Outbursts

Suffering fools a little more gladly. Apologies for the length of this post, but I am a fan of detail. I was diagnosed with ADHD last year. It's been a difficult year, with the stimulants causing dysthymic side effects; my new wife suffering a miscarriage and year-long postpartum depression and her stepfather's death. I'm also still dealing with the suicide of my first wife a few years ago and a very demanding career. And yes, we both see counselors and are very open and honest with each other and the marriage is very strong. I'm using Wellbutrin while awaiting some research from my neuropsychiatrist about next steps re: other medication options. I have a coach too. The reason for my post is that I'd like to hear from other members about how they deal with their short tempers. Over the first 35 years of my life, I was slow to anger and quick to joy. Over the past five years, I've been quick on both fronts ... and I don't like it. For example, tonight I blew up at a pharmacist. My wife and I had walked to the drug store, talking about the rough two days she's had. When we attended, the pharmacist informed us that my drugs were not covered on my wife's new plan. We knew this not to be the case, as we had just been dealing with our insurance agent on this point the week before. I told him it didn't matter as I would just pay for my drugs but my wife took the time to explain that she was sure that I should be covered. After the pharmacist ignored me and proceeded to instruct us both, in excruciating detail, about how we were obviously mistaken in respect of our coverage, I waited what seemed like three minutes (likely 30 seconds) before I interrupted him, explaining that with five degrees and a legal career, I was quite capable of discerning the extent of our insurance coverage. He was taken aback and challenged me; I challenged back. My wife asked me to stop, but it took me another two or three minutes before disengaging, with her in tears and the pharmacist huffing about how he had never been treated so rudely by another professional. Afterwards, my wife completely agreed that the pharmacist was a condescending buffoon who deserved to be dressed down. Still, both she and I understood that it was our moral duty to avoid rising to anger about such a trivial annoyance. She also reminded me that whenever I start my communications with mention of my college experience and legal training, there is not going to be a happy ending. I know why I lose my temper so easily; I am justifiably under incredible stress and battling both my wife's depression and my own dysthymia. We all have our limits and I've been finding mine in recent years. I am most vexed by displays of bureaucratic ineptitude and slowwittedness. In other words, I really, really don't suffer fools gladly anymore. So, after that belaboured introduction I have a simple question: how can I control my temper better? Given the time of night, my Adderall XR would have worn out anyway. I knew as the words were coming out of my mouth that this was an ill-timed outburst in which I was about to engage - and yet, I just couldn't help it. His behaviour was just so incredibly annoying and before I knew it I was in an argument. Worse still, as a barrister I am very skilled at argument. Even worse, I rarely turn down the opportunity to demonstrate that I am right. While these may be useful skills for my profession, they don't make me a nice person, or the person I would prefer to be. I hope this does not sound too conceited, but it's akin to a professional prize fighter choosing to brawl in a bar with normal patrons. It is unwise, undisciplined and unprofessional. So what tricks of the trade are available to help me hold my tongue more often than I do?

Controlling Your Temper

What I am about to say may sound like I'm speaking negatively about my husband, but I'm not...  Your anger outbursts sound very similar to the ones my husband used to have.  He, too, is an exceptionally bright man (went through MIT - both undergraduate AND graduate -  in a total of 3 years) with strong opinions, a love of choosing just the right words (and a past desire to hold me exactly to mine that he has overcome - thank God!), an unwillingness to suffer fools, and an ability to observe his anger outbursts but not change them.  He also had a strong sarcastic streak which could really "bite" the recipient...until he found a medication which happens to help him manage both his anger and his sarcasm.

The medication was for his ADD, not his anger, but it turns out that the side effect was that his anger is now a thing of the past.  The other unexpected side effect he has gotten is a better ability to initiate and disengage from things he is doing.  It may be that these two things are related - because he is better able to disengage from what he is doing he is able to observe that he is getting angry and disengage from it.

My husband is also quite a bit more mellow now, though both of us attribute that to turning our marriage around, not to his meds (because there was a period of time when he was on these med but decidedly not mellow).  I will say, for me it's much easier to love - and respect - a man who doesn't rip others to shreds through sarcasm or anger, so his changes have been WONDERFUL for our marriage.

It could be that your anger is a manifestation of an inability to control impulses - an ADD symptom - and if it's bothering you as much as you suggest, perhaps you should talk with your doctor about whether a different type of ADD meds might help you control that symptom more effectively.  The med that my husband is taking is Wellbutrin (an antiepressant), which works differently from Adderall (a stimulant).  You might find that it controls the same symptoms that Adderall controls plus addresses your anger, or you might not.  But trying it with a doc's supervision shouldn't hurt... (you would probably have to stop the Adderall...so you'll want to talk to your doc about this - watch for emotional swings as you do this - a common side effect of cutting back on Adderall)

As a general piece of advice, I tell people to make sure that they get input from their spouse about medicinal changes that they are making and how the patient is reacting to the new meds.  My husband did not realize that the meds were even working for a long time (in other words, he can't feel them working other than a slight improvement in focus) but I observed that many of the symptoms that were bothering our relationship went away.  And, when he did an experiment after a couple of years of meds and stopped taking them for a week, the change "back" to how he had been acting before (and the surprised concern in those around him - including coworkers) was dramatic.  This finally convinced him that his meds really are working for him on more levels than he sometimes realizes.

Here's another idea - trying meditation.  I don't meditate, but I have several male friends who do so as a stress reliever (one is an oncologist - a high stress job, to be sure!)  They say it keeps them a bit more measured in how they deal with life.

Your entries on this blog speak to your high intelligence and many strengths.  It's a credit to you that you wish to take on your angry outbursts and that you wish to do something to control them.  Those around you will thank you for your efforts! 

Melissa Orlov

Drugs and Outbursts and Blunt Coaches

Thanks Melissa. Sadly, the thought of attempting meditation is about as appealing to me as eating glass! :0 Wellbutrin hasn't done it for me, unfortunately. It's better than nothing, and it helped ameliorate the dysthymic effects of the 15mg/d of Adderall XR, before I discontinued it last month. In my last meeting with the neuro-psychiatrist, I suggested Modafinil and Buproprion (i.e. adding the former to my continued daily does of 300mg of the latter). He also proposed a tricylic but it took me over a year to get down to a healthy BMI and weight gain is not in my plans! I may just have to tough it out until the new stimulant formulations available in the US are introduced up here. Also, as my wife's emotional health improves, I would expect mine to improve as well. We spoke to the coach about this episode the other night (I have my wife sit in on all of our conversations because it helps provide her with more on the ADHD perspective) and the coach had some blunt but appropriate advice: "The world can be full of idiots, especially if your brain is spoiling for a fight. Limit the opportunity to allow them to upset you (eg don't run errands after a troubling discussion with your wife about the current state of her mental health)." And for my wife: When he starts acting inappropriately, walk away. Make sure you have the keys and let him walk home, if necessary. That should help him get the picture when kicking him under the table doesn't seem to work." Not bad advice, but I hope I have some pharmacological help soon too!
clancy's picture

I am so glaD

I am so glad this topic is being discussed right now. A few days ago my husband went into a rage over not finding the keys he misplaced. Of course, he found them under my daughter's purse and then the tirade began.....this and that and finally i'm going to board up this house and condemn it. I was very sad because i know this is a recurring theme and there will always be some disorganization in this household. But I had to ask myself if this is what i want for the rest of my life now that i'll be turning 60. I had an appointment with my psychiatrist a few days later who treats both of us for ADHD. I spoke with him about this and he felt that the ADHD isn't the problem, that most people are compliant after being treated with meds. I told him about this blog and hopefully he'll check this out. But how ironic the topic of discussion lately has been on outbursts of anger. I'm going to keep reading as I consider if this is really what i want to do for the remainder of my life, to continue living with these rages. I'm not at fault for his perceptions of what he deems needs to be fixed. I'm over that one, thankfully. Oh, and he is definitely someone who doesn't mince words and has very strong opinions he doesn't mind sharing with others.
clancy's picture

Comments

Rereading my post, I can hear the anger in the tone of my writing. I was angry that day because something I did caused me to receive the silent treatment. It's really amazing denial, how it can make one not take a bit of responsibility for something that requires two people to interact, a relationship. Now that things have are somewhat in a more balanced state I still have these ambivalent feelings about a future with someone who is prone to raging. It doesn't happen a lot, and I do see myself trying to be proactive and handle somethings before a blowout but I'm not in charge of the drivers on the road, nor the county, state I and country I live in . I liked your coach's advice on accepting that the world is full of idiots. I hear so much blame but when the blame is projected onto my adult children I draw the line. I've just begun to set boundaries on that topic but it requires a lot of energy and focus to detach and not become defensive. His blunt words and anger have cost him so many job opportunities. He's a very accomplished stone mason and amateur sculpture, but he isn't considered a desirable "tempermental" artist to have on a job site. His lack of financial contribution has always hurt the stability of this family, but especially now in these economic times. So much to consider.

ADD

Melissa, Enjoyed your comment. I love a couple that works on the problems instead of running. I have a terrible problem that is two fold. I hate a confrontation. Even now, my boyfriend and I are not speaking because neither one of us can bring ourselves to call and end the relationship. So I'll sit and stew and yell at others and have out bursts because I can't settle this. Would add medicine help me? And will a medical doctor prescribe it or should I seek professional help? Thanks in advance for your response.

Add meds help?

The answer to your question about whether or not ADD meds might help you is "I don't know"!  You'll want to talk directly with your doctor about that to make sure you have an accurate diagnosis and that the meds he/she might prescribe are the best options.

The best person to get a diagnosis from if you think you have ADD or something similar would be a psychiatrist who specializes in mental health issues.  80% of adults with ADD actually also suffer from something else as well - it is in your best interests to have a full evaluation - not just go to your primary care physician and ask for ADD meds.  You'll get better treatment from someone used to pulling apart all of these issues that look so similar.

I say psychiatrist rather than psychologist because the former can prescribe, the latter cannot.

Best of luck!