It's renamed Intermittent Explosive Disorder, but it's still not okay, writes Kate Holmquist
The greedy and materialistic are shopaholics, lotharios are sex addicts, shoplifters have theft disorders, people with multiple unpaid credit card bills are debt addicts . . and so it goes, as previously shameful habits become bona fide psychiatric conditions.
People who spend hours in the gym exercising in front of the mirror aren't vain any more. They're exercise bulimics.
The sad pervert who spends hours looking at dirty pictures on the internet has been rebranded as a cyberporn addict.
So when "road rage" was revealed by Harvard doctors this week as a condition with the extraordinary name of Intermittent Explosive Disorder (IED), the cynic could be excused for Schadenfreude. Whatever next?
Forty per cent of people in US household surveys have a psychiatric disorder of some kind, and with new ones being invented every year it's only a matter of time before the "normal and well-adjusted" become a protected species.
Until this week, IED was little more than the pet project of Dr Emil Coccaro, chair of the department of psychiatry at the University of Chicago. For two decades, he has ploughed a rather lonely academic furrow, defining IED and carving out his own academic niche around the alleged condition, pulling in the research dollars along the way, says Dr Conor Farren, a psychiatrist in Dublin.
Dr Coccaro has long argued that people with IED overreact to certain triggers with uncontrollable rage, feel a sense of relief during the angry outburst and are remorseful afterwards. These rages occur about three times per year, involve violence or the threat of violence and can cause thousands of euro in property damage. IED has not been diagnosed in Ireland, where psychiatrists are wisely cautious about such trends.
"IED may have been used creatively in legal settings by enthusiastic barristers and psychiatric legal teams in the defence of cases of road rage or domestic violence, but it would not have been regarded as a robust diagnosis," adds Dr Farren, who spent 10 years in the US as an academic researcher.
All that changed this week, however, when research into IED at Harvard University was published in the Archives of General Psychiatry, a highly esteemed journal. The report's co-authors are among the most highly respected in the world and include Dr Ronald Kessler, professor of health care policy at Harvard Medical School.
Not only does the research prove that IED exists, apparently 7.3 per cent of people have it. That's a lot of road rage. And in terms of the harm inflicted by domestic violence, it's terrifying.
"Research of this quality will make psychiatrists pay attention to the concept of IED. In Ireland, almost no one would know about it," says Farren.
When he read the research this week, he decided that IED now deserves a place on his list of possible disorders when assessing patients.
BUT HOW DO you know the difference between someone blowing their top because they're having a bad day, and IED or even some other mental disorder?
In IED, the angry outbursts are more extreme, involving more than gesticulating out the car window with a few choice obscenities thrown in. The road-rager with IED will crash his car into someone else's, or get out of the car and attack the other driver.
IED starts at about age 13 for boys and 19 for girls. But angry outbursts and irritability are also symptoms of mood disorders, such as depression and bipolar disorder, so a diagnosis has to be made by a psychiatrist. Sufferers typically develop the habit of using alcohol and drugs in their attempts to control their behaviour, or they may develop anxiety disorders, which affect up to 12 per cent of the adult population.
Among people diagnosed with IED in the Harvard study, 81.8 per cent had been previously diagnosed with depression (which affects 13 per cent of Irish people over their lifetimes), anxiety (affecting up to 12 per cent) and alcohol or drug abuse disorders (affecting 5 per cent). Yet the age of onset of IED is usually much earlier than these other disorders, indicating that sufferers had developed other psychiatric conditions because their IED was undiagnosed and untreated.
"People with this disorder may be more susceptible to other disorders because of increased stressful life experiences as a result of their disorder, such as financial difficulties or divorce," says Kessler. He believes that outreach programmes in schools targeting teenagers could prevent a lot of anguish later in life.
The ideal treatment for IED is cognitive behavioural therapy involving restructuring patterns of thinking, coping skills training and relaxation training. Anger management classes, like those assigned to Hollywood bad boys and girls, adds Dr Farren, have no proven benefit.