Anxiety and

It was a familiar scene in my office where I practice as a clinical psychiatrist. The well-dressed woman sat across from me with a worried frown between her brows.

“Doctor, my husband and kids say I get too angry,” she said. “It’s hard for me to control my temper. Do you think I have bipolar disorder?’

After a thorough evaluation, I concluded that my patient’s verbal outbursts and tendency to throw dishes did not stem from a severe mood disorder, but from uncontrollable anxiety. My patient was surprised. Maybe you are too.

Read more: What is anxiety and how can anxiety defeat us?

Anxiety has jumped since the start of the COVID-19 pandemic, with at least 40 million US adults currently suffers from at least one anxiety disorder, according to the Anxiety and Depression Association of America. Therefore, it is more important than ever to recognize the possible consequences of these problems and the possible causes behind them. One of the most misunderstood connections is between anxiety and angry outbursts.

Understanding Anxiety Disorders

Anxiety disorders come in all shapes and sizes. Regardless, all of the examples below can cause enough fear and anxiety to interfere with the sufferer’s daily quality of life.

  • Social anxiety disordersometimes called EAD, refers to a fear of negative evaluation by others in social or performance situations.
  • Obsessive-compulsive disorderor OCD, involves debilitating “looping” thoughts that lead to unwanted repetitive actions.
  • Generalized anxiety disorder is the tendency to worry uncontrollably about ordinary and common life circumstances.
  • Panic disorder is felt in the body with symptoms such as shortness of breath and rapid heart rate.

When anxiety leads to anger

It’s tempting to think of anxiety and anger as opposite ends of a spectrum—that is, fearful people are anything but aggressive. But having an anxiety disorder can actually make you more likely to have angry outbursts. Anger and anxiety both involve some type emotional dysregulation and perceived threat, according to psychiatrist Franklin Schneier, co-director of the Anxiety Disorders Clinic at the New York State Psychiatric Institute.

This threat activates a part of the brain called amygdala, which serves as a center that processes both fearful and threatening stimuli. The result? “It’s the classic fight-or-flight dilemma,” says Schneier.

Read more: OCD, PTSD, Generalized Anxiety Disorder and More: What’s the Difference?

It seems logical that people with anxiety disorders would choose to “escape” or avoid the threatening situation. But this is not always the case. The presence of a threat is just as likely to cause irritability – or aggression. In fact, the connection between anxiety and anger can be so close that it seems appropriate to call the combination “anxiety,” as the informal word “hungry” used for anger resulting from hunger.

But while fear and anger may be closely related, they are not the same emotion. Although anger can sometimes lead to anxiety, our focus here is the opposite, where fear is the primary emotion and aggression is the behavior.

Why anxiety can lead to anger

Research supports the claim that anxiety can lead to anger. Jesse Kugle, professor of psychology at Florida State University, and his team studied the frequency of aggression in several different anxiety disorders, according to research published in the journal Depression and anxiety. Researchers have found elevated levels of anger in all anxiety disorders.

There are several possible reasons for this relationship. On the one hand, the very experience of anxiety is a type of emotional arousal that can be debilitating. In other words, people with anxiety may tend to overreact in general.

“When someone cuts them off in traffic, or when there’s a perception of slight danger or inconvenience — that can lead to anger because they’re already in an upset and agitated state,” Kugle says.

Another possible reason may include the temptation to push away anxious feelings. “When you avoid feelings, you don’t deal with them as well. “Just avoiding the anxiety—not acknowledging it because it’s too scary—can cause anger to build up until it becomes uncontrollable and explodes,” says Schneier.

Read more: If humans are social creatures, why did social anxiety evolve?

Take social anxiety. Those with SAD tend to avoid conflict and may go out of their way to appease others. But they also expect others to act negatively toward them. The feeling of rejection can I lead to irritability or behavior that is aggressive—the exact opposite of the timidity one might expect from someone with social anxiety. For example, if you put a socially anxious teen in an environment where they can’t judge the other’s intentions — like a high school dance — and when the teen returns home, she lashes out at her parents for forcing her to go.

Another overlooked link between anxiety and anger is lack of sleep. People with anxiety disorders have difficulties falling and falling asleep. In extreme cases, this accumulated fatigue can lead to a temper tantrum.

How to deal with anxiety and anger

And 2021 study by Florida State University researchers showed that reducing anxiety can have a beneficial effect on reducing anger. But which types of treatment work best?

One first line of defense is to be aware of negative emotions. It is important for the “anxiety” sufferer to be aware of their thoughts – especially spiraling, catastrophic thoughts. This is where cognitive behavioral therapy (CBT) comes in. The therapist can help the patient to look at thoughts differently and adjust their behavior.

“CBT approaches are useful for self-monitoring anxious and angry thoughts and impulses,” says Schneier.[It’s about] using anger as information to either deal with the underlying conflict or to calm it down so it doesn’t get out of hand.”

Read more: Anxiety and depression relief, no therapist required

Because people with “anxiety” are more likely to drop out of treatment than those with anxiety, in some cases treatment needs to target both halves of the equation.

“We have treatments that are not focused on one diagnosis. […] “They’re trying to reduce things like ‘negative affectivity,’ a broad construct that’s common to both anger and anxiety,” Kugle adds.

“Mindful emotional awareness” (or simply the practice of attentiveness) is one such therapy. It refers to the ability to feel the first signs of anger or anxiety in our body and accept those feelings without judgment.

Of course, anger is linked to many other disorders, including depression, bipolar disorder, and borderline personality disorder, to name a few. Avoiding hidden anxiety can be difficult, both for the sufferer caught in the moment and for their loved ones. The effects of “anxiety” are often frightening, so seeking professional diagnosis and treatment can bring much-needed relief.

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