Anyone can have trouble controlling their anger from time to time. You may be frustrated because you’ve just made a huge mistake in a big project and have to start again from scratch. Perhaps you’re stuck in a long commute and will be an hour late getting home. You might be angry at a relative who just won’t back off from demanding your time and attention. All of these are situations that can lead anyone to yell out in rage, if only at the fates.
How about people you know who chronically seem ready to explode with little or no provocation? What kinds of situations arouse them to higher and higher levels of fury, or are they always on the verge of exploding over nothing? And when they release their anger, what happens next? They’ve yelled at their partner over practically nothing, and now the partner walks out the door, annoyed and disgusted at being treated in such a rude and offensive manner. This rejection only inspires even more of their outrage.
Why might anger be such a problem for some people? According to psychologist Nienke de Bles and colleagues (2019), of Leiden University in the Netherlands, the source of both chronic anger and episodes of rage may lie in the psychological disorders of anxiety and depression. For example, the authors note that there is a surprisingly high 50% rate of irritability among people with major depressive disorder, with 26 to 49% experiencing attacks of anger. People with dysthymia, a chronic but less extreme form of depressive disorder, have a similarly high rate of anger attacks, estimated at 28 to 53%. Among people with an anxiety disorder or obsessive-compulsive disorder, there are also high rates of hostility and anger.
As impressive as these statistics are, the Dutch authors believe that the data may be flawed. Research studies establishing these percentages used measures of anger that, the research team points out, were not sufficiently validated. In some cases, the statistics were based on very short tests of anger and irritability, ranging from a single item to perhaps four drawn from another assessment not initially intended to examine anger.
Furthermore, previous studies didn’t separate what’s known as “trait” anger (the tendency to be angry all the time) from “state” anger (being enraged at the time of testing). As the authors note, “Making a distinction between patients with an angry disposition as a constant factor embedded in personality, and patients that respond angrily to an immediate situation, is of clinical importance” (p. 260).
To test the role of both forms of anger in anxiety and depressive disorders, de Bles et al. drew participants from a large-scale longitudinal study based in the Netherlands that followed people for a period of four years. The original sample consisted of nearly 2,900 adults ages 18 to 65 years of age recruited from a variety of treatment sites in the community, although there were also controls who did not have a lifetime history of psychological disorders. The data for the anger study came from nearly 2,300 who participated in the fourth wave of the follow-up.
Included in the study were not only the anger scales but also demographic measures including educational background, body mass index, smoking history, lifetime history of alcohol dependence and abuse, and use of drugs in the past month. The average age of the sample was 46 years old, with most between 33 and 59 years of age; two-thirds were female. As might be expected in a psychiatric sample, those with anxiety and depressive disorders were more likely to smoke, had higher body mass, and reported having a history of alcohol dependence and abuse.
To measure trait anger, the Dutch authors asked participants to complete a 10-item scale widely used in personality research. Half of the trait anger items assessed a general disposition for experiencing anger and eventually expressing it (temperament); the remaining five asked whether participants were more likely to express anger after some sort of provocation. Sample trait items were “I get annoyed quickly” and “I am quickly irritated.” The tendency to express anger in the form of an outburst, or the more state-like quality, was tapped by a self-report scale in which participants stated that they frequently experienced irritation, overreacted to minor annoyances, inappropriately expressed anger and rage toward others, and had at least one anger attack in the past month. To be counted as an anger attack, participants had to check off symptoms such as feeling their heart was racing or short of breath, trembling, feeling dizzy, sweating, feeling like attacking others, and throwing or destroying objects.
The researchers divided their participants into five diagnostic groups that included those with a current depressive disorder (204 participants), anxiety disorder (288), comorbid (joint) depressive and anxiety disorder (222), no psychiatric diagnosis (470), and a history of past anxiety and/or depressive disorder that was no longer active (1107). As the authors predicted, the scores on the trait anger measures were highest in the comorbid anxiety and depression group, with approximately 45% classified as above the 75th percentile of scores. The combined group also had a higher prevalence of anger attacks, at approximately 23% within the past month. The highest rates of anger attacks occurred for people with major depressive disorder and, of the anxiety disorders, social phobia, panic disorder, and especially generalized anxiety disorder.
Of all the other predictors, only past month use of a drug predicted higher rates of anger attacks. However, participants with remitted disorders also had higher trait anger scores and rates of anger attacks, so that even in recovery, anger remains a problem for individuals with a history of these psychological disorders.
An important takeaway from this study, according to the authors, is that clinicians working with people who have these disorders may easily overlook the trait of anger and anger attacks because “they are not part of core … symptoms, and insight and self-consciousness of feelings of anger may be hampered” (p. 262). Notably, people who experienced worry and symptoms of depression had higher levels of anger, suggesting a more general problem with emotion dysregulation, or the inability to maintain control over their feelings. It is also important, as the authors point out, to address anger among people with these psychological disorders as a public health precaution, given the many adverse outcomes that can be associated with an anger outburst in people whose anxiety and depression go untreated.
To sum up, the study shows the unrecognized but important role of anger in psychological disorders not usually conceived of in terms of the tendency to experience rage. Looking at the findings from another perspective, if people you know seem unusually angry and ready to explode, consider the possibility that anxiety and depression may be the source of their emotional turmoil. Helping them manage their psychological disorders may prove, in the long run, to help them be better able to manage their angry emotions.
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de Bles, N. J., Rius Ottenheim, N., van Hemert, A. M., Pütz, L. E. H., van der Does, A. J. W., Penninx, B. W. J. H., & Giltay, E. J. (2019). Trait anger and anger attacks in relation to depressive and anxiety disorders. Journal of Affective Disorders, 259, 259–265. doi:10.1016/j.jad.2019.08.023.