The effects of hostility, anger, & irritability on health, well-being & medical care.
Patrick Randolph, Ph.D. Date updated: 5/30/2019
Anger, hostility and irritability have overlapping features that range from mild frustration to outright rage and aggressive behavior. While anger can be useful and healthy, most researchers agree these feelings have considerable negative effects on our happiness and health (1).
The body’s reaction to anger
The body responds to anger by releasing stress hormones such as adrenaline, noradrenaline and cortisol that increase breathing, heart rate, blood pressure and body temperature in an attempt to fight or run away from a threat. While anger may help us survive, it can hurt our health in many ways.
- High blood pressure
- Irritable bowel syndrome
- Skin disorders
- Heart attack and heart disease
- Weakened immune functioning resulting in more infections, colds and influenza
- Accidental deaths
- Eating disorders
- Respiratory diseases
Do you hold it, blow up, or mindfully show it?
Sitting on anger, expressing it indirectly, or going to great lengths to control it, termed “anger-in,” may be linked to hardening of the arteries and the development of heart disease (2). It seems that when we become cold-hearted with anger, cynicism and resentment, the arteries harden as well, leaving us more likely to die of a broken heart.
Spewing anger openly and harshly, known as “anger-out,” seems to inflate the risk of “blowing a gasket,” increasing blood pressure, bleeding within the brain or having a stroke from a blood clot to the brain. One researcher found that blood pressure (3) remained high a full 2 hours after subjects becoming hostile and angry.
On the other hand, cardiac patients with healthier anger control naturally had fewer physiological reactions to hostility that could eventually result in the development of coronary heart disease (4).
Anger effects health-related decision-making:
The natural judgment system is turned down in reaction to fight or flight with more primitive responses taking over to engage in action, sometimes at the expense of rational decision making and healthy judgments. Anger is more likely to be partnered with aggressive, erratic and impulsive behaviors, resulting in a pattern of risky, health-inhibiting behaviors.
For instance, among 411 teens, researchers found high anger-in and anger-out to be associated with the adoption of unhealthy lifestyle behaviors such as lack of physical activity, consumption of alcohol, cigarettes and caffeine (5).
Subjects high in anger, combined with impulsivity, were associated with an increased likelihood of binge eating and vomiting (6).
Diabetes has been linked to angry temperament, due in part to nicotine use and higher caloric intake that tend to accompany it (7).
Anger is also associated with an increase in risk of road accidents (8) due to increased aggressiveness and risk taking, having a positive relationship with crash related conditions such as losing control of the vehicle, impaired concentration and crashing in simulator studies
Anger’s relation to well-being
Worsens all forms of emotional suffering
Research (9) suggests the presence of anger among alle motional disorders in general results in greater symptom severity and worsens treatment responses. Anger worsens symptoms of Generalized Anxiety Disorder (10) while depression (11) tends to worsen, especially when anger is turned in on ourselves.
Erodes valuable support
Anger and hostility also erode social support and hamper access to a very powerful cushion between life distress and our health. Investigators reviewing studies on social support (12) in the Journal of Psychiatry conclude:
“The effect of social support on life expectancy appears to be as strong as the effects of obesity, cigarette smoking, hypertension, or level of physical activity… In contrast to low social support, high levels appear to buffer or protect against the full impact of mental and physical illness.
How anger effects long-term health and limits responses to medical care
Declines in health despite medical care
Chronic anger states may hamper positive responses to medical treatment. For instance, patients with heart disease who expressed their anger openly and had low emotional support were more likely to see their disease worsen over time, regardless of medical treatment they received (13).
A Harvard scientist found that simply recalling an angry experience from their past caused a 6 hour dip in antibody immunoglobulin A, the cells first line of defense against infection(14). Hostility may also effect the course of cancer treatments. Family dementia caregivers (15) and men with prostate cancer (16) having high anger also had decreased production of cancer killing cells.
Anger and hostility have been found to predict cardiac and total mortality (death from all forms of disease) (17).
Anger and surgical outcomes
Recovery from surgery differs widely among patients having similar procedures but seems highly related to patient-specific immune functioning (17) which as reported, is affected by patient anger and hostility
Certain patterns of chronic anger expression have been associated with longer surgical recovery and more post-surgical complications as found in a sample of patients with colorectal cancer (18) who had longer hospital stays.
Researchers gave blisters to 98 participants and found those with poorly controlled anger had slower healing (19) on 8 day follow-up.
Couples took one day longer to heal from blister wounds following the discussion of a marital disagreement (20) compared to those who had a supportive conversation.
Notably, the couples who had high hostility across both visits took two more days to heal on average compared to less hostile couples. Relaxation interventions seem to facilitate recovery following surgery (21).
The poor management of anger may contribute to a host of health problems by activating the fight or flight system and impulsively triggering unhealthy behaviors in regard to eating, exercise, driving and substance use. Healthier choices may result from being slow to anger.
Hostility and the resulting behaviors tend to alter immune functioning, hamper responses to medical care, slow surgical recoveries, increase the possibility of post-operative complications and lead to a shorter life (22).
The body seems to prefer a balanced compromise between anger-in and anger-out, where frustrations are aired out for problem solving and releasing internal burdens, minus the extreme expressions of emotion that are hurt relations and upset the balance of the body long after they occur.
We have more personal control of anger and its affects to health by exercising relaxation techniques in our day to day living.
- Hostility, anger, aggressiveness and coronary heart disease Timothy Smith, John Ruiz, Linda Gallo, Journal of personality, 2004).
- Hostility and anger, Int J Psychophysiology. 2009 Vella E Friedman).
- Hostility and Anger In: Cardiovascular Reactivity and Recovery to Mental Arithmetic Stress Elizabeth J. Vella, Ph.D. a and Bruce H. Friedman, Ph.D. b
- (Ishihara S, Makita S, Imai M, Hashimoto T, Nohara R. Relationship between natural killer activity and anger expression in patients with coronary heart disease. Heart Vessels. 2003;18:85–92.[PubMed].
- Psychoneuroendocrinology, 2006 & Musante l, treiber, FA. The relationships between anger coping styles and lifestyle behaviors teenagers, J of adolescent health. 2000
- (Engel, Bosek. The relationship of momentary anger and impulsivity to bulimic behavior. Behavior research and Therapy 2007).
- Golden, Williams, and Ford Anger temperament is modestly associated… 2006)
- (Sullman MJM, Gras, Cunill. Driving in Spain. 2007 Personality and Individual Differences).
- Anger: The Unrecognized Emotion in Emotional Disorders Clair Cassiello‐Robbins David H. Barlow First published: 04 February 2016 https://doi.org/10.1111/cpsp.12139
- The Role of Anger in Generalized Anxiety Disorder. Article in Cognitive behaviour therapy 41(3):261-71 · March 2012 with 2,083 Reads DOI: 10.1080/16506073.2012.666564 · Source: PubMed)
- (The role of Dependency and Self-Criticism in the relationship between anger and depression Author links open overlay panel RudyAbi-Habib a PatrickLuyten ab )
- Social Support and Resilience to Stress – NCBI – NIH https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/ May 11, 2007
- Impact of social support,cynical hostility and Anger. Expression on progression of Coronary Atherosclerosis, 2000 J of Am College of cardiology.
- High Immunoglobulin A Levels Mediate the Association Between High Anger Expression and Low Somatic Symptoms in Intimate Partner Violence Perpetrators)
- (Scanlan JM, Vitaliano PP, Zhang J, Savage M, Ochs HD. Lymphocyte proliferation is associated with gender, caregiving, and psychosocial variables in older adults. J Behav Med. 2001;24:537–559.[PubMed].
- (Penedo FJ, Dahn JR, Kinsinger D, Antoni MH, Molton I, Gonzalez JS, Fletcher MA, Roos B, Carver CS, Schneiderman N. Anger suppression mediates the relationship between optimism and natural killer cell cytotoxicity in men treated for localised prostate cancer. J Psychosom Res. 2006;60:423–427. [PubMed]
- Hostility and Health, handbook of behavioral medicine , John Barefoot and redfor Williams pp 169-183
- Patient-specific Immune states before surgery are strong correlates of surgical recovery, Anesthesiology, 2015. Fragiadakis).
- 2007 Sharma A, Sharp DM, Walker LG, Monson JRT. Patient personality predicts postoperative stay after colorectal cancer resection. Colorectal Dis In Press. [PubMed])
- ( The influence of anger expression on wound healing. Gouin, Kiecolt-Glaser, Malarkey, Glaser Brain behavior Immun 2008, july).
- (Kiecolt-Glaser JK, Loving TJ, Stowell JR, Malarkey WB, Lemeshow S, Dickinson SL, Glaser R. Hostile marital interactions, proinflammatory cytokine production, and wound healing. Arch Gen Psychiatry. 2005;62:1377–1384. [PubMed]
- Montgomery GH, David D, Winkel G, Silverstein JH, Bovbjerg DH. The effectiveness of adjunctive hypnosis with surgical patients: a meta-analysis. Anesth Analg. 2002;94:1639–1645. [PubMed]