When Pat Willard was 6, her older cousins wouldn't let her join in their game. She pitched a fit, and someone snapped a photo of the moment: She's screaming—face flushed, eyes closed—and her father has his arms and legs wrapped around her, holding her so she won't hurt herself.

"I was this little spitfire with an Irish temper," says Willard, now 47, and director of communications at the City University of New York. "But tantrums didn't fit well with the good-girl thing. They were not genteel." Instead, her mother's silent fury became her model for anger. When her mom got mad, she turned dead quiet, not speaking for days. "She would not say why she was angry," says Willard. "But the house got black."

So Willard learned, as countless women have, to hide her temper. By the time she was in her 30s, she had high blood pressure, headaches, rashes, depression, difficulty parenting two young sons, and a troubled marriage. But it never occurred to her to think of herself as angry. Rather, she thought she was a bad mom and a stifled wife. Depression, not anger, was the red flag that hustled her into therapy.

Willard's story isn't unusual: Many women, unlike most men, tend to express their anger indirectly, research finds, and the result can be depression, heart disease, or an earlier death, regardless of the cause. Unfortunately, blowing up has health consequences as well. So what's a pissed-off woman to do? If you learn to release hostility in a controlled and constructive manner, you will add years—and satisfaction—to your life.

Squashing Emotion

Why do women struggle with anger? Many learned to bury feelings from their mothers and grandmothers, whose silences protected marriages that were their livelihoods. They couldn't risk behavior that might get them booted out of the house. As Willard's mother believed, anger turned you into a fishmonger screaming in the streets.

"Feeling the emotion meant they'd be tempted to show it," says Deborah L. Cox, PhD, an associate professor of counseling at Missouri State University and coauthor of The Anger Advantage. Many simply stopped experiencing anger as anger: It became depression or frustration, emotions safer to express.

Although younger women may believe they're comfortable being assertive, when it comes to anger, they still struggle, says psychologist Sandra Thomas, PhD, chair of the PhD program in nursing at the University of Tennessee, where she has been studying women and anger for 15 years. "A college woman, for example, may be freer with profanity, but she is still reluctant to tell her boyfriend she's angry if she thinks an outburst will drive him away," says Thomas.

Paying Anger's Price

But hiding anger may be far more costly than losing a relationship: Last year, a study by Cox and others revealed that women who deal with anger indirectly or attempt to suppress it are—as Willard was—more likely to experience depression, anxiety, and physical complaints than women who are more direct.

Such suppression may even be deadly. Last February, Wisconsin epidemiologist Elaine D. Eaker, ScD, and colleagues from Boston University announced the findings of a decadelong study of 1,500 married women. Those who suppressed feelings of any kind—anger, depression, frustration—during conflicts with their spouses were four times more likely to die of all causes during the 10-year follow-up than those who spoke up. "Being quiet may or may not protect your marriage," says Eaker, "but you sure aren't doing your health any good by being silent."

Eaker's research comes on the heels of other studies linking suppressed anger to cardiac problems, high blood pressure, headaches, irritable bowel syndrome, and cancer. In a notable study from 2003, researchers at Columbia University did emotional screenings on more than 300 middle-aged women with coronary heart disease: 50% were angry and 37% were depressed.

Overeating, drinking, and smoking may be linked to anger that women shove under the rug. Cox's research has also turned up evidence of suppression in those who abuse alcohol. True to form, Willard's mother drifted into alcoholism as her angry silences escalated over the years. A 2003 British study found that women with eating disorders tended to squelch anger. Kathy Parks, a 40-year-old financial planner in Knoxville, TN, recalls that in her youth, she stuffed down her rage by overeating. "That's why I weighed 200 pounds in high school," she says. "I felt frustrated and hopeless."

Women choking back fury are often the ones tossing and turning at night, as well, ruminating over what they wish they'd said during an incident, stoking the internal fires. "Anger is an energy," says Thomas. "If it's not expressed, your heart rate and blood pressure rise; your stomach acids churn." Anger triggers a fight-or-flight reaction: Adrenaline and other stress hormones rise, breathing rate increases, and muscles tighten. Your body revs up, and when anger is chronic, it stays revved.

Finding Hidden Rage

"Anger's shadows are everywhere," says Cox. "If you don't think you are angry, look at other parts of your life." Do you eat or drink too much and then regret it? Are you a perfectionist who has to be on top of things, who has no other life but looking perfect, being just-right thin, and working hard without ever relaxing? And how's your sex life? Is sex painful?

A 2002 study by Sally Stabb, PhD, an associate professor of counseling psychology at Texas Woman's University and co-author with Cox of The Anger Advantage, found that women who repress their anger have more critical feelings about their bodies and more negative physical experiences—like pain—during sex.

But the biggest clue to hidden anger in women is often depression, says psychologist Dana Jack, EdD, a professor of interdisciplinary studies at Fairhaven College/ Western Washington University and author of Behind the Mask: Destruction and Creativity in Women's Aggression.

"If a woman is unaware of her anger or thinks it's bad, she can float from anger straight to depression," Jack says. "I often suggest to women that every time they see their mood collapse, they chart what happened just before, and it's usually that they got angry. But we feel like we're forbidden to feel that, so instead we get depressed."

Even if you blow up from time to time, you can't assume that you're not a suppressor. Cox and her colleagues divide suppressors into four types:

Container She knows she's angry but chooses to hold it in and hopes it will blow over. Most of us are containers at least some of the time.

Internalizer She blames herself for whatever happens to her, absorbing the anger she really feels about other people. She's often full of self-loathing.

Segmenter She denies her anger in part because she finds it an ugly trait. She tends to be passive-aggressive, another way women reroute or disguise anger, says Jack. "For example, you say you'll do something and then not do it. Or you may switch targets, feeling fury at your husband but getting mad at your kids instead." This is the type that most alarms Cox, who notes, "If you don't even realize you're angry, it's very difficult to do something about it."

Externalizer She contains her anger until she simply explodes, usually at people who are less powerful than she is. "Some women swing from silence to aggressive anger," says Jack. "But just acting out doesn't help. That creates guilt and shame and reinforces the notion that anger is bad."

Actually, this aggressive, explosive anger—throwing things, screaming—usually causes more frustration, says Jack. "It's indirect because you're not talking about the problem that caused the anger. And exploding can make a woman feel more powerless because it rarely changes anything." In Cox's study, externalizers had the most physical symptoms, including headaches, stomach problems, and upper respiratory infections.

"But there is no one pure type," says Thomas. "You may be a woman who explodes at home but never at work. Or one who could never show anger to your mother but can to your kids." Parks, for example, always saw herself as someone who had difficulty hiding her emotions. "If I'm upset, it's evident," she says. Yet she wrapped anger in sarcastic comments that never improved her relationships with others. Another muffle: turning the anger against yourself. "You're a safe target," says Jack.

Releasing the Beast

Aiding us in all this subterfuge is confusion about anger itself. "Many women think anger is a bad thing, and if they are angry, something is wrong with them," says psychiatrist Jean Baker Miller, MD, director of the Jean Baker Miller Training Institute at the Stone Center in Wellesley, MA, where she researches women and anger. "But anger is an emotional reaction indicating that something is wrong and that something needs to be done."

In fact, women's anger usually centers on their most intimate relationships--their husbands, their mothers, their best friends, says Thomas, who has interviewed both men and women extensively about their anger. "Anger for women is intermingled with hurt and pain because they cannot understand how a person they are close to could behave a certain way. We never, ever interviewed a woman who didn't mention her partner. Never." Yet men tend to focus on other parts of their lives, like cars and politics, she says. They tell stories of vehicles that are lemons, or computers that don't work, or politicians who are louses.

A woman's focus on intimate relationships may also increase her vulnerability to anger's ravages. According to Timothy W. Smith, PhD, a psychologist studying anger, marriage, and heart health at the University of Utah, angry women married to angry husbands face a twofold hit. He's found that not only does their own anger raise heart rate and blood pressure, but their angry spouses also up their stress, increasing heart risk even more.

These aren't happy facts for long-suffering women—they may make our blood boil a bit more. But we don't have to rid ourselves of anger. That's just not going to happen, nor would we want it to. "Anger can be a healing force," says Jack. "And learning to express it appropriately can be positively transforming. It can give you backbone. Or space in your relationship for your feelings. Or it can help you leave. The goal is to use anger constructively."

The first step toward using anger well is to assess how you deal with it now. After all, we could all benefit from understanding and managing our anger better. But that takes a bit of introspection and practice. Below are suggestions that can help you get started. You may also want to consider seeing a therapist if you have symptoms that are possibly related to suppressed anger, such as depression, headaches, stomachaches, or recurrent colds, or if you feel hopeless or isolated.

Embracing Your Fury

Examine your anger roots. You can't learn to express anger until you know how you experience it now and where that style originated. Ask yourself how your parents got angry. Were you allowed to lose your temper, or were you punished for it? Once Willard understood that her own silence, ill health, and relationship woes were the legacy of her mother's anger, it also became clearer what patterns she had to break. "I had to learn to say how I felt," she says.

Try a practice session. If you're a suppressor, chances are that expressing your anger feels pretty awkward. Jack suggests practicing with friends before you speak with the person you're mad at.

Share the anger. Talk about the anger you feel, with the goal of solving a specific problem. If you're angry with your spouse or someone close to you, talk calmly with that person about your pattern of anger. "Look at how anger works in your relationship," says Jack. "If you have a husband who is going to escalate the anger, tell him that his anger silences you, that you can't communicate your feelings because you know he'll go ballistic."

Willard would get so angry that she couldn't speak. "But my husband, who had gone into therapy, too, helped me find a vocabulary," she says. "He would sit down with me and say, 'Let's go through the situation.' We started going back and forth about the words, talking about how you share your displeasure."

Put pen to paper. Writing about your anger helps you acknowledge and begin to understand it, says James W. Pennebaker, PhD, a professor of psychology at the University of Texas. "Ask yourself in writing what makes you angry in a certain situation or toward a certain person. That process helps undermine the anger both psychologically and physiologically." Thomas also suggests that women keep a journal, reflecting on incidents they feel angry about. "Women often get confused during an angry episode because it's so distressing and they find themselves thinking afterward, What started that? But if you keep a record for a month of angry incidents with a specific person, for example, you will begin to see recurring themes. Once you've calmed down, you can talk to that person about the anger in a clearer way."

Managing the Argument

Calm your body. "If you're aware you're angry, stop and ask, What do I need to do about this?" advises Stabb. "Taking time to calm down is important because it gives you time to process the information your emotions are telling you."

Stick to specifics. Instead of beginning by hurling accusations and cries of "You always do this," talk only about the specific incident that angered you, suggests Thomas. "Let's say your husband is 45 minutes late to meet you. Begin by saying, 'We were supposed to meet at 7 and you came at 7:45. I'm really angry and I want to talk to you about this.' Then state a consequence: 'Next time, I won't wait.' State the anger clearly and make sure you follow through."

Learn to listen. Part of processing anger is being able to listen to another person's feelings as well as expressing your own, says Stabb. "You can acknowledge his anger without agreeing by saying something like, 'I know that you have a different point of view from mine, but this is my point of view and this is why I feel angry.'" Acknowledging another's anger makes it more likely he'll accept yours.

Take an anger break. Don't expect to overhaul a situation or your anger all at once, says Miller. "If you feel, for example, that your spouse begins to hear you, then at least something is moving. Talk for 20 minutes and then take a break."

Ultimately, such practices work. As Willard found words for her anger, her depression lifted, her health problems abated, her self-esteem rose, and her marriage righted itself. She still has plenty of anger, but she reacts differently. Recently, she left work depressed about the disrespect she felt from one of her young male employees. But that evening she thought about how to handle the situation, wrote down the points she wanted to make, and then scheduled an early-morning meeting with him. "We still need to work on things, but it was the beginning of his understanding that I'm the boss. And I'm happy about that. Here I am in my late 40s, and I've finally grown up."

A Day in Anger Hell

Solution Middle-of-the-night ruminations hit when you're not only angry but unhappy with the way you're handling a situation. So you relive a scene, seething anew each time. Next time, get up and write about it. People who toss and turn are most likely to benefit by exploring the issue in writing. Ask, Why am I feeling the way I am? What is it about this situation and this person that's getting to me? What is it about me that made me so angry about this? That defuses the rage.

Dorothy Foltz-Gray Dorothy Foltz-Gray is a freelance writer who writes primarily about health issues.

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