Under-diagnosed rage disorder more prevalent than previously thought

A seldom-studied mental illness called Intermittent Explosive Disorder, characterized by recurrent episodes of angry and potentially violent outbursts — seen in cases of road rage or spousal abuse — has been found to be much more common than previously thought.

Depending upon how broadly it is defined, this disorder affects as many as 7.3 percent of adults, or 16 million Americans, in their lifetimes. In a year, Intermittent Explosive Disorder affects nearly 4 percent of Americans, or 8.6 million adults, reports Ronald Kessler, PhD, professor of health care policy at Harvard Medical School, and colleagues. The study also found that Intermittent Explosive Disorder may predispose people to other mental illnesses and substance abuse. These results are reported in the June 2006 issue of Archives of General Psychiatry.

Intermittent Explosive Disorder attacks are out of proportion to the social stressors triggering them and are not due to another mental disorder or the effects of drugs or alcohol, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). People with this disorder overreact to situations with uncontrollable rage, feel a sense of relief during the angry outburst, and then feel remorseful about their actions.

“Intermittent Explosive Disorder is not a clinical term well- known in society, but the weight of these numbers should help patients and physicians come to recognize the pervasiveness of this disorder and develop appropriate treatment strategies,” says Kessler, senior author of the study. The study is based on data from the National Comorbidity Survey Replication (NCS-R), a nationally representative face-to-face household survey of 9,282 American adults, conducted from 2001 to 2003. The NCS-R is carried out in conjunction with the World Health Organization World Mental Health Survey Initiative.

This work was funded by the National Institute of Mental Health, the National Institute on Drug Abuse, the Substance Abuse and Mental Health Services Administration, the Robert Wood Johnson Foundation, and the John W. Alden Trust.