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Neuropsychiatry - Does Anger require treatment?

Does Anger require treatment?

Prof. Dr. U. Gauthamadas
MD PhD DPM DCBD
Neuro Behavioural Medicine Specialist
Website: www.docgautham.com

(continuation from October issue)

Anger is a program designed to motivate the target of the anger to show greater care for the welfare of the angry individual. Individuals in a position of power with enhanced abilities to inflict costs on others or to confer benefits on others have a better bargaining position in conflicts. Such individuals have greater expectations that others will do as they are requested. Consequently, if these expectations are violated, they will experience greater frustration and a higher propensity for anger. 
Transgressions of conventions / rules / regulations are significantly more likely to induce anger than transgressions of affection / care. Conventional rules are rules describing the expectations of authority/ high status figures regarding the behavior of subordinates/ low status individuals (children should not talk in class and personal assistants should not put their feet up on the CEOs desk during a meeting). The thwarting of these expectations leads to frustration and anger. 
Children also experience frustration and anger. How the child ultimately copes with these emotions is in part determined by their observation of how their parents / caregivers handle anger, and in part by how their caregiver(s) responds to their distress. Located in the prefrontal cortex of the brain, is the mirror neuron system (MNS) which scans the intentions of others through non-verbal signals, interprets those signals and simulates (mirrors) the intention within the receiver of the signal. The MNS simulates within the receiver, the observed emotional state in the other. So, when we observe another person's pain, sadness, or anger, we may actually be feeling it. Handling of frustration and anger by caregivers triggers the mirror neuron systrem in the child who then internalises their behavioural response. Thus children can "learn" to react explosively to frustrations. Most people with Anger Disorder grow up in families where explosive behavior and verbal and physical abuse are common. Being exposed to this type of violence at an early age makes it more likely these children will exhibit these same traits as they mature. 

Avoidant children (who feel insecure in the presence of parents / caregivers and avoid them) deactivate distress and therefore anger is more likely to be expressed in more indirect ways. Resistant children (who see their care givers as a threat and resist them) are more likely to be chronically angry, and to express other emotions through their anger. Disorganized children (who are confused about their attachment to their care givers) may get so overwhelmed with emotional flooding, that they become aggressive toward self or others. However, secure children (who feel secure in the presence of their caregivers and are attached to them) do become angry too, but they are more likely to express it directly to others. When the source of anger is not available they can rely on mental representations that allow for self-soothing and returning toward a state of emotional well-being. Insecure children lack a positive mental representation of soothing, so their mental representations are likely to contribute to more anger, rather than less. 

Strategies for dealing with anger persist into adulthood. Some expressions of the strategies may become more sophisticated, whereas some may not be too dissimilar from a child's expression of anger (we all know adults who can throw a full-fledged temper tantrum). The healthy expression and handling of the anger, will usually lead to increased self-esteem, greater trust and intimacy with others, and a general feeling of wellbeing. 

Anger Disorder or Intermittent Explosive Disorder (lED) is actually a bouquet of behaviors, characterized by repeated episodes of impulsive, aggressive, and violent behavior or angry verbal outbursts grossly out of proportion to the situation. The disorders in this bouquet may have various clinical diagnostic labels attached to them, but are linked together by the underlying explosive eruptions of anger. It occurs due to a disordered TPS.

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