Aspirin may help ‘rage disorder,’ research shows
Mental illness marked by outbursts of anger
There are no charity runs or walks for the patients Dr. Emil Coccaro treats and if there is one thing he is certain of, it is this: “I can guarantee you that there is nobody out there who wants to be the poster child for this disorder.”
Coccaro is chair of the department of psychiatry and behavioural neuroscience at the University of Chicago. He’s also an expert in IED, or “intermittent explosive disorder” — a mental illness marked by outbursts of uncontrollable rage and that Coccaro’s just-published research suggests may be treatable with something as simple as Aspirin.
Emerging research suggests IED is more common than previously thought, affecting three to five per cent of the adult population.
While many people might be adding, “I resolve not to get so angry” to their list of resolutions for the new year, anger is a normal human emotion. Normal people occasionally blow up, Coccaro says.
IED is decidedly different. The Diagnostic and Statistical Manual of Mental Disorders, or DSM, psychiatry’s official “bible” of mental dysfunction, defines IED as “recurrent, problematic, impulsive aggression” that is grossly out of proportion to the situation. Even the most minor provocations can trigger explosions of rage. People lose control, break or smash things.
The disorder first appeared in the DSM in 1980. In previous editions, physical aggression was required for a diagnosis. In the latest and newest edition, released in May, verbal aggression — yelling, screaming and abusive language — now also qualifies.
Under the new criteria, which Coccaro and his group defined, people have to experience “high intensity” outbursts of aggression — “three huge events,” as Coccaro describes it — at least three times a year, or less intensive explosions at least twice a week.
“These people blow up frequently, and it’s getting them into trouble,” Coccaro said. “Not necessarily with police. It gets them into trouble in their relationships; it gets them into trouble at work.
“Sometimes they can mask it, or keep it under wraps. But after a while, they can’t. It’s hard to live with these people.”
The disorder tends to appear more often in males than females though there isn’t a “whopping” gender difference, Coccaro says. The behaviour usually first appears in adolescence, around age 13 for boys and 19 for girls, and continues into adulthood.
Researchers have shown a connection between low levels of certain brain chemicals, notably serotonin, and impulsive aggression.
Now, in new research published this month in JAMA Psychiatry, Coccaro and his co-authors found that people with IED have higher than normal blood levels of two proteins — C-reactive protein, or CRP, and interleukin-6, or IL-6. The liver produces CRP in response to inflammation. IL-6 stimulates production of CRP.
In their study, CRP levels were twice as high for people with IED compared to normal, healthy volunteers.
Earlier studies in animals showed that, “if you actually put inflammatory proteins into certain areas of the brain which are relevant for aggression, you can make animals more aggressive,” Coccaro said.
Other studies have shown that people with IED have a higher risk of cardiovascular disease, chronic pain, arthritis and other inflammatory conditions.
The new finding suggests that drugs that reduce inflammation “may also drive down aggression,” Coccaro said.
His team plans to test the antiinflammatory drug Celebrex in people with IED.
Current treatments, including Prozac-like antidepressants, the mood stabilizer lithium and cognitive behaviour therapy, bring less than half of people with IED into remission, “meaning they’re not doing aggressive stuff anymore at all,” Coccaro said. “We’re still missing a significant number of people.
“What isn’t clear is why the field or society is not interested enough in studying and treating these problems, which is just remarkable.”
IED has been controversial. Some observers worry that perpetrators of spousal abuse and other violent crimes could avoid jail by hanging their behaviours on a “rage disorder.”
“The fact is aggressive people are not considered to be very sympathetic, because they’re doing things to people,” Coccaro said.
“But the people we’re studying are not psychopaths. They’re not doing these things on purpose,” he said.
“There’s a biology to this. There are circuitry issues that are out of balance, there is biochemistry that is out of balance,” he said. “This is a real thing.”