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PTSD & Anger: Connections, Complications, & Treatment Options

Published: June 15, 2022 Updated: November 25, 2022
Published: 06/15/2022 Updated: 11/25/2022
Headshot of Shirley Porter, RP, CCC
Written by:

Shirley Porter

RP, RSW, CCC
Headshot of Dr. Kristen Fuller, MD
Reviewed by:

Kristen Fuller

MD
  • What’s the Link Between PTSD and Anger?Connection
  • How Can Anger Complicate PTSD Symptoms?Symptoms
  • PTSD & Anger in RelationshipsRelationships
  • Constructive and Destructive PTSD AngerConstructive & Destructive
  • Signs That PTSD Anger Is Becoming an IssueSigns
  • How to Handle PTSD Anger AttacksTips
  • How to Get Help for PTSD and AngerGet Help
  • How Loved Ones Can HelpFor Loved Ones
  • Final Thoughts on Dealing With Anger & PTSDConclusion
  • Additional ResourcesResources
Headshot of Shirley Porter, RP, CCC
Written by:

Shirley Porter

RP, RSW, CCC
Headshot of Dr. Kristen Fuller, MD
Reviewed by:

Kristen Fuller

MD

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.

Recovering from PTSD can be difficult, but you don’t have to do it alone. BetterHelp has over 20,000 licensed therapists who provide convenient and affordable online therapy. BetterHelp starts at $60 per week. Complete a brief questionnaire and get matched with the right therapist for you.

Choosing Therapy partners with leading mental health companies and is compensated for marketing by BetterHelp

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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

Help For Trauma / PTSD

Talk Therapy – Get help recovering from trauma from a licensed therapist. Betterhelp offers online therapy starting at $60 per week. Get matched With A Therapist


Virtual Psychiatry – Get help from a real doctor that takes your insurance. Talkiatry offers medication management and online visits with top-rated psychiatrists. Take the online assessment and have your first appointment within a week. Free Assessment


Guided Psychedelic Journeys – Ketamine is a prescription medication that clinicians can prescribe off-label to treat trauma, depression, anxiety, and OCD. Innerwell pairs ketamine with support from licensed psychotherapists. Find out if you’re a good candidate: Take Online Assessment 

Choosing Therapy partners with leading mental health companies and is compensated for marketing by BetterHelp, Talkiatry, and Innerwell.

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:

  1. Walk away from the situation for a moment (if possible): Give yourself some physical and emotional space.
  2. Breathe: We often forget to breathe when we feel afraid or angry, so focus on your breathing for 60 seconds.
  3. Notice what has triggered your anger: Ask yourself what line do you feel has been crossed? What do you feel is being threatened?
  4. 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.
  5. 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.
  6. 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.

Additional Resources

Education is just the first step on our path to improved mental health and emotional wellness. To help our readers take the next step in their journey, Choosing Therapy has partnered with leaders in mental health and wellness. Choosing Therapy may be compensated for marketing by the companies mentioned below.

Online Therapy 

BetterHelp – Get support and guidance from a licensed therapist. BetterHelp has over 20,000 therapists who provide convenient and affordable online therapy.  Complete a brief questionnaire and get matched with the right therapist for you. Get Started

Virtual Psychiatry

Talkiatry – Get help from a real doctor that takes your insurance. Talkiatry offers medication management and online visits with top-rated psychiatrists. Take the online assessment and have your first appointment within a week. Free Assessment

Mindfulness

Mindfulness.com – Change your life by practicing mindfulness. In a few minutes a day, you can start developing mindfulness and meditation skills. Free Trial

Guided Psychedelic Journeys

Innerwell – Ketamine is a prescription medication that clinicians can prescribe off-label to treat trauma, depression, anxiety, and OCD. Innerwell pairs ketamine with support from licensed psychotherapists. Find out if you’re a good candidate: Take Online Assessment 

Choosing Therapy Directory 

You can search for therapists by specialty, experience, insurance, or price, and location. Find a therapist today.

Choosing Therapy partners with leading mental health companies and is compensated for marketing by BetterHelp, Talkiatry, Innerwell, and Mindfulness.com

For Further Reading

  • Mental Health America
  • National Alliance on Mental Health
  • MentalHealth.gov
18 sources

Choosing Therapy strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our articles. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy.

  • Rosen, C., Adler, E., & Tiet, Q. (2013). Presenting concerns of veterans entering treatment for posttraumatic stress disorder. Journal of Traumatic Stress, 26(5), 640-643.  Retrieved from:  https://www.ptsd.va.gov/professional/articles/article-pdf/id87766.pdf

  • American Psychiatric Association. (2013), Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: APA.

  • Eshel, N., Maron-Katz, A., Wu, W., Abu-Amara, D., Marmar, C. R., & Etkin, A. (2021). Neural correlates of anger expression in patients with PTSD. Neuropsychopharmacology, 1-8.

  • Orth, U., Cahill, S. P., Foa, E. B., & Maercker, A. (2008). Anger and posttraumatic stress disorder symptoms in crime victims: A longitudinal analysis. Journal of consulting and clinical psychology, 76(2), 208.  DOI: 10.1037/0022-006X.76.2.208

  • Taft, C. T., Creech, S. K., & Murphy, C. M. (2017). Anger and aggression in PTSD. Current opinion in psychology, 14, 67-71.  Retrieved from:  https://www.sciencedirect.com/science/article/pii/S2352250X16302147

  • Hagenaars, M. A., Fisch, I., & van Minnen, A. (2011). The effect of trauma onset and frequency on PTSD-associated symptoms. Journal of affective disorders, 132(1-2), 192-199.  Retrieved March 13, 2021 from:  https://www.sciencedirect.com/science/article/pii/S0165032711000711

  • Dyer, K. F., Dorahy, M. J., Hamilton, G., Corry, M., Shannon, M., MacSherry, A., … & McElhill, B. (2009). Anger, aggression, and self‐harm in PTSD and complex PTSD. Journal of clinical psychology, 65(10), 1099-1114.

  • Castillo, D. T., Baca, J. C. D., Conforti, K., Qualls, C., & Fallon, S. K. (2002). Anger in PTSD: General psychiatric and gender differences on the BDHI. Journal of Loss & Trauma, 7(2), 119-128.

  • Miller, M. W., & Resick, P. A. (2007). Internalizing and externalizing subtypes in female sexual assault survivors: Implications for the understanding of complex PTSD. Behavior therapy, 38(1), 58-71.  Retrieved March 6, 2021 from:  https://www.sciencedirect.com/science/article/pii/S0005789406000694

  • Taft, C. T., Watkins, L. E., Stafford, J., Street, A. E., & Monson, C. M. (2011). Posttraumatic stress disorder and intimate relationship problems: a meta-analysis. Journal of consulting and clinical psychology, 79(1), 22.  Retrieved from:  https://www.researchgate.net/publication/49780282_Posttraumatic_Stress_Disorder_and_Intimate_Relationship_Problems_A_Meta-Analysis

  • Jakupcak, M., & Tull, M. T. (2005). Effects of trauma exposure on anger, aggression, and violence in a nonclinical sample of men. Violence and victims, 20(5), 589-598.

  • Morland, L. A., Love, A. R., Mackintosh, M. A., Greene, C. J., & Rosen, C. S. (2012). Treating anger and aggression in military populations: Research updates and clinical implications. Clinical Psychology: Science and Practice, 19(3), 305-322.

  • Chemtob, C. M., Novaco, R. W., Hamada, R. S., & Gross, D. M. (1997). Cognitive-behavioral treatment for severe anger in posttraumatic stress disorder. Journal of consulting and clinical psychology, 65(1), 184.  Retrieved March 20, 2021 from:  https://www.researchgate.net/profile/Raymond-Novaco/publication/14113442

  • Shea, M. T., Lambert, J., & Reddy, M. K. (2013). A randomized pilot study of anger treatment for Iraq and Afghanistan veterans. Behaviour research and therapy, 51(10), 607-613.  Retrieved from: https://www.sciencedirect.com/science/article/pii/S0005796713001010

  • Stapleton, J. A., Taylor, S., & Asmundson, G. J. G. (2006). Effects of three PTSD treatments on anger and guilt: Exposure therapy, eye movement desensitization and reprocessing, and relaxation training. Journal of Traumatic Stress, 19(1), 19–28. https://doi.org/10.1002/jts.20095

  • Bernardy, N. C., & Friedman, M. J. (2015). Psychopharmacological strategies in the management of posttraumatic stress disorder (PTSD): what have we learned? Current Psychiatry Reports, 17(4), 564–564. https://doi.org/10.1007/s11920-015-0564-2

  • Albucher, R. C., & Liberzon, I. (2002). Psychopharmacological treatment in PTSD: a critical review. Journal of psychiatric research, 36(6), 355-367.  Retrieved from:  https://www.sciencedirect.com/science/article/pii/S0022395602000584

  • Yehuda, R. (1999). Managing anger and aggression in patients with posttraumatic stress disorder. Journal of Clinical Psychiatry, 60(15), 33-37.  Retrieved March 27, 2021 from:  https://www.psychiatrist.com/wp-content/uploads/2021/02/14889_managing-anger-aggression-patients-posttraumatic-stress.pdf

update history

We regularly update the articles on ChoosingTherapy.com to ensure we continue to reflect scientific consensus on the topics we cover, to incorporate new research into our articles, and to better answer our audience’s questions. When our content undergoes a significant revision, we summarize the changes that were made and the date on which they occurred. We also record the authors and medical reviewers who contributed to previous versions of the article. Read more about our editorial policies here.

  • Originally Published: April 14, 2021
    Original Author: Shirley Porter, RP, RSW, CCC
    Original Reviewer: Kristen Fuller, MD

  • Updated: June 15, 2022
    Author: No Change
    Reviewer: No Change
    Primary Changes: Updated for readability and clarity. Reviewed and added relevant resources. Added “PTSD and Relationship Violence”, “Anger and PTSD in Combat Veterans”, and “How Can Anger Complicate PTSD Symptoms?”. New material written by Silvi Saxena, MBA, MSW, LSW, CCTP, OSW-C and reviewed by Kristen Fuller, MD.

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Headshot of Shirley Porter, RP, CCC
Written by:

Shirley Porter

RP, RSW, CCC
Headshot of Dr. Kristen Fuller, MD
Reviewed by:

Kristen Fuller

MD
  • What’s the Link Between PTSD and Anger?Connection
  • How Can Anger Complicate PTSD Symptoms?Symptoms
  • PTSD & Anger in RelationshipsRelationships
  • Constructive and Destructive PTSD AngerConstructive & Destructive
  • Signs That PTSD Anger Is Becoming an IssueSigns
  • How to Handle PTSD Anger AttacksTips
  • How to Get Help for PTSD and AngerGet Help
  • How Loved Ones Can HelpFor Loved Ones
  • Final Thoughts on Dealing With Anger & PTSDConclusion
  • Additional ResourcesResources
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