Could Your Panic Be Anger?

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Could Your Panic Be Anger?
From Cathleen Henning,
Your Guide to Panic / Anxiety Disorders.

An introduction to anger attacks
You feel trapped. Your heart begins to race, and your hands begin to sweat and tremble. As your chest begins to hurt, you realize that you cannot take deep breaths. You've been arguing with your spouse and as your words grow louder, you become afraid of losing control. You can't even remember how this started, but now you feel so overwhelmed that you want to throw something against the wall.
You've just experienced a panic attack, right? Maybe not . . .

What Is an Anger Attack?
Maurizio Fava, MD, and Jerrold F. Rosenbaum, MD, are leading the way in the research of anger attacks and their treatment. Their studies have included research on anger attacks in both depressed and anxious subjects. According to Fava and Rosenbaum, anger attacks may be defined as follows:
Anger attacks are sudden intense spells of anger that resemble panic attacks but lack the predominant affects of fear and anxiety associated with panic attacks. They typically occur in situations in which an individual feels emotionally trapped and experiences outbursts of anger that are later described by the patient as being uncharacteristic and inappropriate to the situation at hand. (Fava & Rosenbaum)
Anger Attacks vs. Panic Attacks
If anger attacks and panic attacks are so similar, how do we tell the difference? The feeling of being trapped may trigger both kinds of attacks. Both attacks begin suddenly and feel intense. Fava and Rosenbaum point out that fear and anxiety are not predominant symptoms in anger attacks as they are in panic attacks. The problem is that sudden intense emotions often feel similar to one another. How do we know which emotion is "predominant"? To understand these two kinds of attacks further, it may help to see the symptoms of each type of attack:
Anger Attacks
(from Fava & Rosenbaum)
Irritable feelings in past 6 months
Angry overreaction to small irritations
1 or more anger attacks experienced in past month
Inappropriate anger directed towards others
The occurrence of at least 4 of the following --
heart pounding, racing
chest pains
sweating
shaking, trembling
shortness of breath
dizziness, lightheadedness
tingling, itching skin
fear of losing control
intense fear, anxiety
cold or hot flashes
feeling like attacking others
attacking others (physically, verbally)
throwing, destroying objects
Panic Attacks
During a panic attack, some or all of the following symptoms occur:
Noticeably quick or pounding heartrate
Pain or other discomfort in the chest
Sweating
Shaking
Difficulty breathing, shortness of breath
Dizziness
Tingling sensations
Fear of going crazy or losing control
Fear of dying
Derealization or depersonalization
Choking sensation
Nausea
Cold or hot flashes
As can be seen, anger attacks contain the same symptoms as panic attacks; however, to be an anger attack, the experience must contain additional symptoms. By exploring feelings such as ongoing irritability and behaviors such as directing anger towards others or throwing objects, one may gain a better understanding of the differences between the two kinds of attacks.
Anger Attacks and Psychiatric Disorders
During their years of anger attack research, Fava and Rosenbaum have conducted a number of studies on the prevalence of anger attacks in different depressive and anxiety disorders. The main conclusion of these ongoing studies is that 30 to 40 percent of depressed people experience anger attacks. Research participants without depressive or anxiety disorders did not experience anger attacks at all. In a study by RA Gould, et al, slightly over 30 percent of subjects with panic disorder experienced anger attacks. The same prevalence was found in other anxiety disorders. The Gould study also found that anxious participants who experienced anger attacks were also more likely to be more depressed than anxious participants who did not experience anger attacks.
It may be concluded, then, that if you experience anger attacks you are at greater risk of depression than people who do not experience anger attacks.


If you have an anxiety disorder, depression may complicate your recovery. It is worthwhile to discuss your panic symptoms and/or anger experiences with your treatment provider.
The Good News
Anger attacks are treatable. Fava and Rosenbaum have focused on pharmacological treatments for anger attacks. Luckily, these treatments, in the form of antidepressant medications, are also often used to treat depressive and/or anxiety disorders. If you feel you have experienced anger attacks, your current treatment may already be helping, or you may want to discuss the Fava/Rosenbaum research with your treatment provider. If you are in therapy, you may want to discuss your anger experiences and what you might do to manage them and/or resolve the issues that may be causing them. Anger Management is a feature article that may help you consider the causes of your anger as well as find self-help techniques for managing it.
In the long run does it matter whether or not you label your attacks as anger or panic? Only you and your treatment provider can answer that question. However, if anger attacks are signaling untreated depression, it can be an important step to determine what your are experiencing.

References:

Fava M, Rosenbaum, JF (1999), Anger attacks in patients with depression. J Clin Psychiatry 60(suppl 15): 21-24.

Gould RA, Ball S, Kaspi SP, Otto MW, Pollack MH, Shekhar A, Fava M (1996), Prevalence and correlates of anger attacks: a two site study. J Affect Disord 39(1): 31-8.