|
Because there is no
formal diagnosis called "Rage Attacks," there are
no agreed-upon diagnostic criteria. But there are a
number of terms in the professional literature that
seem related, if not identical to, "rage attacks."
The closest diagnoses would appear to be
"Intermittent Explosive Disorder" (IED) or
"Oppositional Defiant Disorder" (ODD). Other terms
used in the literature include "anger attacks,"
"explosive outbursts," and "episodic
dyscontrol."
While the label
"Intermittent Explosive Disorder" may seem to
"fit," the diagnostic criteria do not really match
what many patients or parents report, so let's
consider how mental health professionals diagnose
IED1:
Criterion
A. Several discrete episodes of failure to
resist aggressive impulses that result in
serious assaultive acts or destruction of
property.
While there are some
children and adults with "rage attacks" who do hit
or kick others, the common experience is that these
attacks are unlikely to lead to serious assault on
individuals or serious destruction of property.
Criterion
B. The degree of aggressiveness expressed during
the episodes is grossly out of proportion to any
precipitating psychosocial stressors.
Criterion B seems to
"fit well" with the reported experience of how
seemingly innocuous events can trigger the
attack.
C. The
aggressive episodes are not better accounted for
by another mental disorder (e.g., Antisocial
Personality Disorder, Borderline Personality
Disorder, a Psychotic Disorder, a Manic Episode,
Conduct Disorder, or
Attention-Deficit/Hyperactivity Disorder) and
are not due to the direct physiological effects
of a substance (e.g., a drug of abuse, a
medication) or a general medical condition
(e.g., head trauma, Alzheimer's
disease).
A study by Kessler et al. (2006) (pdf) on adults who met their research criteria for IED found significant comorbodity between IED and other disorders. They also found that the average age of onset of the attacks was early adolescence.
Since many of the
children and teens who have "rage attacks" do have Bipolar Disorder, Attention Deficit Hyperactivity Disorder with or without Oppositional Defiant Disorder, anxiety disorders, Obsessive-Compulsive Disorder, and because some people experience activation or
agitation on medications used to treat ADHD and/or
OCD, it seems that the 'rage attacks' in these
children or teens might be better accounted for by these
conditions.
Thus, Criteria A and
C both suggest a poor match between the diagnosis
of IED and "rage attacks" as experienced by many
individuals with neurobehavioral conditions. But
what about the other terms in the literature?
As with IED, the definitions of these other terms
demonstrate some overlap with how the term "rage
attacks" have been used colloquially by parents and
patients, but are not identical. For example,
Fava
and Rosenbaum (1999), in discussing "anger attacks" in adults
with depression, provide a definition that
incorporates both emotional/behavioral and
autonomic features:
Anger
attacks are sudden intense spells of anger that
resemble panic attacks but lack the predominant
affects of fear and anxiety associated with
panic attacks. Anger attacks typically occur in
situations in which an individual feels
emotionally trapped and experiences outbursts of
anger. Dysregulated anger is a state in which
the behavior must be provoked in order to be
observed. Thus, an anger attack is a combination
of predisposition--or some enduring state of
vulnerability--and provocation.
Fava's term was based primarily on work with patients with depression. Again, if we believe that these episodes are related to a disorder, why are we talking about them as if they are a separate disorder and not a symptom or feature of the diagnosed disorder?
Perhaps one of the most interesting outcomes of recent research was a suggestion by Kessler et al. that if these episodes occur early in life, they may be a marker or predictor of future emergence of other problems. They write:
|
The early age of onset of IED is an important finding with regard to comorbidity because it
means that IED is temporally primary to many of the other DSM-IV disorders with which it
is comorbid.37 Within-person analyses (detailed results available on request) found that this
was especially true for major depression, generalized anxiety disorder, panic disorder, and
substance use disorders, where the vast majority of respondent reported that their IED began
at an earlier age than these other disorders. This raises the possibility that IED might be either
a risk factor or a risk marker for temporally secondary comorbid disorders.38 Consistent with
this possibility, a recent family study showed that the offspring of depressed adults with anger
attacks have higher delinquency and aggressive behavior than the children of depressed adults
without anger attacks.39 This suggests that intermittent explosive behavior might emerge quite
early in subjects at risk of the subsequent onset of mood disorders. However, we are aware of
no systematic research on the possibility that IED is a risk marker for temporally secondary
disorders. It is interesting to note in this regard that the one published study that examined the
family aggregation of IED found high inter-generational continuity of the disorder independent
of comorbid conditions,37 which means that common genetic factors are unlikely to account
for the comorbidity of IED with other DSM disorders. |
|
THE MYTH OF "RAGE ATTACKS" BEING PART OF TOURETTE'S SYNDROME
|
|
Over 10 years ago,
some people talked about "Tourettic rage" as if
rage attacks were associated with Tourette's
Syndrome. In
case anyone has heard that myth, let me take this
opportunity to correct it yet again: there is no
evidence (and never has been) that people who have
Tourette's Syndrome without any other conditions
are more likely to have "rage
attacks." If they do have Tourette's
Syndrome and rage attacks, it appears to be due to
the presence of comorbid conditions -- and the more
comorbid conditions they have, the greater the
likelihood of having rage attacks. Does that mean
that every person who has Tourette's plus comorbid
conditions will experience such problems? No, it
doesn't. While a significant percentage of
individuals seen with TS+ in clinics have or have
had problems with anger or outbursts at some point
in their history, we need to be mindful that: (1)
these are not random samples but clinic samples
where you are more likely to encounter individuals
with more serious symptomatology, and (2) in some
cases, people who experience difficulty with anger
without having these explosive outbursts may be
included in the estimates.
That said, it is
probably true to say that about one-third or more
of patients who have Tourette's Syndrome
plus comorbid conditions seen in clinics
have experienced problems managing anger or
explosive outbursts and that these problems are
often the primary reason for them seeking medical
attention. But it bears repeating that there is no
evidence that Tourette's alone increases any risk
of such problems.
|
|
WHAT CONDITIONS ARE ASSOCIATED WITH "RAGE ATTACKS?"
|
|
So what are the
comorbid conditions that appear to be associated
with "rage attacks" or increased risk of such
explosive outbursts? If one were to ask what
diagnoses are more likely to be associated with
anger outbursts, explosive aggression, rage
attacks, or Intermittent Explosive Disorder, the
answer would probably be: depression, Bipolar
Disorder, OCD, ADHD+Oppositional Defiant or Conduct Disorder, Generalized Anxiety Disorder, Panic Disorder, Asperger's Syndrome, temporal
lobe epilepsy, head injuries, and Sensory Processing Disorder (although that is not a complete list and not in any particular order of probability).
|
|
*FOOTNOTE
|
|
Sukhodolsky DG,
Scahill L, Zhang H, Peterson BS, King RA, Lombroso
PJ, Katsovich L, Findley D, Leckman JF. (2003).
Disruptive behavior in children with Tourette's
syndrome: association with ADHD comorbidity, tic
severity, and functional impairment. J Am Acad
Child Adolesc Psychiatry, 42(1),
98-105.
|
|
Information
Section: Conditions
Condition:
Rage
Attacks
Article: Overview of "Rage
Attacks"
Source: Leslie E. Packer,
PhD
This page last updated: February 2009
|
Article
Page 1 2
3
|
|
Tourette
Syndrome "Plus" © Copyright 1998 - 2009 Leslie
E. Packer, PhD. except as noted.
All rights reserved
This page last updated February 3, 2009.
Reprint
Policy.
Privacy
Policy.
Contact.
|
|
