The Hidden Victims

Now, another name for rage.
You might call it bad behavior, but in medical terms, it's `intermittent explosive disorder.
By Janet Cromley, Times Staff Writer
June 12, 2006

Most who brave the Los Angeles freeways have experienced the warm, fuzzy ministry of another motorist cutting into their lane while waving the international friendship sign. This can render even the most laid-back, Prius-driving, yoga master a bit testy.

But for a small number of people, this minor driving altercation will spark rage so profound, so visceral, that it leads to car chases, fisticuffs and maybe even a few nights in the slammer. Now researchers say these people may be suffering from a seldom-studied condition known as intermittent explosive disorder, a condition that could be twice as prevalent as thought.

New research suggests that, depending on how it is defined, the disorder may affect 7.3% of the adult population, or as many as 16 million Americans, in their lifetimes, according to a study led by Ronald Kessler, a professor of healthcare policy at Harvard Medical School. In a given year, nearly 4% of the population, or as many as 8.5 million Americans, may experience the disorder, says Kessler.

The findings, derived from a nationwide household survey of 9,282 adults conducted between February 2001 and April 2003, was reported in the June issue of Archives of General Psychiatry.

As characterized by the Diagnostic and Statistical Manual of Mental Disorders — the standard diagnostic reference book for psychotherapists — a person with intermittent explosive disorder has on several occasions been unable to resist aggressive impulses that result in serious harm to individuals or property; the degree of aggressiveness is "grossly out of proportion" to the situation; and the episodes are not better accounted for by another condition, such as ADHD, and are not due to the physiological effects of a drug or a general medical condition, such as head trauma or Alzheimer's.

In some cases, the episode may be preceded by heart palpitations, head pressure or hearing an echo.

In short, true intermittent explosive disorder leaves garden-variety freeway altercations in the dust. In fact, even bona fide road rage — which tends to get the most air-time in the nightly news — isn't how the disorder most often manifests itself.

More typical, says Kessler, is the person who gets furious at a spouse or child for a minor disagreement over something as mundane as dinner not being served on time or neglected chores.

"It's true that periodically you hear about someone beating someone up at a baseball game," says Kessler. "But much more common are the hidden cases where the victims are the spouse and kids."

In another context, these people would be called abusers and their families removed from danger. The people who blow up on the freeway are going to blow up at you next. Flee while you can. Take it from one who knows.