Is excessive anger the only serious concern with a lack of forgiveness?  What about sadness or grief?

You are correct that a person may experience sadness or grief rather than or in addition to anger when treated very unfairly by others.  As documented in the book, Forgiveness Therapy (2024) by Enright and Fitzgibbons, it is excessive anger in particular (the kind of anger that is intense and long lasting) that can lead, over time, to psychological compromise such as anxiety and depression.  So, from a mental health standpoint, it is the excessive anger that is of primary concern and in need of amelioration.

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