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Section 7
Behavioral Anger in Chronic Pain

Question 7 | Test | Table of Contents

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In the last section, we discussed three concepts related to redefining self-worth in chronic pain clients.  These three concepts related to redefining self-worth included:  poor self-image; grieving; and building the new identity.

In this section, we will examine three manifestations of anger commonly found in chronic pain clients. These three manifestations of anger commonly found in chronic pain clients include:  anger arising from limitations; outbursts; and inbursts. 

3 Manifestations of Anger

♦ #1 Anger Arising from Limitations
The first manifestation of anger is anger arising from limitations.  Clients who experience chronic pain find themselves constantly frustrated by the reduced scope of their abilities.  Because of their loss of independence, clients become angry at themselves for their lack of ability but also at those who do not accept or recognize their limitations.  When another person asks a client to perform beyond their capabilities, the client becomes enraged at him or herself for not being able to accomplish it and also at the other person for not recognizing and validating the client's condition. 

Carol, age 31, had an enflamed disc in her spine that caused her constant pain.  One day, a new manager at her office asked her to carry a box down to the warehouse.  Unable to carry the box, but also equally unable to explain her weakness to her manager, Carol instead asked one of her friends to do the task for her, but still complained about the ignorance of her new employer.  Carol stated, "He didn't even ask me if I could carry that box, he just ordered me to!  He's such an inconsiderate ass!  I bet if he expressed one ounce of concern for his employees, his head might implode." 

Carol's unwarranted anger was quick in passing, but I still asked her to explain her condition to the manager the next day.  I stated, "I know that you know people cannot read minds.  If you do not explain to the people around you about your back pain, you will only find yourself becoming more and more angry at your situation."  I asked Carol to make a list of people that should know about her condition to reduce the frequency of her angry outbursts. 

Think of your Carol?  Is he or she angry about his or her limitations?

♦ #2 Outbursts
The second manifestation of anger is outbursts.  These loud and violent displays of anger are often directed at others who are not necessarily the cause of the anger.  Like Carol, these clients express their anger in short bursts of resentment and displays of indignation. 

Outbursts, however, often have more than one source.  Clients with chronic pain tend to be easily frustrated due to the anguish that their condition causes them.  Because of this, many clients build up quite a bit of small grievances that can erupt in an inundation of vehemence.  Most of the time, the victim of these onslaughts are undeserving loved ones and family members.  As a result, relationships become strained to the breaking point, all because the client cannot control or express his or her anger in a productive manner. 

Hal, age 41, became easily annoyed at his inability to perform the slightest house work due to the fibromyalgia.  In addition, his constant pain continually affected his ability to keep track of menial tasks and conversations.  Hal stated, "I always have to ask people to repeat themselves, and I can't keep track of anything!  I don't get mad that easily, but when the little things start to build up, it can really hurt my mood!  Sometimes I'll just blow up at my wife Tiffany, and she doesn't even know what she did wrong!" 

To help clients like Hal who are prone to sporadic outbursts at loved ones, I suggest simple anger control techniques such as counting to ten.  Another technique is just going out for a walk.  For fibromyalgia clients, this exercise is threefold helpful:  it relieves the pain in their joints and leaves them a clearer head; it gives them time to cool off from their potential outburst; and it gives them the satisfaction of completing a task. 

Think of your Hal.  What other activities could he or she try to quell his or her anger?

♦ #3 Inbursts
In addition to anger arising from limitations and outbursts, the third manifestation of anger is inbursts.  Inbursts refer to anger at oneself resulting in a self-hatred.  The client has fully internalized his or her anger to such an extent that he or she is unable to control this anger and may lash out in outbursts.  Often, these inbursts can result from a fear of unlovability.  Faced with the scary prospect of a loved one leaving them due to their condition, a client becomes scared and irritable.  This fear then manifests itself in anger, but in reality the anger is directed at the client themselves. 

Martha, age 47, suffered from lupus and in addition to the pain she experienced, the disease also exhibited itself in red rashes.  Martha stated, "I hate my body!  I hate it!  Why is it doing this to me?  I'm in pain and I'm hideous!  My husband probably can't even stand to look at me.  He thinks I'm a mess and not worth his trouble.  He's so superficial!"  Martha's dissatisfaction with her appearance created an acute self-hatred. 

She had internalized her anger, directing her fury at herself which came out in a direct attack on her husband.  Like Julia in the previous section, I asked Martha to create a list of positive character attributes that she could use to boost her self-esteem.  Like redefining identity, this exercise forces the negative-thinking to pull out the positive and thus begin on a path to self-satisfaction. 

Think of your Martha.  How is she internalizing her anger?  What does this arise from?

In this section, we discussed three manifestations of anger commonly found in chronic pain clients.  These three manifestations of anger commonly found in chronic pain clients included:   anger arising from limitations; outbursts; and inbursts. 

In the next section, we will examine three concepts related to helplessness.  These three concepts related to helplessness include:  humility vs. humiliation; catastrophizing; and asserting independence. 
Reviewed 2023

Peer-Reviewed Journal Article References:
Burns, J. W., Gerhart, J. I., Bruehl, S., Post, K. M., Smith, D. A., Porter, L. S., Schuster, E., Buvanendran, A., Fras, A. M., & Keefe, F. J. (2016). Anger arousal and behavioral anger regulation in everyday life among people with chronic low back pain: Relationships with spouse responses and negative affect. Health Psychology, 35(1), 29–40. 

Gerhart, J. I., Sanchez Varela, V., Burns, J. W., Hobfoll, S. E., & Fung, H. C. (2015). Anger, provider responses, and pain: Prospective analysis of stem cell transplant patients. Health Psychology, 34(3), 197–206.

Guite, J. W., Russell, B. S., Pantaleao, A., Thompson Heller, A., Donohue, E., Galica, V., Zempsky, W. T., & Ohannessian, C. M. (2018). Parents as coping coaches for adolescents with chronic pain: A single-arm pilot feasibility trial of a brief, group-based, cognitive–behavioral intervention promoting caregiver self-regulation. Clinical Practice in Pediatric Psychology, 6(3), 223–237.

Harmon-Jones, C., Hinton, E., Tien, J., Summerell, E., & Bastian, B. (2019). Pain offset reduces rumination in response to evoked anger and sadness. Journal of Personality and Social Psychology, 117(6), 1189–1202.

Noyman-Veksler, G., Shalev, H., Brill, S., Rudich, Z., & Shahar, G. (2018). Chronic pain under missile attacks: Role of pain catastrophizing, media, and stress-related exposure. Psychological Trauma: Theory, Research, Practice, and Policy, 10(4), 463–469.

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Section 8
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