By Dr. Poyap J Rooney 31/05/2016

“Anybody can become angry – that is easy, but to be angry with the right person and to the right degree and at the right time and for the right purpose, and in the right way – that is not within everybody’s power and is not easy”. Aristotle
Anger is a powerful human emotion. We ALL get angry to varying extents and frequency. Our anger may be directed towards our significant other, with the entity that provide us with a financial income (our “employer”), or the driver of the PMV bus taking 25 less fortunate passengers to work that cuts across you in your hilux.

Just like, hunger, thirst and sex, anger does have a biological purpose, that was and I believe still is necessary for our survival as a specie. But that is probably a subject and debate that is better left to evolutionary experts.

In this article I want to discuss the type of anger that is pathological, out of control and excessive, the type of anger that destroys relationships, families, organisations, and communities. I want to discuss the type of uncontrollable and extreme anger that can control someone to brutally end the life of their own loved one, somethings that serve no good purpose whatsoever and often leaves the perpetrator with debilitating sense of guilt and an excruciating psychological scar that they will carry for the rest of their lives.

Different people have different threshold for tolerating frustrations, annoyances and/or something that is said or done that they feel is wrong and unjust to them or significant others. Some people are better than others in keeping calm when faced with such situation, others get angry very quickly, easily and at times excessively.

We all know of someone or perhaps we are someone who is known to be “hot headed” or “short fused”. Some people, and I include myself in this category, were perhaps such an anger-prone person in the past but have learned, continually work at maintaining a calmer personality.

In psychiatry (the specialist area of medicine for mental health issues) there are several well classified and diagnosable psychiatric disorders such as:
• Anti-social personality disorder
• Intermittent explosive disorders in adults
• Borderline “personality disorder”.

Some of those people who are “hot headed” or “short-fused” may very well have one or more of these disorders. If so it would be very beneficial to them, their family and friends and the wider community if they consult an appropriately experienced physician. Ideally the treating physician must to be either a psychiatrist or have a special interest and training in mental health and importantly access to specialist tertiary (Hospital based) care.

The process of diagnosing someone with one of these disorder requires the physician to ask a series of general, open end questions and specific questions to learn about ones symptoms, one’s relationships and one’s experiences. Several sessions may be required before the physician is able to either reach a diagnosis or rules out any psychiatric disorder.

For those who meet the diagnostic criteria for a psychiatric disorder, the physician can offer several treatment options.
Chronic vs acute health conditions

The ACUTE ILLNESSES like dengue, malaria or even broken bones and cuts to the skin are cured relatively quickly (if they are not too severe) and patients usually achieve full recovery.

Unlike these ACUTE ILLNESSES, “personality disorders” are CHRONIC (life-long conditions) ILLNESS. These are conditions that become a part of the individual’s life, whether they like it or not.

The management of chronic illnesses is very different to the management of acute illnesses. It is in ongoing throughout one’s life and with mental illness especially, it requires a strong “therapeutic allegiance” between the patient, the treating physician, the healthcare facility and the wider community in which the patient lives.
Treatment Options for personality disorders

Preferably, a psychiatrist should play the leading role in the treatment of personality disorders. If this is not possible then at least the treating physicians must have adequate training and experience in the area of mental health. The treating physician must work closely with a psychiatrist.

Treatment may include pharmacotherapy (the use of medications) and or psychotherapy and cognitive behavioural therapy. The aim is to retrain the mind and for the patient to learn and develop new ways of thinking and skills to better manage their emotions. In other words the aim is to make the individual’s “fuse” becomes “longer” so that they become calmer and less angry. I will not go into the details of the various treatment option, however if anyone wishes to find out more I am available for consultations and I work closely with a couple of very competent psychiatrists

The physician, on the other hand might not find enough behavioural symptoms and experiences with the individual during the consultation to fulfil the well establish diagnostic criteria for the disorders mentioned above. For some people their angry disposition can be explained by hereditary factors or cultural factor (or a breakdown of well-established and “less angry” cultures).

The detrimental health effects of chronic, inappropriate and excessive anger
Over the long term anger can have detrimental affects on one’s health. Uncontrolled anger can lead to arguments where irrational, nasty and regrettable things are said, it can lead to assault and run-ins with the police and the law, it can lead to damage to one’s own and other’s property.

Physically the body responds to anger by releasing a group of hormones collectively called stress hormone which include adrenalin and cortisol. These hormones have normal functions, however when they are inappropriately elevated over a long period they can cause health problems such as insomnia (inability to fall asleep), anxiety, depression, migraines, high blood pressure, heartburn and even fatal heart attacks and strokes.

Other detrimental effects of anger may include:
• Relationship and family breakdown
• Loss of employment
• Guilt
• Intergenerational propagation of conflicts – just look at some of the Middle East countries – Anger, violence, revenge, war, hate has totally engulfed them.

An important point to mention here is that confidentiality is especially important in mental health and in-fact any health condition that is discussed with a physician. Health workers and the health facility must have in place policies and systems that ensures the best possible protection of privacy of the patient’s personal health information.

I hope this article helps people to identify if they themselves or someone they know has an anger management problem. The author is available to assist as a GP and can also make appropriate referral to competent psychiatrists.

About Dr. Poyap J Rooney

Dr. Rooney is a medical doctor who has gained both his undergraduate medical degree and more recently his post graduate masters degree in clinical biochemistry at the University of Papua New Guinea.
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