What’s New in Psychology?

Explosive Anger Needs Treatment         

Jim Windell

           How many times have we seen YouTube videos of someone flipping out and acting out their rage? Usually, it is at a store, a fast-food restaurant or toward a flight attendant on an airplane. Sometimes these videos make it to the six o’clock or eleven o’clock news roundup. But, the fact is, they seem to be more frequent – and more violent.

           So, what’s going on? Are we more angry as a society? Are more angry people having their rage triggered? Are we less inhibited about venting our anger? Or, are there just more smart phones and people are recording these incidents more often?

           Joe Kita, writing recently in the online website Medscape Psychiatry, suggests that these angry outbursts may be caused by a little-known psychological condition called intermittent explosive disorder, or IED. In an article titled “Why Explosive Anger Isn't Just a 'Bad Attitude,' but a Symptom,” Kita goes on to explain IED.

           Kita points out that about 1 in 25 (or 13.5 million) Americans have the disorder. And he quotes Emil Coccaro, MD, the vice chair of research in the Department of Psychiatry and Behavioral Health at Ohio State University and the recognized world expert on IED, as saying:

           “We don't have any data on whether it's increasing or not. But clearly life is faster paced, people feel more stressed, and that could be promoting it." Coccaro adds that about 80% of those with IED are untreated.

           Coccaro explains that there are two things happening in the brain that are believed to cause the type of reaction characterized an IED. Coccaro points out that aggression is an evolutionary necessity, and that we need a defense mechanism to protect ourselves from threats. So, when a threat is perceived, “the amygdala, which is the reptilian part of our brain, kicks in to trigger either a fight or flight response," Coccaro says. “But in people with IED, the amygdala reacts more quickly and strongly. Their fuse is shorter.”

           Overly aggressive people tend to have lower levels of brain serotonin function. This naturally occurring chemical messenger, among other jobs, works to ease aggression. “Think of serotonin as your braking system,” Coccaro says. If your brake fluid is low, you won't be able to stop.

           It is also explained that people with IED don't plan to have their outbursts. They just happen. Nor do they typically use them to manipulate or intimidate others – That would be antisocial or psychopathic behavior. Rather they simply misperceive threats and then can't control their reaction to those threats. They snap. 

          While the causes of IED are not clearly known, there are ways to manage IED. 

          The first is cognitive behavioral therapy, the classic form of psychotherapy used to treat common behavior problems. "We teach patients how to tell if their perception of an anger-inducing situation is based in fact and then how to not act out aggressively,” says Michael McCloskey, PhD, a professor of psychology and neuroscience at Temple University and a leading IED researcher. “This type of therapy has been shown to reduce aggression by 50% or more over 12 weeks.”

          The second treatment, which can be combined with the first, is medication. “Serotonin reuptake inhibitors have been shown to be effective," says Coccaro. These antidepressant-type drugs improve the behavioral braking system mentioned earlier. Anti-epileptic drugs also appear to have some benefit.

          McCloskey's lab is also working on a new computer intervention that shows some promise in treating aggression. It teaches coping skills by having people view threatening and nonthreatening words or pictures on a screen. “Technology could make treatment more accessible and more engaging,” McCloskey adds.

          McCloskey points out that people with depression or anxiety will readily say that they get treatment for those disorders. However, people with IED tend to think, “I'm just an aggressive person, and there's nothing that can be done about it.”

         But as both McCloskey and Coccaro note, that’s just not true.

          To read the full article, find it at:

https://www.medscape.com/s/viewarticle/996032?ecd=WNL_mdpls_230901_mscpedit_psych_etid5810366&uac=401268FY&spon=12&impID=5810366