**3. Anger**

Anger is the most basic emotion varying from mild irritation to intense fury in response to feeling threatened or hurt.

It has three components:


Unfortunately, anger is also poorly understood in current diagnostic practices. For example, in DSM V, there are no Axis I disorders that directly address the emotion of anger, unlike anxiety and mood disorders.

Anger as such is a natural emotion, but if it increases, it can cause devastating effects upon the body and most conspicuously upon the heart [37]. It is observed that healthy persons may also occasionally have a conspicuous boost in their blood pressure occasionally when they are angry [38, 39] explain that anger is an arousing state with feelings varying from slight irritation to intense fury or rage. It is reported that anger-arousing situations also become an important contributing factor for increased blood pressure [17]. Historically, its roots back to 1939, when Alexander

*Stress-induced Anger and Hypertension: An Evaluation of the Effects of Homeopathic… DOI: http://dx.doi.org/10.5772/intechopen.104589*

#### **Figure 2.**

identified the suppression of anger as a major cause of HTN and further investigated its lethal outcomes in the human body. The reactivity hypothesis describes that individuals prone to HTN react to environmental stress with intense anger [23]. In an earlier study on people with HTN [24] reports that blood pressure rises remarkably during anger states. The association of anger with HTN has been confirmed by many researchers [40, 41], and is a well-established risk factor for CHD [40, 42] further augmenting the association between HTN and cardiovascular diseases.

Anger is an important variable in essential hypertension. Cardiovascular reactivity to stress in which a recurrent pattern of exaggerated sympathetic nervous system activity is proposed to up-regulate basal blood pressure levels over time.

The neurohormonal model shows that psychological characteristics may predispose to CVR and hypertension development by altering the central nervous system control of baroreceptor function, opioid activity, and neurotransmitter levels. Unresolvable anger causes prolonged sympathetic nervous system over-activity. Anxiety and guilt of consequences of expressing anger results in suppression of anger. In vulnerable individuals, neural mediation of repetitive high BP episodes causes structural adjustments in arterioles culminating in sustained hypertension. Anger could be contributing to the elevation of BP directly through psychophysiological activation via the HPA axis and indirectly by facilitating the emergence of a coping style that contributes to the maintenance of elevated BP (**Figure 2**).

According to Addotta [43] anger comes from the reptilian part of our body, known as the amygdala, an almond-shaped structure located just above the hypothalamus, one on each side. They consist of several nerves connected to various parts of the brain, such as the neocortex and the visual cortex. Amygdala is an excellent indicator of threats. Its primary purpose is emotional and social processing. One can react to a threat before the prefrontal cortex, responsible for the brain's thoughts and judgments, can assess the rationality of the reaction. The amygdala is responsible for the brain to react to a threat or fear before the prefrontal cortex can consider the consequences. Resilient people can make rapid recoveries from stress, with their prefrontal cortex working to calm the amygdala. However, the brain cannot release itself out of an emotional rut; and, the body is flooded with the cascade of cortisol or stress hormones ("Effects of Anger,", para. 18).

Before one feels anger, a primary emotion is felt. It can be a feeling of fear, offense, disrespect, force, entrapment, or pressure. When the primary emotions become too intense, the secondary emotion of anger is experienced.

In some cases, minor irritation can trigger full-blown anger within a shorter period. According to Dr. Sietse d Boer of the University of Groningen, "serotonin deficiency appears to be related to pathological, violent forms of aggressiveness, but not to the normal aggressive behaviour that animals and humans use to adapt to everyday survival" (as cited in Society for Neuroscience, 2007, para. 19).

Anger can assemble psychological resources for corrective action. Uncontrolled anger can negatively affect personal and social wellbeing. Many philosophers and writers have cautioned against the spontaneous, wild fits of rage, but they disagree on anger's intrinsic value. Coping with anger has been addressed in the writings of the earliest philosophers up to modern times. Most notable being Bhagvad Geeta in its Chapter 2, Verse 63, says:

क्रोधाद्भवति सम्मोह: सम्मोहात्स्मृतिविभ्रम: |स्मृतिभ्रंशाद्बुद्धिनाशो बुद्धिनाशात्\ ्रणश्यति || Meaning: Anger distorts thought & perception leading to errors in reasoning which results in damage & destruction [44].

Modern psychologists and psychiatrists have also pointed out the harmful effects of suppressing anger.

Anger is a predominant feeling expressed behaviorally, cognitively, and physiologically when a person consciously chooses to stop the threatening behaviour of another outside force immediately [45].

### **3.1 Concept and assessment of anger**

Anger is a universal emotion. It has long been recognized as a significant constituent of human life since long. Individuals face many problems in their daily lives and solve them [46]. While solving these problems, they exhibit different emotional and behavioral reactions, and anger is one of them. Anger is one of the basic emotions felt by almost everyone at times. Simultaneously, it can be suggested that it is one of the most interesting and least understood feelings [47].

Kassinove and Tafrate [48] asserted that anger is often a learned emotion. They believe that anger is partly an inborn quality but mostly modeled from family and the surrounding environment. However, people learn from the social environment about what and when they will get angry and the kind of behaviors they will exhibit [49–52].

Anger is a multidimensional construct that consists of physiological (general sympathetic arousal, hormone/neurotransmitter function), cognitive (irrational beliefs, automatic thoughts, inflammatory imagery), phenomenological (subjective awareness and labeling of angry feelings), and behavioral (facial expressions, verbal/behavioral anger expression strategies) variables [53–55]

#### **3.2 Anger expression/anger subcategories**

Spielberger et al. [56] stated that the expression of anger must be distinguished conceptually and empirically from the experience of anger as an emotional state (S-anger) and individual differences in anger as a personality trait (T-anger).

Anger-In (AX-In): mean anger held in or suppression of angry feelings. Anger-Out (AX-O): this is defined as the frequency at which angry feelings are expressed in verbally or physically aggressive behavior.

Anger Control (AX-Con): this refers to attempts to control and suppress or mitigate anger expression.

*Stress-induced Anger and Hypertension: An Evaluation of the Effects of Homeopathic… DOI: http://dx.doi.org/10.5772/intechopen.104589*
