Anger disorders are pervasive in America, and slowly spreading to other countries. (See, for example, my prior post on violent events in China.) Pathological anger or rage can manifest in many ways, including chronic resentment, embitterment, hostility, hatred, temper tantrums, rage attacks, and frequently, verbal and physical abuse. Sometimes even murder. Most domestic violence is, in my view, related to an underlying anger disorder, often exacerbated and disinhibited by drugs and/or alcohol. One such classic anger disorder is known as Intermittent Explosive Disorder, and defined by the American Psychiatric Association as involving "several discrete episodes of failure to resist aggressive impulses that result in serious assaultive acts or destruction of property." Such outbursts of rage and violence, more common but not exclusively occurring in males, are "grossly out of proportion to any precipitating psychosocial stressor," and tend to result in negative consequences not only for the unfortunate targets of these violent assaults but also for the easily enraged perpetrator him or herself. According to one study by sociologist Ronald Kessler at Harvard Medical School, this particular anger disorder is on the rise, and may be present in more than fifteen million Americans. And this is only the proverbial tip of the iceberg. We Americans are in the midst of an anger epidemic that poses a very real and perilous public health threat.

The person suffering from IED, technically categorized as an impulse-control disorder, may describe these repeated rages as "seizures," "spells" or "attacks" which, very much like sexual orgasms, build up to an intolerable crescendo of tension and arousal, reach a point of no return, and are, at first, followed by pleasurable relaxation and relief. But after the fact, the violent perpetrator may (though not always, which can indicate the possible presence of psychopathic narcissism) feel remorseful or ashamed of their bad behavior or evil deed. However, even in between these destructive and dangerous episodes, such individuals manifest subtler signs of an anger disorder: poor impulse control, hyperaggressiveness, irritability, hostility, embitterment and barely controlled rage expressed in somewhat less violent ways, like screaming, ranting, intimidating, threatening, throwing things, slamming doors or punching walls.

According to the DSM-IV-TR, patients exhibiting "narcissistic, obsessive, paranoid, or schizoid traits may be especially prone to having explosive outbursts of anger when under stress." I would say this is equally true of those with more severe forms of Antisocial or Borderline Personality Disorders. And, as the current diagnostic manual makes quite clear, "Aggressive behavior may, of course, occur when no mental disorder is present. Purposeful behavior is distinguished from Intermittent Explosive Disorder by the presence of motivation and gain in the aggressive act. In forensic settings, individuals may malinger . . . to avoid responsibility for their behavior. Anger as a normal reaction to specific life events or environmental situations also needs to be distinguished from the anger that may occur as part of an aggressive episode in Intermittent Explosive Disorder . . . with little or no provocation." (pp. 666-667)

What is an anger disorder? What causes it? Anger disorders describe pathologically aggressive, violent or self-destructive patterns of behavior which, in my opinion, are symptomatic of and driven by an underlying and chronically repressed anger or rage. Anger disorders result primarily from the long-term mismanagement of anger, a process in which normal, existential anger turns insidiously over time into resentment, bitterness, hatred, and hair-trigger rage. Anger disorders may also be caused or exacerbated by psychosis, neurological impairment and substance abuse, all of which can impair one's ability to resist aggressive, angry or violent impulses. Today, many patients suffering primarily from an underlying anger disorder are diagnosed, inappropriately in my opinion, with Bipolar Disorder, which is incorrectly considered by most (not all) psychiatrists and psychologists to be a genetically based biochemical imbalance best treated with medications rather than psychotherapy.

But, for the most part, anger disorders cannot be blamed on faulty neurology, defective genes or bad biochemistry. They arise from a failure to recognize, fully acknowledge and consciously address anger as it arises, before it becomes pathological and doubly dangerous. Typically, anger disorders are deeply rooted in childhood frustration, neglect, abandonment or physical and emotional abuse. As regards anger, we suffer in our culture from a similar attitude as the Victorians took toward sexuality in Sigmund Freud's day. We are collectively taught that anger is something negative, improper, dangerous, unspiritual, useless, selfish, willful, vile and evil. And hence, shameful. For many, anger is closely associated with fear, anxiety, guilt and shame. Which is why we tend to repress or suppress it starting from childhood. And this negative attitude toward anger and resulting chronic repression is, paradoxically, the source of most anger problems in both children and adults.