The study was based on a national face-to-face survey of 9,282 U.S. adults
who answered diagnostic questionnaires in 2001-03. It was funded by the National
Institute of Mental Health.
About 5 percent to 7 percent of the nationally representative sample had had
the disorder, which would equal up to 16 million Americans. That is higher than
better-known mental illnesses such as schizophrenia and bipolar disorder,
Coccaro said.
The average number of lifetime attacks per person was 43, resulting in $1,359
in property damage per person. About 4 percent had suffered recent attacks.
The findings were released Monday in the June issue of the Archives of
General Psychiatry.
The findings show the little-studied disorder is much more common than
previously thought, said lead author Ronald Kessler, a health care policy
professor at Harvard Medical School.
"It is news to a lot of people even who are specialists in mental health
services that such a large proportion of the population has these clinically
significant anger attacks," Kessler said.
For a couple of decades, intermittent explosive disorder, or IED, has been
included in the manual psychiatrists use to diagnose mental illness, though with
slightly different names and criteria. That has contributed to misunderstanding
and underappreciation of the disorder, said Coccaro, a study co-author.
Coccaro said the disorder involves inadequate production or functioning of
serotonin, a mood-regulating and behavior-inhibiting brain chemical. Treatment
with antidepressants, including those that target serotonin receptors in the
brain, is often helpful, along with behavior therapy akin to anger management,
Coccaro said.
Most sufferers in the study had other emotional disorders or drug or alcohol
problems and had gotten treatment for them, but only 28 percent had ever
received treatment for anger.
"This is a well-designed, large-scale, face-to-face study with interesting
and useful results," said Dr. David Fassler, a psychiatry professor at the
University of Vermont. "The findings also confirm that for most people, the
difficulties associated with the disorder begin during childhood or adolescence,
and they often have a profound and ongoing impact on the person's life."
Jennifer Hartstein, a psychologist at Montefiore Medical Center in New York,
said she had just diagnosed the disorder in a 16-year-old boy.
"In most situations, he is relatively affable, calm and very responsible,"
she said. But in stressful situations at home, he "explodes and tears apart his
room, throws things at other people" to the point that his parents have called
the police.
Hartstein said the study is important because many people are not aware of
the disorder.