Anger Disorder increasing among teens and may lead to other problems, researchers say.

By Ronald Kotulak
CHICAGO TRIBUNE
Tuesday, June 06, 2006

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 University and the University of Chicago report.

Their study found that the condition called intermittent explosive Anger disorder is not the rare occurrence that psychiatrists had thought. About 5 percent of people in the study's nationally representative sample were found to have physically assaulted someone, threatened bodily harm or destroyed property in a rage an average of five times a year. That would make the disorder more pervasive than better-known mental illnesses such as schizophrenia and bipolar disorder, said Dr. Emil Coccaro, the University of Chicago's chief of psychiatry.

Intermittent explosive disorder is different from the common type of anger most people exhibit from time to time, when they pout, throw down a book 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.

People with rage disorder often misinterpret another person's harmless action as a personal threat to them and respond violently, Coccaro said.

"Our new study suggests IED is really out there and that a lot of people have it," Coccaro said. "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 said the disorder involves inadequate production or functioning of serotonin, a mood-regulating and behavior-inhibiting brain chemical.

Coccaro 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 might 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 boys and 19 in girls, that it increases rapidly in the teen years, that it is less prevalent among respondents in their 40s and that it becomes even less so among people in their 60s.

"Is there something profoundly important about how society is changing that's leading to this apparent increase in people not being able to control their emotions and lashing out at other people?" asked Kessler. "Is it that we're bad parents and we're creating these little monsters? Is television doing it?

"We know there's an awful lot of young people who have it today, and older people tell us they've never had it," he said. "Whether they're lying or not, we don't know. But, obviously, now that it's on our radar screen, we're going to be monitoring it very carefully."

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 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.

At the same time, the front portion of their brain, which serves as an executive control over emotional urges, is less active than in normal people, Coccaro said, indicating that people with IED quickly lose control.

"People with this problem have a low threshold for exploding, and that's probably genetically and biologically mediated," he said.

Additional material from The Associated Press.