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Why is Anger a Common Response to Trauma?
Anger is almost always a central feature of response to trauma,
because it is a core component of survival response in humans.
While it has great value for coping with life’s adversities (i.e., by
giving increased energy to persist in the face of obstacles),
uncontrolled anger can lead to a continued sense of being "out of
control" of one’s self, and can result in multiple problems in the
family and 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 confrontedwith extreme threat,
anger is a normal response to events that seem unfair, terror, and feeling out of control or victimized. It can help a
person survive by mobilizing all their attention, thought, brain
energy, and action towards survival. Recent research has shown
that these responses to extreme threat can become "stuck" in
persons with PTSD, leading to a "survival mode" response, being
more likely to react to future situations with "full activation," as if
they were "life-threatening," or "self-threatening." This "automatic
response" of irritability and anger can create serious problems for
individuals with PTSD, in work, family life, in their feelings about
themselves, and in their role in society.
Another line of research is revealing that anger can also result from
a normal response to betrayal or loss of 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, leading to frequent experience of
extreme or out of control emotions, including anger and rage.
How Can Post-Traumatic Anger Become a Problem?
Researchers have described three components of post-traumatic
anger which can become maladaptive, or interfering in adapting to
current situations which do not involve extreme threat:
Arousal: Anger is marked by increased activation of the
cardiovascular, glandular, and brain systems associated with
emotion and survival, as well as increased muscle tension.
This increased internal activation can become reset as the
normal level in individuals with PTSD, and increase the
actual emotional and physical experience of anger. This can
lead one to feel frequently on-edge, keyed-up, or irritable, and
more easily provoked to anger. It is not uncommon for
traumatized individuals to even seek out situations requiring
them to stay alert to ward off potential danger. Conversely
they may use alcohol and drugs to reduce overall internal tension.
Behavior: Oftentimes, the most effective way of dealing
with extreme threat is to act aggressively, in a self-protective
way. Additionally, many people who are traumatized at a
relatively young age have not learned a variety of ways of
handling threat, and tend to become "stuck" in one
characteristic mode of acting towards threat. This is especially
true of people who already 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 adaptive.
Behavioral aggression may take many forms, including
aggression towards others, "passive aggressive behavior" (i.e.,
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 (often the
individual is not fully aware of these) that a person uses to
understand and make sense of their environment, can often
over-exxagerate threat, leading a person to be more likely to
see hostility, danger, or threat to their safety than others
might feel is necessary. For example, a vet may become
angry when others (wife, children, coworkers) around him
don’t "follow the rules," which is actually related to his own
very important need to follow rules during the war in order to
prevent deaths. Often, traumatized persons are not aware of
the way these beliefs are related to past trauma. By acting
inflexibly towards others, for instance, because of their need
to control their environment for threat, they can provoke in
others the very hostility and threat which they are guarding
against, creating a "self-fulfilling prophecy" of belief (i.e., "see,
I told you others were out to get me…"). Common "negative"
thoughts in people with PTSD include: "you can’t trust
anyone," "if I’m 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 Post-Traumatic 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
which shows positive results with this issue, many techniques are
applied to address these three anger components:
For increased arousal, the goal of treatment is to help the
person to find a safe place and way to learn skills to reduce
overall arousal, such as relaxation, self-hypnosis, and
physical exercises to 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 them to expand their future response
possibilities towards one’s that are more adaptive (i.e., by
taking a "time out," by writing their thoughts when angry, by
more verbal, assertive ways of negotiating for themselves, by
helping them to recognize when they are beginning to "act
first, think later," and change it 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 to
apply in place of their more negative thoughts (i.e., "if I am
out of control, I won’t be threatened in this situation," "others
do not have to be perfect in order for me to be
comfortable/survive,"). Situations are often role-played in
therapy so they have some practice at recognizing their
anger-arousing thoughts, and applying more positive thoughts.
There are many strategies for helping individuals with PTSD deal
with the common increases of anger they are likely to experience.
Most individuals have a combination of all three components of
anger listed above, and treatment aims at helping them with all
aspects of anger. One important goal of treatment is to improve
sense of flexibility and control so that individuals do not feel
re-traumatized by their own explosive, or excessive responses to
anger triggers. Treatment will hopefully also have a positive impact
on relationships at both work and home.
Complex PTSD
Complex PTSD (sometimes called "Disorder of Extreme Stress") is
found among individuals who have been exposed to prolonged
traumatic circumstances, especially during childhood, such as
childhood sexual abuse. Developmental research is revealing that
many brain and hormonal changes may occur as a result of early,
prolonged trauma, and contribute to difficulties with memory,
learning, and regulating impulses and emotions. Combined with a
disruptive, abusive home environment which does not foster
healthy interaction, these brain and hormonal changes may
contribute to severe behavioral difficulties (such as difficulty
controlling impulses, aggression, sexual acting out, eating disorders,
alcohol/drug abuse, and self-destructive actions), extreme
emotional difficulties (such as intense rage, depression, or panic)
and mental difficulties (such as extremely scattered thoughts,
dissociation, and amnesia). As adults, these individuals often are
diagnosed with depressive disorders, personality disorders or
dissociative disorders. The treatment of such survivors often takes
much longer, may progress at a much slower rate, and requires a
sensitive and structured treatment program delivered by a trauma specialist.
This article 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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Copyright © National Center for PTSD. (Post Traumatic Stress Disorder). Reprinted with permission.
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