Beyond the Stereotypes: PTSD and Anger

A prime example of this stereotyping is the misconception that Post Traumatic Stress Disorder (PTSD) inevitably causes individuals to become volatile and possibly violent. This misconception can be distressing for those who have PTSD or Complex PTSD (C-PTSD), as it can limit their social and professional opportunities and erode their confidence. These misconceptions may also cause embarrassment and discourage individuals from seeking help.

Unfortunately, the media often reinforces these damaging perceptions of PTSD and C-PTSD through film and TV portrayals that frequently depict extreme reactions to trauma, such as involuntary violence during flashbacks, and resentment towards being offered help. This perpetuates the myth that all individuals with PTSD or C-PTSD are angry and potentially aggressive.

It’s worth noting that with PTSD and C-PTSD, ‘feeling irritable and having angry or aggressive outbursts’ and ‘overwhelming negative emotions, such as fear, sadness, anger, guilt, or shame’ are diagnosable symptoms or PTSD and C-PTSD – and therefore listed in the health professional resource, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), for diagnosis. However, every experience of PTSD and C-PTSD is different – and you don’t need to experience anger for a PTSD or C-PTSD diagnosis.

In this article, we’ll explore the misconceptions about anger and PTSD, and ways to address extreme reactions if that is a symptom you face.

PTSD in a nutshell

First, a quick reminder; what is Post Traumatic Stress Disorder and what are the causes of PTSD and C-PTSD?

PTSD is a psychological and physiological response to trauma, a wide-sweeping term that encompasses any ‘deeply distressing or disturbing experience’. Trauma can be a one-off event, such as a car crash or death of a loved one, or a prolonged experience such as abuse or living in a war zone. It also covers everything in between those examples.

As trauma – and your response to it – differs from person to person, PTSD and C-PTSD are highly complicated conditions.

PTSD and C-PTSD cause disturbance in the way certain areas of the brain function, and in the receptors (chemicals) that carry messages around. This can leave someone with PTSD or C-PTSD in a state of ‘constant alarm’ resulting in flashbacks, nightmares, hypervigilance and poor sleep patterns.

Naturally, this can lead to an extreme emotional reaction to things that observers believe are minor situations or easily explained sensory stimuli. ‘One theory is that increased anger occurs as a consequence of how trauma changes the brain to recognise potential threats. In other words, the brain appears to become more likely to misinterpret the actions and intentions of others as hostile and threatening.’

PTSD or C-PTSD related anger may be expressed outwardly, through hostility or aggression, or be ‘internalised anger’ (self-harming, suicidality, self-hatred) and both can be a source of significant distress.

So yes, people with PTSD and C-PTSD can experience a heightened sense of anger due to their emotional rawness and hypervigilance. Anger can be a defensive mechanism and a way of deflecting when faced with a situation that makes you feel vulnerable. Anger is also a ‘common response to events that seem unfair or in which you have been made a victim. Research shows that anger can be especially common if you have been betrayed by others. This may be most often seen in cases of trauma that involve exploitation or violence’. That said, more often than not, someone with PTSD or C-PTSD who tends to feel extreme anger tries to push it down or hide it from others, however this can lead to self-destructive behaviour.

One PTSD UK supporter said “I’ve never been a sweary person – it’s just not in my nature. But after being sexually assaulted… I felt an anger towards other people who ‘invaded’ my space. One time I was in a supermarket car park, and a man ‘wolf-whistled’ at me from a few cars away. Normally, I’d ignore it and walk on, but instead it made me hot, angry and I shouted ‘F**K OFF’ as loudly as I could. To bystanders (and the man himself) this probably seemed like a total over-reaction, but to me it felt threatening and scared me and I did it to protect myself in a way.”.

What is important to be clear about is that anger and PTSD & C-PTSD are not inevitably linked. Nor are people with PTSD or C-PTSD always easily triggered to acts of violence! In fact, the opposite can be true.

In this article here, we have outlined the different instinctive responses to trauma, including Flight, Fight and Freeze, as well as Fawn and Flop.

The trauma reactions of some people with PTSD  or C-PTSD is to avoid all emotional situations, shutting down and withdrawing inside a defensive shell. They are emotionally detached. Others physically remove themselves from anything that is over-stimulating or hard to process.

This fawn process could actually produce the ‘opposite of anger’ in some people. An example would be an individual focusing on placating and pleasing their abuser as a defence mechanism. It can be one of the most confusing aspects of PTSD or C-PTSD, as there can be a total absence of anger, and the victim appears to rationalise and excuse the things done to them.

Thoughts and beliefs

Researchers have broken down PTSD and C-PTSD anger into three key aspects. These three factors can lead someone with PTSD or C-PTSD to react with anger, even in situations that do not involve extreme threat:

Arousal

Anger is marked by certain reactions in the body. The systems most closely linked to emotion and survival — heart, circulation, glands, brain — are called into action. Anger is also marked by the muscles becoming tense. If you have PTSD, this higher level of tension and arousal can become your normal state. That means the emotional and physical feelings of anger are more intense.

If you have PTSD, you may often feel on edge, keyed up, or irritable. You may be easily provoked. This high level of arousal may cause you to actually seek out situations that require you to stay alert and ward off danger. On the other hand, you may also be tempted to use alcohol or drugs to reduce the level of tension you’re feeling.

Behaviour

Often the best response to extreme threat is to act aggressively to protect yourself. Many trauma survivors, especially those who went through trauma at a young age, never learn any other way of handling threat. They tend to become stuck in their ways of reacting when they feel threatened. They may be impulsive, acting before they think.

Aggressive behaviours also include complaining, “backstabbing,” being late or doing a poor job on purpose, self-blame, or even self-injury. They are not able to use other responses that could be more positive.

Thoughts and beliefs

Everyone has thoughts or beliefs that help them understand and make sense of their surroundings. After trauma, a person with PTSD may think or believe that threat is all around, even when this is not true. He or she may not be fully aware of these thoughts and beliefs.

If you have PTSD, you may not be aware of how your thoughts and beliefs have been affected by trauma. For instance, since the trauma you may feel a greater need to control your surroundings. This may lead you to act inflexibly toward others. Your actions then provoke others into becoming hostile towards you. Their hostile behaviour then feeds into and reinforces your beliefs about others. Some common thoughts of people with PTSD are:

• “You can’t trust anyone.”
• “If I got out of control, it would be horrible, life-threatening, or could not be tolerated.”
• “After all I’ve been through, I deserve to be treated better than this.”
• “Others are out to get me,” or “They won’t protect me.”’

How common is violence in people with PTSD?

There are some studies that have shown the risk of violence can be higher in people with Post Traumatic Stress Disorder, but crucially, when other factors like alcohol and drug misuse, additional psychiatric disorders, or younger age are considered, the association between PTSD and violence is decreased.

“For example, in a study of a representative sample from the U.S. population excluding combat Veterans, PTSD was associated with increased risk of violence (7% compared to 3% among those without PTSD). However, when alcohol use and anger severity were controlled, PTSD was no longer statistically associated with an increased risk of violence. Similarly, in one study of Veterans who served post-9/11, PTSD when examined on its own was associated with an increased risk of violence. However, when alcohol misuse was statistically controlled, PTSD was no longer associated with an increased risk of violence.”

Additionally, the term ‘violence’ as evaluated can be misleading. Threats, criminal activities or breaking things can get added into the same figure as acts of aggression and domestic abuse, for instance.

Can you be angry with yourself, with PTSD?

PTSD or C-PTSD anger may not appear as resentment or annoyance directed at others. It can turn inwards, and you start to punish yourself for what has happened and your response to it. For example, becoming furious with your progress in tackling PTSD or C-PTSD symptoms and the effect that has on your loved ones, career and quality of life.

This can lead to depression, self-harming and suicidal thoughts, or a storm of emotions that result in you not feeling worthy of support, or beyond help.

However, professional support to manage self-anger is available, alongside PTSD and C-PTSD guilt and self-recrimination.

If you find your anger does affect your loved ones, relationship counselling can also help. It provides your partner or children with more context and understanding and guides you towards ways to channel your emotions into healthier responses.

Tackling anger and PTSD

Being honest, PTSD & C-PTSD or not, we all get angry about situations and people who upset us sometimes. Consequently, a certain degree of outrage and frustration is often a natural part of PTSD or C-PTSD, and everyone has a right to feel angry when something bad happens in their lives – especially if the trauma was at the hands of another person/people.

Anger can be a very difficult emotion to manage, especially if it feels intense and out of control, so finding ways to vent anger can be an important part of the PTSD and C-PTSD healing processes.

However, what can you do if you have PTSD or C-PTSD and find that your annoyance – or rage, does become frequent or extreme? Or, you feel the urge to act on your feelings of anger in a potentially damaging way?

First, be kind to yourself. This is not a permanent and unfixable change to your personality. Even violent acts can be an instinctive defence mechanism or an involuntary reaction to a severe disturbance in your psyche and brain activities.

Take immediate action and talk to a professional openly about feelings of anger, especially if they start to result in physical acts that put others or yourself at risk. There are PTSD and C-PTSD therapists who deal with specifics of anger management, and other extreme reactions to traumatic experiences.

If the anger and aggression associated with PTSD or C-PTSD are affecting your daily life and relationships, enrolling in anger management counselling programs can facilitate long-term transformation in how you handle your emotions.

Effective therapeutic treatments for managing anger related to PTSD encompass various techniques such as Cognitive Behavioural Therapy (CBT), Exposure Therapy, Eye Movement Desensitization and Reprocessing (EMDR), Dialectical Behavioural Therapy (DBT), and Relaxation Training.

How to Handle PTSD or C-PTSD Anger Attacks

‘If you are finding it difficult to redirect your anger in a positive way, there are techniques and strategies to express, release, and transform how you feel. Remember, despite the fact that PTSD can be responsible for causing increased anger among trauma survivors, it does not excuse personal responsibility or accountability for violent behaviour.

Here are six techniques and strategies to help you deal with your anger:

• Walk away from the situation for a moment (if possible): Give yourself some physical and emotional space.
• Breathe: We often forget to breathe when we feel afraid or angry, so focus on your breathing for 60 seconds.
• Notice what has triggered your anger: Ask yourself what line do you feel has been crossed? What do you feel is being threatened?
• Notice the “size” of your anger in comparison to the “size” of the situation: If it seems too big, then you’re likely being triggered. Acknowledgment can help release some of the tension.
• Let out the anger through a safe physical release: If you’re able, tap into and release your anger while doing physical activity. If you feel it in your lower body, consider going for a walk or run. If you feel it in your upper body, hit a punching bag, do push ups, chest presses, or arm curls.
• Once calm, have a respectful conversation with the person you feel has offended you: Focus on your observations and feelings, but avoid name-calling, blaming, and bringing up the past. Try to understand the other person’s point of view and intentions, and accept an apology if offered. Work together to find a way to move forward, if needed.’

Setting the record straight on PTSD and anger

You have a right to recover, free from assumptions about PTSD or C-PTSD. This condition can be lonely and isolating anyway, so avoiding social contact due to the misconceptions of others can make things worse. People with anger from PTSD or C-PTSD may feel both ashamed of their emotions and entitled to them. This challenging cocktail makes it difficult to talk about how they feel or to try new coping strategies.

If you feel people are pre-judging you, and assuming you will be aggressive due to PTSD or C-PTSD, direct them to this article. Or calmly ask them to research PTSD or C-PTSD to gain awareness of its causes, outcomes and treatments.

PTSD and C-PTSD can disrupt a person’s life and relationships. It can make them feel hopeless and even suicidal. But treatment and help is available, and if you need extra support with anger – speak to your GP or mental health team.