Might have this disease

It happens alot at the shooting range

"Road rage? It Could Be 'Intermittent Explosive Disorder'"

(Associated Press, Jun. 5, 2006)

CHICAGO - To you, that angry, horn-blasting tailgater is suffering from road rage. But doctors have another name for it - intermittent explosive disorder - and a new study suggests it is far more common than they realized, affecting up to 16 million Americans.

"People think it's bad behavior and that you just need an attitude adjustment, but what they don't know ... is that there's a biology and cognitive science to this," said Dr. Emil Coccaro, chairman of psychiatry at the University of Chicago's medical school.
Road rage, temper outbursts that involve throwing or breaking objects and even spousal abuse can sometimes be attributed to the disorder, though not everyone who does those things is afflicted.

By definition, intermittent explosive disorder involves multiple outbursts that are way out of proportion to the situation. These angry outbursts often include threats or aggressive actions and property damage. The disorder typically first appears in adolescence; in the study, the average age of onset was 14.

The study was based on a national face-to-face survey of 9,282 U.S. adults who answered diagnostic questionnaires in 2001-03. It was funded by the National Institute of Mental Health.
About 5 percent to 7 percent of the nationally representative sample had had the disorder, which would equal up to 16 million Americans. That is higher than better-known mental illnesses such as schizophrenia and bipolar disorder, Coccaro said.

The average number of lifetime attacks per person was 43, resulting in $1,359 in property damage per person. About 4 percent had suffered recent attacks.

The findings were released Monday in the June issue of the Archives of General Psychiatry.
The findings show the little-studied disorder is much more common than previously thought, said lead author Ronald Kessler, a health care policy professor at Harvard Medical School.
"It is news to a lot of people even who are specialists in mental health services that such a large proportion of the population has these clinically significant anger attacks," Kessler said.
Four a couple of decades, intermittent explosive disorder, or IED, has been included in the manual psychiatrists use to diagnose mental illness, though with slightly different names and criteria. That has contributed to misunderstanding and underappreciation of the disorder, said Coccaro, a study co-author.

Coccaro said the disorder involves inadequate production or functioning of serotonin, a mood-regulating and behavior-inhibiting brain chemical. Treatment with antidepressants, including those that target serotonin receptors in the brain, is often helpful, along with behavior therapy akin to anger management, Coccaro said.

Most sufferers in the study had other emotional disorders or drug or alcohol problems and had gotten treatment for them, but only 28 percent had ever received treatment for anger."This is a well-designed, large-scale, face-to-face study with interesting and useful results," said Dr. David Fassler, a psychiatry professor at the University of Vermont. "The findings also confirm that for most people, the difficulties associated with the disorder begin during childhood or adolescence, and they often have a profound and ongoing impact on the person's life."

Jennifer Hartstein, a psychologist at Montefiore Medical Center in New York, said she had just diagnosed the disorder in a 16-year-old boy.

"In most situations, he is relatively affable, calm and very responsible," she said. But in stressful situations at home, he "explodes and tears apart his room, throws things at other people" to the point that his parents have called the police.

Hartstein said the study is important because many people are not aware of the disorder.

Study: Volatile rage not rareDisorder goes beyond throwing a book, researchers say

Ronald Kotulak Chicago Tribune Jun. 6, 2006 12:00 AM

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 unjustified, researchers from Harvard and the University of Chicago have found.

The nationwide study found that the condition called intermittent explosive disorder's not the rare occurrence that psychiatrists had previously thought. Four percent to 5 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 storm out of a room. The disorder 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 the disorder might be an unrecognized major mental-health problem. He also pioneered therapy designed to treat the disorder involving anti-depressants, mood disorder medications like lithium and cognitive therapy.The new research, in the current issue of the Archives of General Psychiatry, involved person-to-person interviews of 9,282 people 18 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 the disorder is rising among teenagers and that it may set the stage for the onset of mental conditions such as depression. Eight out of 10 people with the anger disorder 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 boys and 19 in girls, increases rapidly in the teen years, is less prevalent among respondents in their 40s and becomes even less so among people in their 60s.