Angry Outbursts - Responsibility to Get Help, Enabling & Biochemical Drivers

& What the Presence or Absence of Remorse Suggests Biochemically

Whether it’s an older child with frequent tantrums, or an adult who easily loses their temper, I think of angry outbursts as a symptom with underlying root causes.   While there may be triggers, someone’s inability to regulate their emotions, in my experience, suggests a biochemical and/or inflammatory driver.  In this newsletter, I’ll discuss:

• An important difference between angry outbursts and other symptoms.

• The impact on the neuro-physiology of others.

• Reasons this behavior may be enabled by others.

• Associated diagnoses.

• The four most common underlying physiologic factors that I see in my practice that appear to drive angry outburst.

• What the presence or absence of remorse after a tantrum can tell us about underlying physiologic drivers.

Here are my 10 thoughts:

1. Responsibility

Though I think of angry outbursts as I would any other symptom (depressed mood, anxiety, or inattention), angry outbursts more directly affect others.  One doesn’t have to be touched, screamed at or have their property damaged to be impacted.   This means there’s an additional level of responsibility for those with this symptom, to seek help (or for parents in the case of a child). There is not one way to address this symptom. I will share how I approach this from a holistic and functional (root cause) perspective. While such approaches can be impactful (and why I use them), they are not an appropriate starting point for someone who is highly unstable or a danger to themselves or others. In such cases, an immediate assessment through an emergency room is indicated.

2. Impacts

The consequences for angry outbursts extend beyond embarrassment, damaged relationships, removal from school, loss of employment - or in more extreme cases - legal consequences.  Those who are the recipients of the rage or even those witnessing an episode of rage may be momentarily unsettled, or they may be triggered (given their own past experience) or even traumatized.   The severity, frequency, and how threatening the episodes, will determine the impact on others’ neurophysiology, as does the others’ temperaments.  Even having to walk on eggshells because of the threat of someone losing their temper, reinforces the neuronal connections around vigilance.  We have different temperaments. One person may feel a football player losing his temper with a coach is not a big deal, others will feel it’s a big deal. This week, I heard a sports analyst insisting loudly that Travis Kelce’s behavior at the Super Bowl was appropriate.  He repeatedly interrupted his two colleagues who felt the behavior was inappropriate.  Even if the coach who was bumped and screamed at, didn’t - or said he didn’t - have a problem with it, that doesn’t make it okay. Also, he wasn’t the only person impacted.  There were families with children watching.  They saw a man (nearing royalty status in this country) model aggressive and out of control behavior ...and then, get a big trophy and a big kiss by Taylor Swift, the most culturally influential woman in the U.S at the moment.  The obvious message, “You too can act like that and be rewarded.”

3. Enabling

Generally speaking, enabling means giving somebody the ability to do something. In the case of tantrums, it means giving someone the ability to continue to have angry outbursts and not get help. There are many reasons someone may enable this behavior. They may fear the person.  It may be in their interest (financial or otherwise) to cater to the person who has tantrums. They may be so focused on the details of why the person got angry, that they lose sight of the big picture and the harm being done to that person and those around them.  Someone might enable because they identify as someone who is good at helping others and they think they can fix the person, or love them out of the behavior.  How adults respond to another adult's angry outbursts often speaks to what was normalized in the household they grew up in. Maybe they had a parent who couldn’t or chose not to control their temper or other problematic behavior.  And, maybe they had another parent who normalized it, joked about it or suggested there was a good reason for it.  This can be especially confusing for children, looking to the seemingly reasonable parent to make sense of things.  This early experience can lead to future adults who express their anger inappropriately, and to future adults who normalize their partner,  boss, employee or even child’s outbursts.  Often people don’t see or are in denial about the leverage they have to help the person get help.  An example of using one’s leverage could be a coach (or team owner) telling a player who tantrums, that if they want to keep playing, they’ll need to get help.  And, they have to mean it. There is much more that can be said about this. I welcome your thoughts:

4. Diagnoses

In my practice, diagnosis becomes less important than the behavior and what is causing it. Intermittent Explosive Disorder is a diagnosis, more often given to adults, to describe an inability to control sudden bursts of anger in the form of arguments, tantrums, fights or even violence. Disruptive Mood Dysregulation Disorder, which is diagnosed in children, similarly involves severe recurrent tantrums, but in this case, there needs to be an irritable and angry mood between tantrums.  For both diagnoses, there are a range of medications (beta-blockers, antidepressants, mood stabilizers and stimulants) that can be used.  The form of therapy most often used is Cognitive Behavioral Therapy or CBT.

5. Associated Diagnoses

• ADHD - Some would consider ADHD a disorder of self-regulation involving not just behavior and attention (as the formal diagnosis includes), but also emotion.  Studies reflect that most (not all) children and adults with ADHD have problems with emotional dysregulation. While emotional dysregulation doesn’t have to mean tantrums, tantrums are emotional dysregulation. I’ll explain below why this link with ADHD makes sense biochemically. 

• Bipolar Disorder- This condition is marked by extreme mood swings, which could include mania (emotional highs) and depression.   Tantrums are not necessarily part of this diagnosis, however, when someone is manic, there can be a mix of impulsivity and mood dysregulation that can result in angry outbursts. When some is diagnosed with intermittent explosive disorder, they are not necessarily having other symptoms between their outbursts.

• Oppositional Defiant Disorder (ODD)- This involves a pattern of negative, hostile and defiant behavior and can include excessive arguing, annoying and pushing buttons. This diagnosis is given to children. I tend to see it as an anxiety in disguise. Nonetheless, angry outbursts can be part of this, but again, not in isolation. Overwhelmingly, most children diagnosed with ODD will be undermethylated (have a methyl/folate imbalance). Undermethylation could also contribute to one becoming angry if they are not getting their own way or winning.  The fuel to the explosions, however, is more likely …

6. High Copper

This is the first thing that I think of when an adult or child has angry outbursts.  High copper also appears to be a common driver of ADHD. Hyperactivity, inattention, insomnia, or high anxiety are also associated with high copper or copper/zinc imbalances. The Walsh Research Institute found that 68% of adults and children diagnosed with ADHD had a copper/ zinc imbalance, meaning that the copper was relatively high in relation to zinc. Bringing down copper is usually not difficult using an individualized Walsh nutrient protocol.  

7. High Pyrroles

This is the second thing I think about. High pyrroles can occur with high copper.  Here, I would expect the person to have low stress tolerance, mood swings, and more difficulties in settings where there is over stimulation. High pyrroles results in deficiencies of zinc, B6, magnesium. Someone could have high pyrroles, and thus low zinc leading to high copper (zinc keeps copper in check). This too can be addressed using an individualized Walsh nutrient protocol.

8. Mast Cell Activation

Though mast cells are not in the brain, when triggered (stress is one of the things that can trigger them), they communicate with inflammatory cells in the brain.   If these cells in the brain have been “primed” by things like head trauma, toxicity, or emotional trauma, then when another insult comes along (which could be a moment of frustration, an illness, another physical or emotional trauma), this inflammatory process can more easily and rapidly occur.  In some ways, angry outbursts are not unlike a panic attack in that they appear to involve interactions between our autonomic nervous system, our hormonal stress response and these inflammatory cells. In combination with Cognitive Behavioral Therapy (CBT), I find that interventions that target the autonomic nervous system (accessing the vagus nerve - to take the body out of fight or flight) and thereby lowering the hormonal stress response, can be helpful. EMDR, somatic based therapies, limbic system retraining can also be helpful here, as can interventions to stabilize mast cells. 

9. Mold Toxicity

This is a surprisingly common driver of mast cell activation, an increased fight or flight response, high pyrroles and even high copper.  Mold toxicity essentially is an internal threat that already has the body closer to that fight or flight response. A  little more threat  or frustration for some could lead to angry outbursts, for others panic attacks, high anxiety and still others, checking out.  When I see families that have more than one family member having problems with angry outbursts, I think of genetics, modeling this way of managing anger, but also sharing environmental exposure to water damage. Aside from addressing the mold exposure, there are treatments to address mold toxicity in the body. A shared exposure to very high electromagnetic fields in a family could also cause this, which again has treatment interventions.

10. Remorse

Not everyone is remorseful (or shows remorse) after they have an angry outburst. When someone does show remorse, it is more likely that they will have high copper. I’m not sure why this tends to be the case, but relative to the other three factors, high copper does not lower serotonin activity.   If a child is extremely oppositional or if an adult is highly competitive, very strong willed and unable to see the big picture, but rather only the details of what they were angry about, they are less likely to show remorse. They are also more likely to be undermethylated.  Obviously remorse can impact how motivated someone will be to seek or want help.

If you, or someone in your life, has problems controlling anger, I hope something here helps motivate you to seek professional help.

Until next time,

Courtney

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Medical Disclaimer:

This newsletter is for educational purposes and not intended or implied to be a substitute for professional medical advice, diagnosis or treatment for either yourself or others, including but not limited to patients that you are treating (if you are a practitioner). Consult your own physician for any medical issues that you may be having.