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Why People, And Medical Researchers, Need Help with Anger

April 16, 2019

Anger is the first negative emotion babies can express and research shows that as many people seek treatment for it as depression and anxiety combined.

Yet it is not officially classified a mental health disorder which, according to Dr. Ray DiGuiseppe, director of education with the Albert Ellis Institute and chair of the Department of Psychology at St. John’s University, means treatment often falls short.

“We do not handle anger well and we do not study anger well,” Dr. DiGuiseppe noted as part of a presentation to clinicians at the Institute of Living. “It’s hard to define it and there are no diagnostic categories. Without a diagnosis, no one can get funding for their research.”

Dr. DiGuiseppe, who developed the Anger Disorders Scale for adults and Anger Regulation and Expression Scale for children and adolescents, said the relationship between anger and depression is “complex and often sequential,” meaning it is the result of or leads to other problems.

“Are you depressed because of the results or your anger?” he said, explaining that anger can damage relationships, job opportunities or belongings, leaving one feeling depressed or anxious.

He added that anger can also trigger shame and disgust sequentially.

“Research shows that people who are angry don’t want to change,” he said. “They don’t come to us for change, they come for supervision. They don’t suffer with anger disorder, they revel in their disorder. They feel righteous in their anger!”

Some of the nation’s mental health professionals, including Dr. DiGuiseppe, have recommended establishing Anger-Aggression/Expressive Disorder as an official diagnosis. The suggestion has not made much progress despite the prevalence and dangers of anger, and the fact that, when combined with other mental health issues such as depression or schizophrenia, anger tends to worsen symptoms and reduce a person’s reaction to treatment.

One likely obstacle, he said, is the popular belief that creating a diagnosis for anger will “hold people less culpable for antisocial and aggressive behavior” in legal matters.

In the meantime, Dr. DiGuiseppe said anger is often included with aggression or tucked under the existing category Disruptive Mood Dysregulation Disorder. The grouping, which includes oppositional defiant disorder and conduct disorder, is similar to anger but not exactly the same, he said.

Other myths about anger, he said, include:

• Anger is related to self-esteem. This is untrue, even though self-condemnation tends to trigger anger.
• Catharsis is good. In reality, acting on one’s anger only helps in the moment and the person will act aggressively again in the future.
• Practicing an “anger in and anger out” approach to process the emotion does not generally work.
• The confusion about anger as a mental health condition in the healthcare system can block people from receiving adequate treatment. Cognitive behavior therapy, Dr. DiGuiseppe said, doesn’t address every aspect of anger and he suggests instead a form of exposure intervention in which the person learns and practices a new response to something that would ordinarily trigger anger. When they’re exposed to the trigger, they practice their new response.

He suggested that people with anger or aggression concerns also be checked for other mental health conditions, including:

• Alcohol use disorder and substance use disorder.
• Anxiety disorder.
• Avoidant personality disorder.

For more information about treatment for mental health concerns, including anger, click here.