It was a familiar scene in my office, where I practice as a clinical psychiatrist. The well-dressed woman sat across from me with a worried furrow between her eyebrows.
“Doctor, my husband and kids say I get too angry,” she said. “I have trouble controlling my mood. Do you think I have bipolar disorder?”
After a thorough evaluation, I concluded that my patient’s verbal outbursts and tendency to throw dishes did not stem from a serious mood disorder, but from uncontrollable anxiety. My patient was surprised. Maybe you are too.
Learn more: What is anxiety and how can worries overwhelm us?
Anxiety flew since the beginning of the COVID-19 pandemic, with at least 40 million American adults currently affected by at least one anxiety disorder, according to the Anxiety and Depression Association of America. As such, it is more important than ever to recognize the possible consequences of these issues and the possible causes behind them. One of the most misunderstood relationships is that between anxiety and outbursts of anger.
Understanding anxiety disorders
Anxiety disorders come in different shapes and sizes. Nevertheless, all of the examples below can produce enough fear and anxiety to interfere with the sufferer’s daily quality of life.
social anxiety disordersometimes called SAD, refers to the fear of negative evaluation by others in social or performance situations.
Obsessive Compulsive Disorderor OCD, exhibits debilitating “looping” thoughts that lead to unwanted repetitive actions.
Generalized anxiety disorder is the tendency to worry uncontrollably about habitual and routine life circumstances.
Panic disorder makes itself felt in the body with symptoms like shortness of breath and rapid heartbeat.
When Anxiety Leads to Anger
It’s tempting to think of anxiety and anger as opposite ends of a spectrum, that is, people who are afraid are anything but aggressive. But having an anxiety problem can actually increase the likelihood of angry outbursts. Anger and anxiety involve a kind of emotional dysregulation and a perceived threat, according to psychiatrist Franklin Schneier, co-director of the Anxiety Disorders Clinic at the New York State Psychiatric Institute.
This threat activates a part of the brain called tonsil, which serves as a center that processes both frightening and threatening stimuli. The result? “It’s the classic fight-or-flight dilemma,” says Schneier.
Learn more: OCD, PTSD, Generalized Anxiety Disorder and More: What’s the Difference?
It seems logical that people with anxiety disorders choose to “flight” or avoid the threatening situation. But it’s not always the case. The presence of a threat is just as likely to produce irritability – or aggression. In fact, the link between anxiety and anger may be so close that it seems appropriate to call the combination “anxiety”, after the informal word “hungry” used for anger as a result of being hungry.
But while fear and anger may be closely related, they are not the same emotion. Although anger can sometimes lead to anxiety, here we focus on the opposite, where fear is the underlying emotion and aggression is the behavior.
Why Anxiety Can Lead to Anger
Research backs up the claim that anxiety can lead to anger. Florida State University psychology professor Jesse Cougle and his team studied the frequency of aggression in several different anxiety disorders, according to a study published in the journal Depression and anxiety. Researchers have found high levels of anger in all anxiety disorders.
There are several possible reasons for this link. For one thing, the very experience of anxiety is a type of emotional arousal that can be distressing. In other words, anxious people might tend to overreact in general.
“When someone cuts them off in traffic or there’s a slight perception or inconvenience, it can lead to anger because they’re already in a state of distress and excitement,” says Cougle.
Another possible cause could include the temptation to put aside anxious feelings. “When you avoid feelings, you don’t deal with them as well. Simply avoiding anxiety — without acknowledging it because it’s too scary — can cause anger to build up until it spirals out of control and explodes,” Schneier says.
Learn more: If humans are social creatures, why has social anxiety evolved?
Take social anxiety. People with SAD tend to avoid conflict and may go out of their way to appease others. But they also expect others to act negatively towards them. Feelings of rejection can carry out irritability or aggressive behavior – the exact opposite of the shyness one would expect from someone with social anxiety. For example, if you put a socially anxious teenager in a setting where they can’t judge another’s intentions – like a high school dance – and when the teenager comes home they go after their parents for forcing her to go.
Another overlooked link between anxiety and anger involves lack of sleep. People with anxiety disorders have difficulty fall asleep and stay asleep. Over time, this pent up fatigue can lead to an outburst of irritability.
How to deal with anxiety and anger
A 2021 study Researchers from Florida State University have shown that reducing anxiety can have a beneficial effect on reducing anger. But what types of treatments work best?
A first line of defense is to be aware of negative emotions. It is important for the “anxious” person to be aware of their thoughts, especially spiraling catastrophic thoughts. This is where cognitive behavioral therapy (CBT) comes in. The therapist can help the patient see their thoughts differently and adjust their behavior.
“CBT approaches are useful for self-monitoring anxious and angry thoughts and impulses,” says Schneier. “[It’s about] use anger as information to resolve the underlying conflict or calm down so it doesn’t get out of hand.”
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Since people with “anxiety” are more likely to drop out of treatment than those with anxiety alone, in some cases treatment should target both halves of the equation.
“We have treatments that are not focused on a single diagnosis. […] They try to reduce things like ‘negative affectivity’, a broad construct that anger and anxiety have in common,” Cougle adds.
“Conscious Emotional Awareness” (or, simply, the practice of mindfulness) is one of these therapies. It refers to the ability to feel the first signs of anger or anxiety in our body and to accept these feelings without judgement.
Of course, anger is associated with many other disorders, including depression, bipolar disorder, and borderline personality disorder, to name a few. Unraveling the underlying anxiety can be difficult, both for the victim caught in the heat of the moment and for those close to them. The consequences of “anxiety” are often frightening, so seeking professional diagnosis and treatment can provide much-needed relief.