Anger and Aggression

Anger Defined

Anger is a powerful, naturally occurring emotional state that is rooted in our most primordial brain structures. Anger can be identified in early infant development and the experience of anger is unique to each person. This emotion typically leads to a cascade of physical responses that grow upon each other. Anger is distinct from, but commonly mistaken for, aggression, hostility and hate (Weiner, 2010). 

Anger may manifest as a mild form of irritation or as an intense rage (APA, 2019). The individual expression of anger is heavily mediated by socialization and legal ramifications that vary based on location (VIU, 2020). 

Anger is often caused by a perceived threat to our physical well being, self image, social status, comfort, property, and present or future resources. We may also feel anger when we want to maintain our preferred social roles and rules. When angry, we may gather and evaluate information with a focus on attributing blame to others, then attempt to thwart, attack, control, drive off or retaliate against the source of the perceived threat (Weiner, 2010). 

Anger is motivated by the desire to resolve a problem, control our environment, seek revenge or reduce tension. It is also the only negative emotion that most often causes approach behavior toward a problem as opposed to the more typical avoidance behavior (Weiner, 2010).

Anger can be broken up into five distinct phases, each with its own physical and psychological changes (VIU, 2020):

• A trigger phase initiates the anger cycle. We experience a real or perceived threat and our body prepares to defend ourselves. The fight/flight/freeze/fawn response begins a hormonal cascade.
• An escalation phase follows the hormone cascade and the adrenal glands produce adrenaline and noradrenaline. These hormones move throughout our bodies to increase respiration rate, increase heart rate, increase blood pressure, tense muscles and enlarge the pupils.
• Stance and affect change, and facial features show perceivable anger as the brows draw together, the mouth squares and the eyes narrow and fixate (Myers, 2020).
• The crisis phase begins when our body takes action and ends when the action is complete. The action will have a target, which may be ourselves or another significant object, pet or person. The action we take vents the angry emotion using controlled aggression to execute influence over our target. Because the body is pumping stress hormones from the adrenal gland - our judgment, reasoning, and situational/emotional awareness all become less reliable.
• During the crisis, the target of the anger has a reaction to the anger which may provoke more anger or move toward resolving the crisis.
• Recovery phase initiates after the crisis phase ends, and our body attempts to return to homeostasis. Our body has been temporarily exhausted by the effects of adrenaline and hormones continue to fluctuate as the return to baseline levels. The survival response dissipates and cognition improves. 
• Depressive phase follows as guilt, regret and fear of consequences enters into our thought processes. Our body begins purging itself of that episode of anger by filtering out excess hormones which causes a brief withdrawal condition.

Anger is not always a negative experience with a negative outcome. Healthy and justified anger can serve to reestablish social boundaries, compel others to listen to our directives, and promote the pursuit of justice (APA, 2019). Anger can even be adaptive when it presents itself as assertiveness and conflict resolution (Weiner, 2010).  

Aggression Defined

Aggression is defined as behavior that is intended to psychologically or physically injure another person. Subtypes of aggression include: 

• Impulsive - an immediate, reactive and overt response to a heightened emotional state (Potter, 2020).
• Predatory - deliberate, premeditated and planned acts committed in a calm, controlled, unemotional manner with a specific goal in mind (Potter, 2020).
• Sometimes called instrumental aggression (Weiner, 2010).
• Relational - a form of predatory aggression used to control interpersonal relationships. This can involve taunts and gossip as well as social exclusion (Weiner, 2010). 
• Isolative -  similar to relational aggression, with added focus on damaging relationships between the target and others with the goal of encouraging others to stay away (Weiner, 2010).
• Passive - here the angry person will fail to help at important moments or fail to complete needed tasks in order to block the goals or well-being of their target (Wiener, 2020).

The impact of aggression on self and others cannot be overestimated and the act of aggression should be seen as deliberate as opposed to the often verbalized 'loss of self control' even when the motivation behind the behavior is subconscious (Bancroft, 2002).   

Aggression is considered to be the most destructive force within relationships, and its presentation varies based on the angry individual's intelligence quotient, self image, self esteem, heredity, body chemistry, capacity for self control, culture of origin, and the level of success aggressive behavior provides in their current culture (Myers, 2020). 

The purpose of aggression varies based on the values and beliefs of the individual or community expressing that aggression. Aggression is meant to draw attention to the angry person or people and can serve the following functions (Bancroft, 2002):

• Reinforce control over a situation or others.
• Threaten or intimidate others into meeting the angry person's emotional needs or desires.
• Preserve the angry person's sense of self in times of challenge or conflict. 

Aggression can be broken down into three strategies - open aggression, passive aggression, and assertive anger (HUG, 2021). Open aggression is what often comes to mind when aggression is discussed. It is the verbal and physical acts of violence against self, others, pets or property that occur when a person lashes out (Bancroft, 2002). Open aggression may manifest as physical fights, yelling, bullying, making accusations, blackmailing others, injecting harsh criticism and self-harm (HUG, 2021).

Passive aggression occurs when an angry person utilizes manipulative tactics in an effort to hurt the target of their anger by withholding or withdrawing actions (Bancroft, 2002). By failing to complete a task, a passive aggressive individual can stall progress and block goals for others (Weiner, 2010). This can manifest as withdrawing attention or affection (stonewalling), withdrawing conversation (silent treatment), or devaluing time spent together (sulking, irritability, insults) (Bancroft, 2002). This approach allows the angry person to avoid direct confrontation while increasing the control they exert over the emotions and behaviors of others (HUG, 2021).

Assertive anger is the healthy approach to anger, where the angry person is confident in their understanding of their feelings and values, maintains control over their behavior, and seeks mutual understanding and interpersonal cooperation to resolve conflict. Conflict resolution like this involves actively listening to others, thinking about what will be said before speaking, and focusing on relationship building and mutually beneficial outcomes (HUG, 2021).

Signs and Symptoms of Anger and Aggression

Anger can manifest physically with headaches, muscle tension, elevated heart rate, elevated respiration rate, and dilated pupils (APA, 2019). When angry, we may feel warm or hot, feel tight in the chest, have an upset stomach, see the world as if tinted in the color red, and/or verbalize feelings of frustration, anxiety, irritation, humiliation, or guilt (Mind, 2021). Anger can also manifest through verbal cues that include yelling, sarcasm, arguing, insults, and cursing (APA, 2019). 

Aggression manifests through actions directed at the target of anger, including sulking, avoidance, clenching fists, throwing things, breaking things, shoving, hitting, kicking or the use of a tool or weapon to threaten or intimidate (APA, 2019). An angry person may glare, stare, pace or make vulgar gestures. It is not uncommon to become loud with slamming and shouting or make verbal threats. Pushing, slapping, pinching and biting may also occur (Potter, 2020 Box 30-2). 

Aggression is quantified in the United States by tracking the rates of criminal acts. Depending on location, between 85% and 91% of homicides are committed by males. Evolutionary psychology theories portend that such high rates of male aggression is the result of male competition for status and resources that increase reproductive odds. This aligns with the correlation between high rates of testosterone and aggressive behaviors (Weiner, 2010).

How Anger and Aggression Develop

The anger emotion serves the evolutionary purpose of identifying a threat and activating a physical response (Myers, 2020). Anger is instinctual, and motivates powerful feelings of self preservation and produces behaviors that allow us to defend ourselves when under attack (APA, 2019). 

Typically, anger is a targeted emotion, meaning that someone or something is both the trigger and the focal point. Feeling anger towards a target is normal. The behavior we use to respond to our anger is where interpersonal conflict arises. Conscious and subconscious processes are used to express, suppress or calm anger, either by directing it outward towards others or inward towards the self (APA, 2019).

Anger caused by and focused on socially unacceptable targets (a boss refusing a pay raise) may cause an individual to choose another, more socially acceptable and accessible target (a spouse) upon which to express their anger (Bancroft, 2002).

Aggression can be triggered internally by rethinking past events or worrying about future events. It may also be triggered externally by perceived slights from others or the loss of something tangible (APA, 2019). Aggression is often precipitated by feelings of frustration or a perceived lack of care or respect from others (VIU, 2020). 

Short term increases in aggression have been identified after exposure to violent media. Aggression is more likely to occur if it is hot outside, if someone is experiencing discomfort, physical pain, hunger, overcrowding, noxious smells, or if another person is using verbal insults (Weiner, 2010).  

Severe Aggression in the United States

Individuals who engage in domestic violence, self-harm behaviors, mass shootings, online or in-person bullying, or other acts of violence may be experiencing negative effects of unresolved anger (or other powerful emotions) and their impact on others warrants intervention and treatment (APA, 2019). 

The aggressive expression of anger (or another strong emotion) that harms the bodily autonomy of self, others or property, or acts that violate major social norms, is considered disordered. Disordered aggression related to the expression of anger is higher in males than females and is linked to the externalization of symptoms (DSM-5).

Disruptive, Impulse-Control, or Conduct Disorders include oppositional defiant disorder (experienced by 3.3% of the general population in a given year), intermittent explosive disorder (experienced by 2.7% of the general population in a given year), conduct disorder (experienced by 4% of the general population in a given year), and antisocial personality disorder (experienced by 0.2% to 3.3% of the general population in a given year) (DSM-5). 

Impact of Anger and Aggression on Physical Health 

When we have uncontrolled anger, either expressed or repressed, we are at a significantly increased risk of cardiovascular diseases due to the influence of the hormones released during repeated flares of anger. These diseases include atherosclerosis, coronary artery disease, dysrhythmias and high blood pressure (Staicu, 2010). 

Beyond the impact on the heart and circulation, excessive anger is known to factor into the adoption of unhealthy lifestyle choices that include smoking, alcohol consumption and high calorie diets. Lifestyle combined with excessive stress hormones places those with increased anger at a higher risk of type 2 diabetes (Staicu, 2010).

Aggression and its related anti-social behavior increases the risk that an aggressive person will experience a vehicle collision or engage in violent behavior that puts them at increased risk for bodily harm (APA, 2019). Due to increased risk for physical injury and elevated stress over time, the aggressive person is more likely to experience chronic pain (Weiner, 2010).

Anger is an expressive emotion, and when we don't express anger and ruminate over angering situations internally, we create what is called an anger-in. An anger-in causes constant and severe internal strain and is associated with multiple chronic medical problems including depression (Weiner, 2010). 

Impact of Anger and Aggression on Mental Health

Anger and aggression inhibit the formation of healthy relationships and the maintenance of established relationships. This puts the aggressive individual at increased risk for reduced social standing and social isolation, both of which can increase the risk of disability and death from physical ailments (APA, 2019).

Equally important are the long term changes that occur when excessive feelings of anger are given priority over other feelings. Individuals who are preoccupied with feelings of anger are more likely to respond with anger to triggering stimuli, and are at increased risk of having a more severe anger reaction when stimulated (APA, 2019).

Anger is closely associated with anxiety, as both utilize the fight/flight/fawn/freeze response. If someone perceives a threat as stronger than themselves, it is typical for anxiety to develop. Whereas if the threat is weaker, it is typical for anger to develop instead (Weiner, 2010).

Strategies to Overcome Anger and Aggression

When instances of anger arise, we need to postpone any and all conversation until we have a chance to reflect on what specifically is causing our anger. We benefit from removing ourselves from the angering situation and focusing on something soothing. We may also repeat a calming word or phrase (APA, 2019). 

Deep breathing recommended for managing all forms of intense emotion, as it allows us to take a step back from the upsetting stimuli, catch our breath and self-soothe. This is accomplished by focusing our energy on slow, deep, even inhalation and exhalation (USDHHS, 2021 April). To start, breathe in deeply (we can imagine filling our stomach with our breath, allow our abdomen to expand on inhale) while counting to four. Next, we hold our breath for four seconds. Then exhale for four seconds. We do this at least five times in a row before moving on to our next task. Consider playing music with a slow beat, and breathing to the rhythm (USDHHS, 2021 June).

We can take a walk or do something physical to expel the increase in energy (APA, 2019). For a list of ideas regarding mind/body interconnectedness and movement, click here.

We should take a step back from our anger and ask ourselves if we have a physical need (food, water, sleep, hygiene) that may be causing the anger (APA, 2019). For more information on how to assess physiological needs, click here.

We can work to accept our emotions as a natural part of life and make a conscious effort to avoid the desire to place blame (BHC, 2021). We can consider what outcome we are hoping for, if our sense of anger is proportional to the situation, and what options we have access to that may help to resolve the conflict (APA, 2019).

Certain behavioral exercises may help reduce the number of angry instances and the severity of the anger response. One such technique is exposure and response prevention therapy (Weiner, 2010) which is available by clicking here.

Cognitive approaches focus on identifying and restructuring automatic or dysfunctional thoughts, irrational beliefs, and hostile attributions while increasing social skills related to problem solving and interpersonal relationships (Weiner, 2010). For access to cognitive behavioral therapy methodologies, click here.

Emotional regulation is the ability to control how our emotions fluctuate over time and how those emotions are expressed. This ability is heavily influenced by the context of our environment, our culture and our personality traits. Those successful at self-regulation are able to control both how they experience their emotions as well as the physical manifestations of emotion, even at the height of a trigger (Thompson, 1991). For more information on emotional regulation, click here.

Developing positive coping mechanisms can help insulate us from negative thoughts and emotions, allowing us to become more adaptable to the stressors of life (Weiner, 2010). For more information on adaptive strategies, click here.

If these above strategies are not helping, and we feel that we are a danger to ourselves or others, additional safe guards can be implemented. First, we must enlist the help of those we trust by communicating the reality of the situation to them. We can ask them to advocate on our behalf to reduce or remove the stressors that are causing anger, and we can work with them to seek out and accept support (Merrill, 2013).

Next, we can make a commitment to safety by removing tools of harm (guns, knives, other weapons, medications) from the home. We then write down a plan for safety that details how we will respond to intense feelings of anger. Include who we will reach out to, where we will go and what actions we can take that have helped us in the past. We can create structure for our time to reduce the amount of time spent in anger and increase time spent using outlets to diffuse intense emotions (Merrill, 2013).

If we are still struggling with intense anger and ideas of directing aggression toward ourselves or others, we need to reach out to a skilled mental health care professional. There are therapies and medications available that can alleviate these feelings and move us toward long term recovery (Merrill, 2013). 

Coping with an Angry Person

Anger is most often seen in people with high, unstable self esteem. Aggression is often seen in men who are not of high financial or social status. Such people may become triggered when they perceive someone is not respecting them in the way they feel they deserve to be respected (Weiner, 2010).

When experiencing anger, there may occur a hostile attribution of intent, where the angry person feels that the slight was done intentionally and with malice. When the angry person feels as though they have it worse than others and is experiencing an unfair condition, resentment can develop to prolong the angry feelings (Weiner, 2010).

Because anger generates feelings of moral certitude, righteousness, justification and a sense of power, there is motivation for angry people to alter their angry habits (Weiner, 2010). 

When we encounter someone who is angry in the community or while driving, its best to attempt to avoid them as much as possible. There is little that can be done to help someone reduce their angry feelings until their crisis phase has resolved. Engaging the angry person will only serve to make us the target of their anger (APA, 2019). 

If they engage us directly, we can attempt to acknowledge their anger verbally ('I understand that you are angry') and then excuse ourselves from the situation ('I'm sorry, but I have to go') (APA, 2019). 

When we encounter someone who is angry at work or in a social setting, we have less options for avoiding them. When approached, attempt to disengage and reschedule ('I'm sorry, I'm busy right now. Can we meet again later?') to give the angry person time to calm down and reflect. If we need to engage them, we can acknowledge their anger and ask them where the anger is coming from (APA, 2019).

Avoid placing blame, making accusations or using insults or curse words. Anger may dissipate slightly when offered a sincere invitation to communicate about the frustration or feelings of disrespect (APA, 2019).

Someone else's anger may provoke our own fight/flight/freeze/fawn hormone cascade. It's important to pay attention to our body and try to remain calm to reinforce their calm. Take four deep breaths with a four second inhale, four second hold and four second exhale (APA, 2019).

If the signs and symptoms of the other person's anger have not been reduced by this point, we are best served by removing ourselves from the situation. If the angry person is not able to engage in the process of diffusing themselves, there is a risk they will continue to escalate (APA, 2019).