Is poor anger control an illness ?

Anger has become a very common problem in the modern world giving rise to various undesirable consequences. Anger is an emotion. The Oxford Dictionary defines anger as a strong feeling of annoyance. Anger gives rise to psychological and biochemical changes within you. This week’s edition of Health Capsule got Dr. Kosala Amaranayake, MBBS, MD (Psych), who is a Lecturer at the Department of Psychiatry, Faculty of Medicine, University of Peradeniya and Honorary Consultant Psychiatrist at the Teaching Hospital, Peradeniya to speak about anger.     

Anger can be present without a detectable psychiatric illness. However it can be a symptom of a psychiatric illness as well. Anger gives rise to many complications. These complications are physical as well as psychological. Scientists have found that when you are angry there is a set of chemicals produced within the body system that can affect your health badly. Cortisol, adrenalin and noradrenalin are among them. These chemicals give rise to changes in the biochemical functions of the body, eventually giving rise to changes in your body and mind. Hypertension is common among people who get angry easily, which is one of the physical complications of this condition. 

 
The ability to think ahead plus attention and concentration are lost when you are angry. You tend to have ‘tunnel thinking’, meaning that you are unable to consider various aspects of a problem when you take a particular decision. As a result you tend to take very poor decisions. 

 
Domestic violence is one of the main problems of poor anger control. Misunderstandings and mistakes are common in married life. However a person who is having poor anger control does not handle his or her problems well. This gives rise to psychological problems in the person who is being abused. Depression is common among them. There are instances when domestic violence gives rise to death of the partner. Other problems related to poor anger control are road rage and road accidents. Many lives could be saved if anger is controlled.   

Psychiatric illnesses
Depression is among the commonest that give rise to poor anger control. Irritability is considered as one of the commonest symptoms of depression. Particularly in children irritability and poor anger control are  common symptoms. Obsessive-compulsive disorder (OCD) is an unrecognized cause of poor anger control. Patients with OCD are obsessed with symmetry and orderliness and whenever things are not in order they become irritable and angry. Other psychiatric illnesses like anxiety disorders, psychotic disorders and even sexual disorders can give rise to poor anger control. In the latest classifications of psychiatric diseases there is a separate entity called ‘impulse control disorders’ where poor anger control is a predominant symptom without symptoms of other psychiatric illnesses. Substance use disorders are also common among psychiatric illnesses giving rise to poor anger control. Some drugs in their intoxication (when you consume the drug) gives rise to poor anger control. In some when they are withdrawing (not taking the drug) from the drugs, they experience poor anger control. People who have particular personalities are more vulnerable to poor anger control. They are anti-social personality, borderline personality and anankastic personality(obsessional personality). The personality disorder is also an unrecognized cause of poor anger control. A patient with a borderline personality disorder is impulsive and wants to release his or her emotions in a low level of threshold. Further they release their emotions without the concern of the future consequences. Borderline personality disorders are commoner among females compared to males.   

What you should do 
As discussed early, poor anger control can give rise to various undesirable consequences, if unaddressed. It is important to detect and address it early. Hence it is always better to obtain the opinion of a psychiatrist if you have poor anger control. First it is important to exclude any treatable psychiatric illnesses, which gives rise to poor anger control. If any psychiatric illness is identified it should be treated accordingly. Commencement of antidepressants for a depressive disorder, anti psychotic for a psychotic disorder and treating substance dependence are examples of treating a psychiatric illness. Psychotherapies (commonly known as talking therapy) are also being used in treating these psychiatric illnesses. If there is no treatable psychiatric illness identified, anger management strategies will be applicable.   

Vital tips 
It is important first to acknowledge that you have a problem with anger control and recognise your anger signs. When you identify that you have a problem with managing anger, maintain a log of situations of poor anger control, which gives an insight into situations, precipitating factors and consequences of your anger. When you are about to show anger you will feel the physical symptoms. When anger is present the heart beats faster and you breathe quickly. You might also notice other signs, such as tension in your shoulders or the clenching of your fists. These are signs of loosing control. If you notice these signs get out of the situation so that you can prevent disastrous consequences. If you take time and calm yourself down it will take away the complications of anger. Counting to 10 gives you time to cool down. This helps you think clearly and overcome the impulse to lash out. Breathing exercises have proved helpful in controlling anger. However it is important that you practice beforehand what you would apply when you are angry. Breath in the maximum you can and breathe out one third of it and keep the rest until you find you are uneasy. Exhale the rest on two occasions. This practice also gives rise to a physical reaction around your lungs as well as giving a psychological rest to your mind. Bringing down your general stress also helps anger control. Looking after yourself, having a timetable for your life and planning ahead will reduce your general stress level. Create time to relax regularly and ensure that you get enough sleep. There is a misconception among the general public that drugs and alcohol can reduce your stress levels. However drugs and alcohol can worsen anger problems. Therefore it is important to refrain from drugs and alcohol especially when you have anger control issues. Also bring down your general stress levels with exercise and relaxation with activities like running, walking, swimming, yoga and meditation. At the same time creative activities like writing, making music, dancing or painting can release tension and reduce feelings of anger. Moreover it is important to have a supporting network, thus discussing your feelings with a friend can be useful and can help you get a different perspective of the situation. Miscommunication contributes to frustrating situations. The better your listening skills, the easier it is to find a resolution that does not involve an angry response. Assertiveness is also important during anger control. When you are assertive you focus on balance and you are honest about what you want and respect the needs of others.   

Anger is common. There are many reasons behind anger and it can give rise to disastrous consequences. It is important to identify your anger, control it and seek help of an expert.