A new study suggests anger is a powerful emotion that intensifiesanxiety and compromises therapyleading to serious health consequences.

Researchers from Concordia University discovered anger can exacerbate symptoms of generalized anxiety disorder (GAD), a condition that affects millions of individuals.

Sonya Deschênes investigated the subject after conducting a literature review for her Ph.D. research. In her review of published studies she realized that anger and anxiety were linked, yet poorly understood.

“This was surprising to me because irritability, which is part of the anger family, is a diagnostic feature of Generalized Anxiety Disorder,” she explains.

GAD is a serious affliction characterized by excessive and uncontrollable worry about everyday things.

It often interferes with a person’s ability to function normally. Individuals suffering from GAD typically anticipate disaster, and are overly concerned about everyday issues, such as health, money, and relationships.

Deschênes and her colleagues reviewed how specific components of anger — hostility, physical and verbal aggression, anger expression and anger control — contribute to GAD.

To do this, the team assessed more than 380 participants for GAD symptoms and their tendency to respond to anger-inducing scenarios.

Researcher’s assessed individual response to statements as, “I strike out at whatever infuriates me” and “I boil inside, but I don’t show it.”

The study, which was recently published in the journal Cognitive Behaviour Therapy, found that in the 131 participants who exhibited GAD symptoms, higher levels of anger and its various dimensions were associated with worry and anxiety.

Furthermore, hostility and internalized anger contributed to the severity of their GAD symptoms.

Experts believe this suggests that anger and anxiety go hand in hand, and that heightened levels of anger are uniquely related to GAD status.

Even more, internalized anger expression — boiling inside without showing it — is a stronger predictor of GAD than other forms of anger.

Deschênes acknowledges that more research is needed to understand why anger and anxiety tend to co-occur.

Researchers believe a possible explanation for the associated between anger and anxiety link is that, “when a situation is ambiguous, such that the outcome could be good or bad, anxious individuals tend to assume the worst.

“That often results in heightened anxiety. There is also evidence of that same thought process in individuals who are easily angered. Therefore, anger and GAD may be two manifestations of the same biased thought process.”

Deschênes also argues that symptoms of anger could get in the way of the treatment for anxiety, which often employs cognitive-behavioral therapy.

“If anger and hostility are contributing to the maintenance of symptoms, and these are not targeted during treatment, these people may not be benefiting as much from that treatment,” Deschênes said.

“It’s my hope that, by furthering our understanding of the role of anger in GAD, we can improve treatment outcomes for individuals with this disorder.”

The brains of people with generalized anxiety disorder (GAD) have weaker connections between a brain region in charge of emotional response and the amygdala. 

This suggests that the brain’s “panic button” may be chronically pushed down due to lack of regulation, according to a new University of Wisconsin-Madison imaging study.

GAD, which is characterized by excessive, uncontrollable worry, affects nearly 6 percent of the population.

The findings support the hypothesis that reduced communications between parts of the brain result in the extreme anxiety felt by people with GAD, said lead author Jack Nitschke, Ph.D., associate professor of psychiatry.

For the study, two types of scans showed that the amygdala, which triggers the “fight-or-flight” response, appears to have weaker “white matter” connections to the prefrontal and anterior cingulate cortex, the center of emotional regulation.

Two types of imaging were used — diffusion tensor imaging (DTI) and functional magnetic resonance (fMRI) — on the brains of 49 GAD patients and 39 healthy volunteers.

Compared with the healthy participants, the scans revealed that the brains of GAD individuals had reduced connections between the prefrontal and anterior cingulate cortex and the amygdala.

These connections went through the uncinate fasciculus — a “white matter” path that connects these brain regions. This lowered connectivity was not found in other white matter tracts in other parts of the brain.

“We know that in the brain, if you use a circuit you build it up, the way you build muscle by exercise,” said Nitschke.

The question arises whether this weak connection results in the extreme defensive anxiety and worry that is the hallmark of GAD, because the anterior cingulate cortex is unable to tell the amygdala to “chill out.”

It also suggests that behavioral therapy, in which patients learn to consciously attempt to regulate this emotion, helps reduce anxiety by strengthening the connection.

“It’s possible that this is exactly what we’re doing when we teach patients to regulate their reactions to the negative events that come up in everyone’s lives,” Nitschke says.

“We can help build people’s tolerance to uncontrollable future events by teaching them to regulate their emotions to the uncertainty that surrounds those events.”

Generalized anxiety disorder (GAD) is more than the normal anxiety people experience day to day. It’s chronic and exaggerated worry and tension, even though nothing seems to provoke it. Having this disorder means always anticipating disaster, often worrying excessively about health, money, family, or work. Sometimes, though, the source of the worry is hard to pinpoint. Simply the thought of getting through the day provokes anxiety.

People with GAD can’t seem to shake their concerns, even though they usually realize that their anxiety is more intense than the situation warrants. People with GAD also seem unable to relax. They often have trouble falling or staying asleep. Their worries are accompanied by physical symptoms, especially trembling, twitching, muscle tension, headaches, irritability, sweating, or hot flashes. They may feel lightheaded or out of breath. They may feel nauseated or have to go to the bathroom frequently. Or they might feel as though they have a lump in the throat.

Many individuals with GAD startle more easily than other people. They tend to feel tired, have trouble concentrating, and sometimes suffer depression, too.

Usually the impairment associated with GAD is mild and people with the disorder don’t feel too restricted in social settings or on the job. Unlike many other anxiety disorders, people with GAD don’t characteristically avoid certain situations as a result of their disorder. However, if severe, GAD can be very debilitating, making it difficult to carry out even the most ordinary daily activities.

GAD comes on gradually and most often hits people in childhood or adolescence, but can begin in adulthood, too. It’s more common in women than in men and often occurs in relatives of affected persons. It’s diagnosed when someone spends at least 6 months worried excessively about a number of everyday problems.

Specific Symptoms of Generalized Anxiety Disorder:

Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

The person finds it difficult to control the worry.

The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months; children don’t need to meet as many criteria).

Restlessness or feeling keyed up or on edge

Being easily fatigued

Difficulty concentrating or mind going blank

Irritability

Muscle tension

Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)

Additionally, the anxiety or worry is not about having a Panic Attack, being embarrassed in public (as in Social Phobia), being contaminated (as in Obsessive-Compulsive Disorder), being away from home or close relatives (as in Separation Anxiety Disorder), gaining weight (as in Anorexia Nervosa), having multiple physical complaints (as in Somatization Disorder), or having a serious illness (as in Hypochondriasis), and the anxiety and worry do not occur exclusively during Posttraumatic Stress Disorder (PTSD).

The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism) and does not occur exclusively during a Mood Disorder, a Psychotic Disorder, or a Pervasive Developmental Disorder.