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Re: is anger a sign of depression or.....?

Posted by Elizabeth on May 27, 2001, at 14:42:50

In reply to Re: is anger a sign of depression or.....?, posted by loosmrbls on May 24, 2001, at 11:09:58

> It really is impossible to make a diagnosis on this information.

This is always true on internet discussion boards...and of course, what you'll be getting is not a true diagnosis, but an educated guess (few professionals are willing to hazard an online diagnosis, IME). Still, it's something to start from.

> It is obvious he has mood lability and irritability, but those symptoms go along with numerous conditions -- including depression.

Mood lability (mood swings, including shifts from one dysphoric mood to another -- e.g., anxiety to anger to sadness) is definitely not what is meant by "depressed mood" in the diagnostic criteria for depression. In the context of depression, "mood-reactivity" refers to the ability to be cheered up on by pleasant events (but usually, the person has lost interest in former interests and will not actively seek out pleasure). The "mood reactivity" associated with borderline personality includes excessive, "out-of-control" anger that is out of proportion to whatever the person claims to be angry about. N.P.'s description of her husband's behaviour does sound somewhat like BPD -- inappropriate or out-of-proportion anger attacks that are intense but brief, stormy or unstable relationships and home life, the appearance of manipulativeness, the belief that his behaviour is "normal" or "acceptable," etc. -- but I think that personality disorder diagnoses are red herrings. (To say that BPD is the result of a lousy home life ignores the question of why only some of the many people who had lousy childhoods grew up to become "borderlines," and why some "borderlines" had extremely difficult childhoods (sexual and physical abuse, etc.) while others had only moderately difficult ones.)

Irritability is sometimes a prominent feature in depression -- some people express their depressed mood in this way -- but it seldom dominates the picture. Brief anger episodes in the context of an otherwise normal mood are not characteristic of depression; a depressed/dysthymic person with anger attacks would be gloomy, pessimistic, perhaps sarcastic. Also, irritability or anger by itself is not sufficient for a diagnosis of depressive disorder. Although I agree with loosmrbls that there isn't enough information, depression isn't what comes to mind based on the description given.

To me, this sounds like something that I've heard referred to as "ADHD spectrum disorder" -- see the writings of Akiskal for a discussion of spectrum theory of mental disorders. Basically what I mean is that the problems described don't fit into any of the current pigeonholes described in DSM-IV, but ADHD looks like the closest match based on the available information. (There are also some features associated with borderline personality disorder, which appears to be related to ADHD in many cases.)

Although they do often have difficulty with concentration and attention, people with ADHD are known to focus intensely on certain activities; what particularly caught my eye was the suggestion of "computer addiction." This seems to be very common among people with ADHD (in my experience). Angry outbursts are also common among adults (as well as children) with ADHD. These outbursts are thought to be due to impatience or poor frustration tolerance.

As loosmrbls points out, ADHD is a life-long, temperamental disorder. N.P., could you tell us anything about what your husband was like as a child? That would be very helpful. A chaotic home life, as you described, is especially harmful to a child who is sensitive, impulsive, and inattentive. I can easily imagine that such a child would not "grow out" of these traits if he grew up in a chaotic environment.

It would also be helpful to know more about what your husband's personality is like when he is not having anger attacks -- what do you see as his strengths and weaknesses?

Medically, the most effective treatments for the ADHD-borderline spectrum of disorders are probably antidepressants (e.g., SSRIs, Effexor, MAOIs -- but *not* tricyclics), psychostimulants (Ritalin, Dexedrine, Adderall, Cylert), and anticonvulsants (Depakote, Tegretol, Lamictal). There are also cognitive-behavioural psychotherapies that can be effective, but I think they are probably less effective if the mood aspects of the disorder (in this case, the anger attacks) are not treated first.

I hope that this makes sense and can help lead you to a solution. I know your husband seems like the "bad guy" when he's having these episodes of anger, but my guess is that they are a source of shame and pain for him as well as for you and your children.

Best wishes,




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