How ‘seeing red’ can do more than damage your heart

By Melissa Sammy, for MDLinx
Published November 21, 2019

Key Takeaways

Americans are angrier now than they were a generation ago—at least according to results from the latest NPR-IBM Watson Health Poll—and experts fear that this unmanaged anger may be jeopardizing their health.

About 3,000 Americans were surveyed to gauge their attitudes and opinions across a wide range of healthcare issues. In all, 84% of respondents said that they feel Americans are angrier compared with the previous generation, and 42% reported that, over the last year, they were angrier more often than they had been in the past. Perhaps more concerningly, 29% of respondents said they get angry often.

“I think of anger as a health risk. The fact that the survey showed that we have a generation of Americans who believe that they are more angry than they were a generation ago tells me that this is going to lead to some consequences from a health point of view,” Anil Jain, MD, vice president and chief health information officer, IBM Watson Health, told NPR.

Since ancient times, people have been aware of the negative impact of anger on health. In Buddhism, for instance, anger is referred to as one of the Three Poisons of the Mind, along with greed and foolishness. Today, most people know that anger can increase blood pressure levels, thereby elevating the risks for heart attack and stroke. But unmanaged anger can also manifest in the form of other significant short- and long-term health problems.

Irritable bowel syndrome. The bidirectional communication between the CNS and gut microbiota—the gut-brain axis—has been a topic of significant research in recent years. Researchers have shown that the gastrointestinal tract is particularly sensitive to emotion—namely stress and anger. These emotions can trigger a slew of digestive ailments ranging from mild heartburn and indigestion to more severe abdominal cramps and constipation or diarrhea. Irritable bowel syndrome (IBS), in particular, has been linked to both stress and anger.

In a 2014 study comparing the differences between patients with IBS and healthy volunteers, researchers found that patients with IBS had higher mean scores for trait anger. Although the cross-sectional nature of their study could not confirm a causal relationship, the authors speculated that the “predisposition to anger contributes to [the] development and evolution of IBS, perhaps through modulation of colonic motor activity…The tendency to become angry has potential implication in evaluation and treatment of IBS patients.”

Anxiety. Anger and anxiety often go hand in hand—just not in the way you’re probably thinking. Although it’s not unusual for individuals with anxiety disorders to progress toward feelings of anger and hostility, researchers have also found evidence implicating anger in anxiety’s etiology.

In a study published in Cognitive Behaviour Therapy, for instance, anger was found to exacerbate symptoms of generalized anxiety disorder. According to lead author Sonya Deschênes, PhD, Department of Psychology, Concordia University, Quebec, Canada, this result is surprising, given that irritability—a component of anger—is a diagnostic feature of generalized anxiety disorder.

The results of a more recent study examining the link between anger and anxiety in youth seem to validate this association, in which investigators found significant evidence supporting the relationship between youth-reported trait anger and increased severity of anxiety in 40 children and adolescents with anxiety disorders.

Depression. Sigmund Freud believed that depression was the result of internalized aggression. And while some may chafe at this oversimplification of a highly complex relationship, there’s no doubt that anger does play a significant role in the development of depression. In a 2013 study, researchers investigated the role of self-criticism in the relationship between anger and depression, and found that self-criticism and the act of turning anger towards the self was associated with increased depression severity.

These findings echo those from a publication in Advances in Psychiatric Treatment, in which the author concluded that: “A series of psychoanalytic theorists and clinicians have suggested that conflicts about anger play a central role in the development of depression. Research data have supported the notion that patients struggle with the experience and expression of angry feelings. Anger in people with depression often stems from narcissistic vulnerability, a sensitivity to perceived or actual loss or rejection. These angry reactions cause intrapsychic conflicts through the onset of guilt and the fear that angry feelings will disrupt relationships. These conflicts lead to anger being directed inwards, further lowering self-esteem, creating a vicious cycle.”

Insomnia. Chances are, most of us have experienced feelings of frustration and anger after a bad night’s sleep, and there is some evidence to support this association, with more research emerging on the topic. But now researchers are finding that the connection between sleep and anger may be more reciprocal in nature than previously thought. For example, in one study that investigated the association of anger tendencies and sleep, researchers found that individuals who demonstrated greater anger control had shorter sleep onset latency, fewer sleep fragmentations, and less time awake during the nights.

“This study provided the first evidence that anger tendencies predict objectively measured sleep. Importantly, differences in anger control seemed to be at the core of this relation. Altogether, the findings offer strong evidence that anger is related to actual sleep and not an artifact of self-report biases nor reducible to other contributing factors. These findings add to the growing evidence that being prone to anger may lead to poor sleep and that anger and sleep are intimately connected,” the authors concluded.

Eczema. While the cause of eczema, or atopic dermatitis, is unknown, certain emotional stressors—including anger, stress, and embarrassment—have been shown to trigger flare-ups. And health experts have suggested that repressed anger in particular can cause these break-outs. In one study that examined the roles of anger and assertiveness among patients with atopic dermatitis, patients with psoriasis, and control participants, researchers found that patients with atopic dermatitis “felt angry more readily but were less likely to express it, were more anxious and less assertive, and felt less effective in expressing anger,” compared with controls.

Psoriasis. Like eczema, the exact cause of psoriasis is unclear, but anger is known to trigger and exacerbate this inflammatory autoimmune disease. Researchers have shown that increases in anger levels are directly correlated with elevations in serum levels of interleukin-6, a pro-inflammatory cytokine that is highly expressed in patients with psoriasis.

Coronary heart disease. As previously mentioned, the association of anger with high blood pressure, heart attack, and stroke are well known. What is less known is the link between anger and coronary heart disease (CHD). While some investigators have shown anger to be protective, other researchers have shown anger to increase the risk of CHD in larger and longer analyses.

In a study involving 785 men and women who were followed for 10 years, decreased constructive anger (focusing anger to resolve a problem) in men and increased destructive anger justification (blaming others for one’s anger) in men and women were correlated with increased risk of 10-year incident CHD. Furthermore, in a meta-analysis of 25 studies that evaluated CHD outcomes in initially healthy populations and 19 studies that assessed CHD outcomes among individuals with existing disease, anger and hostility were associated with increased CHD outcomes both in healthy and CHD populations.

Obviously, these are but a few of anger’s many negative health effects. Other significant disorders in which anger has been implicated include unhealthy weight gain and obesity, eating disorders such as bulimic behavior and binge-eating disorder, the risk for type 2 diabetes, sexual dysfunction, and chronic fatigue.

Check yourself before you wreck yourself

Although antidepressants like Prozac, Celexa, and Zoloft are commonly prescribed for anger control, these drugs do not target anger itself; rather they produce calming effects to attenuate rage and negative emotions. For a non-drug approach, an anger management program may be the best choice. Alternatively, the American Psychological Association offers some strategies for expressing and managing your anger in healthy ways:

Recognize the red flags. Be able to identify warning signs that you’re starting to become irritated. When you do, step back from the situation and try to relax to prevent your irritation from escalating.

Avoid triggers. Likewise, avoid known triggers. If you know, for example, that driving in a certain location during a certain time of day will result in a massive case of road rage, try to adjust your schedule to avoid it.

Let go. Instead of rehashing a past incident, try to let it go. One way to do so is to focus on things you appreciate about the person or the situation that made you angry.

Look for the silver lining. Through a technique known as cognitive restructuring, you can replace unhelpful negative thoughts with more reasonable ones. For example, instead of lamenting “Everything is ruined!” tell yourself “Yes, this sucks, but it’s not the end of the world.”

Relax. Seems like an obvious tactic, but simple techniques like deep breathing and thinking of relaxing imagery or positive thoughts can help soothe angry feelings.

Communicate respectfully. When people are angry, they tend to jump to (wrong) conclusions and say things they oftentimes end up regretting. Instead, stop, listen, and think carefully before speaking. There’s nothing wrong with hitting pause on a conversation to cool down.

Anger is a perfectly healthy, natural emotion. When bottled up or dealt with explosively, however, it can adversely affect your well-being and personal relationships. By making an effort to effectively address and control your anger, you and those closest to you will be healthier and happier in the long run.

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