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Suggest Treatment For Anger And Aggressive Nature

Posted on Mon, 14 Apr 2014

Question: Hi Doctor I have a person in our family who is very aggressive and unable to control his anger. Because of his uncontrolled anger he has hurt himself and people who live with him. Also in anger his wife complains that he starts to hit her and looses complete control. Please let me know how to treat his anger because as observed by me he is a person who also never realizes of what wrong he does out of his anger. He has embarrassed his parents and wife several times because of this and we (me & my husband) don't want this to happen ahead. Please suggest if some medication might help him!

Answered by Dr. Manisha Gopal (1 hour later)

Brief Answer: donot loose hope; need few more details Detailed Answer: hello XXXXXXX On reading your question it is almost certain that the person concerned needs help from a psychiatrist. It is evident that he is quite volatile in his temperament & gets irritable and voilent at trivial issues without any guilt for the same. As you said, i guess he is the head of the family or atleast the main earning member? And with such behavioral disposition it is questionable that he would ever agree for treatment.. However, do not loose hope as it is a common persentation and there are provisions for their treatment too. I would like to know few necessary details before deciding upon the diagnosis: 1. Is he suspicious in nature, suspects near ones for trying to harm him? 2. How is he at work place? Does he have frequent fights? 3. His sleep these days? 4. Does he spend too much\ boast of himself\ demanding? 5. Will he go for treatment willingly/ can anyone pursuade him for this among frends & family? The answer to these questions will help us in moving ahead with a suitable plan of managment. Please feel free to ask more questions related to this Wish you good luck Dr. Manisha Gopal MD Psychiatry

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Manisha Gopal (6 days later)

Hi Doctor, As I queried from his wife, he won't agree for the treatment because this discussion I also had with him when I saw such behavior but he denied for the same. At workplace he is fine enough but according to his wife, he does gets into fights, not frequent but sometimes. Also his wife explained that his company people are very co-operative and he has called his manager several times in anger that he will resign but due to good understanding of his manager he has continued well in the company and recently promoted also. Inquiring from his wife about his sleep she says that he sleeps fine but wakes up even on small disturbance outside home. And as far as suspicion is concerned, I would term this as insecurity because this even I have observed that he is very insecure about number of things and also he is stuck to several past incidences of past for which every now and then he keeps blaming his wife and all. The most shocking thing of all is that his wife, my very close friend, has suffered severe circumstances which when she told me I was shocked. They have love marriage and his family isnt supportive enough for this, although they do talk and all but because of them number of times they have had severe fights, once he locked in her room and had beaten her like animals. Later after 15 days he somehow realized but several fights in which he has hit her have happened. When I came to know all this I realized that a normal human being can not behave this way! Very nicely when I and my husband tried to convince him he said No and blamed his wife for all this. He says that if his wife doesnt shouts he may not behave this way but at time when I was at his home he slapped his wife's younger sister and when she started shouting on him for this he hit her and anyhow we controlled the fight ahead. And yes sometimes he is very demanding and in case that is not fulfilled he loses his temper and starts relating his life to past incidences which happened 7-8 years ago and blames his wife for the same. I am really upset because this might harm many people if my friend loses her patience but she bears in a hope that some solution might be foud. So please help.

Answered by Dr. Manisha Gopal (3 hours later)

Brief Answer: He can be helped & ask her to remain at guard Detailed Answer: Hello It is ok , such patients never agree for treatment voluntarily but there are provisions for their treatment also. Secondly, she should avoid picking up arguments with her, espically whe they are alone and at night. it will be better that she has her own separate bank account and maintain good terms with both families. Thirdly, if possible can you people take help of his family members to persuade him for treatment? It is seen that many times there is someone in patients family who has some good influence over him & can help out. But then too the drugs will have to be given by her wife and it should be given daily for good results. Fourthly, it is not insecurities but suspiciousness and poor anger control which makes him pick up fights and beat his wife. many times such people have hidden suspiciousness towards wife and that lead to more violence at home. She should try not to talk about any male with him as this might provoke anger and fight. She must handle his anger smartly. Fifthly, there is no need to loose hope. such cases are frequently seen in clinical practice daily and are handled nicely. However, the treatmnt has to be done smartly. Once they feel better with drugs : many times patients start taking it voluntarily; but till then they have to be managed somehow. Sixth, it is fine that he has good working capacity. many areas of life are not affected severely till late part of illness. his personalit is also seem to be at fault along with the illness that he picks up fights there. behaviour of such people is not very good with their peers and just due to good work performance they are kept in job. But that too is to a certain limit. can she get him for blood tests? certain blood tests are needed to start medicines , though they are not mandatory. Tell me if he is into any drugs , like alcohol or smoking or anything else? these things also affect the menegment. Hope this helps you Wish you good luck! Dr. Manisha Gopal MD Psychiatry

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Manisha Gopal (47 minutes later)

Yes doctor he sometimes takes light beer and that is very occasional and right now I had a talk to my friend.She says that in his family he has his father who hasn't supported him since childhood and there is also a grandmother from whom he is influenced but his family members won't agree to what my friend says and they will tell her husband all this and telling them to convince him would create more problems. She says she has already tried it earlier. Blood tests she says she will convince him for that anyhow. Also my friend has said that sometimes he has hit her on very minor things on which you can not even imagine to have a hard argument also. One more thing she says is that there are times when everything goes perfect but all of a sudden on some or the other issue,over an argument the condition becomes horrible. Also sometimes the person is over loving.Let me know doctor what are the tests needed so that I can inform my friend ans she may try for the same.

Answered by Dr. Manisha Gopal (21 minutes later)

Brief Answer: Get the test empty stomach. Detailed Answer: Hello XXXXXXX She should persuade him for blood tests: routine blood counts, liver function tests, kidney function tests, sugar fasting, TSH, t3, t4, Sr. B12 levels, lipid profile. these should be done empty stomach in morning ( can take only water before it). Many labs come to take blood at home in morning, you can check the one near your home. this is convenient and fasta nod patients Donot have reason to delay. she may get hers too just to show him that it is been done routinely. I can understand her dellima that he becomes over loving sometimes and over critical and violent other times without enough provocations factors. This is the part of illness and personality factors. Becuase of these extreme loving behaviour expressions these people are able to influence the opposite gender and they fall prey to them. These people are very demanding and dominating , they try to segregate and make the partner dependent on them totally, they curb their social life altogether many times. It is ok, I can get that his family is not helpful, fine, she should not talk to them about this anymore if they may tell him. But is there anyone in her family who can help her out? Even if indirectly, she has to have some support. Does anyone lives near her home, any close relative of hers? She should also take precaution that he should not drink at all, even if it is beer, it is harmful. Without making him angry she should try this, if not possible, then just leave it. Donot push him for anything he doesn't like, it will just make him cross/ violent. Please feel fre to ask more queries if you have , I will be pleased to help you in every possible way. Wish you good luck and have courage.. Dr. Manisha Gopal MD psychiatry

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar