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PTSD Questions & Answers
Joyce Boaz & Dr. Frank Ochberg, M.D.

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PTSD Symptoms: Anger.

Q: Dear Frank, A support pal with PTSD asked me how to deal with her PTSD symptoms, particularly anger and irritability. She gets angry and then takes it out on the people around her even though they are not the ones who traumatized her in childhood. It is distressing to her because she doesn't want to hurt those dear to her and she doesn't want to lose her friends and the family she does talk to.

A: Dear Joyce, I'm encouraged by this GFW support pal's recognition of her anger. That is a very important first step. Many people with PTSD are easily irritated and the irritation can be way out of proportion, reaching states of rage and violence. There is a condition called Intermittent Explosive Disorder or IED. My veterans returning from Iraq and Afghanistan think of IEDs as roadside bombs that kill their buddies. But they, themselves, can feel like a ticking time-bomb. When a person with PTSD reports this type of anger management problem to me, I evaluate their risk for deadly outburst very carefully. We need a plan to reduce immediate access to deadly weapons (not an easy task when the person is a veteran who feels very insecure when separated from a "tool of the trade" that confers a sense of safety). We need to work together to identify situations likely to result in aggression, such as classroom discussions in which he feels defensive or humiliated by a cock-sure student advocate for some change in military policy, having never served in combat. We need to limit binge drinking. We need to bring helpful friends and family into the equation, giving a buffer zone to help diffuse explosive feelings. I have had patients who confided homicidal impulses. Believe me, it isn't easy to find yourself being the one who works as an intimate advisor, who keeps confidences, who helps someone else develop a longer fuse. No quick fix, here. No sure-fire pill.

This GFW pen pal is not a veteran with an explosive personality, She is honest with herself, aware of her behavior, and looking for ways to help tame the tiger within. Good! Physical fitness is often the best place to begin. Are you in good shape? If not, why not? If so, can you add a bit of energy to your routine? Exercise does wonders. Even if you are limited by injury or money or cold weather or a habit of avoiding exercise. There is always something you can do to improve your strength, endurance, flexibility, muscle tone and sense of physical fitness. Are you reading this and saying, "not for me?" Or are you saying, "I can start today." Take a brisk walk. Sweat. Shower. Tell yourself you are on the path. Stay on the path. If you read the web, find a site that speaks to you about getting in better shape. Working out is the best first step for anger management. The adrenalin that drives your PTSD set of anxiety and anger symptoms is put to good use. You sleep better. You have healthy rather than unhealthy cycles of arousal and repose. When you start feeling more fit, you have physical and emotional rewards. Your anger fuse lengthens.

Analyze your sources of irritation. For a while, you will be easily moved to snapping back and lashing out. That comes with the PTSD territory. But you have already accepted responsibility. It's you and your PTSD, not every one else's problem. Do what you can to increase your contacts with people and places and activities that give you peace and pleasure. Do what you can to limit your exposure to Kryptonite - the stuff from a previous life that makes you weak and vulnerable. Sound simple? It isn't. But others have done it. Other's who visit the GFW pages have done it. Tune in. Share ideas. Apply them to yourself in specific ways.

Read a bit on DBT - dialectical behavioral treatment. I've discussed it briefly elsewhere. Here's a user friendly link: Although DBT was created for people with borderline personality, it works well for PTSD anger. You learn how to be mindful. You learn how to modulate emotion. You take responsibility without putting yourself down or blaming others.

There are medications that help some, but the usual PTSD anger can be managed without meds. I always explain the use of medication to establish a normal sleep pattern, to control panic-type anxiety, to overcome severe depression and, sometimes, to help break an addiction to alcohol or abusive drugs. I'm not anti-drug. But there is not a standard drug for anger control. It takes careful diagnosis and caring prescription.

There are anger management classes. Often these classes help a person become assertive without becoming aggressive. A decent therapist can often provide these skills -- and the therapist need not be a trauma specialist. When anger is clearly a component of PTSD, wholistic treatment for PTSD will help reduce all the symptoms, including the anger. Here's my chapter on treatment: It was written a couple of decades ago, but it still has relevance. I hope it helps you. If not, its OK to be angry with me. A little.

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