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Section 16
Anger, Defense and Personality Disorder

Question 16 | Test | Table of Contents


It's hard to let go of anger after you've learned to employ it as a defense. It always seems as if the anger is easier to feel than fear or hurt or guilt or emptiness. And of course it is. At that moment. All addictions feel good at the moment, all addictions serve to block pain, and all addictions offer a short-term feeling of control and well-being.

The problem with addiction is never in the moment, but in the aftermath. The long-term effects of chronic anger on health and relationships have been discussed in previous chapters. There is a third and equally damaging effect from addictive anger. In everything except direct threat, anger tends to lead you away from appropriate action. When you use anger to block painful feelings, you never get to deal with the feelings themselves. And you never get to address the problem that generated the feelings to begin with.

Anger keeps you from dealing with the source of fear. Fear derives from one of two things: misattributions (distorted and exaggerated perceptions of danger) or actual danger. Consider Irma's case as an example of misattribution. She was convinced that her 16-year-old son was a heavy drug user. She buried her fear underneath frequent outbursts about his clothes, choice of friends, sexual activities and, of course, his suspected drug use. Her son, whose drug use consisted of smoking marijuana once a week, dismissed her as a "person whose IQ approaches absolute zero." Anger prevented her from getting accurate information about her fears. She had no way of correcting her misattribution because her communications had a blaming rather than fact-finding function.

Anger not only prevents you from correcting fear-inducing distortions, it stops you from effectively coping with real threats. A man who had been mugged in a dangerous neighborhood railed against his company for relocating in the "knock-you-down-for-a-dollar part of town." For months he talked about the details of the mugging and the poor treatment he received from the police, made racial slurs, and began referring to every young man on the street as a "f***ing thief." His anger prevented him from dealing effectively with the danger. There were choices he could make: he could buy a car, stop working late, arrange for a lift home, or even get a job in a safer part of town. He failed to explore a single one of these options because he wasn't motivated to. His anger was masking most of his fear; he simply wasn't scared enough to make an adaptive decision.

Anger keeps you from dealing with your pathological critic. This is the voice inside of you, spawned by hurt, neglect, and criticism from your parents, that attacks you for every flaw and imperfection. It's the pathological critic who makes you feel wrong and bad and worthless when you make a mistake or when you're criticized. It's the critic who internally abuses you when you fail to live up to your highest standards. Some people are in so much pain from their critic that they learn to turn it loose on the world rather than go on feeling worthless and bad. If they can just make the mistake someone else's fault, if they can just find some reason to attack and blame, they can shut off the chanting inner voice that keeps saying "bad, bad, wrong."

The trouble with using anger to calm your critic is that you never learn to talk back to its abuse. You never cope directly with the crippling things it says to you. Harold was a trombone player in a major symphony and a perfectionist about his playing. His pathological critic would denigrate an entire performance if his tone was unsatisfactory for a few notes. But he learned to shut these feelings off by focusing on the performance of other musicians in his section. He raged about sloppiness, lack of preparation, and "musical incompetence that should have been obvious at their audition." Expecting the worst from others became a psychological trademark. The real problem was never addressed: low self-esteem and a killer critic.

Anger keeps you from examining the values that generate your guilt. Guilt results from a collision between needs and values. Sometimes the values are healthy and appropriate; sometimes they are not. Arlene worked for an attorney who frequently was poorly prepared for hearings. She helped him by preparing one- or two- page summaries of the salient issues in each case before he appeared in court. Whenever he was embarrassed or lost a case, she blamed herself and then defended against the guilt by criticizing her daughter's school work when she got home. Anger kept Arlene from questioning her values. Was she really responsible for the incompetence of her employer? Was it her job to anticipate every pitfall of a case?

The other side of the coin is also true. Many people run from guilt generated by appropriate and healthy values. A man who had custody of his 15-year-old daughter was rarely home to supervise her. He dealt with his guilt by denouncing her as "undisciplined and irresponsible, a nightmare on 12th Street." Here the anger prevented a reexamination of his behavior and a square look at how his night life was incompatible with good parenting.

Anger keeps you from facing loss. Chronic anger prevents you from grieving, from letting go. You just keep replaying the sins and violations of the person who abandoned you. The short-term effect is that you don't have to feel sad. The long-term consequences are symptoms of unresolved grief and the inability to trust or bond with others. Serena was a topflight model who suffered minor facial scarring in an auto accident. She railed at the plastic surgeon's incompetence, filed a lawsuit, and dumped the boyfriend whose driving led to the accident. Anger helped to keep the grief away. She thought very little about a new career, about decisions that lay ahead. But her bitterness was palpable when she interviewed for jobs as a receptionist or salesperson.

Anger keeps you from saying what hurts. Angry people don't talk about their pain. They talk about the faults of others. No one knows how much they hurt, how wounded they are by a remark or gesture. While the short-term effect of anger is to block feelings of hurt, the long-term consequences are that no one ever learns to recognize or accommodate vulnerabilities.

Arnie feels hurt whenever his wife mentions his recent six-month period of unemployment. He sees himself as an incompetent breadwinner, and so he counters with a discussion of her spending habits or picks a fight about their inability to save. Arnie's wife never hears about his hurt, and the core problem is never communicated. The truth is that she would gladly change her behavior if she only knew.

Anger keeps you helpless by stopping problem solving. When you're angry it's hard to fix things. You feel like a victim; life seems out of your control. While the deep frustration of feeling stuck can be somewhat masked by anger, the impulse to blame or attack prevents you from real problem solving. As in the case of the man who was mugged or the model who was disfigured, anger works in the short term to keep feelings of helplessness at bay. The long-term consequence is that important decisions never get made. And your self-defeating behavior remains unexamined.

Anger keeps you empty. Angry damages the very relationships that are the source of nourishment. Laurie's husband is a sports addict; she hates the sound of football because she associates it with loneliness and isolation. But the more she cornplains, the more her husband withdraws into the games. Anger keeps Laurie from taking more effective steps to increase the level of intimacy in her relationship.
- McKay, Matthew, Rogers, Peter & Judith McKay, How to Change Painful Feelings Into Positive Action When Anger Hurts, MJF Books: New York, 1989.

Borderline Personality Disorder: Current Drug Treatments
and Future Prospects

- Olabi, B. and Hall, J. (2010). Borderline personality disorder: current drug treatments and future prospects. Therapeutic Advances in Chronic Disease, 1(2). p. 59-66. doi: 10.1177/
2040622310368455

Personal Reflection Exercise #9
The preceding section contained information about borderline personality disorder and the addictive nature of defense. Write three case study examples regarding how you might use the content of this section in your practice.

Update
Anger Instability and Aggression
in Borderline Personality Disorder
- An Ecological Momentary Assessment Study

- Neukel, C., Bullenkamp, R., Moessner, M., Spiess, K., Schmahl, C., Bertsch, K., & Herpertz, S. C. (2022). Anger instability and aggression in Borderline Personality Disorder - an ecological momentary assessment study. Borderline personality disorder and emotion dysregulation, 9(1), 29.

Peer-Reviewed Journal Article References:
Jacobs, I., Lenz, L., Dörner, S., & Wegener, B. (2019). How do schema modes and mode factors align with defense styles and personality disorder symptoms? Personality Disorders: Theory, Research, and Treatment, 10(5), 427–437.

Prunas, A., Di Pierro, R., Huemer, J., & Tagini, A. (2019). Defense mechanisms, remembered parental caregiving, and adult attachment style. Psychoanalytic Psychology, 36(1), 64–72.

McIntyre, K. M., Mogle, J. A., Scodes, J. M., Pavlicova, M., Shapiro, P. A., Gorenstein, E. E., Tager, F. A., Monk, C., Almeida, D. M., & Sloan, R. P. (2019). Anger-reduction treatment reduces negative affect reactivity to daily stressors. Journal of Consulting and Clinical Psychology, 87(2), 141–150

QUESTION 16
What is the problem with using anger to calm the inner critic? To select and enter your answer go to the Test.

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