The Link Between PTSD, Anger, and Irritability

Anger and post-traumatic stress disorder (PTSD) often occur together. Common in this condition, anger is one of the hyperarousal symptoms of PTSD and it may affect relationships with people around you.

It's important to know that the anger of people with PTSD can become so intense that it feels out of control. When that happens, you may become aggressive toward others or even harm yourself. That doesn't always happen, however, and not everyone with PTSD lashes out angrily.

This article discusses the connection between anger and PTSD and some of the effects it can have. It also discusses treatments and coping strategies that can help.

How Anger and PTSD Are Connected

After experiencing trauma, people frequently experience a variety of symptoms, including intrusive thoughts, hypervigilance, irritability, hostility, avoidance, anxiety, and depression. Other challenges, including troubling memories, problems sleeping, and unhealthy coping mechanisms, can also make anger worse and more challenging to manage.

Anger is only one symptom of PTSD. While people with PTSD may experience anger, it is not a requirement for receiving a PTSD diagnosis.

People with PTSD also experience anger in a variety of ways. Sometimes this anger is directed outward and may appear as aggression or even violence toward others. But this is not necessarily the case.

Signs of Anger in PTSD

Anger and irritability are hyperarousal symptoms of PTSD. Think of hyperarousal as a constant state of "fight or flight." This heightened anxiety can have a variety of symptoms including:

• Difficulty sleeping
• Irritability
• Hypervigilance

While anger is a common response to these symptoms, there are ways to cope with each of these. Anger can be constructive at times, helping to motivate and fuel change. But it can also be a destructive force that can lead to damage to individuals and to others.

Types of Anger in PTSD

People often primarily view anger as a negative or harmful emotion. But that's not always the case. It's true that anger can often lead to unhealthy behaviors like substance abuse or impulsive actions.

You may have heard anger classified into two types: constructive anger and destructive anger. Constructive anger can help with healing, forward movement, and recovery, while destructive anger can cause harm. It's a good idea to understand this difference and find ways of managing both in your life.

Impact of Anger and PTSD

Anger related to PTSD can have a number of damaging effects. For veterans with anger issues, it can make returning to civilian life more challenging. It can also create issues with relationships, contribute to chronic stress, and lead to unhealthy coping mechanisms.

Anger and PTSD in Combat Veterans

Military service is connected to an increased risk for PTSD. It's become clear that veterans are at risk for a number of mental health problems, including PTSD and extreme anger.

While troubling and disruptive, there is help available. The more we learn about PTSD in veterans, the more we are learning about effective therapies, and more service members are finding help.

PTSD and Relationship Violence

Unfortunately, research has found a connection between PTSD and relationship violence. Research has found that having both depression and PTSD increases the likelihood of relationship aggression.

If your relationship is affected by PTSD, it's wise to learn about the association between it and violence. While the two are connected, not everyone with PTSD engages in abusive behavior. However, if you or someone you know is a victim of relationship violence, it's important to know there are resources available.

Self-Destructive Behaviors in PTSD

Although intense anger can cause people with PTSD to be aggressive toward others, more often than not they'll try to push down or hide their anger. This can be effective in the short term, but in the long term, it can build up anger until it's out of control.

When that happens, some people turn their anger on themselves in the form of self-destructive behaviors. This may include substance abuse or deliberate self-harm.

Treatment for Anger and PTSD

Treatments for PTSD include medication, psychotherapy, or a combination of the two. 

Medication

Antidepressants are often prescribed to treat symptoms of PTSD, including symptoms related to mood and sleep. Four types of selective serotonin reuptake inhibitors are recommended for treating PTSD:

• Zoloft (sertraline)
• Paxil (paroxetine)
• Prozac (fluoxetine)
• Effexor (venlafaxine)

Psychotherapy

Therapy can also help people process trauma and manage symptoms of PTSD, including feelings of anger.

Cognitive behavior therapy (CBT) is a type of therapy that is often recommended. This approach helps people identify negative thinking and replace those thoughts with more helpful, realistic, and positive ones. 

Other types of therapy can also be helpful, including cognitive processing therapy (CPT), exposure therapy, and eye movement desensitization and reprocessing (EMDR).

Coping With Anger and PTSD

Anger can be a very difficult emotion to manage, especially if it feels intense and out of control. Rather than turning to unhealthy behaviors to try to cope, it's a good idea to learn useful anger management techniques.

Take a Time-Out From Anger

Within those useful anger management skills is the suggestion to take a "time-out" when you feel yourself starting to get angry.

You can do this by:

• Developing a plan for how you will deal with anger before it happens
• Being aware of signs that you are getting angry, such as rapid breathing, increased heart rate, and muscle tension
• Telling the people you are with that you need to take time out to cope with your feelings
• Going to a quiet place where you can practice your anger-coping skills
• Giving yourself time to cool off

When you develop a time-out plan, you give yourself specific steps to take when you feel anger. Many people with PTSD have found this a great source of relief and an excellent strategy for their relationships.

Use Self-Soothing Skills for Anger

Self-soothing skills can be useful when you find yourself getting angry. They're easy to learn and use because they're designed to make you feel better, and you do them on your own.

Beneficial self-soothing strategies can include:

• Soaking in a warm bath
• Doing some gentle stretching
• Drinking some warm herbal tea
• Burning a favorite candle
• Reading a book
• Watching a favorite movie or tv show
• Listening to soothing music

Self-soothing skills make use of your five senses—touch, taste, smell, sight, and sound. The key is to focus on the activity. By remaining mindful of something other than your anger, your mind and body naturally become calmer.

Seek out Social Support

Talking with others as a way of "getting your emotions out" can be effective in preventing anger from building up inside. For one thing, it can help you see another person's point of view. It also gives you the opportunity to express your frustrations in a constructive way.

Support groups for PTSD are widely available and many people have found them to be a great help with their own challenges. Anger management courses can also be helpful.

Learn Anger Management Skills

Believe it or not, coping skills for managing anxiety can also help manage your anger effectively. Why? Because intense anger and anxiety are similar emotions in that both tend to ignite a "fight or flight" response.

Helpful strategies that can help you better manage feelings of anger include:

• Being aware of your anger triggers and identifying the emotions that are contributing to anger
• Assessing whether your anger is constructive or destructive
• Removing yourself from the situation when it gets to be too much
• Engaging in brisk exercise to reduce stress and increase your frustration tolerance
• Finding distractions to take your mind off your anger
  
• Deep breathing
• Practicing mindfulness and meditation
• Finding someone you trust to talk things out with
• Writing in a journal
• Doing yoga

When you learn skills for coping with intense anxiety, you're also learning ways to keep your anger at less intense levels. Remember that your PTSD triggers may provoke either feeling, so it's worth your time to learn coping skills for both.

A Word From Verywell

Anger can sometimes occur as a hyperarousal symptoms of PTSD. It can be challenging to manage and can have a devastating impact on relationships and well-being. Fortunately, there are treatments that can help you cope with PTSD and learn more deal with your anger more effectively.