a relaxing scene, or repeat a calming word or phrase, such as “Take it easy.” You might also listen to music, write in a journal or do a few yoga poses – whatever it takes to encourage relaxation.

Because of its destructive potential, an inability to manage anger can be frightening and hopeless. You don’t have to go it alone. Schedule an appointment with a mental health professional and begin your journey toward better emotional health.