Explosive rage less rare than once thought

CHICAGO – One in 20 Americans may be susceptible to uncontrollable anger attacks, in which they lash out in road rage, spousal abuse or other severe transgressions that are totally unjustified, researchers from Harvard and the University of Chicago have found.

Their nationwide study found that the condition called intermittent explosive disorder, or IED, is not the rare occurrence that psychiatrists had previously thought. Four to five percent of people in the study were found to have physically assaulted someone, threatened bodily harm or destroyed property in a rage an average of five times a year.

Intermittent explosive disorder is different from the common anger most people exhibit from time to time when they pout, throw a book down or walk out of a room, activities that are better described as mild temper tantrums. IED is defined as repeated and uncontrollable anger attacks that often become violent.

“Our new study suggests IED is really out there and that a lot of people have it,” said Dr. Emil Coccaro, the University of Chicago’s chief of psychiatry. “That’s the first step for the public to actually get treated for it, because if you don’t think it’s really a disorder, you’re never going to get treated for it.”

Coccaro was the first to show, through a preliminary 2004 study, that IED might be an unrecognized major mental health problem. He also pioneered therapy designed to treat the disorder involving anti-depressants (of the serotonin reuptake inhibitor class), mood disorder medications like lithium and cognitive therapy.

The new research, reported in the current issue of the Archives of General Psychiatry, involved person-to-person interviews of 9,282 people 18 years and older conducted from 2001 to 2003. The subjects were part of the National Comorbidity Survey Replication, a government-funded epidemiological study of mental health.

The authors said their findings suggest two disturbing trends that will require additional study: that IED is on the increase among teenagers and that it may set the stage for the onset of such other mental conditions as depression and alcoholism. Eight out of 10 people with IED subsequently develop other mental disorders, they found.

“Given its age of onset, identifying IED early, determining its causes and providing treatment might prevent some of the associated secondary disorders, such as anxiety and alcohol abuse,” said Ronald Kessler, a professor of health-care policy at Harvard.