Trailing on Will’s entry from yesterday, Reuters Health also reported that anger disorder more common than thought:

A surprising number of Americans suffer from a psychiatric disorder marked by angry, often violent, outbursts, — called intermittent explosive disorder, or IED — a national survey suggests.

Based on the findings, up to 16 million U.S. adults may have the condition. People with the disorder erupt in reactions that are grossly out of proportion to a perceived provocation — attacking another person, threatening others with violence or destroying property.

Until now, there had been no good estimates of how prevalent IED is among Americans, and the new findings indicate that it is much more common than experts have suspected.

The survey, published in the Archives of General Psychiatry, included a nationally representative sample of 9,282 U.S. adults. Standard diagnostic interviews showed that when IED was broadly defined — three or more outbursts in a person’s lifetime — 7 percent of respondents had suffered the disorder at some point.

Just over 5 percent met a narrower IED definition of three anger “attacks” in one year.

This got me thinking…

Previous prevalence rates put the rate at somewhere between 3% and 4%. So in the “narrow IED definition” (which isn’t the clinical definition, but useful nonetheless), the researchers found a 1% to 2% point increase. At the broader definition, the researchers found it twice as prevalent as previously thought.

According to the study, however, Criterion B was assessed:

DSM-IV criterion B for IED requires that the aggressiveness is “grossly out of proportion to any precipitating psychosocial stressor.” This criterion was operationalized in the CIDI by requiring the respondent to report either that they “got a lot more angry than most people would have been in the same situation” or that the attack occurred“without good reason” or “in situations where most people would not have had an anger attack.”

The researchers didn’t really assess whether there was any psychosocial stressor prior to each incident and rate each incident individually according to the stressor (only a more in-depth clinical interview can get at that information). How reliable is a person’s own self-assessment of their reaction to a stressor? Can they accurately say, “No, I overreacted in that situation”? I think that’s another research question that I’m not sure we have a good answer for at present. For instance, one person hits a wall with his fist when he learns his girlfriend left him. Would most people hit a wall? Is that an “anger attack”? Or is that a fairly normal reaction to a specific psychosocial stressor? How would that person view that behavior, normal or an overreaction? How would others?

With such nebulous diagnostic criteria, I suspect disorders such as “Intermittent Explosive Disorder” may have limited usefulness.

Dr. John Grohol is the founder & CEO of Psych Central. He is an author, researcher and expert in mental health online, and has been writing about online behavior, mental health and psychology issues -- as well as the intersection of technology and human behavior -- since 1992. Dr. Grohol sits on the editorial board of the journal Cyberpsychology, Behavior and Social Networking and is a founding board member and treasurer of the Society for Participatory Medicine.

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    Last reviewed: By John M. Grohol, Psy.D. on 7 Jun 2006
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