How Do Anger and Aggression Relate to OCD Symptoms?

What you need to know

• People with OCD reported higher levels of anger and anger suppression compared to healthy controls on self-report measures.
• However, people with OCD did not differ from healthy controls on an implicit measure of aggressiveness.
• Difficulty accepting negative emotions and an inflated sense of responsibility were found to mediate the relationship between OCD and anger/anger suppression.
• Teaching emotion regulation skills and addressing beliefs about responsibility may help reduce anger in OCD.

Anger and aggression in OCD

Obsessive-compulsive disorder (OCD) is a mental health condition characterized by recurring, unwanted thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) that a person feels compelled to perform. While OCD is primarily known for symptoms like excessive hand washing or checking behaviors, some theories suggest that anger and aggression may also play a role in the disorder.

This study aimed to examine anger and aggression in people with OCD compared to healthy individuals without the disorder. The researchers used both self-report questionnaires and an implicit measure to assess different aspects of anger and aggression.

Higher self-reported anger, but similar implicit aggression

On self-report measures, people with OCD reported:

• Higher levels of trait anger (the tendency to experience anger in general)
• More suppression of angry feelings

However, when using an implicit measure called the Aggressiveness Implicit Association Test (Agg-IAT), which assesses automatic associations related to aggression, there was no difference between the OCD group and healthy controls.

This suggests that while people with OCD perceive themselves as experiencing more anger, they don’t show evidence of more aggressive self-concepts at an implicit level. The researchers propose a few potential explanations for this discrepancy:

1. The implicit measure may not capture the specific type of anger/aggression relevant to OCD.
2. People with OCD may be more aware of and willing to report anger due to high moral standards.
3. Difficulty accepting emotions in OCD may lead to over-reporting of anger on self-report measures.

Factors linking OCD to anger

The study also examined potential mediating factors that might explain the relationship between OCD and increased self-reported anger. Two key factors emerged:

1. Non-acceptance of emotions

People with OCD showed greater difficulty accepting negative emotions. This non-acceptance was linked to both higher trait anger and more anger suppression.

When we don’t accept our emotions, we may:

• Judge them as “bad” or wrong
• Try to push them away
• Become frustrated by their presence

This can paradoxically intensify the emotion and make it harder to regulate effectively.

2. Inflated sense of responsibility

People with OCD often feel an excessive sense of responsibility for preventing harm. This inflated responsibility was found to mediate the relationship between OCD and anger suppression.

The researchers suggest this may occur because:

• Feeling overly responsible creates more opportunities for frustration
• When anger arises, the person may suppress it due to beliefs about needing to be “in control”

Clinical implications

These findings have several potential implications for treating OCD:

1. Assessing and addressing anger may be important, even if not an obvious symptom.

2. Teaching emotion regulation skills could help, particularly around accepting negative emotions rather than judging or suppressing them.

3. Working on beliefs about responsibility may indirectly help reduce anger and its suppression.

4. Patients may benefit from understanding that while they report more anger, they don’t show evidence of being more aggressive people at a core level.

5. For some patients, approaches like Acceptance and Commitment Therapy that focus on accepting difficult emotions might be helpful alternatives or additions to standard exposure therapy.

Conclusions

• People with OCD report experiencing more anger and suppressing anger more than those without the disorder.
• This increased anger is linked to difficulty accepting emotions and an inflated sense of responsibility.
• However, people with OCD don’t show signs of more aggressive self-concepts on implicit measures.
• Addressing emotion regulation and beliefs about responsibility may help reduce anger in OCD treatment.