A little-studied mental illness, marked by A episodes of angry, potentially violent outbursts like those seen in road rage or spousal abuse, is more common than previously thought, researchers report. In fact, the illness, known as intermittent explosive disorder (IED), may affect 8.6 million Americans, the researchers found.

IED may also predispose people to other mental illnesses, such as depression and anxiety, as well as substance abuse problems.

The Research

Researchers based their findings on an analysis of data on 9,282 adults who participated in the National Comorbidity Survey Replication conducted from 2001 to 2003. They found that 82% of the people who had IED also had depression, anxiety and alcohol or drug abuse disorders, although it was the IED symptoms that usually surfaced first.

"We found that IED is strongly related to depression and anxiety and other mental health problems," says the study's lead author Ronald Kessler a professor of health-care policy at Harvard Medical School.

'An awful lot of people in America have IED," says Kessler. "IED is characterized by explosive anger attacks that they can't control and are out of proportion to what is going on in their lives and that lead to physical assault or breaking things," he says.

Defining The Disorder

According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), people who have IED overreact to certain situations with uncontrollable rage, experience a sense of relief during the angry outburst, and then feel remorse about their actions.

Because IED can first appear in childhood, Kessler wonders, "What would be the implications in the school years of finding these kids and getting them into treatment? Would it prevent later divorce, job loss, drug or alcohol addiction or legal problems?"

"Aggression is often a symptom that brings people for psychiatric attention," says Dr. Rene Olvera, an assistant professor of psychiatry at the University of Texas Health Science Center at San Antonio. IED appears to be a combination of a mood disorder and poor impulse control, he adds.

For adults, one hope is that they start seeing the problem in themselves, Olvera says. "These folks have a very narrow field of response in terms of their coping strategies-they have very few coping strategies that they use," he says.


Not many people who have IED are treated, Kessler says. "They usually don't think they have a problem. They think somebody else has a problem," he says.

However, there are effective treatments for IED, Kessler says, including cognitive-behavioral therapy, the antidepressants known as selective serotonin reuptake inhibitors (SSRIs) and/or mood stabilizers.

One expert thinks that early diagnosis and combination treatment-talk therapy and medication-is the best approach to treating IED.

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