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Road Rage, a passing emotion or IED?

Just about everyone has experienced road rage, yelling at another driver (windows rolled up), a one-finger salute, or worse, being accosted or assaulted. It seems that it is epidemic. Is it simply a result of fatigue or momentary rage-soon dissipated or could it be, in some cases, something more profoundly wrong?
Kris Van Cleave, CBS Sunday Morning reports, “Take a deep breath before you head out on that holiday drive — all the better to help keep your cool if you have an unwelcome brush with ROAD RAGE”.

Punches thrown in the middle of a Houston intersection … grown men and a woman brawling in front of stunned onlookers … then one of the drivers purposely ramming his truck into the other car before speeding off.

Road rage, it seems, is everywhere (and caught on video) as drivers use bats, fists, guns, even golf balls in street showdowns that can sometimes have tragic consequences.

Fatal road rage incidents are up more than 30 percent since 2010, and were the cause of more than 1,700 deaths between 2010 and 2014.
Mike McCloskey, an expert on aggression and a professor of psychology at Temple University in Philadelphia, says one of the aspects about driving that makes some people so angry is that it is stressful: “The days of taking a leisurely drive have kind of gone. Now when you’re driving, you’re really trying to get from A to B, and you usually haven’t given yourself enough time to do that. So just the trip itself is very, very stressful.”

“Mind you that the majority of that is relatively minor,” said McCloskey. “It’s the honking your horn real loud, flipping someone off, screaming. But for a small portion, like a couple percent, they engage in much more violent, destructive behaviors — trying to run people off the road, trying to attack people.”
(CBS NEWS, Sunday Morning, Trying to put the brakes on road rage, broadcast, reported by Kris Van Cleave, May 29, 2016, 9:08 AM)

This is not to say that every participant in road rage has a mental disorder.
But, could it be intermittent explosive disorder?
“A little-known mental disorder marked by episodes of unwarranted anger is more common than previously thought, a study funded by the National Institutes of Health’s (NIH) National Institute of Mental Health (NIMH) has found. Depending upon how broadly it’s defined, intermittent explosive disorder (IED) affects as many as 7.3 percent of adults — 11.5-16 million Americans — in their lifetimes. The study is based on data from the National Comorbidity Survey Replication, a nationally representative, face-to-face household survey of 9,282 U.S. adults, conducted in 2001-2003.
People with IED may attack others and their possessions, causing bodily injury and property damage. Typically beginning in the early teens, the disorder often precedes — and may predispose for — later depression, anxiety and substance abuse disorders.

Nearly 82 percent of those with IED also had one of these other disorders, yet only 28.8 percent ever received treatment for their anger. they suggest that treating anger early might prevent some of these co-occurring disorders from developing.
This is not to say that every participant in road rage has a mental disorder.

To be diagnosed with IED, an individual must have had three episodes of impulsive aggressiveness “grossly out of proportion to any precipitating psychosocial stressor,” at any time in their life, according to the standard psychiatric diagnostic manual. The person must have “all of a sudden lost control and broke or smashed something worth more than a few dollars…hit or tried to hurt someone…or threatened to hit or hurt someone.”

Evidence suggests that IED might predispose toward depression, anxiety, alcohol and drug abuse disorders by increasing stressful life experiences, such as financial difficulties and divorce.

What can be done?

Given its earlier age-of-onset, identifying IED early — perhaps in school-based violence prevention programs — and providing early treatment might prevent some of the associated psychopathology, propose the researchers. Although most study respondents with IED had seen a professional for emotional problems at some time in their lives, only 11.7 percent had been treated for their anger in the 12 months prior to the study interview.
(Kessler RC, Ph.D., Harvard Medical School Jaeger S, Jin R, Walters E. also, Dr. Emil Coccaro, University of Chicago, Dr. Maurizio Fava, Massachusetts General Hospital, and Dr. Savina Jaeger, Robert Jin, and Ellen Walters, Harvard University. The prevalence and correlates of DSM-IV intermittent explosive disorder in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2006 Jun; 63(6):669-78)

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