Digging Deeper Into Anger

John McManamy Health Guide
  • Last week, in a sharepost, we talked about anger - and did we talk! At the time of this writing, I count 23 comments, all of them extremely insightful and enlightening. Trust me, this is how I learn - from you.

    What immediately struck me was your near-unanimity in seeing anger as a major issue in your lives. Obviously, we need to continue the conversation. Let's make our point of departure a comment by Tabby:

    "These different types of anger you've listed could actually describe a whole host of differing types of anger that even those without a diagnosis of bipolar go through ... "

    Tabby goes on to say: "Even 'normies' have impulsive, grumpy, anxiety, etc. anger types - especially if they have been stressed or under stress ... "

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    Yes! Exactly! We're in absolute agreement, Tabby. In fact, brain science is organizing itself around the very principles you are referring to.

    What is happening is that researchers are investigating phenomena that so-called "normal" people experience ("endophenotype") such as the stress that you mention. From there, they have been connecting the dots to mental illness, though there are a lot of lines that need filling in.

    In 2003, Science magazine cited a series of studies involving the stress connection as the second-biggest scientific breakthrough of the year. The initial studies had to do with depression and aggression, but subsequent research has widened the enquiry to all manner of behavior. The same studies also shed valuable light on how different parts of the brain talk to each other.

    This has made my job a lot more difficult, because if we're looking at characteristics that the general population also experiences that may also be common to both bipolar and say borderline personality disorder, then I have to be reading the borderline literature, too. It just so happens I've been engaging in such an exercise (and writing about it this week on my Knowledge is Necessity blog).

    What we know about borderline is that stress looms large. The situation around those who live with borderline becomes too much for them to handle. They lose it. Predictably, they express, in the words of the DSM, "inappropriate intense anger."

    We know that the limbic system plays a major role in stress, most notably the amygdala which mediates arousal and fear. Thanks to a hypersensitive amygdala, some of us are more vulnerable than others to stress. There is an added complication: Certain cortical regions - most prominently the anterior cingulate cortex (ACC) - appear to be underdeveloped. The ACC, it turns out, is wired into the limbic fear hub.

    Thus, when the ACC is not booting up right, the thinking parts of the brain taken off-line.

    Last year, the NIMH reported on a series of studies that compared the brain scans of borderline patients with healthy controls. In response to viewing images of "scary faces," the borderline patients displayed overactivity in the amygdala and underactivity in the ACC.

    In a normal brain, the ACC would be a lot more engaged in applying the brakes to the runaway amygdala.


  • Additional scans showed that, relative to the control subjects, the borderline patients showed greater density in parts of the amygdala and decreased density in parts of the ACC. Kind of like showing up to a gunfight with a knife.

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    So, do these findings explain anger? No. But they do provide a strong indication of how anger may occur. Significantly both the amygdala and the ACC have been fingered in bipolar research, as well. Too much emotion, not enough control - kaboom!

    As wkb4447 puts it:

    "I would describe my anger event as a small thermo-nuclear reaction that simply cannot be repressed.  Something sets me off and BOOM!...I'm gone.  The rage is absolutely awesome and terribly frightening to anyone that witnesses it ... "

    Let's make this a little bit more complicated, this time with reference to OCD. Patients with OCD have enormous trouble filtering out certain thoughts. Significantly, researchers have pinpointed the malfunction to the ACC. The thought literally take over the brain to the point where the victim is compelled to act on the thought, no matter how irrational.

    "Thought gating" malfunctions also play a prominent role in schizophrenia. Literally, too much input, nowhere for it to go.

    Let's hear from April, who was clearly having trouble blocking certain thoughts:

    "Today I was baking banana-cupcakes for my son's 17th birthday, and I was ticked off for baking them for him, because he doesn't bother to communicate. So in the back of my mind, I think that little sh$% ... The frustration I feel comes out in ways, like throwing the dishes I used to bake the cupcakes back in the sink ..."

    We hear you, April.

    Final Word

    Please don't interpret this piece as a scientific explanation of anger. Clearly, it is not. We are simply pointing to various things that may go wrong in the brain that result in us displaying anger. In very simplistic terms, we may break down the phenomenon into too much emotional input, too much thought input, too little modulation.


    Are these features unique to bipolar? Obviously not. Can bipolar make a bad situation worse? That's what we need to figure out.

     

    One parting thought: The brain is remarkably plastic. Although what I have described appears to be defects in the hard drive, to a large extent we are talking about bugs in the software that can be patched. Literally, the brain can lay down new roadwork, but - like learning to play a musical intrument - it takes practice-practice-practice.

     

    Practice your recovery techniques. Live well ...

Published On: May 08, 2009