Anger is usually a central feature of a survivor's response to
trauma because it is a core component of the survival response in
humans. Anger helps people cope with life's adversities by
providing us with increased energy to persist in the face of
obstacles. However, uncontrolled anger can lead to a continued
sense of being out of control of oneself and can create multiple
problems in the personal lives of those who suffer from PTSD.
One theory of anger and trauma suggests that high levels of
anger are related to a natural survival instinct. When initially
confronted with extreme threat, anger is a normal response to
terror, events that seem unfair, and feeling out of control or
victimized. It can help a person survive by mobilizing all of his
or her attention, thought, brain energy, and action toward
survival. Recent research has shown that these responses to extreme
threat can become "stuck" in persons with PTSD. This may lead to a
survival mode response where the individual is more likely to react
to situations with "full activation," as if the circumstances were
life threatening, or self-threatening. This automatic response of
irritability and anger in individuals with PTSD can create serious
problems in the workplace and in family life. It can also affect
the individuals' feelings about themselves and their roles in
society.
Another line of research is revealing that anger can also be a
normal response to betrayal or to losing basic trust in others,
particularly in situations of interpersonal exploitation or
violence.
Finally, in situations of early childhood abuse, the trauma and
shock of the abuse has been shown to interfere with an individual's
ability to regulate emotions, which leads to frequent episodes of
extreme or out of control emotions, including anger and rage.
How can posttraumatic anger become a problem?
Researchers have described three components of posttraumatic
anger that can become maladaptive or interfere with one's ability
to adapt to current situations that do
not involve extreme threat:
Arousal
Anger is marked by the increased activation of the
cardiovascular, glandular, and brain systems associated with
emotion and survival. It is also marked by increased muscle
tension. Sometimes with individuals who have PTSD, this increased
internal activation can become reset as the normal level of arousal
and can intensify the actual emotional and physical
experience of anger. This can cause a person to feel
frequently on-edge, keyed-up, or irritable and can cause a person
to be more easily provoked. It is common for traumatized
individuals to actually seek out situations that require them to
stay alert and ward off potential danger. Conversely, they may use
alcohol and drugs to reduce overall internal tension.
Behavior
Often, the most effective way of dealing with
extreme threat is to act aggressively, in a self-protective way.
Additionally, many people who were traumatized at a relatively
young age do not learn different ways of handling threat and tend
to become stuck in their ways of reacting when they feel
threatened. This is especially true of people who tend to be
impulsive (who act before they think). Again, as stated above,
while these strategies for dealing with threat can be adaptive in
certain circumstances, individuals with PTSD can become stuck in
using only one strategy when others would be more constructive.
Behavioral aggression may take many forms, including aggression
toward others, passive-aggressive behavior (e.g., complaining,
"backstabbing," deliberately being late or doing a poor job), or
self-aggression (self-destructive activities, self-blame, being
chronically hard on oneself, self-injury).
Thoughts and Beliefs
The thoughts or beliefs that people
have to help them understand and make sense of their environment
can often overexaggerate threat. Often the individual is not fully
aware of these thoughts and beliefs, but they cause the person to
perceive more hostility, danger, or threat than others might feel
is necessary. For example, a combat veteran may become angry when
others around him (wife, children, coworkers) don't "follow the
rules." The strength of his belief is actually related to how
important it was for
him to follow rules during the war in order to prevent
deaths. Often, traumatized persons are not aware of the way their
beliefs are related to past trauma. For instance, by acting
inflexibly toward others because of their need to control their
environment, they can provoke others into becoming hostile, which
creates a self-fulfilling prophecy. Common thoughts people with
PTSD have include: "You can't trust anyone," "If I got out of
control, it would be horrible/life-threatening/intolerable," "After
all I've been through, I deserve to be treated better than this,"
and "Others are out to get me, or won't protect me, in some
way."
How can individuals with posttraumatic anger get help?
In anger management treatment, arousal, behavior, and
thoughts/beliefs are all addressed in different ways.
Cognitive-behavioral treatment, a commonly utilized therapy that
shows positive results when used to address anger, applies many
techniques to manage these three anger components:
For increased arousal
The goal of treatment is to help the
person learn skills that will reduce overall arousal. Such skills
include relaxation, self-hypnosis, and physical exercises that
discharge tension.
For behavior
The goal of treatment is to review a person's most
frequent ways of behaving under perceived threat or stress and help
him or her to expand the possible responses. More adaptive
responses include taking a time out; writing thoughts down when
angry; communicating in more verbal, assertive ways; and changing
the pattern "act first, think later" to "think first, act
later."
For thoughts/beliefs
Individuals are given assistance in
logging, monitoring, and becoming more aware of their own thoughts
prior to becoming angry. They are additionally given alternative,
more positive replacement thoughts for their negative thoughts
(e.g., "Even if I am out of control, I won't be threatened in this
situation," or "Others do not have to be perfect in order for me to
survive/be comfortable"). Individuals often role-play situations in
therapy so they can practice recognizing their anger-arousing
thoughts and applying more positive thoughts.
There are many strategies for helping individuals with PTSD deal
with the frequent increase of anger they are likely to experience.
Most individuals have a combination of the three anger components
listed above, and treatment aims to help with all aspects of anger.
One important goal of treatment is to improve a person's sense of
flexibility and control so that he or she does not feel
re-traumatized by his or her own explosive or excessive responses
to anger triggers. Treatment is also meant to have a positive
impact on personal and work relationships.
This fact sheet was based on:
Chemtob, C.M., Novaco, R.W., Hamada, R.S., Gross, D.M., &
Smith, G. (1997). Anger regulation deficits in combat-related
posttraumatic stress disorder.
Journal of Traumatic Stress, 10(1), 17-35.
