With nearly 1 in 12 teens diagnosed, is 'Anger Disorder' the next big thing?

Illustration for article titled With nearly 1 in 12 teens diagnosed, is 'Anger Disorder' the next big thing?

With all that teens have to go through on the way to adulthood, it's understandable that many of them lash out and lose it everyone once in awhile. But a new study from Harvard suggests that nearly 8% of teens are now exhibiting outbursts so violent, they fall into the category of a mental disorder.


Given its prevalence, some are suggesting that it's a growing problem that needs to be addressed — while others claim that we're once again pathologizing normal behavior and looking at the wrong places for a solution.

According to a Harvard Medical School finding published online in the Archives of General Psychiatry, nearly two-thirds of adolescents (63.3%) admitted to having lifetime anger attacks that involved the destruction of property, threats of violence, or ourtight violence. Out of these, 7.8% experienced outbursts so severe that their behaviors were classified by the researchers as falling within the DSM-IV's "intermittent explosive disorder".

IED is typically characterized by extreme anger, often to the point of violence, and disproportionate to the situation at hand. The DSM-IV states that the diagnosis is not applicable to persons under the age of 18, making the recommendations of Harvard researchers Katie A. McLaughlin, Ronald Kessler, and their team highly contentious.

That said, IED occurs in the adult population, at nearly the exact same rate.

But not everyone is convinced that IED is a valid diagnosis for teens. Writing at Boston.com, Deborah Kotz reports:

"The problem rests in trying to determine what's out of proportion to what's happening in the circumstances," said Jerome Wakefield, a professor of psychiatry and social work at New York University and author of the Loss of Sadness. "Rage often is cumulative and something that may have irritated you 25 times in the past can cause you to blow your top on the 26th time."

Adolescents, in particular, put a high premium on looking good in front of their peers, Wakefield added, so they may be more likely than adults to lash out when feeling humiliated or threatened.

It's often tough for doctors to distinguish between everyday anger and physical skirmishes that mark the high school years and violent outbursts that might lead a teen to bring a gun to school. But Kessler, who has served as a paid consultant for pharmaceutical manufacturers, said it's vital for physicians to recognize the warning signs and refer teens for psychiatric care before they develop the depression, anxiety, and substance abuse problems that often go along with the disorder and can make violent tendencies worse.

"We're talking about dysfunctional anger and destructive behavior that may cause injuries that require medical attention or destroying things of non-trivial value," said Kessler. "A lot of kids have anger attacks, but those with this disorder have a chronic problem that's likely due to a biological predisposition."

Pinpointing an exact cause has not been easy. Home life could be part of the problem, but there's not enough evidence to support such an association. And as Kessler notes, it may very well be something that's latent.

Assuming that IED is as serious as the researchers suggest, a pertinent question to ask is what to do about it. Mood-altering drugs like Paxil and Celexa may help, but they are are often seen by some as an all-too-convenient solution to the real-life circumstances that may be causing the outbursts.


Alternately, teens with anger problems can be put into individual or group anger management classes, or be given cognitive behavioral therapy. But as Kotz notes, slightly less than half of those who are treated with drugs or therapy experience significant improvements in their behaviors.

Given that the Harvard study found fewer than 7% of IED-likely teens being treated for their anger, there clearly needs to be a heightened sense of awareness.


Top photograph by Suzanne Tucker via Shutterstock.com.


It seems to me "intermittent explosive disorder" is a cheap, easy diagnosis when the "doctor" is at her wits end about what's happening emotionally/cognitively/psychologically, and I do not think "Anger disorder" contributes much to the discussion regarding mood and developmental disorders. And like the article briefly says, what's the use in pathologizing a reaction that might very well be a symptom to a real underlying cause (e.g. bipolar, schizophrenia, brain tumor, brain damage) considering that reaction, i.e. anger, is itself a relatively common and basic human emotion. Further, there is much ambiguity: what does "explosive" mean and when does it happen? When is anger, explosive or otherwise, an "over-reaction" to a "trivial" cause? When is anger itself inappropriate? We need to ask more basic questions regarding human emotion and mood, and define our terms/concepts, before we can call angry teens, or angry adults, mere victims of one's own biochemical make-up.

However, blatantly dismissing "explosive anger" and attributing it to moody teens, many of whom are not moody but are emotionally compromised by a mental illness, disorder, abuse, or trauma, seems to be equally disingenuous.