With all those raging hormones, every teenager is bound to “lose it” at one time or another. But a recent study suggests that adolescents’ attacks of anger may indicate something more serious than your standard puberty-related mood swings: nearly two-thirds of youth report having had a bout of uncontrollable anger that involved threatening violence, destroying property or engaging in violence toward others, and nearly 8% — or close to 6 million teens — meet the criteria for intermittent explosive disorder (IED), which is characterized by persistent, out-of-control anger attacks that can’t be explained by a mental or medical disorder or substance use.
The findings, by researchers at Harvard Medical School, came from national surveys of nearly 6,500 American teens, aged 13 to 17, and their parents. The researchers found that IED was more common than thought, and that it is severe and persistent; kids usually start showing signs of IED in late childhood and the disorder persists through adolescence, the authors say. IED in teens is also linked with later problems, like depression and substance abuse in adulthood.
The study found, however, that many teens weren’t getting the help they needed. Among the study participants, 38% of those with IED received treatment for emotional problems in the year prior to the survey, but only 17% of these teens — or just 6.5% of all teens who had diagnosable IED — had received treatment specifically for anger.
If IED could be detected and treated early, however, clinicians could help prevent a substantial amount of future violence and related mental harms, said senior author Ronald Kessler, professor of health care policy at Harvard Medical School.
To meet the definition of IED, according to the Diagnostic and Statistical Manual of Mental Disorders, a person must have three episodes of “impulsive aggressiveness grossly out of proportion to any precipitating psychosocial stressor,” at any time during their lives. In the current study, the researchers also used narrower definitions of IED that required attacks of anger within the previous 12 months and found that many teens met the standard. (The study excluded teens with other mental or emotional disorders like bipolar disorder, ADHD, oppositional defiant disorder and conduct disorder.)
“It’s a problem because it really gets in the way of your life,” says Kessler. “There are lots of things people don’t get treatment for because it doesn’t really impact them. This does. The problem is an awful lot of people have it — more than I thought — it’s awfully chronic, and it’s impairing.”
The authors find that IED is not only underdiagnosed, but understudied as well. They write: “The number of PubMed research reports dealing with panic attacks is roughly 60 times the number dealing with anger attacks even though the lifetime prevalence of IED is considerably higher than the prevalence of panic disorder.”
Part of the problem may be that overly angry or aggressive people fail to acknowledge their own behavior. “I think one reason [IED] is understudied is that people who have these anger problems very often do not consider it a problem. They don’t go in for help. They may get arrested, but they don’t seek help on their own,” says Kessler. “Some things like this and other social disorders can fall through the cracks, and this is one of them.”
The authors say further research is needed to understand the risk factors for IED in teens and to improve diagnosis, screening and treatments.
The findings are published in the journal Archives of General Psychiatry.