Biology of Anger

We all get angry at times. But some of us get angry often and what is worse, we do not seem to be able to control it. We lash out verbally and sometimes physically at objects and people around us. Can we do something about our anger or is it something over which we have no control?

Let us seek to understand the evolutionary basis of anger and what happens inside our brains when we are angry. Anger is usually provoked by a threat; either real or perceived. Our ancestors had to react (and react immediately) to survive; or to protect themselves or their resources. To take time to think would be to lose valuable time. So the brain evolved a mechanism for immediate action.

An almond-shaped area of grey matter deep within our brains - the amygdala perceives threat and generates the emotions of anger and fear. It raises an alarm, and kick-starts the body responses which we collectively know as “arousal”. Our heart beats faster to pump blood to our muscles, the muscles tense for action, breathing becomes faster and shallower, voice becomes shriller. Our face assumes the expression of anger (clenched jaw, lowered brows) as a warning to the adversary; much in the same way that a dog growls and bares its teeth when threatened. All this happens in a matter of seconds.

The frontal cortex, (the part of our brains responsible for conscious decisions) is by now aware of these bodily reactions and the threat perception. It evaluates the situation and the social context. Based on past memory, learning and our individual experience, it decides to respond in a particular way.

So what we have here is an immediate emotional response, and a later conscious response. An example will make things clearer.

• Imagine yourself at a crowded mall. Someone pushes you and moves on un-heeding. You will naturally be annoyed, your face will mirror your displeasure. You are aroused and vigilant - your muscles tense, you breathe faster. This is the immediate response. You realise though after a minute or so that it was probably accidental and think no more about it.
• On the other hand, you may remember that a friend had his wallet stolen in the same way, you may remember reading media reports about pick-pocketing, and you may be having a substantial amount of money in your wallet. Your reactions will be stronger. You may yell at the person, or may even push him in turn. Your conscious mind from past learning and in the present situation causes you to respond differently.

Our emotions; (anger, fear etc) are innate; but our response styles are mostly learnt. We may have seen the same kind of behaviour in our parents (our first role models) in childhood. Or aggression may be our reaction to abuse or bullying. Or we may have observed that anger is the best way to get what we want. Genes, gender (males are known to be more physically aggressive when angry), and our own personality traits also contribute.

Since emotional arousal occurs involuntarily, you may well ask “How can I have any control over my anger?” You can control the behavioural manifestations of anger.

1. Firstly, recognise the signs of anger and arousal. 
2. Then learn to consciously control these processes. Breathe slowly, lower your voice, relax your muscles, stop frowning. 

Does it help? Yes! When we consciously speak slowly and lower our voices, when we relax our tense muscles, when we wipe the frown on our faces and replace it with a smile, we influence activity of the emotional regions of the brain. fMRI scans show less activation in the amygdala. The arousal process is reversed. This is the science behind and the biological basis of anger management. Cognitive Behaviour Therapy further seeks to modify your perceptions – may be what made you angry in the first place, what you perceived to be a threat; was not so at all?

Impulse Control Disorders – Skin Picking, Hair Pulling & More

Skin Picking, Hair Pulling & other Impulse Control Disorders

Impulse control disorders are a treatable group of disorders which share a common feature. This is the failure to resist an impulse or temptation to do something harmful, either to oneself or to others. The person usually senses increasing tension or arousal prior to the act; and pleasure, gratification or relief following the act.

Common Impulse Control Disorders

1. Trichotillomania or Compulsive Hair Pulling
2. Dermatillomania or Skin Picking Disorder
3. Kleptomania
4. Compulsive Buying Disorder
5. Pathological Gambling
6. Internet Addiction

Trichotillomania in simple terms is compulsive hair pulling. There is a recurrent or persistent urge to pull out hair leading to noticeable hair loss – usually from the scalp but sometimes from the eyelashes and eyebrows. It occurs more often in females and starts in adolescence. Sometimes the person may do it consciously, but mostly she is unaware of it, doing it when she is alone; - watching TV, talking on the phone or reading. It may be triggered by stress but may occur even when a person is calm and relaxed. The loss of hair is distressing to the person and she tries to hide the hair loss by using a cap or a scarf. In extreme cases, she may avoid going out and all social situations.

Dermatillomania or skin picking disorder is a similar disorder. A person may constantly pick at real blemishes (acne, scars, moles) causing bleeding, bruises, infections or permanent damage to the skin. Sometimes a person will pick at imagined defects which no-one else can see. The face is the commonest area. It may be a conscious response to anxiety or depression, but is frequently done as an unconscious habit.

Both trichotillomania and dermatillomania can be effectively treated by various forms of CBT such as Habit Reversal Training, Stimulus Control Techniques or Cognitive Restructuring. Compulsive hair pulling may occur in schizophrenia, therefore a psychiatry consultation is advisable. Medications may be required in severe cases.

Kleptomania is probably the best known of the impulse control disorders and has been described from the early 19th century. There is an irresistible urge to steal objects but these are not acquired for personal use or monetary gain. The objects may be discarded, given away or hoarded. There is a sense of tension prior to the act of stealing and a sense of gratification during and following the act.

Compulsive buying disorder, first described in the early years of the 20th century, is a preoccupation with shopping and spending. 80-90% of those affected are women, and it is more common in developed countries where there is a wide availability of items, higher incomes and leisure time. These people tend to share certain characteristics - they frequently shop alone, usually on credit (having many credit cards), buy items they do not need and are often in debt. Buying urges are episodic and can be frequent (daily) or infrequent (less than a month). Four distinct phases have been identified, including

1. Anticipation - in which there are thoughts and urges of shopping or having a specific item
2. Preparation – the stage at which the person plans and decides when and where to shop.
3. Shopping – which is usually described as “intensely exciting”
4. Spending – which is accompanied by a sense of relief but often feelings of disappointment with oneself.

Many of these women have low self-esteem; and the shopping temporarily allows them to feel better about themselves. It also explains why items purchased are mainly clothes, shoes, cosmetics and jewelry.

Pathological gambling: More common in young men, a person suffering from this disorder has an intense urge to gamble despite severe and often devastating personal, family or work-related consequences. He is unable to stop even with an effort of will. He is preoccupied by thoughts and images of gambling. He needs to gamble with increasing amounts of money to achieve the same level of excitement and is restless and irritable when attempting to stop or cut back. These features of tolerance and withdrawal are similar to those seen with alcohol and drug abuse.

Internet addiction or compulsive/problematic internet use: though much highlighted in the media, this requires further study. What is known is that compulsive internet use can interfere with daily life, work and relationships. When a person feels more comfortable with his online friends than his real ones, when he cannot stop himself from playing games, gambling, internet shopping, or compulsively checking his laptop or phone; it is probably time to acknowledge a problem and seek professional help.

Diagnosis

Impulse control disorders share features with obsessive compulsive disorders and with substance abuse. It is important to see a psychiatrist to rule out co-existing or underlying disorders. Impulse control disorders also need to be distinguished from other medical conditions. Milder cases can be treated as outpatients with medication and psychotherapy. Severe cases such as those with pathological gambling often require admission in a rehabilitation centre.

References

1. Black DW. A review of compulsive buying disorder. World Psychiatry. 2007;6(1):14-18. Accessed 09-May-2017
2. Grant JE, Schreiber LR, Odlaug BL.Phenomenology and treatment of Behavioural Addictions. Can J Psychiatry. 2013 May;58(5):252-9. Accessed 10-May-2017
   
3. Trichotillomania – Symptoms and Treatment Accessed 09-May-17
4. Skin Picking Disorder (Dermatillomania) – Symptoms and Treatment Accessed 09-May-2017