Do you have an anger problem?

A classic symptom list for depression will usually include feelings of 'irritability' or 'easy agitation'; yet anger is often overlooked in discussions about the condition.

Dr Mark Salter, Consultant Adult General Psychiatrist and spokesperson for the Royal College of Psychiatrists, stresses that anger is very rarely a stand-alone condition unless it's extreme. Instead, anger is often a symptom of another mental health problem.

There are five main human emotions: anger, sadness, fear, disgust and joy. Anger usually occurs as part of our 'fight or flight' response - our body's reaction to a situation it perceives as harmful.

"In order to understand how anger is a symptom of something like depression, you've got to understand what the emotional state of an individual is, how they see the world and how they react to things that challenge them," Salter reveals.

He concludes that as long as the anger is short-lived and not an excessive response, it usually serves a healthy purpose. Short-term anger can be good for immediate situations as it can jog us into action. However, if a person is angry on a long-term basis, this can have detrimental health effects. Prolonged anger can lead to unhealthy lifestyle choices, such as excessive drinking, or poor diet and lack of exercise - not to mention the negative consequences on relationships.

The effects of long-term anger

Repressed traumas, or PTSD, often lead to chronic anger as a coping strategy, Salter reveals. It's more common for men to turn to anger when dealing with past trauma, while women tend to become anxious or depressed, although this is not true for everyone.

Long-term anger results in an increase in the stress hormone cortisol in the body. Chronically raised levels of this hormone can lead to increased adrenaline, raised pulse rate, and high blood pressure, and can even be bad for your immune system.

"People with long-term anger often become tense, exhausted, irritable, depressed, confused and at greater risk of developing type 2 diabetes," says Salter.

Common causes of anger problems

Counsellor Natasha Clewley, a spokesperson for the British Association for Counselling and Psychotherapy, says that as children, we learn to express things by observing things around us and copying them.

"If we witnessed unhealthy expressions of anger as children - whether that be violent outbursts or suppression - we ourselves may struggle to express anger in a balanced healthy way as adults," she points out.

Suppressed anger can lead to turning negative feelings towards ourselves, causing anxiety and low self-esteem. And outbursts of uncontrolled anger may cause physical or psychological harm to ourselves and others. This could lead to alienation and disruption of normal life, through job loss or a relationship breakdown, for instance, if you have no constructive way to process these feelings.

"All these things can increase our anger as we feel more and more isolated and unsupported, leaving us stuck in an anger spiral," says Clewley.

So what can be done to avoid this?

Identifying the red flags

Recognising that you have a problem is the first step, and it's a tough one. But remember, short-lived and proportionate anger can be helpful as long as it doesn't cause anyone harm.

However, Salter notes: "Common signs of chronic anger problems such as prolonged violence, rage, sulking and passive aggression are tremendously energy-consuming and detrimental to our health."

So first of all, ask yourself these questions, advises Clewley:

• Is your anger disproportionate to the situation at hand?

• How quickly do you get angry and how long do you hold on to anger?

• Have people mentioned to you they are worried about your anger; are they scared or do people find it difficult to communicate with you?

• Are you suppressing your anger and trying to avoid it?

• Do you often get upset or angry at yourself for thoughts or feelings you might have? Are those thoughts intrusive?

• Do you use substances or self-harm to mask or suppress your anger?

• Do you often find yourself getting irritable?

• Do you react violently when angry?

How you can help yourself

Imagine a fizzy drink

Clewley suggests imagining a bottle of fizzy drink:

"If you shake it up, and take the lid off straightaway, it will go everywhere. So learn to let your emotions out a bit at a time instead. If someone makes you angry, let your anger decompress by waiting 90 seconds before you respond - or simply walk away."

If you are able to, have a constructive discussion about your feelings with a friend or therapist, as long as it's someone who doesn't fuel your anger.

"And if you don't want to share, write it down in a journal, or write on bits of paper, then screw them up and throw them away," says Clewley.

Try mindfulness

Mindfulness and relaxation exercises are helpful tools to help you focus your mind and emotions.

Get moving

Exercise often provides a constructive physical outlet for anger, but it's best if it increases your heart rate.

"Most people who run will meditate without realising," says Salter. "Running is associated with a drop in blood pressure, a drop in pulse, and a relaxation of the mind."

After more than 10 minutes of exercise, most people will feel a release of 'feel-good' hormones (endorphins) to the brain. It can be hard to get going, but Salter notes that recognising your own self-defeat by putting off or refusing to exercise is an important part of anger management.

Make a change

Long-term solutions to managing your anger problems might include giving up alcohol and stimulants, a healthy balanced diet, tackling other life stresses at work or home, and taking up a new hobby.

How you can help a friend

People who are angry usually cannot consider an alternative to their emotions while they are feeling the rage. So wait until they are feeling calmer before you bring it up.

"Often," says Salter, "a person has had such a lot gained from being chronically angry, they discount the exhausting consequences in the long term because it works for them."

You must always take a step back, then get them to relax and have a chat about the situation. If they are irritable you will often be able to recognise when they are about to get angry so try to distract them if possible.

Seeking professional help

The first port of call for an anger management problem, as for any mental health issue, is usually your GP. They may be able to refer you to local services on the NHS. But do be aware - if you decide to start anger management counselling, be prepared to tackle difficult emotions and where they stem from.

"This involves a trusted relationship with a therapist," says Salter. "Psychotherapists listen to people and help reflect back to them how their sense of 'me' came about."

He says that this kind of therapy requires having an enormous amount of courage to face up to what is underneath your anger. It's tough, but the long-term benefits are immeasurable.

If one-to-one psychotherapy seems daunting or isn't a viable option, Salter recommends group therapy sessions. Organisations like Mind will work with local charities to run anger management workshops near you.