Are We Overlooking Anger in Psychiatric Practice?

Anger and irritability often surface in clinical practice yet remain underrecognized in psychiatric assessment and treatment. In this interview, Mark Zimmerman, MD, shares some of the takeaways from his session presented at the 2025 Psych Congress titled "'I’m So Angry There Are No Talks About Anger': Recognizing and Managing Anger (the Overlooked Affect) in Clinical Practice."

Dr Zimmerman highlights why anger deserves more attention, reviews evidence-based pharmacologic strategies, and shares practical tools for integrating anger assessment into routine intake. 

For more news and insights from Psych Congress 2025, visit the meeting newsroom here on Psych Congress Network.

Psych Congress Network (PCN): Why did you decide to present a session on anger at the 2025 Psych Congress? 

Mark Zimmerman, MD: During the past couple of decades there has been intense interest in the treatment of depression, and less so but still significant interest in anxiety, and relatively little research on the prevalence, psychosocial morbidity, and treatment of anger and irritability. Not infrequently, during the course of treatment for depression, my patients have spontaneously told me that they are less irritable than they had been. Because there is no anger or irritable item on the Hamilton Depression Rating Scale or the Montgomery-Asberg Depression Rating Scale, insufficient attention has been given to the treatment of anger in depressed patients.  

PCN: Is there an anger disorder? 

Dr Zimmerman: Anger is a diagnostic criterion of several disorders, and it is the central criterion of intermittent explosive disorder. As a symptom anger is not that much less frequent than anxiety or depression. However, as a disorder intermittent explosive disorder is much less frequent than depressive or anxiety disorders.  

PCN: What pharmacologic options for the treatment of anger are currently supported by evidence, especially in disorders like borderline personality disorder or mood disorders? 

Dr Zimmerman: There are no approved medications for borderline personality disorder. However, a recent Cochrane review of pharmacotherapy of borderline personality disorder found that antipsychotics, antidepressants, and mood stabilizers all have a beneficial effect on anger/irritability. Regarding the treatment of anger in depressed patients, because there is no anger or irritable item on the Hamilton Depression Rating Scale or the Montgomery-Asberg Depression Rating Scale insufficient attention has been given to the treatment of anger in depressed patients. 

PCN: What are some key questions or screening tools that busy clinicians can incorporate into their intake process to better assess for clinically significant anger or irritability? 

Dr Zimmerman: There is little difference in the assessment of anger/irritability as a symptom than there is in the assessment of depression/sadness or anxiety/nervousness. Over the years we have developed clinically useful self-report measures of depression, anxious distress, and anger, and have recently combined these measures into a single 25-item measure. We also included items to assess the intensity and chronicity of anger on our difficult to treat depression scale.   

PCN: What areas of anger research or treatment do you believe are most urgently in need of development? 

Dr Zimmerman: Some basic data is needed to draw attention to the clinical significance of anger/irritability. For example, how frequent is the symptom of anger in patients presenting for treatment, how frequently do patients want treatment to address anger/irritability, and how do these frequencies compare to depression and anxiety? In doing this research, the same questions should be used to assess each of these constructs. 

Mark Zimmerman, MD, is a professor of psychiatry and human behavior at Brown University and Chief of Ambulatory Psychiatry and Behavioral Health at South County Psychiatry. 

Dr Zimmerman received his undergraduate degree from Columbia University, and his medical degree from Chicago Medical School. He completed his postgraduate training at the Medical College of Pennsylvania. 

Dr Zimmerman is principal investigator of the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project. He is also the author of more than 450 articles published in peer-reviewed journals, and serves on the editorial board of 10 journals. He is the associate editor of the Journal of Personality Disorders. Dr Zimmerman was the Personality Disorders section editor for DSM-5-TR. He has developed several measures of psychiatric disorders for use in clinical practice. He is the author of the Interview Guide to Diagnose DSM-5-TR Psychiatric Disorders and the Mental Status Examination.