Rage Disorder More Common Than Thought

Intermittent explosive disorder can fuel road rage, spousal abuse, study finds

MONDAY, June 5, 2006 (HealthDay News) -- A little-studied mental illness marked by episodes of angry, potentially violent outbursts like those seen in road rage or spousal abuse is more common than previously thought, researchers report.

In fact, the illness, known as intermittent explosive disorder (IED), may affect as many as 7.3 percent of American adults -- up to 16 million people -- in their lifetimes. In a given year, the disorder affects almost 4 percent of Americans, or 8.6 million adults, the researchers found.

Intermittent explosive disorder may also predispose people to other mental illnesses, such as depression and anxiety, and substance abuse problems.

The findings of the study, funded by the National Institute of Mental Health, appear in the June issue of the Archives of General Psychiatry.

"An awful lot of people in America have IED," said study lead author Ronald Kessler, a professor of health-care policy at Harvard Medical School. "IED is characterized by explosive anger attacks that they can't control and are out of proportion to what is going on in their lives and that lead to physical assault or breaking things," he said.

According to the bible of mental illness, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), people with IED overreact to certain situations with uncontrollable rage, experience a sense of relief during the angry outburst, and then feel remorse about their actions.

Kessler and his colleagues based their findings on an analysis of data on 9,282 adults who participated in the National Comorbidity Survey Replication conducted from 2001 to 2003. "We found that IED is strongly related to depression and anxiety and other mental-health problems," Kessler said.

Eighty-two percent of those with intermittent explosive disorder were also diagnosed with depression, anxiety, and alcohol or drug abuse disorders, although IED symptoms usually surfaced first.

Not many people with IED are treated, Kessler said. "They usually don't think they have a problem. They think somebody else has a problem," he said.

But there are effective treatments for IED, Kessler said. They include cognitive-behavioral therapy, as well as the antidepressants known as selective serotonin reuptake inhibitors (SSRIs) and mood stabilizers.

Intermittent explosive disorder can first appear in childhood, Kessler said. "What would be the implications in the school years of finding these kids, getting them into treatment?" he asked. "Would treatment be effective? Would it prevent later divorce, job loss, drug or alcohol addiction or legal problems?"

One expert thinks that combination treatment -- talk therapy and medication -- is the best approach to treating IED, as well as early diagnosis.

"Aggression is often a symptom that brings people for psychiatric attention," said Dr. Rene Olvera, an assistant professor of psychiatry at the University of Texas Health Science Center at San Antonio. IED appears to be a combination of a mood disorder and poor impulse control, he added.

"You start seeing IED in young children and adolescents," Olvera said. "You want to look at the causes in the environment, and you need help from parents and the school."

For adults, one hope is that they start seeing the problem in themselves, Olvera said. "These folks have a very narrow field of response in terms of their coping strategies -- they have very few coping strategies that they use," he said.

Olvera agrees that people with IED need a combination of therapy and medication to help them deal with their aggression.

More information

The American Psychological Association can tell you more about anger management.

SOURCES: Ronald Kessler, Ph.D., professor of health-care policy, Harvard Medical School, Boston; Rene Olvera, M.D., M.P.H., assistant professor of psychiatry, The University of Texas Health Science Center at San Antonio School of Medicine; June 2006, Archives of General Psychiatry
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