How Do Depression and Anger Interact?

Devin reported a variety of complaints about his significant other regarding finances, in-laws, and parenting. Raphael described anger with his coworkers and supervisor, mostly with regard to his belief that they were inept. By contrast, Greg recounted pervasive anger—with friends, loved ones, and with strangers. He cited the many ways in which they led him to become agitated.

These men were participants in one of my anger management classes. After hearing their concerns, I shared the perspective that anger is most often a reaction to and distraction from inner suffering—feelings such as sadness, powerlessness, shame, anxiety, inadequacy, and isolation. It was when I detailed the connection between anger and depression that the entire group became silent. Whereas previously they were physically animated, they suddenly became still, even physically turned inward with their eyes averting direct contact with others.

Almost all participants indicated that the anger-depression connection seemed to resonate with them. They realized, and fully experienced, that their anger was both an outgrowth of, and meaningful distraction, from the intense pain of underlying depression. This is often the case for many individuals who seek my help for anger.

By contrast, others who have sought my services for depression have come to recognize how anger directed inward contributes to their anger. And some individuals have sought my services for depression with a combination of anger directed both outward and inward.

Angry man

Source: 123rf Stock Photo/iakovenko

Anger as an Outgrowth of Self-Compassion

Anger stems from some perceived sense of threat to our emotional or physical well-being. It is also a reaction to and often a distraction from, other negative emotions and the physical tension associated with them. Anger forces us to direct our attention outward. This was reflected in the initial complaints voiced in my class—their stated grievances regarding what they perceived as the shortcomings of others. This external focus even interferes with their body awareness, being unable to identify how their body reacts during anger arousal.

Through my clinical work, I’ve come to view anger as an unwitting act of self-compassion—an attempt to rid ourselves of such suffering. In this manner, it may be viewed as a buffer against experiencing depression and the feelings and thoughts associated with it.

Symptoms of Depression

Clinical depression is defined by a depressed mood accompanied by symptoms such as:

• Insomnia or sleeping too much
• Feelings of worthlessness or inappropriate guilt
• Significant unintentional weight loss or gain
• Agitation or psychomotor retardation
• Fatigue or loss of energy
• Poor concentration or indecisiveness
• Recurring thoughts of death

Anger is not listed as a symptom in the official guidelines for the diagnosis of depression. However, in recent years, there has been increased study of the association of anger and depression. More specifically, some studies have highlighted how anger can be a mask for depression.

Depression as Anger Directed Inward

The psychoanalytic perspective views depression as very much related to anger directed inward. This is an accurate assessment for many individuals. The elevated self-criticism, deep sense of shame, and accompanying sense of hopelessness and helplessness associated with depression can be viewed as consequences of intense and ongoing self-judgment, a barrage of self-directed anger over dissatisfactions with ourselves. These are coupled with discomfort and even fears associated with directing anger at their true sources.

Anger turned inward is often the consequence of childhood neglect or physical or emotional abuse. Through the eyes of a helpless child, it is understandable that he might be confused and overwhelmed by the emotions surrounding such experiences. Subsequently, he may blame himself for such treatment, as his entire well-being is dependent upon his caretakers. This fosters a predisposition to a lack of feeling “good enough.”

Certainly, other experiences in developing years as well as in adulthood can precipitate depression. These might include significant losses and trauma. However, the intensity of their impact may also be mitigated by the degree to which earlier experiences fostered emotional and mental resilience.

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Anger might be a consequence of depression, an outgrowth of the frustration, hopelessness, and irritability associated with depression. This tendency is not mutually exclusive with the perspective that underlying depression may reflect anger directed inward.

The relationship between depression and anger is complex. The more we can specifically identify the details of this association, the more accurate we can be in the diagnosis and treatment of both anger and depression.

Research Regarding the Association of Depression and Anger

Research has increasingly attended to determining the specific association of depression and anger. In one study, 293 outpatients diagnosed with depression were assessed over a certain time frame to determine to what extent irritability might predict anger attacks (Manish, Fava, Abu, et. al., 2020). Anger attacks were defined as uncharacteristic sudden bouts of anger. While these can occur with or without aggression, this study only considered those that were aggressive in nature. Questionnaires administered concluded that those who scored high levels of irritability had significantly more anger attacks.

Another study sought to determine the relationships among posttraumatic stress disorder, depression, hostility, anger, and verbal and physical aggression in returning veterans (Bhardwai, Angkaw, et. al. 2019). Through assessing 195 participants, it was determined that depression symptoms explained part of the relationship between post-traumatic stress disorder (PTSD) and verbal aggression, physical aggression toward others and objects, and self-directed physical aggression. However, trait anger, a chronic tendency toward anger arousal, explained part of the relationship between PTSD and verbal and physical aggression toward objects and others.

One study assessed anger in the context of postnatal depression by a comprehensive review of 24 papers that addressed anger and postnatal depression (Ou and Hall, 2018). It found that anger was experienced for some postnatally depressed woman, revealed by a) anger accompanying depression, b) powerlessness associated with depression and anger, and c) anger as a result of expectations being violated. Such anger can be directed toward oneself, children, and family members.

Another study attempted to better identify factors that contributed to the association between anger and depression (Mohammad, Mahin, et. al., 2012). A group of 88 patients with major depressive disorder were assessed with the Beck Depression Inventory (BDI), the Multidimensional Anger Inventory (MAI), the Cognitive Emotion Regulation Questionnaire (CERQ), and the Anger Rumination Scale (ARS). It concluded that challenges in emotional regulation and anger rumination were key to the association of anger with depression.

Anger is not considered a mental disorder. However, it has been found to be present in a variety of psychological disorders, including emotional disorders, both the anxiety and depressive disorders. One review of this association emphasizes that in general, anger is elevated in these emotional disorders (Cassiello-Robbins and Barlow, 2016). More importantly for treatment, however, the study concludes that when it is present, it is associated with greater symptom severity and worse treatment response.

Much of emotional suffering arises as a result of our judgment of our feelings. We may experience anger or sadness about feeling depressed, anxiety about anger, or become depressed and angry with the presence of shame, and so on. These emotional reactions to our emotions are often called Meta-emotions. In fact, much of clinical work focuses on helping individuals become more self-compassionate, which includes developing the capacity to recognize and accept the full range of emotions that are part of being human.

In one study 79 individuals were asked to log and complete a self-report regarding their emotional experiences over a seven-day period (Bailen, Haiijiing, and Thompson, 2019). The study concluded that higher levels of negative emotions, about negative emotions, was strongly associated with depressive severity. In effect, anger about depression only exacerbates the intensity of depression.

Perhaps one of the most comprehensive studies of the anger-depression relationship was one that assessed 944 Canadian high school seniors over a period of twenty-five years (Galambos, Johnson and Krahn, 2018). It concluded that those higher in expressed anger were similarly higher on depressive symptoms.

And finally, one study assessed the presence of anger and irritability in 536 individuals diagnosed with a unipolar major depressive episode. Overt irritability and anger were present for 292 participants. Additionally, overt irritability and anger were associated with significantly increased depressive severity, longer duration of the major depressive episode, poorer impulse control, a more chronic and severe long-term course of the illness, higher rates of lifetime comorbid substance abuse and anxiety disorder, more antisocial personality disorders, greater psychological impairment, reduced life satisfaction, and a higher rate of bipolar ll disorder in relatives.

Conclusion

Research and clinical observation have confirmed an association between depression and anger. As such, whether engaged in self-help or when seeking professional services for depression or anger, accurately clarifying the details of this association is critical for improved well-being.