Anger management book for an older woman who throws tantrums?
November 10, 2015 12:44 PM   Subscribe

I'm currently taking care of an injured friend after she broke her back and sternum in a very bad car accident. She's severely mentally ill and throws screaming shitfits at least a dozen times a day. She acknowledges that this is a problem and thus I'm hopeful that she'd be receptive to reading a self-help book on the topic.

To head off any concern for me: I have a very high tolerance for screaming and other displays of anger, so while her shitfits are annoying (especially in public), I don't feel like she's abusing me. Basically, I react to her fits as I would to a toddler throwing a tantrum (she seems to have a similar level of emotional control), which is to just sigh because what else can you expect from a toddler? So I don't need any advice on coping or being told that I don't need to put up with it or whatever. She's been a good friend to me in other ways and mentally ill people deserve compassion and friendship even when they're being difficult.

Her background: She's 57 and has been on disability for mental illness for several years. Her inability to control her anger is one of the main reasons she's unable to hold a job and thus was granted disability benefits. I haven't pried into her exact diagnosis, but I'm guessing that PTSD is at least part of it (she was abused as a child) and that something has probably gone awry with her amygdala and adrenal response system. Thus, there are probably some very real biological limitations to how much she can control her behavior even if she wants to.

The frequency, severity, and unreasonableness of her fits are noticeably worse when she forgets to take her Zoloft, so I now remind her to take it on the days I'm taking care of her. I suppose there's been an uptick in the frequency of her shitfits lately due to her very understandable frustration with her physical limitations while she heals, but I know from my history with her that if she were well she'd just find something else to scream about.

Some examples of the causes and nature of her shitfits:

If something doesn't work or fit where it's supposed to on the first try, she immediately starts screaming, swearing, and banging it against things until it breaks or she hurts herself. This is of particular concern right now because she's not supposed to be out of bed much less banging and throwing things around the house! For example, something as minor as not being able to tear open the plastic wrap on a roll of paper towels with her fingers was enough to set her off punching the counter, stomping around, and screaming, instead of just reaching for the scissors that were RIGHT THERE.

She goes off on loud 10+ minute rants in public if any random person annoys her in any way. Her annoyance threshold is very low and she takes everything as a deliberate personal affront, without any understanding or compassion for other people who are just doing their best. For example, she insisted on going with me to the laundromat (we decided that she could do her prescribed walking exercise there while I did the laundry), and then spent the whole time loudly ranting about the "rudeness" of a) the employee who was trying to wipe down the machine next to her and thus was in her way and b) a small child who was running around and making noise. (For perspective, if I were there alone I would not have even *noticed* these things much less have been bothered by them.)

People don't even have to have done anything to annoy her personally to trigger a loud, nasty, public rant about them -- everyone who doesn't act and believe exactly as she does is "stupid" and she will go off on extended, loud, and repetitive monologues about how stupid they are. These eventually wind down into her just screaming, "They're stupid! They're just so stupid! How can they be so stupid?!" repetitively for a couple of minutes. The repetitiveness of these rants almost seems compulsive? I don't know.

I've tried gentle verbal nudges in the moment -- e.g., "Slow down," "Let it go," "Don't sweat the small stuff," "I'm sure they didn't mean it," or when she's being particularly obnoxious, "You're harshing my mellow" -- and have had some success in calming her or at least shortening the duration of her fits. I've also emphasized to her that letting herself get angry over every little thing is raising her stress levels and thus impeding her healing, in the hopes that this might incentivize her to calm down for her own sake.

In her more rational moments she'll talk about how she has an anger problem and how it's not only unfair to the people around her but also negatively impacting her life (e.g., the dearth of people willing to visit her and help out when she's hurt and how she's alienating her doctors by yelling at them). She's also been receptive to my attempts to change her mind about other things (e.g., some of her loonier conspiracy theories.) And she loves to read books. So I'm hopeful that she would be receptive to reading a book about anger management if I gave it to her.

There's a lot of books about anger management out there but they mostly seem to be aimed at men who are physically abusive. The ones I've seen for women seem to start with the premise that your anger is justified and you just need to communicate it better -- but in my friend's case, I'd say at least 80% of the things she throws screaming shitfits over are not worth noticing/remembering, much less getting angry about!

So, any book recommendations for this type of person and this type of anger? Or maybe a book that comes at it from a different angle, like how to be less emotionally reactive to things in general? Or maybe something about general self-control around other people? I'm not sure on what the best approach is here.

Please advise, thanks!
posted by Jacqueline to Human Relations (12 answers total) 3 users marked this as a favorite
 
It sounds like she would be a great fit for Dialectical Behavior Therapy. This book, Don't Let Your Emotions Run Your Life, might be a starting point, but if she can get involved with a DBT program down the line, I think it might be really helpful for her.
posted by goggie at 1:00 PM on November 10, 2015 [1 favorite]


IAMA Psychologist and IAMY Psychologist, but...

you could try the Kazdin Method for Parenting the Defiant Child. This is a guide book to Parent Management Training. It is not a self help book, so you'd need to sign up for the parent role. The behavior you're describing is very similar to some of the behavior in the book, so maybe it could work.
posted by alms at 1:07 PM on November 10, 2015


Mod note: Couple of comments deleted. Please keep it to helpful suggestions of resources. Thanks.
posted by LobsterMitten (staff) at 1:56 PM on November 10, 2015


This isn't a book, but:

Maybe you could give her a reminder device for taking her medication, like this timer bottle cap. Perhaps that would help a lot.
posted by amtho at 2:01 PM on November 10, 2015


Response by poster: Clarification: I am not a professional caregiver. I am just her friend and I am doing all this stuff (staying with her 5 days/week, lifting/fetching things, taking care of her cats, cooking, cleaning, driving her around, running her errands, bringing her videos and books, keeping her company, etc.) for free because she doesn't have anyone else to do that stuff for her.

Regarding DBT, etc., she is on Medicaid and thus only has access to whatever treatments that Medicaid will pay for. Meanwhile, she has a history of being an uncooperative patient and noncompliant with her medications, so even if Medicaid would pay for therapy I doubt that she'd actually go. :( But I think she would read a book.
posted by Jacqueline at 2:11 PM on November 10, 2015


It is good you are willing to help your friend. It does sound like her anger has a biological basis rather than a pure lack of coping skills. Thus, a book on anger management is about as useful as giving a book on running to someone that has a broken leg in the hope they will heal faster.

I would actually recommend a different bibliotherapy - fiction books with well-written characters that will hopefully help her develop empathy.

Considering her finances, I would suggest contacting your local public library and asking about their services for the house-bound. They usually have experience with choosing books according to a theme. Be honest and explain about your friend and they may have someone who is comfortable with bringing her the books. I would not recommend bringing or suggesting your friend visit the public library. Her public behaviour is abusive and should not be knowlingly inflicted on others by you, as your continued taking her out gives her tacit approval to continue to abuse strangers.
posted by saucysault at 4:06 PM on November 10, 2015 [1 favorite]


If she has a smartphone, there are DBT apps available. Here is a DBT self-help site that reviews some of them. DBT self-help in general might be worth a try.

Does music, or a soothing podcast, help to calm her down? Maybe try a meditation podcast.

Since she is on disability, she should be "in the system" and may be eligible for a case worker of some sort to see if there is any help available to her that she is not aware of. Try contacting your local Department of Disability Services, or Department of Aging and Disability Services, or whatever it is called in your area.
posted by Rosie M. Banks at 4:18 PM on November 10, 2015 [3 favorites]


If she was abused as a child, she has trained herself to scan the surroundings for any sound or movement in case there's a threat. All noises and activities are at the same "importance" and there is no filter. So the woman wiping down a machine, or a child playing nearby is equal to you talking to her face. All are getting her attention at the same level.

She needs to tell herself that the woman is not a threat. The child's noises is not a threat. Get her to acknowledge that this is , "Not a threat". It's "volume" diminishes and she can ignore it.

This is a trick I made up and it's working for me.
posted by Coffeetyme at 5:07 PM on November 10, 2015 [3 favorites]


Her doc should have her in braces/immobilizers to support the healing. What does she see as options for physical impulse control when you're around?

As far as reading, Murderball might feel unorthodox, however is about anger and recovery. Yes, it's a movie....that is based on a book.
posted by childofTethys at 5:44 PM on November 10, 2015


I have not read this book so I can't definitively recommend it, but I saw recently either on MetaFilter/AskMeFi, Reddit, or Captain Awkward a recommendation for the anger management book The Cow in the Parking Lot and it sounds like what you're looking for.
posted by vegartanipla at 6:31 PM on November 10, 2015


Standard avoidance of anger triggers may help here. Does she get angry more often when hungry, tired, in pain? It may not prevent outbursts, but could lower their frequency and intensity, to make sure she eats enough, and has enough painkillers. Also if she is in pain she might not be sleeping well which is unlikely to help.

I don't know if this has gotten worse since the accident, or if you're just more aware of it because you're around more, but if you think the behavior is increasing it might be worth seeing if some age-related issues could be coming in. 57 is a bit young but not outlandish.
posted by nat at 10:11 PM on November 10, 2015


Anything by: Peter Levine, Bessel van der Kolk, or Pema Chodren.

In the Realm of Hungry Ghosts by Gabor Mate.

TED talks by Brene Brown. She is an Oprah person, but I try not to hold that against her.
posted by orsonet at 7:51 PM on November 11, 2015


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