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High Unexpressed Anger in Multiple Sclerosis Patients Linked to Nervous System Damage, Not Disease Severity
ScienceDaily (Nov. 24, 2009) — People with multiple sclerosis (MS) feel more than twice as much withheld anger as the general population and this could have an adverse effect on their relationships and health, according to a study published in the December issue of the European Journal of Neurology.

Italian researchers assessed 195 patients with MS, using a range of scales that measure anger, depression and anxiety, and then compared them with the general population.

They were surprised by the results, which showed that while patients experienced almost twice the normal level of withheld anger and exerted low levels of control on their anger, their expressed anger levels were similar to the general population.

This, together with the fact that the elevated withheld anger levels were not related to the severity of the patients' MS, suggests that these inconsistent changes were caused by nervous system damage, rather than an emotional reaction to the stress of the disease.

"We believe that the higher levels of withheld anger shown by the study subjects is due to demyelination, loss of the substance in the white matter that insulates the nerve endings and helps people receive and interpret messages from the brain" explains lead researcher Dr Ugo Nocentini from the IRCCS S Lucia Foundation in Rome.

"The way we process anger is controlled by complex interconnections between the subcortical and cortical systems, notably the amygdale and basal ganglia and the medial prefrontal cortex. We believe that the demyelination process that causes the root symptoms of MS also disrupts the pathways that control how we deal with withheld anger."

The patients who took part in the study comprised 150 with relapsing-remitting MS and 45 with progressive MS. More than two-thirds (68 per cent) were women, the average age of the participants was 40 and the average time since diagnosis was 11 years.

Researchers evaluated the participants using the State Trait Anger Expression Inventory, the Chicago Multiscale Depression Inventory and the State Trait Anxiety Inventory.

The researchers then looked at age and sex-matched subjects in the general population and identified the levels of anger experienced by the 25 per cent of people with the highest scores.

They found that MS patients:

Were more than twice as likely to experience high levels of withheld anger, with 60 per cent of patients recording the same high levels as the top 25 per cent of the general population.

Exerted a low level of control on their anger, with just 11 per cent of patients reporting the same high levels of control compared to the top 25 per cent of the general population.

Were about the same as non MS patients when it came to expressed anger, with 30 per cent of patients reporting the same high levels as the top 25 per cent of the general population.

During the study the authors also compared the anger scores against selected demographic and clinical characteristics and found they were independent of age, education, disease duration and course, disability and fatigue severity. The only notable difference was that women reported higher levels of current anxiety.

"Our findings clearly show that anger characteristics in MS patients differ from those observed in the general population and the overall results surprised the research team" concludes Dr Nocentini.

"For example, patients reported low levels of anger control and high levels of withheld anger, yet the scores for expressed anger were similar to those of the general population.

"We would have expected greater consistency between withheld and expressed anger and higher levels of expressed anger as a consequence of low anger control."

The authors conclude that damage to the fibres in the areas of the brain where anger issues are processed is the most logical explanation. They also say the findings have important implications for clinical practice.

"Anger disrupts interpersonal relationships and this is particularly true for withheld anger, which might go unrecognised by other people" says Dr Nocentini. "Witheld anger has been reported to be associated with physical problems, in particular high blood pressure and vascular disorders, and may have a negative effect on the general health of MS patients.

"Because withheld anger has no, or few, overt manifestations, and is unlikely to be recognised by clinicians or reported by patients, it is important that MS patients are asked if they experience abnormal anger."

Anger is one of many neuropsychiatric symptoms of Multiple Sclerosis.
Check out this previous discussion: http://tr.im/FU3k

Maybe I haven't had MS long enough to have the anger issues. I am too overwhelmed and tired from trying to manage fear and anxiety to get angry at much any more. There are many times I should feel anger but don't because it takes too much energy and is draining.

actually this whole topic is really pissing me off right now

I think this is true...something is going on up there causing depression/anger, rather than the patients just being sad at being ill. My husband has had this and when I suggested to the neuro that some thing had probably occurred in my husband's brain ( a new lesion?), he said no it is not like that....

My husband said he must be keeping me well because he thinks I've no problems expressing my anger to him
Seriously though, I do wonder about this. Sometimes I feel rage over and above what would be appropriate and I suspect it is just another MS symptom. The thing is I've been simmering and stewing over stuff for so many years now, I wonder what is my personality at all, and what is MS? If they were to find a true cure in the morning, what would I be like at all? Maybe I would be placid

Personally I think whether we know it or not, admit it or not, this condition creates an ever simmering level of anxiety. Anxiety it the perfect agitator and creates a short fuse. It may be a lesion or it may be because we are thinking about lesions. The perplexing, cyclical, contrary MS we hate so much strikes again.

These questions have no easy answers, expect the ever-popular: everyone is different!

So I have to share with all of you my view on this article since I posted it. I definitely fall into the withholding anger category. I hardly ever express my anger, I hate conflict. But when I lose control of my temper-I really lose it. My boyfriend loves to tell a story to anyone who'll listen of how I screamed profanities at a bowl of bean salad for a half hour because the cover wouldn't fit correctly. That being said, I guess this article might be true for me. Honestly, I have never considered that it was caused by MS because I have always been this way. Maybe it's my personality, maybe not. Either way, I think money could be better spent in finding a way to "cure" the cause of a lot of our anger (whether situational or physical) rather then figuring out if we are more angry then other people. Does it really matter in the end?

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scoobyjude wrote:My boyfriend loves to tell a story to anyone who'll listen of how I screamed profanities at a bowl of bean salad for a half hour because the cover wouldn't fit correctly. That being said, I guess this article might be true for me.

Scooby, there are people who go over the edge because they lost their job, however long ago, their homes, lost their wife, shoot up their families, etc. How many who post on this board have gone through all that as well as the capacity to attack and overcome these kinds of problems due to the unpredictability of MS disabilities? Rather than auto-attributing your extended outburst at the bean salad to MS or a new lesion, doesn't it make sense, considering what has been stolen from you that the salad was something you took lots of pent up frustration on, harmlessly???

It's true that people can be angry at being ill, but sometimes being ill makes them angry. I see this often with my mother, who gets frustrated quickly when her blood pressure is high up there....you could say that her anger made her blood pressure go up, but sometimes, anxiety makes it go up, and she is just irrationally angry. Of course, the rest of the time, she is lovely and I do love her. Same goes for my husband, I love him, but sometimes he is angry and then I have to tell him to stop...really, we can only take so much.

I found that going to doctors makes me angry. Nothing like being told to get a new hobby (no, really, I just want my leg to work right -- I already have hobbies, thank you.)

My withheld anger is directly proportional to how much time I spend around medical professionals.

Since most MS patients spend significant amounts of time around doctors (and then, insurance companies! and relatives!), I think the research really ought to explore that connection.

I'd think a neurologically-induced anger thing would vary from patient to patient more, the way other neurological symptoms do. Plus, why only more withheld anger, but not expressed anger? It doesn't make all that much sense.


Jen.

[Edited to clarify that the 'neuro' in the last paragraph referred to disease process, not neurologists.]

Perhaps it is the iron in our brains that contributes to anger and depression. We need studies to support this, though.

Jennifer, I have the exact type of anger against doctors. I get so frustrated that I avoid visiting my neurologist. I consider his specialty very useless for my condition, so visiting him is not worth the frustration.

What is common among "official" advice about MS is that it is 100% useless, no matter whom it comes from. Of course, the doctors will never think that it is THEM that piss us off! "It can't be us! We are the best humans! It HAS to be the demyelination!"

sou

It sounds to me like they found that there is more to the story of anger in MS patients than just anger at an illness - as if that weren't enough sometimes. Basically, that our emotional response and expression of anger (and maybe frustration?) is more complicated than we might think on the surface.

At the same time, Spider Robinson said (and I agree) "Anger is always fear in disguise."

I have always been quick to feel anger, and quick to suppress it... and then loose it entirely at inappropriate moments (Sometimes yelling at salad would seem preferable). MS scares me, and upsets me, and I feel like my fuze is shorter, but I've learned to control it better since I was younger, and so I don't express it very much. All this article says is that maybe there's a question about how much of that fuze is burned for me, and that maybe it's a bit longer than I suspected.

Being emtionally labile is one MS symptom for sure, and I'm sure one of the emotions is anger!