Intermittent Explosive Disorder-a parody

Blissfully unaware that she’s been fed junk science, Boston Globe reporter, Carrey Goldberg transcribes rubbish dictated by "authorities:"

"The outbursts are sudden and can include damage to property or physical
harm.  The disorder could affect as many as 7.3 percent of adults.  That
works out to 16 million Americans.  Harvard professor of health care, Ronald
Kessler, PhD says that each year IED affects nearly 4 percent of Americans,
or 8.6 million adults."

Academic researchers grab at every unproven–even discredited theoretical
hypothesis–chemical, neurological, psychological, genetic–to launch yet
another drug marketing campaign in their effort to pathologize assaultive
behavior.

The one pesky detail not mentioned is that such violent assaultive outbursts
may be precipitated by use of psychotropic drugs whose labels acknowledge,
they can induce aggression, agitation, manic, violent and suicidal
behavior–whether the drugs are prescribed by a psychiatrist or illicitly
obtained.

”’There’s a biology and a psychology and a genetics and a neuroscience
behind this, and you can come up with strategies for intervention just like
for anything else, like diabetes or hypertension or depression."  said Emil
Coccaro of the University of Chicago, a leading anger researcher.  

"The numbers translate into many millions of circles of trembling misery and
anxiety. Wives live in fear of their otherwise sweet husbands’ next tirade,
and wonder if they dare bring children into such a violent world of wrath."

The Boston Gloobe neglected to inform readers that:
Dr. Coccaro reports that he receives research grants and serves on the speaker’s bureau or as a consultant to Eli Lilly and Co., Abbott
Laboratories, GlaxoSmithKline, and Forrest Laboratories.

Co-author, Dr. Ronlad Kessler, a professor of health-care policy at Harvard Medical School, has received grants from Eli Lilly, Ortho-McNeil Pharmaceutical, GlaxoSmithKline, Bristol-Myers Squibb, and the Pfizer Foundation.

The Boston Globe reports, "they readily acknowledge that biologically,
impulsive anger — like so much in the brain — remains largely a mystery."

But then the absence of scienctific justifican has never restrained
psychiatrists from prescribing a "wide array of drugs" with (admittedly) no
more than "educated guesses" to support them.

Their institutional affiliations give them the seal of authority–Harvard
and U of Chicago–and pharmaceutical companies provide the financial
incentives.
That means we can expect IED to be widely promoted–much like ADHD in
adults–it won’t die a quick death.

Contact: Vera Hassner Sharav
veracare@ahrp.org <mailto:veracare@ahrp.org>  

    
http://www.boston.com/news/globe/health_science/articles/2005/08/08/out_of_control_anger?mode=PF
Out of control anger
As many as 5 percent of people suffer from a disorder that can ruin theirlives
By Carey Goldberg, Globe Staff  |  August 8, 2005

They used to just call it a bad temper and tell you to count to 10. Then
came bunches of guys sitting around in circles and learning ”anger
management."

Now, increasingly, the catchphrase is ”Intermittent Explosive Disorder."
Researchers delving into pathological anger report that it is more
widespread than anyone had suspected. And that their understanding of its
biological roots is deepening, raising prospects of better treatment.

”It’s not simply bad behavior," said Emil Coccaro of the University of
Chicago, a leading anger researcher. ”There’s a biology and a psychology
and a genetics and a neuroscience behind this, and you can come up with
strategies for intervention just like for anything else, like diabetes or
hypertension or depression."

For all the buzz about phenomena like hockey dads and the recent road rage
incidents, it was only this summer that researchers got definitive data on
how common such volatility is.

A national study found that at some point in their lives, about 5 percent of
people have such frequent, serious blow-ups that they qualify as suffering
from Intermittent Explosive Disorder, a full-fledged psychiatric diagnosis.
It is twice as common in men as in women and tends to begin before age 20.

The numbers translate into many millions of circles of trembling misery and
anxiety. Wives live in fear of their otherwise sweet husbands’ next tirade,
and wonder if they dare bring children into such a violent world of wrath.

Husbands find that sometimes, the smallest provocation of their wives brings
on a firestorm. Parents struggle to understand why a son puts his fist
through things, kicks pets, or screams at siblings. Is this a character
issue? Or a medical problem?

Specialists say that their growing knowledge does not excuse such
explosions, but it can help explain them. A picture has begun to emerge of
what happens in the rage-prone brain, and a central culprit appears to be
the chemical messenger that newer anti-depressants have made a household
word: serotonin.

In broad terms, serotonin — active in the frontal, ”thinking" part of the
brain — is needed when a person stops a bad impulse. When someone is low on
serotonin, that brake can get weak.

Brain structure may also play a role. ”In people with impulsive aggression,
there’s more chaos in the front part of the brain," said Dr. Jon Grant, an
associate professor of psychiatry at the University of Minnesota in
Minneapolis.

So some of the problem may lie in the very formations of the nerves,
suggesting that genes or development may be at fault. Childhood abuse is
also common in people with the disorder, suggesting that environment, too,
plays an important role.

It gets even more complicated. Other brain chemicals are involved — perhaps
some that influence the ”gas" rather than the ”brake." And studies have
found psychological differences in the anger-prone, compared with others.
Tests show that they are likelier to believe other people have hostile
intentions, for example.

Despite such insights, specialists readily acknowledge that biologically,
impulsive anger — like so much in the brain — remains largely a mystery.
But in recent years they have begun to use educated guesses to try a wide
array of drugs to fight it.

None of the drugs has federal approval specifically for Intermittent
Explosive Disorder, but doctors and researchers have been prescribing them
”off-label," and report that they can often help, though not always and not
everyone.

Anti-depressants of the Prozac generation sometimes bring results, they say;
so do mood stabilizers, and drugs that were used initially to stop seizures.

A major, federally funded study published last month in the American Journal
of Psychiatry found that among autistic children, risperidone, a newer
anti-psychotic drug, could reduce violent outbursts for up to six months
with few side effects. Risperidone has prominent effects on serotonin, so
the study’s positive results underscore the importance of serotonin in
impulsive aggression, said its lead author, Dr. James McCracken.

Therapy helps as well, specialists say. When well-run, anger management
groups can prove effective, they say, and so does individual therapy that
helps patients recognize their problematic reactions and find ways to defuse
themselves.Treatment can involve training in relaxation, habits of thought
(like thinking, ”Maybe he wasn’t trying to make you mad"), and coping
skills like walking away when things start to get hot.

”Between both medication and therapy, I’d say probably the majority of
people can find some relief," Grant said. Once, anger problems tended to
lead many straight to jail; now, ”We can offer people some real hope about
what might allow them to get better control over this."

No miracle drug appears to be on its way, though. For now, researchers
predict that they will be largely limited to clinical trials using existing
drugs, because drug companies are unlikely to push hard for specific
anti-rage agents.

For one thing, Coccaro pointed out, company lawyers are scared that if
violent patients go onto a drug and then commit violence again, the company
could be held liable.

There is a broader problem, too, he wrote in a recent journal editorial:
People who explode are not very lovable. No celebrity is likely to volunteer
to be a poster child for Intermittent Explosive Disorder. And
philanthropists are less likely to contribute to research aimed at helping
people viewed as perpetrators rather than patients or victims.

The patients themselves can be problematic as well, resisting treatment even
when surrounded by wrecked lives.

”People say, ‘I don’t have an illness, I have an anger — It’s not I who
have a problem, it’s you," said Ronald Kessler of Harvard University, who
led the national study on how common mental illnesses are. Often, he said,
patients have already lost jobs and spouses before they seek help.

Some specialists say they also hope that now that it is clear how common
impulse disorders are, they will get more attention, despite the obstacles,
from researchers and grantmakers. Kessler’s study found that when all the
impulse disorders are lumped together, from compulsive gambling to Attention
Deficit Disorder, they are even more common than mood problems like
depression.

”The social implications are huge," said McCracken, a professor of
psychiatry at the University of California at Los Angeles. Think, he said,
of the impact of violence and compulsions like gambling, both on the
perpetrators and people around them.

”I think a deeper understanding of these impulse disorders and
better-identified treatment choices could have profound benefits for
society," he said.

Carey Goldberg can be reached at goldberg@globe.com.

Frequency of anger disorder

A June study estimated that roughly 1 in 20 people has had ”intermittent
explosive disorder" — a form of destructive, uncontrolled anger — during
their lifetime. The disorder, considered an impulse-control problem, is most
common among 18-29 year-olds and its prevalence declines with age.

Lifetime frequency of:
    
Any mental disorder     46.4 percent
Any impulse-control disorder     24.8 percent
Conduct disorder     9.5 percent
Attention-deficit/hyperactivity disorder     8.1 percent
Intermittent explosive disorder     5.2 percent

SOURCE: Archives of General Psychiatry, June, 2005

C Copyright 2005 The New York Times Company

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