Seemingly uncontrollable and unpredictable anger is a problem for some people with a mental health condition. As a therapist, I diagnose people with intermittent explosive disorder, which is a DSM 5 diagnosable condition.
Intermittent explosive disorder (IED) is an ‘impulse-control disorder characterised by sudden episodes of unwarranted anger’. The disorder is typified by hostility, impulsivity, and recurrent aggressive outbursts.
People with IED essentially ‘explode’ into a rage despite a lack of apparent provocation or reason. In my work, I have provided treatment for people carrying such a diagnosis and offered psychoeducation for the person diagnosed and for their families.
In most of the cases I have encountered, adolescents and young adults seem to have the most difficulty controlling their symptoms in the wake of a new or mismanaged diagnosis. The prevalence of this disorder among teens and young adults is often rooted in access issues to treatment, developmental, environmental, parental, and cultural considerations, which sometimes, due to stigma, families and other collaterals minimise the reality of this condition or don’t consign to the benefits of seeking mental health treatment.
When I completed home visits for the most severe cases in NYC and the outlying boroughs, it became hard to ignore the very real cultural and ethnic considerations blocking many teens under my care from treatment.
This blockage and access to mental health treatment manifested in different ways. Sometimes families wouldn’t open the door for me or would tell their son or daughter not to trust me, because of fear that I would report their parents to the government for either maltreatment or neglect.
In many cases, as mandated reporters, therapists do open the door to such government investigations and trigger home removal of children who have mental health disorders, and who are also mistreated, neglected, or abused.
In these situations, especially in cases with real abuse and maltreatment, patients are particularly vulnerable to impulse control problems, and have underdeveloped mental filters, or present reactive and disobedient when, in fact, it is a direct response to abuse.
Often, these are the teens and young adults that truly need the help and treatment of an in-home therapist. According to the research, this is the most impactful treatment milieu in targeting the root of this disorder, and most, if not all the underlying contributing external factors which exacerbate symptoms for people carrying this diagnosis.
Think about it, outpatient therapy in the office can only do so much in capturing the environmental problems in a person’s home, the family dynamics, and other external contributing factors which trigger teenage anger and misbehaviour.
Mobile therapists can observe their patients in the classroom too, and provide the sort of collateral treatment necessary to reshape and re-pattern the interpersonal landscape of people suffering from this condition. Thus, the expression of a patient’s personality, which can, in turn, contribute to a person’s volatility or lability, can be monitored in vivid detail, live in a patient’s own environment, when they explode on their friends, family, and neighbours during the course of a session.
After working with so many angry people, I find that it is the most soft-spoken, seemingly calm, and level-headed individuals, who are diagnosed with IED or are outrageously quick to anger. Why is this? I have a few suspicions. People already ‘high-strung’, ‘Type-A’, or just plain loud are usually not the primary culprits for creating large displays and scenes in stores and public venues.
These are the people you are already expecting to have a voice and use it whenever they are in a situation in which they feel silenced or mistreated. Conversely, it is the soft-spoken and extremely calm people that have the potential for such polarities in their demeanour. These are the people that go from zero to 100 in less than a minute, sometimes less than a few seconds.
Very few people struggling with psychosis have the energy or the concerted mental coordination to carry out acts of extreme violence. As a person who experienced a psychotic episode, I spent most of the time disordered living in fear, extreme paranoia, and disorganisation.
Globally, all people, with or without a diagnosis, in the wake of external negative consequences to the extreme or untoward behaviour, will go on exploding on friends, neighbours, and family for just about anything. If you are interested in living in a slightly more predictable world with less volatility and exposure to anger, I suggest we all start pushing back when we see people living their lives without consequences or negative reinforcement.
Max E. Guttman, LCSW is a psychotherapist and owner of Recovery Now, a mental health private practice in New York City.