Craig had some major anger issues and they were only getting worse. Just recently he punched a guy square in the mouth at school because he thought he was talking about him. After the fact, he found out that he misinterpreted the whole situation. He felt horrible, but once again it was too late...

Craig sat on the edge of his bed with his head buried in his hands. He lifted his head and looked around his room.  There were fist holes in the walls and shoe scuffs along the baseboards from his past fits of rage. He looked at his scarred knuckles, forever a reminder of his uncontrollable anger problem. "I can't keep doing this..." he thought, "I 'm going to hurt myself or worse yet someone else." Unknowingly Craig suffered from Intermittent Explosive Disorder, a psychological condition that affects approximately 6 million people in the United States alone. 

How is Intermittent Explosive Disorder (IED) Diagnosed?

Intermittent Explosive Disorder is an impulse control disorder which typically begins in late childhood and persists through the middle years of life. 

According to the DSM IV-TR, a diagnosis of IED requires: several episodes of impulsive behavior that result in serious damage to either persons or  property, wherein the degree of the aggressiveness is grossly disproportionate to the circumstances or provocation, and the episodic violence cannot be better accounted for by another mental (i.e., Attention-Deficit/Hyperactivity Disorder, Antisocial Personality Disorder, Borderline Personality Disorder, Conduct Disorder, A Manic Episode, or aren't attributed to the use of a substance) or physical medical condition (i.e., Traumatic Brain Injury, Epilepsy,  Alzheimer's, or other medical conditions that are related to violent behavior).

The diagnosis of IED should be made by conducting a comprehensive examination. For example, mental health professionals should collect personal history from the client and oftentimes family members and friends to get a better understanding of the client's behavior. Next, information should be gathered from sources such as developmental, medical, psychological and/or educational records. Finally, psychiatric interview is conducted to assess the affective and behavioral symptoms in relation to the criteria listed in the DSM-IV. Intermittent Explosive Disorder is given as a diagnosis when a person has had at least three incidences of being aggressive that is defined as "grossly out of proportion to any precipitating psychosocial stressor."

Relevance of IED to Teens

According to a new study out of Harvard, about two thirds of American teens had a history of anger attacks involving real or threatened violence. The study also found that one in 12 teens met the criteria for Intermittent Explosive Disorder. That's about six million teens nationwide.

Researchers assessed 6,483 adolescents, ages 13-17 years for anxiety, mood, behavior, and substance disorders using criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and World Health Organization Composite International Diagnostic Interview (CIDI).  Additionally, parents of the adolescents provided feedback through questionnaires.

Here are the findings:

  • 63.3 percent of adolescents reported lifetime anger attacks that involved destroying property, threatening others, or engaging in violence
  • 7.8 percent met the DSM-IV/CIDI criteria for lifetime IED
  • 80.1 percent of lifetime cases meeting IED criteria
  • 12 years was the mean age of IED onset.
  • 63.9 percent of lifetime IED cases meeting the criteria for another DSM-IV/CIDI disorder
  • 6.5 percent of teens with 12-month IED were treated specifically for anger, although 37.8 percent received treatment for emotional problems in the year before the interview.
  • 52.5 out 100 IED -related injuries require medical attention

IED is a severe, chronic, commonly occurring disorder that begins early in life. Unfortunately, it is under-treated because those who have severe anger problems may not see it's a problem nor seek help.  

For all of the angry teens out there:

If Craig's story hits a little too close to home, then maybe you could use some additional help before it's too late. Don't let regret for something you did out of anger consume you. Even though you don't think that you have any control, you do and there are people out there who have been trained to help you effectively work through your anger. You can change how you see situations, learn how to cope with the things that set you off, and best of all—change your response to anger. You don't have to be a prisoner to your anger any longer. All you have to do is make a choice to change and then seek the help of a professional(counselor, school counselor, social worker, psychologist) to help you get started.

For all the parents of an angry teen:

Anger is a normal emotion, but it has to be channeled properly. While many teens experience mood swings and irritability, which is perfectly normal, the type of anger that I've referred to in this blog is over the top.

I remember once speaking with a teen client who had just beaten up another student. He became so enraged that he knocked the student on the ground and started hitting him uncontrollably. At that moment his anger was wild, his behavior was erratic and he was uncontrollable. When he was brought to me he was shaking with anger. After some chill time, his body began to return to a normal state. We have to understand that anger can cause physiological changes as hormones get pushed though the body to help fend off danger (it's called fight or flight response). 

Many years later, I still remember him telling me, "I couldn't stop myself, it was like something transformed me and then I "blacked out". After some discussion he admitted that he frequently became so angry that he destroyed things in his path. This is not your typical display of anger.  Unfortunately, this teen felt out of control and afterwards he suffered much regret for his behavior.  Through treatment and medication he began to learn how to cope with his anger. 

In conclusion:

Explosive anger affects millions of people. Physically attacking other people, destroying property and displaying acts of violent or aggressive behavior is a sign that your teen may need professional help. This behavior can be scary not only to you but also to your teen. There is good news.  Professionals can help you and your teen work through this. It also wouldn't hurt to schedule an appointment with your teen's health care provider as well to rule out any medical conditions.


Listen to my interview on Anger and Bullying on Relationships 2.0 with Michelle Skeen.

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