Injured workers, and/or those seeking disability benefits due to psychological disorder, will refer to anger, outrage, or feelings of impending violence toward their employer, case manager, or primary provider. Many, however, are unable to identify their anger and will, instead, refer to themselves as emotionally “hurt” or “disappointed.”

Since the goal is to maximize the recovery potential of the pateint, it is critically important to determine to what degree anger is complicating the recovery process.

There is a two-way association between alcohol consumption and violent or aggressive behavior. Not only may alcohol consumption promote aggressiveness, but victimization may lead to excessive alcohol consumption.

Alcohol may encourage aggression or violence by disrupting normal brain function. According to the disinhibition hypothesis, for example, alcohol weakens brain mechanisms that normally restrain impulsive behaviors, including inappropriate aggression. By impairing information processing, alcohol can also lead a person to misjudge social cues, thereby overreacting to a perceived threat. Simultaneously, an alcohol induced narrowing of attention may lead to an inaccurate assessment of the future risks of acting on an immediate violent impulse.

Intoxication alone does not cause violence. Alcohol consumption may promote aggression because people expect it to. Alcohol-related expectancies of aggressiveness promote male violence.

In addition, a person who intends to engage in a violent act may drink to bolster his or her courage or in hopes of evading punishment or censure. The motive of drinking to avoid censure is encouraged by the popular view of intoxication as a "time-out," during which one is not subject to the same rules of conduct as when sober.

In humans, violence occurs largely among adolescent and young adult males, who tend to have high levels of testosterone compared with the general population. Young men who exhibit antisocial behaviors often "burn-out" with age, becoming less aggressive when they reach their forties. By that age, testosterone concentrations are decreasing, while serotonin concentrations are increasing, both factors that tend to restrain violent behavior.

Some individuals demonstrate violent outbursts of rage which are referred to as intermittent explosive disorder: the failure to resist an impulse, drive, or temptation to perform an act that is harmful to the person or to others. The individual feels an increasing sense of tension or arousal before committing the explosive act and then experiences pleasure, gratification, or relief at the time the act is committed. The individual may also experience remorse, regret, or embarrassment after the act, yet such sorrow had not been helpful in averting aggression in the past. Intermittent explosive disorder may cause violent behavior that results in physical assault, destruction of property, and even homicide.

Anger attacks are sudden intense spells of anger that resemble panic attacks but lack the predominant affects of fear and anxiety associated with panic attacks. They typically occur in situations in which an individual feels emotionally trapped and experiences outbursts of anger that are later described by the patient as being uncharacteristic and inappropriate to the situation at hand.

Depressed patients with anger attacks are significantly more likely to meet criteria for dependent, avoidant, narcissistic, borderline, and antisocial personality disorder than depressed patients without anger attacks.

Most often there is a significant difference between why the patient was psychologically referred and what is truly bothering that patient. DBA