The Role of Anger in Multiple Sclerosis

Anger is an emotional complication of multiple sclerosis (MS) that is believed to result, at least partially, from the disease itself. Keeping angry thoughts bottled up is also associated with a poorer quality of life, according to a study in Multiple Sclerosis.

By understanding more about the role of anger in MS and how it can be managed, you are already taking the first step to better controlling your physical and mental health.

This article discusses anger in multiple sclerosis, what is thought to cause it, and how it can be managed.

Anger and MS

A 2015 study assessed anger in 157 participants with multiple sclerosis. Participants with relapsing-remitting, primary progressive, or secondary progressive types of MS were all included.

Anger in these participants was measured using the State-Trait Anger Expression Inventory-2 (STAXI-2), which is a four-point scale with higher scores indicating more anger. In this test, 196 items are broken down into six scales. Four of those scales include:

1. Trait anger: Measures whether a person has an angry personality and whether a person tends to react angrily when criticized
2. State anger: Measures whether a person currently feels anger and whether they feel like expressing their anger verbally or physically
3. Anger expression-out: Measures whether a person expresses anger towards other people, like shouting at a partner or punching a wall
4. Anger expression-in: Measures whether a person suppresses their angry feelings

Study participants with MS were compared to a control group. The researchers found that people with MS were more likely to be angry (trait anger), have a higher intensity of anger (state anger), and express anger either outwardly or inwardly, as compared to the control group.

In other words, this study suggests that people with MS tend to experience anger more often than those who do not have MS. To test whether this higher level of anger in the MS group was attributed to underlying depression and anxiety, the researchers correlated anger scores with depression and anxiety symptoms. The researchers found no link, suggesting that anger existed alone and was not a marker for an underlying mental health condition.

Anger and Quality of Life With MS

The participants in this study also underwent a health-related quality of life assessment using the Functional Assessment of Multiple Sclerosis HRQoL instrument.

The person taking this test has to choose one of five scores to determine their satisfaction, ranging from "0" which means "not at all" to "4" which means "very much." A higher score indicates a better quality of life and a lower score indicates a worse quality of life.

After a complex statistical analysis, the study found that people who internalized or suppressed their anger had a worse health-related quality of life (this was especially true for women). On the other hand, the trait of anger did not predict a worse health-related quality of life. This suggests that it is not anger itself that affects a person's life satisfaction, but whether they keep those angry feelings to themselves.

Causes of Anger in MS 

The results of the above study suggest that a person with MS is more likely to experience anger than someone without MS. So why is this the case?

Despite the limited scientific evidence, experts suspect that anger in a person with MS is the result of brain lesions, just as blurry vision or a loss of coordination occurs from MS lesions in the brain. In other words, a person's immune system attacks the fatty covering of nerve fibers (called the myelin sheath) in areas of the brain that control emotion, behavior, and personality like the:

• Amygdala
• Basal ganglia
• Frontal lobe

When the myelin sheath of nerve fibers in these brain regions is damaged or destroyed, nerve signaling is impaired. This can affect the function of the brain region leading to a change in emotional expression, personality, behavior, etc.

Of course, a new diagnosis of MS, or other forms of stressful news like your disease progressing or your medication being expensive can cause angry feelings. But again, the anger disturbance experienced by a person with MS may be more of a function of their disease than of the situation.

Finally, even though the above study tested for depression as a source of anger and found no link, anger can be a substitute emotion for sadness or anxiety.

This all being said, teasing out the cause of your anger can be tricky, and while you think you may know the culprit, it's best to get an objective opinion from a healthcare professional.

Treating Anger in MS

When managing your anger in multiple sclerosis, it is important to first undergo a proper evaluation by your healthcare provider, as this will affect your treatment plan. If your practitioner diagnoses you with depression or anxiety, a combination of self-care, medication, and therapy can be extraordinarily helpful.

Self-Care

If you have MS, there are many things you can do to cope with unexpected emotions like anger. For example:

• Communicate with friends and family. Let them know that angry outbursts are a symptom of MS. You can also work together to find ways of handling outbursts when they happen.
• Take a break. If you can, remove yourself from the situation that triggered the emotion.
• Avoid triggering situations. If you know certain places or situations might lead to an angry outburst, avoid them.
• Make time for yourself. Allow some time for activities you enjoy, like listening to music, spending time with friends and family, etc.
• Practice mindfulness. This is a cognitive technique where you learn to appreciate and live in the moment. While it has not been studied as a means of treating anger in multiple sclerosis, it has been found to improve quality of life, anxiety, depression, fatigue, and pain in people with MS. It has also been found to improve anger in people with fibromyalgia, which is a chronic medical condition that is wholly different from MS but shares some similar symptoms, like fatigue and pain.
  

Medications

Your healthcare provider may also recommend certain medications to help reduce irritability and prevent angry outbursts. For example:

• Low-dose Depacon (valproic acid), a mood-stabilizing anticonvulsant
• SSRI antidepressants such as Prozac (fluoxetine) and Lexapro (escitalopram)
  

Therapy

If your anger stems from a new or prior MS diagnosis, therapy may help. There are a few different options available, including:

• MS support groups
• Anger management classes
• Relaxation or talk therapy
• Family counseling
  

Supporting Loved Ones With MS

If you are a family member, friend, or caregiver for someone who has MS, here are some important tips on how to best support them.

• Learn about MS and how it can affect a person's mental and physical health.
• Let them know they can count on you. Ask them what they need and be willing to provide help where you can.
• Offer to attend group counseling or medical appointments with them.
• Spend time with them, even if that means quiet activities at home.
• If you are a caregiver, take care of your own mental health too. If you need help coping, reach out to a mental health care professional.
  

Summary

Anger can be a symptom of multiple sclerosis. It is believed to be a result of demyelination in certain parts of the brain. Anger in MS can have a negative impact on a person's quality of life.

If you experience anger as a symptom of multiple sclerosis, make sure to communicate with your friends and family about the reasons for potential outbursts and practice self-care strategies like mindfulness. Medications and therapy can also be helpful.