Michael J. Prince, B.A., Psychology


National Center for PTSD: Complex PTSD

Why is Anger a Common Response to Trauma?

Anger is almost always a central feature of response to trauma, because it is a core component of survival response in humans. While it has great value for coping with lifeís adversities (i.e., by giving increased energy to persist in the face of obstacles), uncontrolled anger can lead to a continued sense of being "out of control" of oneís self, and can result in multiple problems in the family and personal lives of those who suffer from PTSD.

One theory of anger and trauma suggests that high levels of anger are related to a natural survival instinct. When initially confronted with extreme threat, anger is a normal response to events that seem unfair, terror, and feeling out of control or victimized. It can help a person survive by mobilizing all their attention, thought, brain energy, and action towards survival. Recent research has shown that these responses to extreme threat can become "stuck" in persons with PTSD, leading to a "survival mode" response, being more likely to react to future situations with "full activation," as if they were "life-threatening," or "self-threatening." This "automatic response" of irritability and anger can create serious problems for individuals with PTSD, in work, family life, in their feelings about themselves, and in their role in society.

Another line of research is revealing that anger can also result from a normal response to betrayal or loss of basic trust in others, particularly in situations of interpersonal exploitation or violence.

Finally, in situations of early childhood abuse, the trauma and shock of the abuse has been shown to interfere with an individual's ability to regulate emotions, leading to frequent experience of extreme or out of control emotions, including anger and rage.

How Can Post-Traumatic Anger Become a Problem?

Researchers have described three components of post-traumatic anger which can become maladaptive, or interfering in adapting to current situations which do not involve extreme threat:

Arousal: Anger is marked by increased activation of the cardiovascular, glandular, and brain systems associated with emotion and survival, as well as increased muscle tension. This increased internal activation can become reset as the normal level in individuals with PTSD, and increase the actual emotional and physical experience of anger. This can lead one to feel frequently on-edge, keyed-up, or irritable, and more easily provoked to anger. It is not uncommon for traumatized individuals to even seek out situations requiring them to stay alert to ward off potential danger. Conversely they may use alcohol and drugs to reduce overall internal tension.

Behavior: Oftentimes, the most effective way of dealing with extreme threat is to act aggressively, in a self-protective way. Additionally, many people who are traumatized at a relatively young age have not learned a variety of ways of handling threat, and tend to become "stuck" in one characteristic mode of acting towards threat. This is especially true of people who already tend to be "impulsive" (who act before they think). Again, as stated above, while these "strategies" for dealing with threat can be adaptive in certain circumstances, individuals with PTSD can become "stuck" in using only one strategy when others would be more adaptive. Behavioral aggression may take many forms, including aggression towards others, "passive aggressive behavior" (i.e., complaining, "backstabbing," deliberately being late or doing a poor job), or self-aggression (self-destructive activities, self-blame, being chronically hard on oneself, self-injury).

Thoughts and Beliefs: the thoughts or beliefs (often the individual is not fully aware of these) that a person uses to understand and make sense of their environment, can often over-exxagerate threat, leading a person to be more likely to see hostility, danger, or threat to their safety than others might feel is necessary. For example, a vet may become angry when others (wife, children, coworkers) around him donít "follow the rules," which is actually related to his own very important need to follow rules during the war in order to prevent deaths. Often, traumatized persons are not aware of the way these beliefs are related to past trauma. By acting inflexibly towards others, for instance, because of their need to control their environment for threat, they can provoke in others the very hostility and threat which they are guarding against, creating a "self-fulfilling prophecy" of belief (i.e., "see, I told you others were out to get meÖ"). Common "negative" thoughts in people with PTSD include: "you canít trust anyone," "if Iím out of control, it would be horrible/life-threatening/intolerable," "after all Iíve been through, I deserve to be treated better than this," and "others are out to get me, or wonít protect me, in some way."

How Can Individuals with Post-Traumatic Anger Get Help?

In anger management treatment, arousal, behavior, and thoughts/beliefs are all addressed in different ways. Cognitive-behavioral treatment, a commonly utilized therapy which shows positive results with this issue, many techniques are applied to address these three anger components:

There are many strategies for helping individuals with PTSD deal with the common increases of anger they are likely to experience. Most individuals have a combination of all three components of anger listed above, and treatment aims at helping them with all aspects of anger. One important goal of treatment is to improve sense of flexibility and control so that individuals do not feel re-traumatized by their own explosive, or excessive responses to anger triggers. Treatment will hopefully also have a positive impact on relationships at both work and home.

Complex PTSD

Complex PTSD (sometimes called "Disorder of Extreme Stress") is found among individuals who have been exposed to prolonged traumatic circumstances, especially during childhood, such as childhood sexual abuse. Developmental research is revealing that many brain and hormonal changes may occur as a result of early, prolonged trauma, and contribute to difficulties with memory, learning, and regulating impulses and emotions. Combined with a disruptive, abusive home environment which does not foster healthy interaction, these brain and hormonal changes may contribute to severe behavioral difficulties (such as difficulty controlling impulses, aggression, sexual acting out, eating disorders, alcohol/drug abuse, and self-destructive actions), extreme emotional difficulties (such as intense rage, depression, or panic) and mental difficulties (such as extremely scattered thoughts, dissociation, and amnesia). As adults, these individuals often are diagnosed with depressive disorders, personality disorders or dissociative disorders. The treatment of such survivors often takes much longer, may progress at a much slower rate, and requires a sensitive and structured treatment program delivered by a trauma specialist.

This fact sheet was based on: Chemtob, C.M., Novaco, R.W., Hamada, R.S., Gross, D.M., & Smith, G. (1997). Anger regulation deficits in combat-related posttraumatic stress disorder. Journal of Traumatic Stress, 10, 1, 17-35.