Anger and Trauma in PTSD

Anger and Trauma
Why is anger a common response to trauma?
Anger is often a large part of a survivor's response to trauma. It is a core piece of the survival response in human beings. Anger helps us cope with life's stresses by giving us energy to keep going in the face of trouble or blocks. Yet anger can create major problems in the personal lives of those who have experienced trauma and those who suffer from PTSD.

One way of thinking is that high levels of anger are related to a natural survival instinct. When faced with extreme threat, people often respond with anger. Anger can help a person survive by shifting his or her focus. The person focuses all of his or her attention, thought, and action toward survival.

Anger is also a common response to events that seem unfair or in which you have been made a victim. Research shows that anger can be especially common if you have been betrayed by others. This may be most often seen in cases of trauma that involve exploitation or violence.

The trauma and shock of early childhood abuse often affects how well the survivor learns to control his or her emotions. Problems in this area lead to frequent outbursts of extreme emotions, including anger and rage.

How can anger after a trauma become a problem?
In people with PTSD, their response to extreme threat can become "stuck." This may lead to responding to all stress in survival mode. If you have PTSD, you may be more likely to react to any stress with "full activation." You may react as if your life or self were threatened. This automatic response of irritability and anger in those with PTSD can create serious problems in the workplace and in family life. It can also affect your feelings about yourself and your role in society.

Researchers have broken down posttraumatic anger into three key aspects, discussed below. These three factors can lead someone with PTSD to react with anger, even in situations that do not involve extreme threat:

Arousal
Anger is marked by certain reactions in the body. The systems most closely linked to emotion and survival — heart, circulation, glands, brain — are called into action. Anger is also marked by the muscles becoming tense. If you have PTSD, this higher level of tension and arousal can become your normal state. That means the emotional and physical feelings of anger are more intense. If you have PTSD, you may often feel on edge, keyed up, or irritable. You may be easily provoked. This high level of arousal may cause you to actually seek out situations that require you to stay alert and ward off danger. On the other hand, you may also be tempted to use alcohol or drugs to reduce the level of tension you're feeling.

Behavior
Often the best response to extreme threat is to act aggressively to protect yourself. Many trauma survivors, especially those who went through trauma at a young age, never learn any other way of handling threat. They tend to become stuck in their ways of reacting when they feel threatened. They may be impulsive, acting before they think. Aggressive behaviors also include complaining, "backstabbing," being late or doing a poor job on purpose, self-blame, or even self-injury. Many people with PTSD only use aggressive responses to threat. They are not able to use other responses that could be more positive.

Thoughts and Beliefs
Everyone has thoughts or beliefs that help them understand and make sense of their surroundings. After trauma, a person with PTSD may think or believe that threat is all around, even when this is not true. He or she may not be fully aware of these thoughts and beliefs. For example, a combat Veteran may become angry when his wife, children, or coworkers don't "follow the rules." He doesn't realize that his strong belief is actually related to how important it was for him to follow rules during the war in order to prevent deaths.

If you have PTSD, you may not be aware of how your thoughts and beliefs have been affected by trauma. For instance, since the trauma you may feel a greater need to control your surroundings. This may lead you to act inflexibly toward others. Your actions then provoke others into becoming hostile towards you. Their hostile behavior then feeds into and reinforces your beliefs about others. Some common thoughts of people with PTSD are:

"You can't trust anyone."
"If I got out of control, it would be horrible, life-threatening, or could not be tolerated."
"After all I've been through, I deserve to be treated better than this."
"Others are out to get me," or "They won't protect me."
How can you get help with anger?
In anger management treatment, problems with arousal, behavior, and beliefs are all addressed in different ways. Cognitive-behavioral treatment (CBT), a commonly used therapy, uses many techniques to manage these three anger problem areas:

For increased arousal
The goal of treatment is to help the person learn skills that will reduce overall arousal. He or she may learn how to relax, use self-hypnosis, and use physical exercises that release tension.

For behavior
The goal is first to look at how a person usually behaves when he or she feels threat or stress. The next goal is to help him or her expand the range of possible responses. More adaptive responses include:

Taking a time out
Writing thoughts down when angry
Talking with someone instead of acting
Changing the pattern "act first, think later" to "think first, act later"
For thoughts/beliefs
Clients are given help in becoming more aware of their own thoughts leading up to becoming angry. They are then asked to come up with more positive thoughts to replace their negative, angry thoughts. For example, they may learn to say to themselves, "Even if I don't have control here, I won't be threatened in this situation." Another example would be, "Others do not have to be perfect in order for me to survive or be comfortable." Role-play is often used so you can practice recognizing the thoughts that make you angry and applying more positive thoughts instead.

Summary
There are many ways to help people with PTSD deal with the high levels of anger they may feel. Many people have all three of the anger problem areas listed above. Treatment aims to help with all aspects of anger. One important goal of treatment is to improve your sense of flexibility and control. In this way, you do not have to feel as if you're going through trauma again each time you react to a trigger with explosive or excessive anger. Treatment may also have a positive impact on personal and work relationships.

Sources
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