Anger issues and irritability: is it a mental illness, and how do you control it?

Are anger issues a mental illness?

Anger issues (often called a short fuse, or "khulq dayyaq" as many people in Egypt say) are not a mental illness in themselves. Anger is a normal human emotion, and, as the UK's National Health Service (NHS) notes, most people feel it from time to time. But ongoing irritability can be a symptom of a mental or physical condition that needs treatment, and in its severe form it can be part of a recognized condition called intermittent explosive disorder. What matters is not that you get angry, but how often, how intensely, and what happens afterward.

Cleveland Clinic describes intermittent explosive disorder as repeated, impulsive outbursts of anger or aggression that are far out of proportion to what triggered them, followed by regret and embarrassment. On its page, updated in 2022, it says researchers estimate that between 1.4% and 7% of people have it, and that it is more common in males.

When is irritability a symptom, not just your personality?

• A new change: you get angry faster than you did a few months ago.
• Other symptoms alongside it: sadness or loss of enjoyment, constant worry, or poor sleep.
• Anger out of proportion: a big explosion over something small, followed quickly by regret.
• A link to substances: the irritability started when you began using a drug or pills, or after you stopped.
• A clear impact: repeated arguments at home or problems at work.

Why am I so irritable? Mental and physical conditions behind a short temper

• Depression: the US National Institute of Mental Health (NIMH) notes that some people with depression don't seem sad, but angry or irritable instead. Read about depression in men.
• Anxiety: according to the same institute, signs of generalized anxiety disorder include often feeling irritable or "on edge", along with trouble relaxing and sleeping.
• ADHD (attention deficit hyperactivity disorder): a meta-analysis published in BMC Psychiatry in 2020 concluded that difficulty regulating emotions, such as quickly shifting moods and strong negative reactions, is a core feature in adults with ADHD. Read about ADHD in adults.
• Trauma: the NHS notes that some people who go through traumatic or frightening events develop post-traumatic stress disorder (PTSD), and that it can show up as angry outbursts.
• Pain, long-term illness and some medicines: Cleveland Clinic links irritability to chronic pain and chronic illness, and to the side effects of some medicines or stopping them.
• Poor sleep: sleep deprivation and insomnia can leave you worn out and quick to snap.
• Stress and hunger: pressure from relationships, money and work, loneliness, and even low blood sugar when a meal is late can shorten your fuse.

Cleveland Clinic's page, updated in 2022, also notes that about 80% of people with intermittent explosive disorder have another mental health condition, including anxiety disorders, which are among the most common, and bipolar disorder. That is why the answer starts with looking for the cause, not with blaming your temperament.

Irritability in women

Hormonal changes can add to the causes above. The NHS lists mood swings and irritability among the symptoms of premenstrual syndrome (PMS), and in its more severe form, premenstrual dysphoric disorder (PMDD), symptoms can include severe anxiety, anger and depression, and even suicidal thoughts. Still, don't put every bout of irritability down to hormones: exhaustion, stress and depression are common causes too. Read about depression and hormonal changes in women.

Drugs and withdrawal: a hidden cause of sudden anger outbursts

Cleveland Clinic counts substance use disorder among the causes of irritability, and warns that alcohol and drugs can increase violent behavior in people who have anger outbursts. Anger can also come after stopping a substance: the US National Institute on Drug Abuse (NIDA) says that withdrawal symptoms after heavy or long-term cannabis (hashish) use can include anger, irritability, aggression and insomnia. So a young person whose mood has suddenly turned may be going through withdrawal that the family knows nothing about. Read about hashish withdrawal and its treatment.

What happens in your body during an anger outburst?

When you get angry, your body sets off the "fight or flight" response, as the Better Health Channel of the Victoria State Government in Australia explains, and within moments:

• Stress hormones are released, including adrenaline and cortisol.
• Your heart beats faster, your blood pressure rises and you breathe faster.
• Blood is directed away from your stomach and gut toward your muscles, ready for action.
• Your body temperature rises and your skin starts to sweat.

This response is useful in the face of real danger, but in a family argument it pushes you into a hasty reaction. Cleveland Clinic notes that logic and reasoning can slip away when emotions run high, so people say things they regret. It also lists warning signs that can come before an outburst: rising tension, racing thoughts, a pounding heart, trembling and a tight chest. And when anger is frequent and uncontrolled over long periods, the Australian source links it to problems including headaches, insomnia, anxiety, depression and high blood pressure, and even heart attacks and strokes.

How to control anger: skills that help in the moment

The aim is not to never get angry, but to handle your anger without hurting yourself or anyone else. These steps are based on advice from the NHS and Cleveland Clinic:

1. Catch the first sign: a hot face, clenched fists or a rising voice. The earlier you notice anger, the easier it is to stop.
2. Pause before you respond: count to ten, or leave the room. Agree on a phrase with your family in advance, such as: "I need a few minutes, and I'll come back so we can finish."
3. Breathe slowly: breathe in deeply through your nose, hold it for a few seconds, then breathe out slowly through your mouth, and repeat.
4. Name the feeling: tell yourself, "I'm angry right now, and that's understandable," then ask: what exactly made me angry?
5. Move your body: walking or any physical activity helps you relax and ease tension.
6. Come back and talk about yourself: say "I get upset when…" instead of "You always…", because blame raises the tension.

In the longer term, the Australian health site recommends that you keep a diary of your anger episodes to find out what sets them off, exercise regularly, learn relaxation techniques, and practice saying what you think firmly and calmly, without shouting. Make sure you get enough sleep too, because, as Cleveland Clinic notes, lack of sleep fuels irritability.

How do you repair the damage anger has done to your family?

Cleveland Clinic notes that the families of people who have anger outbursts often live with stress, depression and isolation. Relationships are repaired when others see a sincere and steady effort:

• Apologize without excuses: "I'm sorry I shouted" is enough; adding "but you provoked me" wipes out the apology.
• Talk when things are calm, not while you are still worked up.
• Ask your family what they notice: they may see your anger building before you do.
• Ask for help early: seeking treatment is not weakness; it is the clearest sign that you are serious about changing.

If there are children at home, they learn how to express anger from you, which is why the Australian source advises adults to set an example of expressing it in healthy ways.

When does anger become a danger to the people around you?

Anger becomes a safety issue, not just a matter of temperament, when it turns into threats, breaking things, pushing or hitting anyone in the family, or reckless driving. Cleveland Clinic notes that these outbursts can cause serious injuries, and that people who live with someone who has them should protect themselves and their children. If you notice that you are close to hurting someone, leave the place immediately and ask for help today, not tomorrow.

When should you get help for anger issues?

Based on what the NHS and Cleveland Clinic say, get a professional assessment if:

• you can no longer control your anger, or you have tried the skills above and they haven't helped
• your anger is straining your relationships or causing problems at work or in your studies
• you have acted violently or abusively toward anyone, even once
• your irritability comes with severe stress, anxiety or depression, or your low mood has lasted more than two weeks
• your irritability is linked to using a drug or pills, or to stopping them

How is excessive anger treated?

Treatment starts with an assessment to look for the cause: is it depression, anxiety or ADHD, an old trauma, substance use, or intermittent explosive disorder itself? For intermittent explosive disorder, Cleveland Clinic says cognitive behavioral therapy (CBT) is the main treatment, and it includes:

• reviewing the thoughts that fuel anger, such as "he's insulting me on purpose"
• relaxation training, such as deep breathing and progressive muscle relaxation
• practicing healthy responses, such as calmly walking away from the situation
• relapse prevention, so that a slip is treated as a passing stumble, not a failure

Depending on the cause, a doctor may decide that medication would help, such as certain antidepressants or mood stabilizers. This is a decision made after the assessment, so don't take sedatives on your own. At Oxygen Center, you can start with an appointment with a psychiatrist to assess the cause, then psychotherapy sessions to learn anger-control skills. Both are for men and women aged 15 and over, with a guardian's consent for those under 18. If the person who gets angry refuses to come, the family can come alone first. To book or ask a question: +20 101 687 0711.