Resolution, Not Conflict

The guide to problem-solving.

Got an Anger Disorder? Not According to the DSM

There’s diagnostic labels for anxiety and for depression. Why not for anger?

Anger disorders are real.
Do you know anyone with an anger disorder?  I am a psychologist who specializes in helping couples to face their marriage problems, fix them, and then go on to enjoy long-lasting and long-loving marriage partnerships.  A huge part of how I help these couples involves teaching them more constructive ways of handling feelings of anger.  Yet if I must assign my clients, for insurance purposes, a diagnosis, anger problems is not an option.  The current DSM (DSM-IV) diagnostic manual does not include excessive anger as a diagnosable disorder.  

Psychoanalytic therapists talk about lacunae.  I’ve always liked that word.  Lacunae are gaps.  A lacuna (pl. lacunas or lacunae) comes from the Latin term that, when referring to manuscripts, means a missing section of text.  In music a lacuna is an extended pause or silence.  In psychology, superego lacunae are gaps in superego development characteristic of, for instance, children with conduct disorders who lie, steal, punch and kick with no sense of doing anything wrong.

In the current diagnostic manual, and I believe also in the proposed new version, there is a huge lacuna when it comes to labeling anger.  

There are anxiety disorders, broken down into subcategories such as generalized anxiety disorder, phobias, panic attacks, and agoraphobia with or without panic attacks. 

There are depressive disorders.

Yet there is no listing for anger disorders. The word anger does not even appear in the index!

Look at the catch-all category of Adjustment Disorders, the most commonly used category for outpatient mental health treatment:

Adjustment Disorders

  • 309.9 Unspecified
  • 309.24 With Anxiety
  • 309.0 With Depressed Mood
  • 309.3 With Disturbance of Conduct
  • 309.28 With Mixed Anxiety and Depressed Mood
  • 309.4 With Mixed Disturbance of Emotions and Conduct

Which diagnostic category can a therapist use for a client whose life adjustment difficulties center on excessive anger?  How can a therapist diagnosis clients who react to differing viewpoints by getting mad instead of by engaging in quiet information sharing, mutual listening and creative problem-solving? 

Anger falls into a hole, a gap in what the American Psychiatric Association, publisher of the DSM, recognizes as mental health problems.

Anger is included on the symptom lists for many character disorders: psychopathy, explosive disorder, narcissism, borderline personality disorder, paranoia and more.  This inclusion is good.  Yet for carrying chronic underlying angry feelings that make a person unattractive to get close to, or for getting mad too often, too long, or too intensely, there is no diagnostic category 

Does that mean that anger does not exist as a disturbing mental condition?

Would you consider the following scene normal emotional interacting?

Ask the person with an anger disorder if their anger is a problem.  S/he is likely to tell you “I’m only mad because s/he made me mad!”  That statement, in fact, may well be diagnostic of someone with an anger disorder. 

Ask however any of the couples I see for marriage therapy and they will tell you how corrosive a role anger surpression and/or expression has played in the breakdown of their marriage.  If they could feel angry, use that feeling as a constructive indicator to themselves of where there’s a problem, calm down, and then talk in a mutually respectful, cooperative way about the problem, they wouldn’t be coming to my office or thinking of finding a divorce lawyer.

If there truly were no such thing as anger disorders, our society would not have our close-to-50% divorce rate.  The world would be a better place for all of us. 

Meanwhile, I just sigh.  How bizarre, the DSM's blindness to the reality that excessive anger is a significant mental health problem.

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Susan Heitler, Ph.D. is author of the book, workbook and interactive learning website called PowerOfTwo that teach the anger management and other essential skills for success in marriage.

 

Susan Heitler, Ph.D., is the author of many books, including From Conflict to Resolution and The Power of Two. She is a graduate of Harvard University and New York University.

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