Recently a client showed me a photo of her 19 year old daughter who suffers from what she calls "Rage Disorder". This illness, as with all mental illnesses, is biochemical in nature. Rage Disorder goes by several names including Intermittent Explosive Disorder.
Intermittent explosive disorder (IED), belongs to the greater family of impulse-control disorders as categorized in Axis I of the DSM-IV along with kleptomania, pyromania, pathological gambling, and other impulsive personality disorders (American Psychiatric Association, 1994). Impulse-control disorders are primarily characterized by the experience of impulses that are difficult or even impossible to resist, even if the impulses may be harmful to self or others (Boyd, 2005; Grant, Levine, Kim, & Potenza, 2005). Impulse aggression is non-premeditated, and is characterized as a disproportionate reaction to any provocation felt by the patient (Ibid.). Patients have reported affective symptoms prior to the outburst, e.g., tension, preceding mood changes, energy changes, and so on (McElroy, 1999).
A 2005 study conducted in Rhode Island found the prevalence to be 6.3% (SE, +/- 0.7%) for lifetime DSM-IV IED in a study of 1300 patients under psychiatric evaluation (Coccaro, Posterkan, & Zimmerman, 2005). The national prevalence has not been established, and the disorder is considered to be relatively rare, due at least in part to the fact that an IED diagnosis is usually given only if all other possible disorders and syndromes are ruled out. Prevalence is higher in men than in women (Boyd, 2005). The disorder itself is not easily characterized and often exhibits comorbidity with other mood disorders, particularly bipolar disorder (McElroy, 1999).
In a study conducted by McElroy, et al (1998), 27 subjects exhibiting DSM-IV IED were recruited and interviewed to describe their symptomology and episodic behaviors. All subjects described outbursts as brief, lasting an average of 22 minutes Ī SD of 23 minutes. One-third of the subjects reported experiencing somatization prior to an episode, e.g. “tingling, tremor, palpitations, chest tightness, head pressure, or hearing an echo” (McElroy, Soutullo, Beckman, Taylor Jr., & Keck Jr., 1998). Over half of the subjects reported an alteration in their awareness during the episode, but none reported amnesia of the outburst. Subjects generally reported an inability to resist the impulse to violence, and often reported a feeling of relief (88% reporting) or even pleasure (46% reporting) while committing the acts. After the acts, many subjects reported feelings of remorse at their actions. Remarkably, all 27 subjects reported their experiences with IED consistently.
The DSM-IV criteria for IED include: the occurrence of discrete episodes of failure to resist aggressive impulses that result in violent assault or destruction of property, the degree of aggressiveness expressed during an episode is grossly disproportionate to provocation or precipitating psychosocial stressor, and, as previously stated, diagnosis is made when other mental disorders that may cause violent outbursts (e.g., antisocial personality disorder, borderline personality disorder, attention deficit/hyperactivity disorder, etc.) have been ruled out (McElroy, 1999; McElroy, Soutullo, Beckman, Taylor Jr., & Keck Jr., 1998). Furthermore, the acts of aggression must not be due to a general medical condition, e.g., a head injury, Alzheimer’s disease, etc., or due to substance abuse or medication (Ibid.). Diagnosis is made using a psychiatric interview to affective and behavioral symptoms to the criteria listed in the DSM-IV.
Treatment is achieved through both cognitive behavioral therapy and psychotropic medication regimens. Therapy aids in helping the patient recognize the impulses in hopes of achieving a level of awareness and control of the outbursts, along with treating the emotional stress that accompanies these episodes. Multiple drug regimens are frequently indicated for IED patients. Tricyclic antidepressants and serotonin reuptake inhibitors (SRIs) such as fluoxetine, fluvoxamine, and sertraline appear to alleviate some pathopsychological symptoms; the reasons for such will be explained further in the subsequent section (Goodman, Ward, Kablinger, & Murphy, 1997; McElroy, 1999). GABAergic mood stabilizers and anticonvulsive drugs such as gabapentin, lithium, carbamazepine, and divalproex seem to aid in controlling the incidence of outbursts (Boyd, 2005; Bozikas, Bascilla, Yulis, & Savvidou, 2001; McElroy, 1999). Anxiolytics help alleviate tension and may help reduce explosive outbursts by increasing the provocative stimulus tolerance threshold, and are especially indicated in patients with comorbid obsessive-compulsive or other anxiety disorders (Boyd, 2005).
Impulsive behavior, and especially impulsive violence predisposition has been correlated to a low brain serotonin turnover rate, indicated by a low concentration of 5-hydroxyindoleacetic acid (5-HIAA) in the cerebral spinal fluid (CSF). This substrate appears to have important neurochemical properties, acting on the suprachiasmatic nucleus in the hypothalamus, which is the target for serotonergic output from the dorsal and median raphe nuclei. This site plays a role in the maintaining the circadian rhythm and regulation of glucose metabolism. A putative hereditary component to low CSF 5-HIAA and concordantly possibly to impulsive violence has been proposed upon observation that sons of alcoholic fathers who exhibit violent behavior also exhibit exceptionally low CSF 5-HIAA. Along with low CSF 5-HIAA concentration, vagal tone and increased insulin secretion has been observed in patients with confirmed DSM-IV IED.
Possible polymorphisms in the gene for tryptophan hydroxylase, which is responsible for the production of hydroxytryptophan, the precursor of serotonin. Within violent subjects, a significant relationship was observed between CSF 5-HIAA concentration and specific polymorphism genotypes. The phenotypes associated with these genotypes are extreme and it is hypothesized that these polymorphisms may only be significantly correlated to impulsive behavior (Virkkunen, Goldman, Nielsen, and Linnoila, 1995).
Additionally, lesions in the orbital/medial prefrontal cortex and related areas appear to be correlated to impulsively violent behavior, although currently no study has pinned down a specific area involved in IED. Research has shown, however, that damage in these areas, including the amygdale, increases the incidence of impulsive and aggressively violent behavior, and appears to decrease inhibition and ability to control emotion, as well as decreasing the ability to project consequences for their actions. Subjects who exhibit lesions in these regions may also exhibit decreased glucose metabolism, and concordantly decreased brain function in the prefrontal cortex, the region associated with decision making and action planning. More importantly is a reduced action in serotonergic neurons in this region as well as the amygdala (Best, Williams, & Coccaro, 2002).
A study published in the June, 2006 edition of the Archives of General Psychiatry suggests that IED is much more common than previously suspected, perhaps affecting 16 million Americans.
A study funded by the National Institute of Mental Health surveyed 9,282 adults between 2001 and 2003. The results of the study found that a person with IED had an average of 43 attacks in their lifetime resulting in $1,359 (USD) of property damage.
They concluded that although IED is seldom recognized due to the violent behavior being blamed on other mental issues, the occurrences where it was diagnosed show promising results when treated with a combination of behavioral and pharmaceutical methods.
In puberty children display symptoms of mental disorders which come full blown in their late teen years, generally after High School, if they finish.
Untreated, rage disorder as with other mental illnesses turn young adults to substance abuse as a means to self medicate.
Often these young adults refuse to take medication, due to side effects, not wanting to try other medications to find one that will help, or cite the life path of other family members who have been on drugs most of their lives. In an age of alternative medicine, they try to gain control of their emotions, in alternative ways. Sometimes that works and other times the chemical imbalance in their brain will still create mood swings and rage.
The purpose of the healing grid, is awareness of genetic disorders, abuse issues and how to keep them under control so a person can function. We are bound to the physical grid by electromagnetic energy grid point. There we must always try to "Get a Grip".
People with unrecognized, undiagnosed and therefore untreated personality disorders, generally overlooked, or not addressed, by their parents who abused them, unable to cope, have extremely difficult lives, especially as their seek love and caretakers. Often they sabotage those who come to help them, as they feel unworthy, and follow family genetic patterning. It truly is a vicious cycle. As awareness expands, help can be found.
... And so it has always been ... and so it shall be until the end of time, a bipolar reality locked in chaos and drama as "The World Turns" and the Poles Reverse. These are the "Days of Our Lives." Act 3, Scene 8. CUT!
Clues to violence show up in brain News in Science , March 21, 2006
Genetic Basis for Increased Risk of Impulsive Violence Live Science, March 20, 2006
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