Anger Management
Uzma Mazhar 
Azfar Malik. M.D

Anger affects us negatively at all four levels of our being... the physical, emotional, mental and spiritual levels.  It is also cited as the main cause of stress and stress-related illnesses.  Hostility and anger are highly co-related with coronary heart disease and other physical and behavioral stress problems.  Some health problems that are affected by anger are:  headaches, muscular tension (neck, shoulders, back), gastro-intestinal disorders (ulcers, colitis), skin disorders (rashes, itching), circulatory disorders (high blood pressure, coronary artery disease) and respiratory disorders (asthma, breath-holding in children). 

In addition to the somatic manifestations of anger there is a broad spectrum of emotional problems that result from suppressing anger.  These can extend from episodes of impaired judgment resulting in harmful consequences, to depression to suicide.   Anger influences our thinking and our actions. 

 The English language uses some interesting phrases that show the connection between anger and the physical body.  Expressions of disappointment, frustration, being let down are also indicators of anger, although they are often not recognized as such.   
blowing my top off
blinding rage
splitting headache
 ---- walked all over me
beaten to a pulp
itching to get my hands on ----
my blood boils when ----
lashing out etc;.

Anger is mostly a symptom of Depression, people who are clinically  depressed have increased outbursts of anger, or other variance of anger, like expressing themselves in hate or with hostility. 

Anger can also be an attempt to control others to meet your needs, and is often a result of frustration when you do not get what you want.

Anger in children and adolescents, is associated with problems of impulsivity control, this symptom is seen in kids with ADHD ( Attention Deficit Disorder)

In adults and adolescents who suffer from OCD (Obsessive Compulsive Disorder), anger is a predominant symptom, specially when the patient is not able to rationalize their rituals.  There are other rare psychiatric conditions which present with anger as their initial symptom, like patients in the manic phase of their illness ( Manic Depressive Illness), Impulse Control Disorders; and other forms of Organic Brain Disorders, specially caused by various traumatic injuries: ie:  Strokes, Central Nervous System infections, and Mental Retardation.

Anger is expressed either directly through loud screaming and yelling or "lashing out," or indirectly through passive-aggressive behaviors.  Some express anger by 'displacing' it.... ie: taking it out on something or someone other than the one they are angry at, kicking doors, blaming their spouse or children. The more serious cases may result in domestic violence, in physical abuse of spouse or children.   Passive-aggressive ways of expressing anger are generally covert and not very obvious.  Some of the methods of passive-aggressive anger are: acting belligerent, pouting, 'silent treatment' or being unavailable when needed.  Both styles of expression of anger have serious negative effects on one's health and relationships.  

Anger in itself is neither good nor bad... the manner in which it is expressed is what makes it a problem.  There are some situations which rightfully provoke anger, and should if we are human beings... abuse of children is one of them.  However, this still does not justify violence or aggression against the perpetrator.  

The underlying motivator in anger is usually fear.  Fear stemming from a feeling of lack of control, feeling minimized or belittled by others.   Low self-esteem and a sense of personal worthlessness contribute to the fear of loss of control.

How to Manage Your Anger.
 
1         Recognize that you are angry.
2         Identify the source of anger in yourself.
3         Do a reality-check.
4         Take appropriate action.

Management of  Anger depends on the underlying cause, and treatment of the illness.  Understand your pattern of anger, what provokes you and how you respond to it.  Everyone has different 'triggers' that set them off.  Find out what it is about you that sets you off.  Anger of which we are aware is much less harmful and damaging.  Understand what you do before you explode, follow the sequence of events and thoughts to the underlying dynamics of your own thought patterns that lead to the inappropriate expression of anger.  Be aware of your own thoughts and how they are connected to your actions.

 If you set expectations for yourself and others by saying  that people or things "should" be something other than what they are, then you can get  more frustrated and angered in your life. These 'shoulds and musts' are self-destructive and potentially harmful to your relationship with others.  

The appropriate action is usually about yourself, and how you  handle the situation, not about how you  make the other change or adapt to you.  Right or wrong, everyone has to decide for themselves how to live their life, we cannot make decisions for the other person. Nor can we force the other to live their life according to what we think is right.  Once we understand this and learn to respect each other based on this premise, life does become easier.  ;-)
      
As we have discussed earlier, various treatments are effective for different underlying causes of anger, in the more severe cases medications are used as an adjunct form of therapy.  Many SSRI's ( Serotenergic antidepressants like Prozac, Zoloft, Paxil, Celexa), help reduce anger episodes in patients who do not have  any clinical psychiatric disorders.