Circle of Madness: Chronic Illness and Anger

I was thinking about the interconnectedness of mind, body and spirit, and wondered about the relationship between fibromyalgia (or other chronic pain conditions) and anger. Here are some findings:

Anger causes pain to increase

Over 40 years ago, a study looking at anger with respect to pain and other symptoms of illness found that people with intractable (difficult to treat pain) were more likely to suppress anger. [1] About 20 years later, another study revealed

…a style of inhibiting the expression of angry feelings was the strongest predictor of reports of pain intensity and pain behavior among a group of variables including demographics, pain history, depression, anger intensity, and other styles of anger expression. In a similar manner anger intensity contributed significantly to predictions of perceived pain interference and activity level.[2]

These observations have been validated more recently by a study that looked at self-reporting and correlated it with the perceptions of loved ones.

…in patients with chronic pain, anger arousal and both behavioral anger expression and inhibition in everyday life are related to elevated pain intensity and decreased function as reported by patients. Spouse ratings show some degree of concordance with patient reports.[3]

The value of looking at something like this over a long period of time is that it shows the relationship between anger and higher levels of pain is persistent and consistent. It’s not a fluke.

Anger and Fibromyalgia

Unresolved anger can cause or intensify fibromyalgia symptoms but people with fibromyalgia have may have more difficulty identifying and expressing negative emotions than people with other chronic pain conditions.  For this reason, I’m using fibromyalgia as the key illness for exploring some thoughts about recognizing how emotions amplify symptoms and contribute to chronicity, potentially in any long term condition.

A 2003 study found that when compared with people who have rheumatoid arthritis, people with fibromyalgia were more likely to have difficulty identifying their emotions, and were also more likely to have inwardly directed anger.[4]

What does this relationship mean for people with chronic illnesses? I think it means:

  • we are likely to have anger from the past as well as anger about our current condition intensifying our pain
  • we are more likely to not recognize that we are angry when we are
  • we are more likely to have unexpressed anger towards ourselves

If this relationship is circular, meaning unexpressed anger increases the likelihood of pain, pain increases the likelihood of anger and resentment of limitations, and fibromyalgia increases the likelihood that the anger will build because it is unexpressed, then anger could become something that perpetuates symptom flares in people who would otherwise be able to manage their conditions well.

Implications for Treatment

If this model for the relationship of anger and fibromyalgia (or other chronic illness) has validity, therapies that help people to identify and manage their emotions should result in lower levels of pain and possibly other symptomatic improvements. There is some evidence that this is true, especially with respect to Cognitive Behavioural Therapy and emotional awareness and expression techniques.[5] [6] [7]

Beyond formal treatments, asking ourselves during periods of heightened pain if we are angry about something and waiting for an inner response could be a simple way of breaking the anger-pain cycle by making us more aware, and forgiving ourselves and others for making us angry could prove to be therapeutic.[8]










[8] https://mayoclinic.pure.elsevier…