5 Signs of Anger-Related Difficulties

This week I welcome Dr. Joel Dillon of Orenstein Solutions in Cary, North Carolina, who is here to explain what to look for if we suspect that someone (including ourselves) may have anger management issues.


Anger is a normal healthy emotion. It motivates us when action needs to be taken, and it can empower us when we need to take a stand. It can become abnormal and unhealthy however, when we struggle to manage our anger in appropriate ways. Unfortunately given the course of anger, we don’t recognize the inappropriateness until the damage is done. The consequences can be quite pervasive, affecting several aspects of your life.

First and foremost, poorly managed anger can damage relationships with loved ones, co-workers, and friends. People can begin to view you with fear, consider you hostile, and contribute to distrust among your closest supports. Secondly, unmanaged anger can significantly impact your physical health. It is not uncommon for high levels of anger to be associated with such short-term physical problems as headaches, digestion difficulties, and anxiety; while long-term ailments can include depression, high blood pressure, and increased vulnerability to heart attack and stroke. The impact of poorly managed anger can thus contribute to problems across several domains of your life. Knowing the consequences of anger can help you “stop and think” before you act. However being able to identify poorly managed anger in yourself and others, is the most effective way to prevent negative consequences.

Identifying when you or others may have an anger problem is a necessary step in increasing appropriate coping skills. Ways in which to identify poorly managed anger can take many forms. The following are examples of these forms. Please note however, this list is not inconclusive. Poorly managed anger can affect individuals in different ways, which sometimes are not as obvious as you would think.

  • When you disagree with someone’s opinion, you find it difficult to stay calm and “bite your tongue.”
  • During arguments, you slam doors, break glass, punch and kick walls, or destroy objects.
  • While driving, you become so angry with other drivers you tailgate, honk the horn excessively, or use profanity or the one finger salute.
  • You’ve heard other people refer to you as “hot headed”, “bad tempered”, “having a short fuse”, or having to “walk on eggshells” around you.
  • You hold onto your anger for a long time by refusing to talk to loved ones and cutting off relationships.

Poorly managed anger can have serious consequences in many aspects of your life. However by recognizing when anger is a problem, you are that much closer to taking the steps needed to living a calmer life. If you, a loved one, or co-worker thinks that anger may be problem, there are many qualified mental health professionals who specialize in anger management that can help you develop more appropriate ways to cope with anger.

Joel Dillon, Psy.D., is a licensed psychologist with advanced training in Cognitive-Behavioral Therapy (CBT), and the evaluation and treatment of disruptive behavior disorders. His specialty areas include Child, Teen, and Adult Disruptive Behaviors, Anger Management, Substance Abuse, ADHD and LD Evaluations, and Family Therapy.

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Dementia – Warning Signs and What to Do

My guest today is Dr. Elizabeth Jackson, one of the psychologists from Orenstein Solutions in Cary, North Carolina. Dr. Jackson has some great advice for those of us who are concerned about a parent, spouse or other family member who is showing signs of memory loss.


Everyone’s memory begins to slip as they get older, but for some, the loss encompasses much more than the occasional misplaced car key. In the US, roughly 5% of adults in their seventies will suffer from dementia, but for those in their nineties, the incidence ramps up to 37%. Alzheimer’s is the most common cause of dementia, and it receives the most media attention; however, mini strokes and impaired blood flow to the brain can also lead to dementia, with this type accounting for 20-30% of cases. In the end, cause doesn’t matter, but the early signs of dementia can appear different depending on the types. The decline in Alzheimer’s occurs steadily with the hallmark sign being progressive memory loss. For vascular dementia, the loss of functioning may develop in “steps” with sudden deteriorations resulting in confusion and trouble staying focused on an activity such as cooking.

Although no treatment will prevent the progression of dementia once it’s begun, some medications and other environmental alterations may slow the decline. For that reason, it’s a good idea to pay close attention to how well your loved ones are going about their day-to-day tasks and whether the problems are worsening. For Alzheimer’s the early symptoms involve forgetting, general confusion, inability to perform basic day-to-day tasks, apathy and withdrawal, and sometimes personality changes.

Given that memory loss affects all of us as we age, how do we know if the forgetfulness is standard or more than that? There’s no perfect litmus test, but if your parent or your spouse starts forgetting the name of a grandchild, gets lost on the way home from the grocery store, or doesn’t remember where he or she put the quart of milk, then it may represent a problem. Any of these happening once or twice does not necessarily mean dementia; there needs to be a pattern. If when you remind your mother of what’s missing, and she recognizes what’s been forgotten with an “oh yeah,” then you can relax a little; that may be normal. However, when she begins to become very defensive or tries to pretend she never even touched the quart of milk, then that’s more worrisome.

What kind of confusion can you expect? Your parent may have trouble finding the word for something he or she wants to communicate. It’s understandable if it’s a rarely used word like “orthodontist” or “ubiquitous,” but if your father points to the salt and says with frustration “pass…. pass that…. that thing to me,” start paying attention to how often this happens.

Whenever you notice that your parent or spouse is more and more confused or forgetful, you should consider seeking out a physician’s help. It becomes absolutely necessary when your parent reaches the stage in which she can no longer remember how to turn on the TV or the microwave. This is never an easy conversation, and it’s best not to expect acquiescence on the first go-round. You might start by asking your mother if she has noticed that she’s forgetting more. Does that worry her? If she denies having any problems, maybe you’ll need to gently point out that she’s lost her way home from the grocery store the last three times. Express your own concern and suggest the possibility of help from a doctor. Your parent may become angry, which is always hard. Try to stay calm and wait to bring the topic up again. Within a conversation or two, you might need to insist on a doctor’s appointment and then schedule one.

With dementia affecting so many families, a variety of new and wonderful resources have become available. These websites can offer more information and resources. The Alzheimer’s Organization: details the behaviors associated with a diagnosis, how to cope and how to care for the family member. Lotsa Helping Hands helps you set up an online community for sharing information and for seeking out concrete support from family and friends.

Dr. Elizabeth Jackson is a clinical psychologist in private practice with Orenstein Solutions. She primarily specializes in counseling with individuals and couples who are struggling with major medical problems. She also works more generally with teens, adults and couples.

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Dementia and Signs of Delirium: What Caregivers Can Do

By Leslie Kernisan, M.D., Caring.com senior medical editor, and Paula Spencer Scott, Caring.com senior editor

If your loved one’s sudden mental decline has been diagnosed as delirium, you should get a medical evaluation to look for underlying illness and to help identify the cause or causes of the delirium. But a caregiver’s work in treating delirium doesn’t end there.
People with dementia and delirium often take days (or sometimes longer) to return to their predelirium mental state. During this recovery time, pay extra attention to three sets of tasks:

• Providing supportive care to the person with dementia

• Managing any difficult behavior or problematic confusion

• Making sure you have the added support you will need during this health challenge

How to provide supportive care for the person with dementia

Every additional physical, mental, and emotional stress will make it a little harder for your loved one’s delirium to clear. To help minimize additional stresses, try the following:
Keep your loved one in a reassuring, familiar environment, with familiar caregivers. If your loved one has been hospitalized and is ready to be safely discharged, going to a familiar home may be less stressful than heading for a rehab facility or moving directly into an assisted-living location. If the person can’t go home, bring home to him or her in the form of favorite blankets and photos or other homey touches.

Also, avoid a heavy rotation of new caregivers. One to three familiar faces are much less stressful than someone different every day, every shift.
Make sure eyeglasses, hearing aids, dentures, and other assistive devices are always available. Not being able to see, hear, eat, or walk properly is frustrating and stressful. People with dementia often forget to use even those devices they’ve had for a long time, so they may need to be gently reminded. Note that in the hospital, devices are often removed before procedures or tests; try to make note of the presence of these items throughout the day.

Make sure any pain is adequately treated. Watch your loved one for unarticulated signs of pain, such as wincing, loss of appetite, or favoring one side. Bring concerns to medical staff. Don’t worry that your loved one will get “hooked” on pain meds. Untreated pain is a far more realistic concern, since it can actually worsen delirium.

Monitor your loved one for constipation. It may not seem connected to delirium, but it is. Both constipation and dehydration stress the body, and being constipated can be painful.
Keep up your loved one’s favorite comfort measures. Everyone has different relaxation triggers. If your loved one seems to respond especially well to a certain kind of music, to massage, to time spent with a pet, and so on, lean heavily on those measures now. Use them frequently through the day.

Make sure the room is a comfortable temperature. It should be neither too cold nor too warm. Cozy socks can feel good in a cool hospital room. Just be sure your loved one doesn’t try walking across the floor in them (they’re a falling hazard).

How to manage difficult behavior or problematic confusion

The additional confusion of delirium often puts an older adult with dementia at increased risk of falls. You may also notice that anxious or aggressive behaviors get worse (although sometimes delirium causes the opposite: a quieter and depressed-seeming person).

Try the following:

Practice timed toileting. Making regular reminders and trips to the bathroom will minimize incontinence. Your loved one may no longer be paying attention to body cues to use the bathroom, which means accidents can increase.

Stay calm. It’s only human to respond to strong emotions with strong emotions, but doing so can be like adding kerosene to leaping flames. A soothing environment in which the person with dementia feels safe can go a long way toward minimizing difficult behaviors.
Avoid restraints for agitation. They’re still sometimes recommended for aggressive outbursts by people with dementia; unfortunately, restraints often, paradoxically, make things worse. What works better: Try to talk down the person with a calm, easy voice. Don’t try to reason or rationalize; simply acknowledge the distress and then redirect the behavior.

Get help if the situation deteriorates. The best tools for coping with physical aggression are behavioral. If all else fails, doctors sometimes use low doses of an antipsychotic drug such as Haldol or Risperdal. But they should only be used as a last resort, since these drugs increase the risk of falls. (Beware of tranquilizers such as Valium and Ativan, which may make delirium worse.)
Assess where things stood before the delirium. If you were managing all right, you’ll still need extra reinforcements, because managing delirium care can be taxing, given how unpredictable recovery can be. If you were already struggling, know that this may be the tipping point.

Think both short-term and long-term when it comes to relief. It’s no longer a good idea to leave your loved one alone for periods, even if this worked out fine before. Nor do you want to bring even a mobile loved one out with you on errands — it’s too stressful right now. So you’ll need to be relieved for things such as shopping and running other errands. And because the cumulative stress can be difficult, you’ll also want to get away for longer stretches, even once your loved one appears to be on the mend — or if the “new normal” after delirium is an increase in cognitive problems.
Consider an elder companion. Available from in-home care agencies, these professionals can be a good option for help in keeping a watchful eye on a loved one who doesn’t need much nursing care. Some caregivers hire them during the day while they work; others set up set hours during the week so they can get breaks.

Call on your reserve helpers. Many caregivers have a network of family and friends who vaguely ask to be called “if you need anything.” This is one of those intensive periods where it’s smart to cash in those chips. Even having someone pick up groceries or dry cleaning, or do your laundry, are huge helps that free you up to provide calming, loving companionship during delirium recovery.

Home Care Assistance of Raleigh is locally owned and operated and has been serving the Triangle since 2005. For more information visit www.homecareraleighnc.com, www.homecareassistance.com or call 919-844-9898.

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