Anger. A diagnosis?

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Consider anger:  both inwardly directed (self-harm), and outwardly directed (rage).   What are the potential outcomes with a failure to control oneself?  Here’s a fictitious (but representative) example.  Nina could no longer manage her daughter, Reanne. Reanne would ‘go off’ and get scary. She threatened and shoved her mom, got in her face, broke glasses and dishes, punched the wall, kicked the dog, threw chairs and grabbed a kitchen knife and slashed the furniture. Locked in her bedroom, Nina had to call the cops.  Reanne’s dad had been abusive towards both of them; she harbored hatred towards the man who had even harmed her grandparents and eventually abandoned them all, but hated her mom more for putting up with it.

“In the United States, more than 60% of adolescents have reported at least one angry outburst that resulted in violence, threat of violence, or destruction of property. Of  these young people around 8% meet the DSM-5 criteria for intermittent explosive disorder (McLaughlin, et al., 2012). Although the disorder can persist throughout the lifespan, symptoms are most likely to begin in individuals younger than 40.” http://www.theravive.com/therapedia/Intermittent-Explosive-Disorder-DSM–5-312.34-(F63.81 Theravive Heather Sheaffer, MA, LCSW

In another (fictitious, but representative) example, young Tim flew off the handle even as a pre-school child. Faced with excessive demands in the home, his law enforcement dad encouraged him to ‘be tough’ and berated him for being a cry baby, even with a concussion and possible fracture from extreme sports. Forced to fight to protect himself, Tim developed a deep-seated rage and expressed it by blowing things up and shooting stuff, and spending hours playing violent video games, a loner. Acquaintances at school described him as, ‘angry and kind of weird; unpredictable’.  His speech became increasingly threatening.

“Onset of intermittent explosive disorder usually begins around age 12 (McLaughlin, et al., 2012), but can be diagnosed in children as young as six (American Psychiatric Association, 2013). At least 80% of patients diagnosed with experience an explosive episode at least once per year throughout the lifespan (McLaughlin, et al., 2012). Although no direct cause of intermittent explosive disorder has been identified, several studies have linked the disorder to childhood trauma. In addition to being high among those in military service, high rates of intermittent explosive disorder is also found among individuals who has survived abuse, assault, and human rights violations.” Theravive-Sheaffer

The classic question of trauma-informed care, not, ‘what is wrong with you, but what has happened to you?’ might hone in on one cause of the disorder, though there are many reasons a person experiences toxic anger. A classic question in the mindfulness movement is to ask the emotion what it is telling you. For some, it can be experience of an exceptional injustice, grief, or outrage over being shamed.  ‘It can manifest in not being able to be in a regular school to more of a bipolar manifestation to outright homicidal ideation – perhaps at perceived bullying,’ explained Pomegranate therapist, Erika B. ‘Coupled with hormonal fluctuations and disruptive life events, an adolescent may experience difficulty coping.’

We’re most apt to hear about road rage incidents in the media, as anger gone wrong. The Public Children Service Association of Ohio Factbook 2015-2016 showed primary reason for removal: 20% neglect, 17% dependency, 8% physical abuse, 2% sexual abuse, 15% delinquency/unruly and 38% ‘other’. (There were 1,966 children in custody 1/1/14).

“The DSM-5 explains that because of the violent and intimidating nature of intermittent explosive disorder, the patient is likely to experience significant impairment in many areas (American Psychiatric Association, 2013). Common behavioral manifestations of intermittent explosive disorder include road rage, domestic violence, child abuse, and property damage. Violent and aggressive behavior creates a sense of distrust among family members and friends. (Morland, et al., 2013). Relationships are likely to suffer.” Theravive-Sheaffer

Pomegranate staff receives training in crisis intervention protocol, HBS-Haugland Behavioral System (previously in CPI Crisis Prevention Institute), for when teens become disruptive and have difficulty with impulse control or maintaining themselves safely.

In another real example, client ‘Monica’ hung back after lunch, and became agitated, then, alternatively tearful and shouting. A ‘big brother’ mental health associate stayed with her while another ‘big sister associate’ immediately came and began encouraging her to talk it out, walked with her through a calming sequence, and the issue was successfully resolved. It’s not easy working with anger, yet anger management & resolution is an essential skill in a civilized, healthy functioning society.

https://www.psychologytoday.com/blog/resolution-not-conflict/201305/got-anger-disorder-not-according-the-dsm

http://www.dsm5.org/Documents/Disruptive%20Mood%20Dysregulation%20Disorder%20Fact%20Sheet.pdf

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About Communications

Communications and Social Media @ Sequel-Pomegranate Health Systems
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