Anger and Its Management
Dennis B. Kottler, MD
Westlake Village, CA
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Anger is a naturally occurring emotion. It becomes a problem when it is excessive, inappropriate to the situation, and acted upon in a destructive fashion.
Usually the significant other, a relative, employer or someone else with whom the individual has a relationship encourages the person to seek help...sometimes under threat of drastic action...such as leaving a relationship or terminating the person's employment. Less commonly, the angry person seeks help himself because he has become aware of the destructive potential of the problem.
Aside from children, adult males have more problems with inappropriately acting out anger than adult females. Curiously, in the context of a psychotic episode, females are often more violent.
Persuading the person to get help. Try calm discussion. Then an intervention with family or friends or co-workers. If all else fails, outline the consequences of a failure to deal with the problem...which may include, if appropriate, termination of the relationship.
As with any serious problem, thorough psychiatric assessment is a necessity. It is extremely important that any Axis I (see DSM IVR) diagnoses be ruled out. If the problem is caused by (or exacerbated by) a psychiatric Axis I diagnosis, this must be treated before dealing with interpersonal issues, or any attempt at anger management will be seriously compromised.
Psychiatric disorders which commonly cause (or exacerbate) anger include:
Major Depressive Disorder
Obsessive Compulsive Disorder
Attention Deficit Disorder
Personality Disorder (Especially Narcissistic PD and Obsessive Compulsive PD)
Serious psychiatric disorders have been ruled out at this point or are being treated. It is now appropriate to begin a course of cognitive-behavioral treatment.
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