The Role of Anger in Multiple Sclerosis

Internalizing angry feelings in MS is linked to a poorer quality of life

Angry woman on couch

Anger is an emotional complication of multiple sclerosis (MS) that is believed to result, at least partially, from the disease itself. Keeping angry thoughts bottled up is also associated with a poorer quality of life, according to a study in Multiple Sclerosis.

By understanding more about the role of anger in MS, and how it can be managed, you are already taking the first step to better controlling your physical and mental health.


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Anger & MS

In the study, anger was assessed in 157 participants with multiple sclerosis. Participants with relapsing-remitting, primary progressive, or secondary progressive types of MS were all included.

Anger in these participants was measured using the State-Trait Anger Expression Inventory-2 (STAXI-2), which is a four-point scale with higher scores indicating more anger. In this test, 196 items are broken down into six scales. Four of those scales are:

  1. Trait anger: Measures whether a person has an angry personality and whether a person tends to react angrily when criticized
  2. State anger: Measures whether a person currently feels anger and whether they feel like expressing their anger verbally or physically
  3. Anger expression-out: Measures whether a person expresses anger towards other people, like shouting at a partner or punching a wall.
  4. Anger expression-in: Measures whether a person suppresses their angry feelings.

Study participants with MS were compared to a control group. The researchers found that people with MS were more likely to be angry (trait anger), have a higher intensity of anger (state anger), and express anger either outwardly or inwardly, as compared to the control group.

In other words, this study suggests that people with MS have a tendency to experience anger more often than those who do not have MS. To test whether this higher level of anger in the MS group was attributed to underlying depression and anxiety, the researchers correlated anger scores with depression and anxiety symptoms. The researchers found no link, suggesting that anger existed alone and was not a marker for an underlying mental health condition.

Anger & Quality of Life in MS

The participants in this study also underwent a health-related quality of life assessment using the Functional Assessment of Multiple Sclerosis HRQoL instrument.

The person taking this test has to choose one of five scores to determine their satisfaction, ranging from "0" which means "not at all" to "4" which means "very much." A higher score indicates a better quality of life and a lower score indicates a worse quality of life.

After a complex statistical analysis, the study found that people who internalized or suppressed their anger had a worse health-related quality of life (this was especially true for women). On the other hand, the trait anger did not predict a worse health-related quality of life. This suggests that it is not anger itself that affects a person's life satisfaction, but whether they keep those angry feelings to themselves.

Causes of Anger in MS 

The results of the above study suggest that a person with MS is more likely to experience anger than someone without MS. So why is this the case?

Despite the limited scientific evidence, experts suspect that anger in a person with MS is the result of brain lesions, just as blurry vision or a loss of coordination occur from MS lesions in the brain. In other words, a person's immune system attacks the fatty covering of nerve fibers (called the myelin sheath) in areas of the brain that control emotion, behavior, and personality like the:

When the myelin sheath of nerve fibers in these brain regions are damaged or destroyed, nerve signaling is impaired. This can affect the function of the brain region leading to a change in emotional expression, personality, behavior, etc.

Of course, a new diagnosis of MS, or other forms of stressful news like your disease progressing or your medication being expensive can cause angry feelings. But again, the anger disturbance experienced by a person with MS may be more of a function of their disease than of the situation.

Finally, even though the above study tested for depression as a source of anger and found no link, anger can be a substitute emotion for sadness or anxiety.

This all being said, teasing out the cause of your anger can be tricky, and while you think you may know the culprit, it's best to get an objective opinion from a healthcare professional.

Treating Anger in MS

When managing your anger in multiple sclerosis, it is important to first undergo a proper evaluation by your healthcare provider, as this will affect your treatment plan. If your practitioner diagnoses you with depression or anxiety, a combination of medication and therapy can be extraordinarily helpful.

If your anger stems from a new or prior MS diagnosis, interventions like an MS support group, anger management classes, relaxation or talk therapy, and family counseling can be helpful.

In addition to therapy sessions, sometimes a medication called a mood stabilizer is prescribed to help manage unpredictable mood swings or angry outbursts.

While a mindfulness-based intervention has not been studied as a means of treating anger in multiple sclerosis, it has been found to improve quality of life, anxiety, depression, fatigue, and pain in people with MS. It has also been found to improve anger in people with fibromyalgia, which is a chronic medical condition that is wholly different from MS but shares some similar symptoms, like fatigue and pain.

With that, mindfulness (where a person learns to appreciate and live in the moment) may be a useful strategy for coping with deep-rooted anger.

A Word From Verywell

If you are struggling with feeling angry, and this emotion negatively impacts your relationships and overall daily functioning (remember, it is perfectly normal to feel angry at times), talk with your healthcare provider about next steps. Receive the help you need, you deserve it.

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Labiano-fontcuberta A, Mitchell AJ, Moreno-garcía S, Puertas-martín V, Benito-león J. Impact of anger on the health-related quality of life of multiple sclerosis patients. Mult Scler. 2015;21(5):630-41. doi:10.1177/1352458514549399

  2. Hung Y, Yarmak P. Neurorehabilitation for Multiple Sclerosis Patients with Emotional Dysfunctions. Front Neurol. 2015;6:272. doi:10.3389/fneur.2015.00272

  3. Simpson R, Booth J, Lawrence M, Byrne S, Mair F, Mercer S. Mindfulness based interventions in multiple sclerosis--a systematic review. BMC Neurol. 2014;14:15. doi:10.1186/1471-2377-14-15

  4. Amutio A, Franco C, Pérez-fuentes Mde C, Gázquez JJ, Mercader I. Mindfulness training for reducing anger, anxiety, and depression in fibromyalgia patients. Front Psychol. 2014;5:1572. doi:10.3389/fpsyg.2014.01572

Additional Reading

By Colleen Doherty, MD
 Colleen Doherty, MD, is a board-certified internist living with multiple sclerosis.