PTSD and Anger Problems

Anger is part and parcel of post-traumatic stress disorder (PTSD), as it’s one of the hyperarousal symptoms commonly noted among people with this disorder. However, associated anger problems can go well beyond simple anger and manifest as aggression toward others, self-harm, or both.^[1]

What is PTSD?

PTSD is a severe condition in which the typical stress response to stressful or traumatic events becomes debilitating. In addition to potentially explosive outbursts of anger, people with PTSD suffer from many symptoms, including feeling on edge, flashbacks to the traumatic event, and self-blame.

Likewise, people with PTSD typically avoid situations related to the trauma and have trouble sleeping, reduced interest in enjoyable activities, and increased psychological stress.

Though PTSD is often associated with military veterans who had traumatic experiences during active duty, PTSD can develop as a result of any traumatic event – child abuse, a terrorist attack, or a natural disaster, to name a few.

Some people are at higher risk of developing PTSD, too. For example, survivors of childhood abuse, people with a family history of mental illness, and those lacking family and social support are more likely to develop PTSD after a traumatic event.

What is the relationship between PTSD and anger?

While anger is not required for a PTSD diagnosis, PTSD and anger commonly occur together.

When considering the nature of PTSD, it makes sense that anger might be part of the symptomatology. For example, combat veterans might feel extreme survivor’s guilt for making it out alive when some of their colleagues died on the battlefield. Intense self-blame can lead to self-hatred, the desire to push others away, and a propensity for violent outbursts.

Moreover, people with PTSD are often on edge and might be quick to anger. The body and mind are ready for action when in fight or flight mode. People with PTSD might be described as stuck in this state. When something causes anger, those feelings might be expressed quickly, given the “high alert” state that someone with PTSD is already experiencing.

So, on the one hand, PTSD can lead to the development of anger and the quick expression of that anger. But on the other hand, anger might also be a risk factor for developing PTSD.^[2]

For example, if you are naturally “keyed up” or hyper aroused, you might already be quick to anger. Additionally, if you generally distrust people or expect the worst, anger is a natural reaction to defend yourself against such threats. Add in a stressful or traumatic event, and PTSD might be more likely to develop.

Anger and PTSD have a much more complex relationship than this, though. Below are some common instances in which PTSD and anger might co-occur.

Domestic violence

Violence in a relationship is one of the most common causes of PTSD.^[3] Whether victims are subjected to physical violence, sexual abuse, emotional abuse, or a combination thereof, PTSD and anger might manifest as the victim struggles to cope with their trauma.

However, PTSD might also affect the perpetrator of domestic violence. For example, someone that experiences PTSD rage might lash out at a loved one and strike or kick them while having arousal or reactivity-based PTSD symptoms.

Combat veterans

As mentioned earlier, a group disproportionately affected by PTSD is combat veterans. PTSD anger usually occurs in three domains among military veterans: arousal, behavior, and thoughts and beliefs.^[4] These domains are briefly discussed below:

Arousal-based anger

Some people with PTSD can be described as on edge or irritable. Likewise, they might be easily provoked by frustrating circumstances, the actions of others, and the like.

For example, as a consequence of always being on alert, people with PTSD might also quickly become emotional and feel the physical effects of anger (e.g., increased heart rate and muscle tension).

What’s more, some people with PTSD seek out situations in which a high level of arousal is necessary, such as thrill-seeking behaviors that pose some level of danger (e.g., skydiving) or risky sexual behaviors.^[5] In either case, the arousal associated with PTSD might lead to a greater likelihood of feeling and expressing anger.

Behavior-based anger

Dealing with a threat by using aggression is a natural and common response in humans. However, while most people become aggressive only when threatened, people with PTSD might react aggressively in what others would consider mundane situations.

As mentioned earlier, people with PTSD might be “stuck” in a hyper aroused state. But people who develop PTSD after a traumatic event may not know how to deal with perceived threats other than anger. This is especially true of people that experienced trauma at a young age.^[4]

For example, someone who was physically abused by a parent at a young age might have reacted to that abuse with outbursts of physical violence – kicking, clawing, punching, and so forth – to try to fight off their aggressor. As an adult, that person might instinctively use the same techniques when presented with situations they perceive as threats.

Thought and belief-based anger

Another way that anger and trauma go together is that they can skew one’s view of the world.

For example, a person with PTSD may think that threats are all around them, even if this is not the case. Often, this occurs without the person even realizing it. For example, someone beaten and robbed might develop PTSD and, as a result, feel the need to be highly controlling of their surroundings due to their belief that danger is all around.

As a result, when other people in their lives don’t adhere to the rules of maintaining vigilance and control, the person with PTSD might react with anger. This inflexibility and the resulting anger might not manifest as violent outbursts, but it’s still an angry, aggressive, and emotional response to the situation.

So, it is clear how thoughts and beliefs feed into the relationship between anger and PTSD. Thoughts like “I can’t trust anyone” and “other people are out to get me” result in inflexibility, heightening the likelihood of conflict. This makes it more likely that others get angry with someone with PTSD, whom themselves react with anger. It’s a vicious cycle, to say the least.

Natural disasters

Experiencing a natural disaster like an earthquake or a tornado can lead to the development of PTSD. One study conducted four years after Hurricane Katrina hit New Orleans found that 33 percent of participants had PTSD that was directly linked to the storm.^[6]

Again, we might see the development of anger alongside natural disaster-related PTSD. For example, a mother whose child perished in the storm might develop PTSD anger when friends and family members don’t heed storm warnings and suggestions to evacuate.

Survivors of natural disasters often have survivor’s guilt and blame themselves if a loved one dies during the event. Combined with other PTSD symptoms, survivors often feel on edge and as though the world is a scary place – a prime situation for anger and trauma to manifest as aggressive outbursts.

How does anger affect PTSD symptoms?

As noted above, anger can exacerbate PTSD symptoms in arousal, behavioral, and thought and belief spectrums. The combination of anger and trauma might lead someone with PTSD to lash out, seemingly when there’s no reason to do so.

However, the combination of hyperarousal, negative behaviors, and intrusive thoughts puts people with PTSD on edge, with very little needed to trigger an angry outburst. On the one hand, this makes sense, given that people with PTSD view even neutral stimuli as threatening.^[7]

On the other hand, many people find that anger is much easier to express than “heavier” emotions like fear or hurt. In this regard, expressing anger is a coping mechanism that helps people with PTSD avoid dealing directly with the fear related to their trauma. As a result, there’s a greater likelihood of conflict with others and a lesser likelihood of effectively processing one’s emotions (this is known as destructive anger, which is discussed in more detail below).

Furthermore, PTSD anger seems to be connected to overt negative behaviors.^[7] For example, if someone witnesses a shooting and develops PTSD, they’re likely to harbor internal feelings of fear, helplessness, and even anger.

Then, as stimuli related to that trauma occur in the ensuing months (e.g., seeing a shooting on TV, hearing gunshots in the distance), the person with PTSD might find those subsequent stimuli uncomfortable, if not intrusive and threatening. When threatened, the level of arousal is likely to increase, as are thoughts and beliefs of “I’m not safe.” Anger might result when loved ones ignore or minimize these feelings.

Further experiences of PTSD and anger might include:

Prolonged psychological distress

One of the intrusion symptoms of PTSD is a prolonged period of distress. These intense periods of emotionality are typically triggered by events that resemble the initial trauma.

For example, a child who was sexually abused might enter a period of distress after testifying in court about their experience. As a result, the child might become verbally aggressive during their testimony.

Avoidance of reminders of the trauma

Avoidance is a hallmark symptom of PTSD. Some people with PTSD try to manage their anger by avoiding reminders of their trauma. This is often impossible to do, though.

As noted above, the internal feelings of anger – and the fact that they are bottled up – may lead to a greater likelihood of angry outbursts. In this case, repressing those feelings likely exacerbates the situation, making the person with PTSD even more amped up and quick to anger.

Persistent negative emotional state

Cognition and mood symptoms of PTSD involve everything from episodic amnesia to feelings of detachment from others to a loss of interest in activities that used to bring joy. Of course, anger makes it even more difficult to work through these symptoms.

For example, a person with PTSD might be stuck in a state of shame, guilt, fear, and anger. As a result, their loved ones might be pushed away, which leads to feelings of detachment. What’s more, people with PTSD might feel abandoned by their loved ones, even though they have pushed their loved ones away. Those feelings of abandonment might trigger even more intense anger, and the cycle continues.

Alterations in behavior

A central symptom of the arousal and reactivity cluster of PTSD is alterations in behavior. Someone with PTSD might become verbally aggressive with others, prone to angry outbursts, and even become physically aggressive with others.

What’s more, such intense anger can make it difficult to concentrate, heighten the startle response, and make it difficult to sleep. Each of these is already a symptom of PTSD, so this secondary anger can worsen these symptoms.

Constructive vs Destructive PTSD anger

Anger and trauma are inextricably intertwined. However, the type of anger one feels after trauma can differ.^[2]

Constructive anger is the type of anger that aids in the healing process.^[8] It helps you identify what’s gone wrong, why you’re upset, and it can help you process the situation that led to your anger.

For example, you might become angry when a loved one tells you to calm down. Your anger, if expressed in a manner that communicates your frustration, can lead to a discussion about why being told to “calm down” bothers you.

Conversely, destructive anger describes anger expressed in unhealthy ways, such as aggression or hostility.^[8] Furthermore, destructive anger might manifest as bitterness or resentment. It can be focused inwardly, too – some people with PTSD anger engage in self-harm, physical altercations, or substance abuse because of their destructive anger.

It’s important to note that anger isn’t a bad thing. It’s a valid feeling that should be expressed and worked through appropriately. However, constructively expressing anger is far healthier and more beneficial than destructive anger.

Complications of PTSD anger

PTSD is difficult enough on its own to manage. Add in anger, and you might have your hands full simply trying to function in everyday life.

Recognizing that you have PTSD anger can be difficult, though. This is especially true if you’ve had PTSD and problematic anger for a long time – it’s easy to forget how life used to be.

The following are classic warning signs that might indicate you have PTSD anger and need help:

• You’re persistently irritable
• You’re easily upset or quick to anger
• You lash out at others
• Your anger makes it difficult to concentrate on tasks
• Your anger has negative effects on relationships
• You feel that anger is the best way to solve problems
• You have persistent feelings of being threatened or afraid

Furthermore, you might feel that you can’t control your anger, or, on the opposite end of the spectrum, you might not even realize how profound your anger has become. In this case, loved ones might draw your attention to your propensity for anger.

How to manage PTSD rage

Consult the following list of tips for ways you can manage your PTSD rage or help someone else manage their anger:

• Talk to a loved one – It can be difficult to ask for help. Yet, loved ones can lend an ear and offer support as you seek to get your PTSD anger under control.
• Seek professional help – Anger management, psychotherapy, and group therapy for people with PTSD can effectively manage PTSD rage.^[1]
• Talk it out – If you feel yourself getting angry with someone else, express why you feel angry. Doing so can help others understand where you’re coming from.
• Practice empathy – Try to understand other people’s perspectives by asking them about their thoughts and feelings when you share your thoughts and feelings with them.
• Take a breather – Sometimes, extracting yourself from a situation that’s making you angry is all you need to calm down. Take a moment, leave the room, get some fresh air, and count to 10 while you breathe deeply.
• Express your anger in healthy ways – Writing about your anger in a journal helps you understand it, which can also help you manage it better.^[4]
• Identify common triggers for your anger – If your anger typically builds up at a particular time or place (e.g., work), try to identify what triggers your anger and seek to adjust your environment or schedule to minimize those triggers.

Additionally, it’s important not to let your anger bottle up inside. As discussed earlier, inward-focused destructive anger can lead to dire consequences like violence upon others or self-harm. The more proactive you are with managing your PTSD rage, the less likely it is to lead to outbursts of hostility or violence.

Treatment for PTSD anger

Fortunately, there are many effective therapeutic and drug-based treatments for PTSD and PTSD anger. Below is a brief overview of some of the most common approaches:

• Cognitive-behavioral therapy (CBT) offers many methods by which PTSD anger can be treated. For example, patients can learn strategies to help calm down when anger arises, such as relaxation techniques and self-hypnosis.^[4]
• Prolonged exposure (PE) is a type of CBT that gradually helps patients experience the thoughts, feelings, and emotions of the original trauma to reduce anger, fear, and other feelings associated with that trauma.^[9]
• Eye movement desensitization and reprocessing (EMDR) is a type of talk therapy in which the patient recalls traumatic memories while tracking a back-and-forth sound or movement, such as a tone that alternately beeps in the left and right ear. This technique helps reduce anger, anxiety, and distress while also focusing on positive feelings.^[10]
• Cognitive processing therapy (CPT) is a type of CBT that challenges a patient’s maladaptive thoughts and beliefs about their trauma. Doing so can help patients improve their daily functioning, including reducing angry outbursts.^[11]
• Cognitive therapy (CT) addresses pessimistic memories and feelings related to the trauma while also interrupting maladaptive behaviors (e.g., anger) that cause disturbances to daily life.^[12]
• Medications, particularly selective serotonin reuptake inhibitors (SSRIs) like fluoxetine, sertraline, and paroxetine, have shown promise for treating PTSD symptoms. Effexor, a serotonin and norepinephrine reuptake inhibitor (SSNRI), is also effective.