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Teen anger disorder divides MDs

Harvard study examines controversial illness

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Intermittent explosive disorder -- a controversial mental illness marked by outbursts of uncontrollable rage -- is so common among adolescents it affects one in 12 teens, a large new study finds.

Harvard Medical School researchers, in a study based on in-person interviews with more than 10,000 adolescents ages 13 to 17, found about eight per cent met the criteria for intermittent explosive disorder, or IED.

The findings suggest the disorder is affecting hundreds of thousands of youths -- close to six million in the U.S. alone, according to a statement released with the study.

But observers worry it could trigger a "manufactured epidemic" of mental illness among teens and lead to extreme but predictable teenage behaviour being labelled as a symptom of a mental illness requiring treatment -- including mood-altering drugs.

According to the Diagnostic and Statistical Manual of Mental Disorders -- psychiatry's official catalogue of mental illness, now undergoing its first major revision in nearly two decades -- intermittent explosive disorder's central feature is impulsive aggression grossly out of proportion to the situation. People lose control, break or smash things and attack or threaten to hurt someone.

The study, published this week in the journal Archives of General Psychiatry, is being described as the first to estimate the prevalence of intermittent explosive disorder in American adolescents.

"If we can detect IED early and intervene with effective treatment right away, we can prevent a substantial amount of future violence perpetration and associated psychopathology," said senior author Ronald Kessler, professor of health-care policy at Harvard.

But Christopher Lane, author of Shyness: How Normal Behaviour Became a Sickness, said intermittent explosive disorder has been a source of controversy since it was approved as a mental disorder in 1980.

"Uncontrollable anger and domestic violence are, of course, serious concerns requiring attention," said Lane.

But equally concerning, he said, is the risk of "medicalizing" adolescence itself.

Disorders in the DSM are defined by a list of diagnostic criteria. A person can qualify for a certain diagnosis based on how many criteria they meet.

But there isn't agreement on just how many "episodes" or outbursts of aggression are necessary for a diagnosis of intermittent explosive disorder.

As well, some have proposed broadening the criteria to include outbursts that don't involve threatened or actual violence, but do involve verbal aggression.

The new study is based on a national mental-health survey conducted in the U.S. between February 2001 and January 2004. Nearly two-thirds -- 63 per cent -- of the adolescents surveyed reported at least one anger attack in their lifetime involving either destroying property or threatening or engaging in violence.

Teens had to report three or more anger attacks in their lifetime to meet the criteria for intermittent explosive disorder.

 

-- Postmedia News

Republished from the Winnipeg Free Press print edition July 3, 2012 B4

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