The War Within: Understanding and Managing Anger in First Responders with PTSD

For firefighters, EMTs, and dispatchers, the job comes with immense pressure, unimaginable sights, and the burden of responsibility for the lives of others. Over time, this constant exposure to trauma can lead to post-traumatic stress disorder (PTSD). One of the most overlooked but common symptoms of PTSD is anger—an emotion that, when left unaddressed, can quietly burn through relationships, careers, and personal well-being.

The Origins of Anger in PTSD

Anger is not just a random outburst of emotion—it’s a response to perceived threat or loss of control. For first responders, these threats often come in the form of:

• Moral injury: Witnessing or being part of events that conflict with one’s sense of right and wrong.

• Helplessness: The inability to save someone or feeling powerless in the face of suffering.

• Survivor’s guilt: Living when others didn’t, especially when those others were teammates or patients.

• Hyperarousal: PTSD often puts the nervous system in a constant state of high alert, making people more irritable and quicker to anger.

• Suppressed emotions: In the culture of emergency services, emotions are often buried in the name of strength. Over time, that bottled-up emotion can emerge as rage.

Why First Responders Are More Prone to Anger

Anger in first responders is deeply tied to the nature of the job. Consider this:

• They experience trauma repeatedly, often with no time to process one event before the next call comes in.

• There’s an expectation to remain stoic, especially in male-dominated departments, where vulnerability is still seen as weakness.

• Sleep deprivation is common and worsens emotional regulation.

• The pressure to always be in control on the job can create frustration when things go wrong—or when control isn’t possible.

This pressure-cooker environment means that even small irritations off-duty—traffic, family stress, or feeling misunderstood—can ignite a disproportionate emotional response.

Signs of Anger-Related PTSD in First Responders

• Sudden outbursts or irritability

• Hostility toward coworkers or loved ones

• Persistent frustration or agitation

• Trouble calming down after being upset

• Self-destructive behavior (e.g., substance use, reckless driving)

• Isolation due to fear of hurting others emotionally

Coping Strategies: Taming the Tiger

The good news is that anger, like any emotion, can be understood and managed. Here are some effective strategies:

1. Name It to Tame It

Recognize and admit when you’re feeling angry. This allows you to take control before it controls you. Journaling or speaking with a trusted peer can help identify patterns and triggers.

2. Grounding and Breathing Techniques

Deep breathing, progressive muscle relaxation, and grounding exercises (like the 5-4-3-2-1 method) can help deactivate the “fight or flight” response and return you to a calm state.

3. Physical Activity

Exercise burns off adrenaline and tension and can provide a healthy outlet for frustration. Even a 20-minute walk can help.

4. Therapy

Cognitive behavioral therapy (CBT), EMDR, and trauma-informed counseling can uncover the root causes of anger and offer practical tools for handling it.

5. Peer Support and Group Programs

Talking with others who’ve been in your shoes helps reduce the isolation and stigma of emotional struggles. Programs like Critical Incident Stress Management (CISM) and peer support teams offer a safe space.

6. Mindfulness and Meditation

Mindfulness helps you pause before reacting. Apps like Headspace, Calm, or even 5 minutes of focused breathing can increase emotional regulation over time.

7. Set Boundaries

Sometimes anger is your body’s way of telling you that your boundaries have been violated. Learn to say no, take time off when needed, and advocate for your own mental health.

Healing Is Possible

Anger doesn’t make you broken. It doesn’t make you weak. It’s a signal—an alarm bell from your nervous system telling you that something needs care and attention. PTSD is not a personal failure; it’s a wound from service. And like any wound, it can heal with time, support, and the right tools.

If you’re a first responder struggling with anger, you’re not alone—and you don’t have to fight this battle in silence. Reach out. Talk. Breathe. Heal. If you know of or if you are a first responder that is struggling, please reach out to us at www.riseupfight.org.

Stay safe out there.