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Health COLLECTIONS>MEDICAL STUDENTS PERSONAL HEALTH; Why Angry People Can't Control the Short Fuse By JANE E. BRODY Published: May 28, 2002 I slowed down as I approached a fork in the highway, unsure of which arm to take. The driver behind me was on my tail, so impatient that he tried to pass me on the right just as I headed for the right fork, forcing him to slam on his brakes. He became so infuriated that he pulled right in front of my car and each time I moved he repeatedly slammed on his brakes, forcing me to brake suddenly again and again, endangering not only me but himself and the driver behind me. While his road rage was short of a shooting, it was rage nonetheless and extremely unnerving. I consoled myself by thinking that he most likely had frequent temper tantrums and probably would die of a heart attack or stroke at an early age -- if someone didn't kill him first. Dr. Norman Rosenthal, a psychiatrist in the Washington area and an expert on depression and anger, says drivers who repeatedly tailgate, trying to pressure the cars in front to move faster or get out of the way, ''are always sitting on their arteries,'' which constrict in response to stress hormones that spew forth from their adrenal glands. ''These people live on a razor's edge,'' he continued, ''always vigilant and tense, angry because they want to get someplace quicker and think that they can somehow clear the highway.'' It is hard to say whether rage is now more common than it used to be or we are simply now more aware of it, given high-profile cases like mass shootings by children and evidence that chronically angry people endanger their health, their jobs and their personal relationships. For example, in a 25-year follow-up study of University of North Carolina medical students, Dr. John Barefoot, now at Duke, found that those who scored highest in hostility on a standard personality test were nearly five times as likely to die of heart disease as their less hostile classmates. In a similar study Dr. Barefoot did among law students, those who scored highest in hostility had more than a fourfold risk of dying within the next 25 years. ''People with short fuses are often very self-righteous and unsympathetic about the effect of their anger on other people,'' said Dr. Rosenthal, author of a new book on the science of feelings, ''The Emotional Revolution'' (Citadel Press, $25). ''Angry people don't come into psychiatrists' offices. They think it's everyone else's problem - obnoxious boss, difficult wife, incompetent employees.'' Certainly the time pressures built into many modern lives -- urban, suburban and rural -- give many opportunities for latent anger to erupt. But that does not mean frequent hostile outbursts are either inevitable or productive. As Dr. Rosenthal wrote, ''In most everyday situations we are more likely to pay a greater price for losing our temper than for not getting our licks in quickly enough.'' The advice to count to 10, and if you're still angry, count to 100 before you take any action is far from an old wive's tale. Waiting until you cool down to respond is only one of many effective strategies. Most valuable is to curb the tendency to get angry in the first place. What Makes You Angry? The first step in reducing hostile tendencies is to recognize how hostile you may be and the distorted thoughts and beliefs that give rise to angry outbursts. Are you cynical? Do you think that most people cannot be trusted, are mostly out for their own personal gain, would lie to get ahead, know less than they pretend to know, use people chiefly for what they can get from them, exaggerate their misfortunes, don't really care what happens to you and do the right thing only when it suits them? Do you think most people have hostile motivations? Do you think they are likely to misunderstand the way you do things, are nice to you only when they have an ulterior motive, have something against you, treat you unfairly, are critical of you, talk about you in a negative way, are jealous of your good ideas and fail to give you proper credit for your contributions? Do you often experience feelings of hostility, getting irritated or angry easily, often getting into arguments? Dr. Rosenthal said the driver who kept threatening me appeared to attribute hostile motives to other people. In his mind I deliberately made his life difficult and he was determined to teach me a lesson. ''Different triggers provoke different people,'' he wrote. ''Bad traffic, slow waiters, an insensitive boss, an incompetent employee or an inattentive spouse are all common provocations for angry people.'' Furthermore, he said, common misperceptions often fuel anger. Some people, especially those who are depressed, see hostility where it does not exist. They believe -- incorrectly -- that others feel hostile or critical toward them and tend to defend themselves, in the process actually provoking hostility and a vicious cycle of anger. Others operate from a misperception that the world should be other than it is and become enraged when beset by the ordinary hassles and inconveniences of everyday life -- an airport delay, a traffic jam, a person who breaks into a line. Dr. Rosenthal told of a friend who was often angered by long red lights and whose wife ''reminds him gently that the red light doesn't care, so he might as well save his fury.'' The psychiatrist noted that ''it is easier to change your expectations and recognize that life is often neither fair nor easy than it is to change the world.'' Sometimes chemical influences -- like excessive caffeine, steroids, diet drugs and antidepressants -- foster irritability. If medications may be contributing to your anger, discuss this possibility with your physician. Curbing Hostility When small children act up, parents these days are likely to give them a ''timeout.'' Likewise, people prone to anger need time to calm down and collect their thoughts. Sometimes, Dr. Rosenthal said, this literally means turning the other cheek -''physically moving away from the person who is provoking the anger.'' Only with time and distance may it be possible to respond appropriately, with wit, diplomacy, or proper assertiveness. ''Sometimes the cause of the anger may need to be addressed; at other times it might be better left alone,'' Dr. Rosenthal said. Just because you fail to respond immediately to a provocation does not mean you are ''giving in'' and allowing the person to offend you again and again. You will be much more effective at changing offensive behavior if you wait until you can discuss things calmly and rationally. Keep in mind that even if your anger is fully justified, blowing your top can still cost you; you may lose your job, your spouse or your health. Once you recognize what makes you mad, change the messages you give yourself, Dr. Rosenthal suggests. For example, you might rehearse the idea that just because some people are rude doesn't mean you must let them get to you. Instead, respect yourself for being a competent and polite person. Finding something funny in the situation and distractions like listening to the radio or to a tape of a book while stuck in traffic can often be effective antidotes to anger. Finally, learn how to let go of anger by soothing your body through deep breathing and muscle relaxation. Listening to music and even aromatherapy can be helpful to calm an overactive nervous system.