By Andrea Hellenthal, Ph.D.
Sep. 12, 2022

U.S. Army photo by Renee Rhodes

Problematic anger can be a major burden among military personnel and veterans. It not only negatively impacts our physical and emotional health, but also our social environment and the mission. But there is help for how to tame the inner beast.

Maybe you know the superhero from the comic universe: after an accident with the prototype of a gamma bomb, a nerdy physicist is exposed to large amounts of radiation. From then on, at any hint of anger, the normally cautious and shy guy turns into a raging green monster. His efforts to suppress the beast inside him are futile, as his transformation leads to destructive rampages and conflicts that complicate his life.

Connor Armstrong, who serves as an officer in the Army, thinks of his own green monster as he clears away the broken dishes he threw at the wall in rage ten minutes ago. Like the nerdy physicist, Connor is afraid of the monster inside him, the uncontrollable rage. As with the physicist, Connor's angry outbursts strain relationships with his family, friends and co-workers. But is Connor's anger really as uncontrollable as the beast in the physicist? What is anger and when does it become a problem? Why are service members and veterans especially affected? And what can be done about problematic anger?

What is anger?

According to the American Psychological Association, anger is a normal human emotion that is a natural reaction when you feel wronged. Anger becomes problematic when it causes significant distress, interferes with interpersonal relationships, or is associated with aggressive behavior.¹ Anger is distinct from aggression, as aggression includes the intent to cause harm to another through verbal abuse, threats of or actual violence. Although individuals who become aggressive are typically angry, most episodes of anger do not involve aggression.

Anger as a burden for military personnel, veterans and their social environment

Problematic anger is one of the more common reported issues among military personnel and veterans.² In a study with veterans of Operation Iraqi Freedom who were assessed three and 12 months after their deployment, about 40% of the participants reported aggressive outbursts. Specifically, 35% reported having threatened someone with physical violence and 17% reported having a physical altercation in the past month.³ Difficulty controlling anger was the most prevalent community reintegration problem reported by Iraq and Afghanistan combat veterans² and has many negative consequences for those affected, as well as for their social environment. Problematic anger is commonly associated with the experience of mental health conditions like depression and substance abuse (i.e., nicotine dependence and excessive drinking), and has an influence on suicidal ideation and suicide attempts.⁴ Furthermore, problematic anger is associated with interpersonal problems as it may lead to aggressive behavior, relationship stress with coworkers and family, and risk of criminal activity.²

Anger and trauma

Anger is an important issue among trauma-affected populations.² Problematic anger can co-occur with posttraumatic stress disorder, a mental health condition that may develop following exposure to a traumatic event, such as a deployment-related trauma. Researchers assume that anger is related to a natural survival instinct. People often respond with anger when they are faced with extreme threat. Anger helps to focus all attention toward survival. In people with PTSD, their response to extreme threat can become stuck: they react to any stress with full activation, as if their life was threatened. Those affected with PTSD may often feel on the edge, irritable and easily provoked. Even in situations that do not involve extreme threat, they feel as if they have to fight for their lives. They may react impulsively and act before they are able to think. This can create serious problems in the workplace and family life. On the other hand, increased anger among people with PTSD is also associated with isolating and negative thoughts and feelings about self and others, which can negatively impact social support.³

How can you get help with anger?

If you are affected with problematic anger, you deserve help and support. Connor Armstrong, the Army officer, sought help after his wife gave him an ultimatum: either he would find out where his aggressive outbursts were coming from and what could be done about them, or she would leave him. With the help of a mental health provider, Connor Armstrong got to know and tame his inner beast. Anger and co-occurring PTSD can be treated using various cognitive behavioral therapies.¹ One such treatment is made up of 12 one-hour sessions where individuals learn about anger and PTSD, monitor and identify the cost and benefits of their anger, analyze examples from their life to find patterns, practice coping with anger when provoked, learn relaxation strategies, and assertive communication.¹ The goal of treatment is to help individuals expand their range of emotional reactions and better control their responses to anger triggers.

The Department of Veterans Affairs offers an online Anger Toolkit and an Anger and Irritability course. They also offer comprehensive information on anger and trauma. They answer questions about why anger is a common response to trauma and include video testimonies from veterans who have successfully recovered from co-occurring problematic anger and PTSD.

If anger is causing you distress or disrupting your relationships, consult a mental health care provider. You can schedule an appointment with a provider or speak to your primary care doctor. The InTransition Program can also help you find local mental health care services.

References

1. Cash, R., Varker, T., McHugh, T., Metcalf, O., Howard, A., Lloyd, D., Costello, J., Said, D., & Forbes, D. (2018). Effectiveness of an anger intervention for military members with PTSD: A clinical case series. Military Medicine, 183, 9-10. https://doi.org/10.1093/milmed/usx115
2. Dillon, K. H., Crawford, E. F., Kudler, H., Straits-Troster, K. A., Elbogen, E. B., & Calhoun, P. S. (2017). An investigation of treatment engagement among returning veterans with problematic anger. The Journal of Nervous and Mental Disease, 205(2), 119–126. https://doi.org/10.1097/NMD.0000000000000651
3. Thomas, J. L., Wilk, J. E., Riviere, L. A., McGurk, D., Castro, C. A., & Hoge, C. W. (2010). Prevalence of mental health problems and functional impairment among active component and National Guard soldiers 3 and 12 months following combat in Iraq. Archives of General Psychiatry, 67(6), 614–623. https://doi.org/10.1001/archgenpsychiatry.2010.54
4. Varker, T., Cowlishaw, S., Baur, J., McFarlane, A. C., Lawrence-Wood, E., Metcalf, O., Van Hooff, M., Sadler, N., O'Donnell, M. L., Hodson, S., Benassi, H., & Forbes, D. (2022). Problem anger in veterans and military personnel: Prevalence, predictors, and associated harms of suicide and violence. Journal of psychiatric research, 151, 57–64.https://doi.org/10.1016/j.jpsychires.2022.04.004

Andrea Hellenthal, Ph.D. is a psychologist specializing in clinical psychology. She works for the German Armed Forces and is employed there at the University. Additionally, she treats patients in her own practice. She is currently participating in a scientific exchange program with the U.S. Armed Forces and works for the Psychological Health Center of Excellence.