Anger and Trauma
A National Center for PTSD Fact Sheet
Why is anger a common response to trauma?
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.
Related Fact Sheets
Community
violence
A summary of the research about the effects of community violence on rates
of traumatic stress and PTSD
Coping with
PTSD
Provides information for PTSD survivors on positive techniques for dealing
with PTSD
Domestic
violence
Explains what domestic violence is, its prevalence, the dynamics of an abusive
relationship, and effective treatments
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.
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