(Speaking as someone who sees contact martial arts as a perfectly (mentally-) healthy activity ...)
I've known several amateur fighters, and they all report that the decision to actually attack their opponent in anger is the hardest step for most people making the transition from training for fitness to actual competitive fighting.
Two of those people were exceptions, though: one was a junior lawyer whose approach to her first fight earned her the nickname "Basher", and the second a cleaned-up ex-gang member who used to fight for fun in bars.
I've often wondered whether Basher was merely applying the same mindset she learned as a lawyer to the ring.