Anger History Assessment (Age 16+)

Self-report tool to understand lifetime anger patterns, intensity, duration, behaviors, and consequences since age 16.
Scale: 1 (Minimal) → 5 (Severe). Not a diagnostic instrument.

Double Board Certified Counseling Services, Inc. • Mark Zauss, LMHC, LPC, CCMHC, NBCC, BC-TMC, ADHD-CCSP, C-DBT, CCTP

Provider
Mark Zauss, LMHC, LPC, CCMHC, NBCC, BC-TMC, ADHD-CCSP, C-DBT, CCTP
Double Board Certified Counseling Services, Inc.

Date

Auto-filled. Adjust if completing for a different date.

Client Name

Current Age

ADHD History (Optional but Clinically Helpful)

Any history of ADHD (diagnosed or suspected)? Select… No Yes — diagnosed Yes — suspected / never formally evaluated Unsure

ADHD can affect impulse control, emotional regulation, and escalation speed.

If yes, age of diagnosis (or first suspicion)

ADHD-related notes (optional)

Part A — First Memory & Timeline (Age 16+)

How old were you when you first remember feeling “out of control” with anger?

What happened? (brief description)

Since age 16, which best describes your anger pattern overall? Select… Occasional episodes (rare) Intermittent episodes (every few months) Recurring episodes (monthly) Frequent episodes (weekly) Very frequent (multiple times/week or daily irritability)

When was anger at its worst? Select… 16–2021–2526–30 31–3536–4041+ It has been consistently high across adulthood

In the past 12 months, anger has: Select… Improved Stayed about the same Worsened Fluctuated a lot

Part B — Episode Duration Pattern

Choose what best fits your typical anger episode since age 16, and also your worst episodes.

Typical episode lasts: Select… ~15 minutes 1–3 hours Most of the day Longer than one day

Worst episodes lasted: Select… ~15 minutes 1–3 hours Most of the day Longer than one day

After an anger episode, how long to fully “cool down”? Select… Minutes Hours Until the next day Multiple days

Part C — Lifetime Anger Severity Ratings (1–5)

Rate how true each statement has been for you across adult life (age 16+). 1=Minimal/rare • 3=Moderate • 5=Severe/frequent.

Item	Rating (1–5)	Examples / Notes (optional)
1. I experience anger that feels intense or hard to regulate.	12345
2. My anger builds quickly and feels “sudden.”	12345
3. I stay angry longer than I want to (rumination, can’t let it go).	12345
4. I raise my voice, argue, or become verbally aggressive when angry.	12345
5. I make threats, intimidate, or say things I later regret.	12345
6. I slam doors, throw objects, punch walls, or damage property.	12345
7. I have been physically aggressive toward someone (pushing, hitting, etc.).	12345
8. When angry, I act impulsively without thinking through consequences.	12345
9. I have difficulty stopping once I start arguing or escalating.	12345
10. My anger has harmed relationships (partner, family, friends, coworkers).	12345
11. My anger has affected work/school (discipline, job changes, performance issues).	12345
12. I notice strong body signs when angry (heart racing, heat, tension, shaking).	12345
13. When angry, my thinking becomes rigid (all-or-nothing, “disrespected,” “unfair”).	12345
14. I later feel guilt/shame or regret about how I handled my anger.	12345
15. Alcohol/cannabis/other substances have worsened my anger or made it harder to control.	12345
16. I avoid dealing with anger until it “builds up,” then I explode or shut down.	12345

Part D — Triggers, Themes, and Consequences

Most common triggers (check all that apply)

Checking items adds context (not points).

Feeling disrespected / criticized Feeling controlled / told what to do “It’s unfair” / rule violations Rejection / abandonment Stress / overload / fatigue Boundary issues (being interrupted, rushed, crowded)

Major consequences since age 16 (check all that apply)

Some items trigger a clinical attention flag.

Police involvement / arrests Protective order / restraining order Physical injury to self/others Relationship separation/divorce related to anger Job loss / disciplinary action related to anger Financial consequences (damage, impulsive spending)

Additional notes (optional)

Part E — Current Goal

In one sentence: What do you want to be different about your anger?

How will you know therapy is working?

Scores:

Total Severity Index: --

Calculated as the average of weighted ratings (1–5). Higher = more severe historical anger impact.

Severity Band: --

Click “Score” to generate interpretation.

Domain Averages (1–5):

Core: -- • Behavior: -- • Impulse: -- • Impact: -- • Arousal: -- • Cognitive: -- • Coping/Substances: --

Duration Pattern (typical / worst): --

Longer durations may reflect prolonged rumination/dysregulation.

Safety / Clinical Attention Flag: Higher-risk indicators were endorsed (e.g., physical aggression rating high, legal involvement, or injury). Consider safety planning and appropriate clinical/medical/legal coordination as indicated.

Score Download / Save as PDF Send Results to Mark Copy Results Reset Print

How to send results if “Send Results” is not available: Click Download / Save as PDF and save the file, then email it to [email protected].

Clinical note: This tool measures historical patterns and perceived impact since age 16. It does not determine diagnosis.

---