Which Is Best? Therapy Or Medication For Anger Disorders
By Sarah Fader
Updated June 12, 2019
Reviewer Wendy Boring-Bray, DBH, LPC
Chances are you've been angry at some point in your life. Even the most level-headed people get mad sometimes, but if you find yourself having angry outbursts on a regular basis (or know someone who is), it might signal a bigger problem. It's okay to let out your emotions, good and bad, but when you start to feel angry all the time without knowing why it can be worrisome.
If you think you might have an anger disorder you're probably wondering which is best, therapy or medication?
Anger can be part of a wide range of mental disorders, including things like Intermittent Explosive Disorder, Oppositional Defiant Disorder, ADHD, and Bipolar. Personality Disorders (Narcissistic, Borderline, Antisocial, and Paranoid) can involve anger at times. Angry outbursts can also happen when someone tries to bury their feelings for a long time. Over time these emotions start to bubble to the surface until the person finally explodes.
According to a study by Kessler, R.C., Coccaro, E.F., Fava, M., et al. (2006), Intermittent Explosive Disorder (IED) is more common than people once thought, with more than 7% of the US population experiencing this type of anger in their lifetimes. The study found that angry outbursts can result in a lot of property damage and that the average age of onset for IED was around 14 years old.
Uncontrolled and unpredictable anger can be a danger to those who experience it, the people closest to them, and sometimes to innocent bystanders who are at the wrong place at the wrong time. Anger can affect all aspects of your life, including work and family. If you or someone you know is suffering from an anger disorder, it's important to reach out to a health care professional and seek treatment.
Which Is Best? Therapy Or Medication For Anger Disorders
Luckily, there are several effective treatment options available for people suffering from anger disorders. An important first step in resolving your anger is diagnosing the underlying reason for it. This information will allow your health care provider(s) to make an informed decision on what the first line of treatment should be.
As a patient, you should know that treatments for anger disorders differ depending on the person and situation. You may need to try more than one treatment before finding one that works because what works for one person might not work for you. The important thing is to be patient until you find a treatment that works for you and then stick to that treatment to help you reduce your anger and learn to keep it under control.
Different types of therapy, including cognitive behavioral therapy, are used in the treatment of anger disorders. These types of treatments can be very effective because they teach you how to deal with stress and anger in a healthier, more effective way. For example, by helping individuals realize when their thought processes lead to angry outbursts, therapists can help create long-term positive changes for their clients. As the saying goes: change your thoughts, change your life.
Depending on the severity of the anger disorder, you may have many different options when it comes to the type and intensity of therapy you choose to take on. You may have the ability to choose between in-person therapy sessions, online counseling, group therapy, or even going to a residential anger management treatment facility depending on the severity of your anger and the effect it has on your life.
- In-Person Therapy Sessions
In-person therapy sessions are great because they allow you to see an experienced professional for a set amount of time on a regular basis. Some people prefer in-person to online or phone therapy. Certain patients will also prefer speaking to a therapist one-on-one over attending group therapy.
Therapy that takes place in-person gives the patient a chance to build a relationship with their therapist that is based on trust and mutual understanding. Some cons of in-person therapy are the fact that it can be expensive and sometimes hard to get appointments.
- Online Counseling
Online counseling is a relatively new phenomenon, but it's already proving its merit by giving more people access to quality help. Where traditional services might be spread a little thin these days, online counseling has found innovative ways to pick up the slack and offer customers affordable counseling services.
Services like BetterHelp connect you with a counselor specially matched to your needs, which you can message from anywhere using a computer or their mobile app on your smartphone. Of course, this method might not be the right fit for people who benefit more from face-to-face interactions.
- Group Therapy
If traditional in-person therapy and online counseling are a little over your budget, or just not your style, group therapy is another excellent option. Group therapy not only provides you with access to experienced counselors who are trained to help, but you also get a built-in support group at the same time.
In group therapy, you get to share your challenges, experiences, and triumphs with other members who can become a pivotal part of overcoming or living with an anger disorder. This type of therapy is probably best for social people who don't mind talking about their problems in front of other people.
- Residential Anger Management
If your anger disorder is severe and impacts your life in debilitating ways, residential anger management might be an option you consider. Though more intense, this form of treatment allows you to dig deep and learn to control your anger so that you can reclaim your life.
Some upsides to residential anger management are that these programs allow you to escape regular life and forget about your usual worries (and anger triggers) while you are getting better. This option takes a lot of commitment though, and not everyone would be willing to put everything on hold for treatment.
In addition to therapy, some medications are also available to help treat anger disorders.
According to Harvard Health, "Research on drug treatment [for IED] has been limited. Some medications are known to reduce aggression and prevent rage outbursts, including antidepressants (namely selective serotonin reuptake inhibitors, or SSRIs), mood stabilizers (lithium and anticonvulsants), and antipsychotic drugs." While medications are used to help reduce anger, for many patients, it will not stop it completely.
- Antidepressants (SSRIs)
Antidepressants have been shown to be helpful in treating anger resulting from various mental disorders, including depression and personality disorders.
Fava, M. & Rosenbaum, J.F. (1998) found that "Anger attacks disappear in 53-71% of depressed outpatients treated with antidepressants such as fluoxetine, sertraline, and imipramine." Results from a more recent meta-analysis conducted by Mercer D., Douglass A.B., & Links P.S. (2009) showed, "Antidepressants had a moderate effect on anger reduction, but a small effect on depression," in patients with Borderline Personality Disorder.
- Mood Stabilizers (lithium, anticonvulsants)
In many cases, SSRIs are the first choice for treating issues like IED or anger in patients with depression and personality disorders because they are proven to be effective. In cases where patients' anger doesn't respond to SSRIs, other medications like mood stabilizers can also be considered. Some anti-seizure medications are used as mood stabilizers (like carbamazepine and divalproex).
- Antipsychotic Drugs
A study by Gobbi, G. & Debonnel, G. (2003) found that the atypical antipsychotic drug, Clozapine, can be effective in treating Schizophrenic patients who are hostile and aggressive. "The reduction of aggressive behaviors by clozapine may be explained not only regarding sedative or antipsychotic effects but also by its ability to reduce impulsivity," the researchers explained.
Another study stated that while antipsychotic drugs like Clozapine, Olanzapine, and Quetiapine can help with anger and aggression associated with anger disorders, these medications have more side effects that make them less ideal for long-term treatment.
Safe Medication For Anger
Sometimes medication is the best way to get anger under control in the short term, but with the help of other forms of treatment like therapy, patients might not have to be on medication for too long. Other times, certain medications that have been deemed safe may be used for long-term maintenance.
Of course, medications always come with the risk of side effects and addiction. It's important always to take medication as prescribed by a doctor and be on the lookout for any side effects when starting a new medication. For medications that do involve some risk, doctors may do routine health checks to make sure that potential side effects are closely monitored. Patients should always be careful and consult their doctor before coming off any medication for anger.
Individuals who are reluctant to take anger management medication may find some help in alternative treatments such as calming herbs and essential oils, along with therapy. Practices like daily mindfulness, exercise, and meditation can help patients with anger find calm and balance, but it takes patience and persistence to make these options work.
When considering the question, "Which is best, therapy or medication for anger disorders?", Unfortunately, the answer isn't so clear-cut. Studies have shown that both therapy and medication can be effective for treating anger disorders, including IED and anger related to other psychiatric disorders. The best option is the one that works best for you. That might mean medication, therapy, or a combination of both types of treatment.