Anger is one of the most prevalent symptoms among those who experience PTSD.1 PTSD-related anger that is expressed outwardly, through hostility or aggression, can cause problems in all areas of your life. Internalized anger (self-harming, suicidality, self-hatred) can also be a source of significant distress and danger. Professional counseling and/or medical support can help you manage your anger and address the underlying PTSD.
What’s the Link Between PTSD and Anger?
Research has found that the greater the severity of PTSD symptoms overall, the greater the severity of anger as one of those symptoms.2,3,4 One theory is that increased anger occurs as a consequence of how trauma changes the brain to recognize potential threats. In other words, the brain appears to become more likely to misinterpret the actions and intentions of others as hostile and threatening.5
It has further been suggested that among survivors of complex trauma (prolonged and/or repetitive trauma), anger is more likely a response to changes in self-perception. Trauma can lead to feelings of shame, guilt, a sense of isolation, and perceiving yourself as permanently damaged or “not good enough.” These feelings and beliefs appear to be linked to internalized anger.6
PTSD and Relationship Violence
Those with PTSD who experience a great deal of dysregulated anger are also at risk for acts of aggression towards others, which makes them more likely to engage in violence with interpersonal partners or anyone close to them. The impact of PTSD on one’s ability to manage anger is evident by how strongly-connected poor emotional regulation has on one’s ability to navigate emotions in interpersonal contexts.
Anger and PTSD in Combat Veterans
There is a strong connection between anger and PTSD in combat veterans. Due to the nature of the environment and the constant exposure to violence, combat veterans struggle with dysregulated anger, which makes them at risk for angry outbursts, as well as a heightened risk of suicide. These behaviors are tied with higher likelihood of risky behaviors, criminal activity, and physical aggression towards others.
How Can Anger Complicate PTSD Symptoms?
When you are dealing with PTSD symptoms, there is a likelihood of having an automatic response of anger or irritability as that is how the body has been conditioned to react over the course of the trauma exposure. When anger becomes the go-to response, it can impact a lot of parts of your life, including work and family.
Arousal
Anger is connected to a lot of processes within our body. Our muscles become tense and stiff and our mind and emotions may go into survival mode. This is the body and mind reacting to a PTSD trigger. The emotional dysregulation is very evident in this scenario and can feel much more intense than for someone who does not have PTSD. You may be triggered easily and have a harder time coming down from the trigger, leaving you feeling on edge. You may even self-soothe by harming yourself or someone else, or misusing drugs or alcohol.
Behavior
When we are dealing with anger or any kind of threat, by nature we try to protect ourselves. Those with a history of trauma often react with aggression, and this may be the only known way of handling a threat or dealing with anger. This can leave someone behaving quickly with little thought prior to their actions.
Thoughts & Beliefs
Those who have experienced trauma have their experiences from trauma become their baseline experience, which means that they tend to believe that there is a threat everywhere (called hypervigilance). Those with PTSD have a harder time reconciling these limiting beliefs and may need help understanding how their trauma is impacting their worldview in various scenarios.
Other Symptoms That May Occur With Anger
With PTSD and anger, common symptoms are irritable behavior and angry outbursts (with little or no provocation); these are typically expressed as verbal or physical aggression toward people or objects. Another potential symptom is reckless or self-destructive behavior.2 The latter reflects inwardly expressed anger, while the former is an example of externalized anger.7
Other symptoms that may appear alongside PTSD anger include:7
- Irritable behavior
- Angry outbursts
- Hostility
- Bitterness
- Resentment
- Verbal or physical aggression toward people or objects
- Reckless or self-destructive behavior
- Self-harming
- Suicidality
- Self-hatred
In general, men are more likely to express outward anger, while women with PTSD are more likely to internalize their anger.5,8,9,10
PTSD & Anger in Relationships
PTSD and anger is associated with increased physical and psychological aggression, which can cause significant problems in relationships.11,12 For legitimate reasons, loved ones may become afraid of the trauma survivor’s angry and aggressive outbursts, ultimately leading to an increased sense of isolation and shame for the trauma survivor.
Physical aggression and relationship problems related to PTSD are higher among those in the military vs. civilians, just as rates of physical aggression are higher among men vs. women.10 Still, even civilian men with symptoms of PTSD engage in twice as many aggressive and violent acts in their intimate relationships compared to men who are not experiencing symptoms of PTSD.11
Constructive and Destructive PTSD Anger
Anger as a symptom of PTSD can be used constructively or destructively. For example, it can motivate a productive discussion with someone you feel has offended you or is threatening something important to you. While uncomfortable, you can better understand their intentions and motivations and even improve the relationship. Anger can also motivate you to take positive action in your community.
However, anger PTSD can also be used to feed resentment, bitterness, and hostility. You might use it to fuel aggressive acts towards others in the form of verbal, psychological, physical, or sexual attacks, leading to problems in all areas of your life, as well as destroying important relationships.
Anger can also be destructive if focused inward, which can lead to self-harming (e.g., cutting or burning the skin), high risk behaviors (e.g., alcohol or substance use, drunk driving, starting fights), suicidal actions, and/or self hatred.
Signs That PTSD Anger Is Becoming an Issue
After trauma, your anger may become a serious problem if you notice that it’s negatively impacting your relationships, or if you’re using it to justify threats or acts of abuse. If you notice any signs of problematic anger, you should talk to your primary care physician (PCP) and/or a professional counselor.
Signs that your anger is becoming a problem can include:
- Increased or constant irritability, hostility, or resentment
- Anger and/or aggression is negatively impacting your relationships
- Anger is interfering with your ability to function appropriately in one or more areas of your life
- You are using anger as an excuse to justify threats, or acts of verbal, psychological, physical, or sexual aggression toward others
- Your angry reaction seems much “bigger” than the specific situation warrants
- Increased reliance on alcohol or other substances to numb angry feelings
- Increase negative self-talk and/or participating in self-punishing behavior
How to Handle PTSD Anger Attacks
If you are finding it difficult to redirect your anger in a positive way, there are techniques and strategies to express, release, and transform how you feel. Remember, despite the fact that PTSD can be responsible for causing increased anger among trauma survivors, it does not excuse personal responsibility or accountability for violent behavior.5
Here are six techniques and strategies to help you deal with your anger:
- Walk away from the situation for a moment (if possible): Give yourself some physical and emotional space.
- Breathe: We often forget to breathe when we feel afraid or angry, so focus on your breathing for 60 seconds.
- Notice what has triggered your anger: Ask yourself what line do you feel has been crossed? What do you feel is being threatened?
- Notice the “size” of your anger in comparison to the “size” of the situation: If it seems too big, then you’re likely being triggered. Acknowledgment can help release some of the tension.
- Let out the anger through a safe physical release: If you’re able, tap into and release your anger while doing physical activity. If you feel it in your lower body, consider going for a walk or run. If you feel it in your upper body, hit a punching bag, do push ups, chest presses, or arm curls.
- Once calm, have a respectful conversation with the person you feel has offended you: Focus on your observations and feelings, but avoid name-calling, blaming, and bringing up the past. Try to understand the other person’s point of view and intentions, and accept an apology if offered. Work together to find a way to move forward, if needed.
How to Get Help for PTSD and Anger
Ways to get help for or improve symptoms of PTSD and anger and include therapy, lifestyle changes, and medication. Find a mental health professional who has expertise in PTSD and anger and discuss whether medication for anger would be beneficial for your unique situation. If PTSD-related anger is impacting your intimate and/or family relationships, family or couples counseling might also be helpful.
Therapy
If PTSD-related anger and aggression are impacting your life and relationships, anger management counseling programs can help you to implement long-term change in the way you express your anger.13
Effective therapeutic treatments for PTSD anger include:13,14,15
- Cognitive behavioral therapy (CBT)
- Exposure therapy
- Eye movement desensitization and reprocessing (EMDR)
- Dialectical behavioral therapy (DBT)
- Relaxation training
To find a therapist in your area, consider getting a referral from your primary care physician or using an online therapist directory where you can sort by specialty and insurance coverage.
Lifestyle Changes
Here are a three lifestyle changes that might help to reduce anger and aggression:
- Get enough sleep and eat regular meals
- Reduce unnecessary “drama” or stress in your life, whenever possible
- Practice progressive relaxation
Medication
Although psychotherapy and counseling for PTSD appear to be more effective than medication, it is still a good option for some.16 Certain medications used to treat PTSD, including selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) help with mood stabilization, working to reduce irritability, anger, and aggression.16,17,18 Your physician or psychiatrist can work with you to determine whether medication is appropriate for you.
How Loved Ones Can Help
If your loved one is dealing with PTSD and anger, encourage them to talk with their PCP and/or a professional counselor. Let them know that effective help is available to manage symptoms like increased anger and irritability. You too might benefit from professional counseling support given the distress you are likely dealing with in relation to your loved one’s PTSD anger.
If your loved one is expressing their anger in aggressive or violent ways toward you and/or others, don’t excuse or minimize these behaviors. While their anger may be a result of their PTSD, they are still responsible for how they express it. Take steps to protect yourself and any vulnerable children. When we allow loved ones to get away with aggressive behaviors toward us, they lose respect not only for us, but for themselves as well.
If your loved one is engaging in self-destructive behavior, gently tell them what you have observed. For example, you might say something like:
- “I’ve noticed that you’ve been drinking a lot more lately.”
- “I have seen the scars on your arms.”
- “I love you and see how much you are hurting.”
- “I believe this is related to the trauma you experienced.”
- “If I made an appointment for you to talk with a counselor, would you go with me?”
If they aren’t ready to accept help, you may still need professional mental health support for yourself. It is painful and even traumatic to watch a loved one self-destruct while feeling powerless to stop it.
Final Thoughts on Dealing With Anger & PTSD
What you are dealing with is unique to you because everyone experiences PTSD differently. If PTSD-related anger is causing distress in your life and relationships, it is time to ask for help. Let trusted loved ones know what you are dealing with, and reach out to your doctor and/or a mental health professional. If this seems like too much, ask a family member to help. Remember, PTSD anger does not have to be a life sentence.
