Teenagers are often characterized as over-emotional, prone to outbursts that confuse their parents and leave teachers reeling.
But a study published in the July issue of the journal Archives of General Psychiatry says 1 in 12 adolescents may in fact be suffering from a real and severe anger problem known as intermittent explosive disorder(IED).
Study author Katie McLaughlin, a clinical psychologist and psychiatric epidemiologist, says IED is one of the most widespread mental health disorders – and one of the least studied.
“There’s a contrast between how common the disorder is and how much we know about it,” she said.
IED is characterized by recurrent episodes of aggression that involve violence, a threat of violence and/or destruction of property, according to the Diagnostic and Statistical Manual of Mental Disorders. It often begins around the age of 12, but scientists don’t know whether it continues into adulthood. (A similar study which focused on adults found 7.2% met the criteria for IED).
“Intermittent explosive disorder is as real or unreal as many psychiatric disorders,” wrote CNN’s mental health expert Dr. Charles Raison in an e-mail. “There are people who get really pissed off really quick and then regret it, just as there are people who get unreasonably sad and depressed. In both cases, but especially with [IED], it’s really just a description of how people behave.”
Of the teenage participants, 7.8% reported at least three IED anger attacks during their life. More than 5% had at least three attacks in the same year.
McLaughlin said one of the most interesting things her team found was that very few of the adolescents who met the criteria for IED had received treatment for anger or aggressive behavior. More research needs to be done to determine if treatments that have been developed for ODD or CD anger issues would apply to IED as well.
Additional research should also look into the risk factors for IED, she said. “We know not that much about course of the disorder… Which kids grow out of it and which kids don’t?”
It has gone by many names: battle fatigue, shell shock, soldier’s heart. Most recently it has been called post-traumatic stress disorder.
But as the number of identified cases of post-traumatic stress has skyrocketed among soldiers, returned veterans and first-responders — police officers, firefighters, paramedics, etc. — it may soon undergo another name change.
In its revised handbook, “Diagnostic and Statistical Manual of Mental Disorders,” the American Psychiatric Association may reclassify post-traumatic stress as an “injury,” rather than a “disorder.”
The hope is that the name change will remove a perceived stigma that may be keeping PTS suffers away from the help they need.
Post-traumatic stress refers to the intense and potentially crippling symptoms that some people experience after a traumatic event, such as combat or horrific crimes. The symptoms can include flashbacks, isolation, hyperarousal and rage.
The idea of a name change was initially promoted by the Army, particularly Gen. Peter Chiarelli, who until his retirement in February led the military’s effort to reduce a record-high suicide rate among the troops.
“No 19-year-old kid wants to be told he’s got a disorder,” Chiarelli told APA members and news reporters. An “injury” may be perceived as more treatable and combat-related. The hope is that active-duty soldiers experiencing PTS will reach out for help and their superiors will be more supportive.
The military has good reason for concern about what PTS is called and efforts to provide help to sufferers. According to recent reports, 1 in 6 soldiers is reporting anxiety, depression or symptoms of PTS. With the total number of soldiers having served in Iraq or Afghanistan now numbering about 1 million, an estimated 100,000 soldiers are expected to require long-term mental health care.
And as these numbers continue to grow, concern is being expressed not just about what to call PTS, but how to treat it.
This spring, the Army surgeon general’s office issued a warning to regional medical commanders about the long-standing use of prescription psychotropic drugs to treat PTS. An April policy memo warned that some of the drugs — or “cocktails” of drugs — could intensify, rather than reduce combat stress symptoms and lead to addiction.
A July 2010 Army report noted that one-third of all active-duty military suicides involved prescription drugs. Combined with alcohol abuse, the long-standing protocol for treating PTS could be lethal.
This is not to say that commonly used psychotropic drugs, in conjunction with counseling and therapy, should be abandoned.
But what is needed — and what is now being recognized by military officials — is the combination of a variety of treatments. Some of treatments that were once dismissed as “unproven alternatives” are now being embraced.
For example, I use neurofeedback to treat veterans at Neurofeedback Train Your Brain in Bakersfield. Neurofeedback is training in brain function based on information derived from an electroencephalogram (EEG). The process can bring fairly rapid improvements in sleep problems, pain, anger management and substance dependency. The Veterans Administration is spending about $5 million on a dozen clinical trials and demonstration studies of three meditation techniques to help veterans manage stress and depression. Other “alternative” treatments include acupuncture, yoga and therapy dogs.
A unique, local pilot project that is being conducted under the auspices of Kern County Rotary is an example of what can be accomplished when a need is recognized and addressed.
The Rotary Clubs’ Kern Post Traumatic Stress Assistance project (www.kernptsa.org) provides education, resources, treatment options, community outreach, fundraising and support to veterans and first responders and their families in Kern County. The project is the first step in a global movement of Rotary International to provide resources and support to individuals and families suffering from PTS. On the project’s website are listings for support groups, government agencies and treatment providers, such as Neurofeedback Train Your Brain.
The good news is that PTS finally is receiving the level of attention that the disorder (or injury) and its sufferers deserve. It is bringing together government agencies, community groups and mental health care providers in a campaign to honor soldiers, veterans and first responders by giving them the help they deserve.
Kimberly Smith of Bakersfield is the neurofeedback clinician at Neurofeedback Train Your Brain (www.kerntyb.com).