Attacks of rage might affect 5%

Researchers find chemical signals in brain linked to uncontrolled anger


CHICAGO -- One in 20 Americans might 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 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 type of anger most people exhibit from time to time when they pout, throw a book down or walk out of a room. 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," Dr. Emil Coccaro, 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 antidepressants (of the serotonin re-uptake inhibitor class), mood disorder medications such as 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 authors said their findings suggest two disturbing trends that will require additional study - that IED is on the increase among teenagers and that it could set the stage for the onset of such other mental conditions as depression and alcoholism. Eight 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.

The study found that the rage disorder typically begins at age 13 in males and 19 in females, increases rapidly in the teen years, is less prevalent among respondents in their 40s and becomes even less so among people in their 60s.

Mental health research has concentrated on such problems as depression, schizophrenia, anxiety, panic attacks and substance abuse. Instead of being considered a mental health problem, anger was thought to be a matter of willpower.

But new brain imaging studies show that people with IED have abnormal brain signaling in areas that control anger responses, Coccaro said. When people with rage disorder are shown pictures of people with angry faces, their amygdala lights up far more than is seen in healthy subjects. The amygdala, deep in the center of the brain, governs emotional responses to threats.

Ronald Kotulak writes for the Chicago Tribune.

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