Bent Out of Shape
by Mind Over Matter V 13:
How You Handle Anger Impacts Your Health
How many things in your life do you find irritating, frustrating, unfair, offensive, or threatening, and how do you respond to such things? Do you feel angry about them, and if so, are you angry occasionally or often? When you experience anger, is it mild or intense? Do you express it outwardly or keep it bottled up inside? If you express it outwardly, then do you do so in a burst of fury, or in a calm and constructive way? Your answers to these questions have important implications for your health.
Emotional suppression, defined as a tendency to inhibit the expression of emotion, has long been suspected to influence health. It is a type of coping strategy that involves intentionally avoiding distressing or uncomfortable thoughts by holding feelings in or focusing on other matters. When used from time to time, emotional suppression does not appear to have significant negative consequences. However, repeatedly suppressing your emotions may potentially lead to serious health outcomes in the future.
Anger is an emotion that everyone experiences, but in different ways. It is normal and healthy to feel angry sometimes; in fact, anger can play a key role in survival, as part of an instinctual reaction to threats. However, excessive and/or intense anger is associated with poor mental and physical health. Anger is common among individuals with psychiatric disorders, where it worsens the mental illness symptoms and can make recovery more complicated.
ANGER HAS ALSO BEEN ASSOCIATED WITH A VARIETY OF PHYSICAL CONDITIONS, INCLUDING CHRONIC DISEASES OF THE HEART, DIGESTIVE, AND IMMUNE SYSTEMS.
All of these psychiatric and physical conditions related to anger impact our brain health.
ANGER’S EFFECTS ON THE CARDIOVASCULAR SYSTEM
Anger and hostility were found to be linked with future coronary heart disease (CHD) in a meta-analytic review of 25 studies of initially healthy people and 19 studies of people with pre-existing CHD. While anger and hostility predicted a 19% increase in CHD events for the initially healthy participants, that number was higher (24%) for those with pre-existing CHD.
It is important to note that these findings – from Dr. Yoichi Chida and Dr. Andrew Steptoe, published in 2009 in Journal of the American College of Cardiology – were based on observational studies, so they only reveal associations between variables and do not establish causality. It is possible that the association between anger/hostility and CHD may be complex and indirect. Indeed, further analysis of the data in this review showed that other variables such as sleep, smoking, and diet may be playing a role.
EVEN ACUTE EPISODES OF ANGER (I.E., SHORT, TEMPORARY OUTBURSTS) HAVE BEEN LINKED WITH DETRIMENTAL CARDIOVASCULAR OUTCOMES.
A meta-analysis of nine studies involving thousands of participants – conducted by Dr. Elizabeth Mostofsky and colleagues, published in 2014 in European Heart Journal – examined the association between angry outbursts and the rate of cardiovascular events.
The researchers found that episodes of anger are associated with a higher rate of heart attack and stroke, within two hours immediately following an outburst.
“Within two hours of episodes of anger, there is a nearly five-fold higher rate of heart attacks and a three-fold higher rate of ischemic strokes (the type due to insufficient blood to the brain),” said Dr. Mostofsky, an instructor in the Department of Epidemiology at Harvard T.H. Chan School of Public Health. She highlighted that the risk is highest among individuals with other risk factors for heart disease and stroke.
“THE RISK OF EXPERIENCING A HEART ATTACK OR STROKE AFTER ANY SINGLE ANGRY OUTBURST IS FAIRLY LOW, BUT THAT RISK IS HIGHER FOR PEOPLE WHO HAVE FREQUENT OUTBURSTS OF ANGER, AND PEOPLE WHO HAVE OTHER RISK FACTORS SUCH AS CIGARETTE SMOKING, HYPERTENSION, AND DIABETES.”
Not all research into the association between anger and CHD has reached consistent conclusions, though. While many studies suggest a significant link, others do not. Some studies have even suggested that anger might be protective. Emotions like anger are inherently challenging to study.
Perhaps the impact anger has on heart health varies depending on how the anger is expressed. Dr. Mostofsky and a colleague conducted a study investigating that possibility and shared their findings in 2010 in American Heart Journal. In that research, which involved 785 Canadian women and men (50% of each) who did not have CHD at the beginning of the study, the researchers looked at the links between the rates of CHD events and three different types of anger expression:
1. constructive anger – using a goal-oriented, problem-solving approach (e.g., discussing anger to resolve a situation);
2. destructive anger justification – self-justification and blaming others to defend one’s position and excuse oneself from blame; and
3. destructive anger rumination – brooding over an anger-inducing incident (e.g., holding grudges and discussing or thinking about anger repeatedly, thereby intensifying angry feelings over time).
Much anger research relies on self-reporting tools, but this research used a different approach. For this study, trained observers assessed the participants’ type of anger expression, in order to provide a more accurate portrayal of the motivation underlying the anger expression. (Research has shown that individuals usually believe that their anger expression is mostly constructive, even if friends, family, and observers may report it as primarily destructive.)
Their findings showed that the ways in which anger is expressed may indeed have implications for heart health. “Over an average follow-up of 8.4 years, higher levels of constructive anger were associated with a 41% lower rate of CHD among the men only, while higher levels of destructive anger justification were linked with a 31% higher rate of CHD in women and men,” said Dr. Mostofsky.
“BY MODIFYING OUR WAYS OF COPING WITH FEELINGS OF ANGER AND LEARNING HOW TO EXPRESS THIS ANGER IN A CONSTRUCTIVE WAY, WE MAY BE ABLE TO LOWER CARDIOVASCULAR RISK.”
PHYSIOLOGICAL RESPONSES TO ANGER THAT NEGATIVELY IMPACT HEALTH
Feeling angry triggers your body’s stress response, starting with the activation of the amygdala (the region of the brain primarily associated with emotional processes), which kicks off a cascade of effects ultimately leading to the release of stress hormones such as adrenaline and cortisol from your adrenal glands.
Certain parts of the brain are especially vulnerable to elevated cortisol levels. The prefrontal cortex and hippocampus both experience loss of neurons when exposed to too much cortisol, negatively impacting the ability to use good judgement in decision making and planning for the future, as well as weakening short-term memory.
Excessive cortisol also decreases serotonin levels, which can lead to depression and increased aggression, as well as a tendency to feel anger and pain more easily. (Notice the potential for a vicious cycle here: anger leads to increased cortisol levels, which in turn leads to an increase in anger and aggression.)
In addition, excessive stress hormones are known to affect numerous body systems, including the cardiovascular system, which experiences symptoms such as increased blood pressure and arterial tension, increased blood glucose and blood fatty acid levels, and eventually damaged and clogged blood vessels, contributing to increased risk of heart attack and stroke.
AN ANGER PREVENTION STRATEGY: GET ENOUGH SLEEP
Lack of sleep – either sleep deprivation or sleep debt – is associated with increased anger and aggression, according to a 2018 academic review by Dr. Javeria Syeda and colleagues, published in Cureus. The researchers looked at 17 studies that had been published within the previous five years, all involving humans (i.e., no animal studies were included).
SLEEP DEPRIVATION WAS FOUND TO EXACERBATE PRE-EXISTING MOOD DISTURBANCES, INCLUDING ANGER, AND PEOPLE OF ALL AGES ARE AFFECTED IN SIMILAR WAYS.
When people get enough sleep each night, they tend to exhibit fewer angry outbursts and aggressive behaviours. Just one sleepless night can have a negative impact, so it is important to ensure that you get enough sleep regularly.
ADDICTED TO ANGER
Despite its many negative consequences, anger can be a challenging habit to break for some people. Anger can feel quite good in the moment. By inducing a release of dopamine in the brain, the expression of intense anger can provide a “rush” similar to what is experienced during thrill-seeking activities or when using commonly abused drugs like opiates and cocaine. The brain registers that “rush” as pleasure, which can positively reinforce the angry behaviour (i.e., driving one’s desire to have more angry outbursts).
STRATEGIES FOR HEALTHY ANGER EXPRESSION
Just because intense angry outbursts can have an addictive quality does not mean that they are inevitable. It is possible to learn how to better express anger through practice and training. Remember, feeling angry is normal and healthy; the key is learning how to handle any anger you feel in healthy ways. Here are some strategies to help:
· Try yoga, meditation, and/or mindfulness training to decrease your stress overall, develop bodily awareness to help you recognize early signs of anger brewing, and learn to be less reactive to triggers.
· In an angry moment, take some slow, deep breaths. (It is common to hold your breath when you are seething with anger.) Perhaps take a time out, removing yourself from the triggering situation until you calm down, so that you can respond in a constructive way when you return. A short time out with a focus on calm breathing may be enough, or you might want to engage in something more vigorous to blow off some steam, like going for a run.
· Be constructive in how you deal with anger (i.e., approach the situation with the intention to solve the problem, perhaps through direct discussion), rather than destructive (i.e., where you focus on how right you are and wrong others are, or endlessly ruminate about the situation and hold grudges). If it is not possible to solve a situation through discussion with the other individual(s) involved, perhaps diarize your feelings or talk to someone else to process and then release your angry emotions.
· Get professional support if you need it, such as neurofeedback training or cognitive-behavioural therapy for anger management.