Helping Ragers: Confronting Intermittent Explosive Disorder

Fearless. He would take no guff from anyone. All his life Clark had been known as one who would rather fight than negotiate. Back in his school days he spent plenty of time in detention halls, in fact, he took pride in his reputation as one who was crusty and mean.

Now Clark was in his mid-30s and going through his third divorce. In each of his marriages he had been physically abusive. Little things would send him into rages. At home, he lived with a my way or the highway approach to marriage. If his wife did not fit his mold he would shout and curse until he forced her into agreement. For a while, he would be able to get away with his bully act, but inevitably it would wear thin and she would be on her way out of the relationship.

Marriage was not the only place where Clarks rage emerged. Traffic problems were especially taxing on him and more than once he had gotten out of his car to threaten a driver who had done him wrong. He had never been fired from a job, but that was because he owned his own plumbing company. Over the years, many employees quit because they could not tolerate his anger binges. Likewise, he had a reputation in his industry of being difficult to work with, something that certainly did not help his companys bottom line.

In addition to being diagnosed with bipolar disorder, Clark struggled with intermittent explosive disorder, characterized by unpredictable episodes of extreme anger or physical outbursts. He was capable of acting pleasant at times, but the raging episodes could appear with little or no warning.

Almost always, people like Clark need medical intervention to assist them in controlling their rages. Mood stabilizers (anticonvulsant medicines) and SSRIs tend to be the front line choices in treatment. In addition to treating the physiological elements, counseling is warranted. With the combination of both approaches, an individuals odds for improvement can be somewhat good.

When counseling people like Clark, I tend to focus on the depth of their dependency needs. Normally people like Clark will describe themselves as strong and independent, when they actually are nowhere close to exhibiting either of those qualities. Most raging individuals are too proud to admit it, but they are a scared and highly dependent lot.

When I suggest such a thought to ragers, I usually hear a tough rebuttal: I aint afraid of nothing! That flattering self-assessment may soothe their fragile egos momentarily, but I dont believe it for a moment.

Very early in life, most ragers received the message that they did not measure up to the requirements of harsh or critical authorities. Non-acceptance was common. Belittlement was routine. To their credit, in the early development of anger responses, these people determined not to remain in the down position.

They decided to stand up for themselves in order to communicate that they deserved better treatment. The problem with their angry responses was not that they communicated a message of selfpreservation, but that they were trying to force that right message at someone elses expense.

At the very core of any anger, even rage, is a craving to be respected. Treat me like Im somebody, is the intended thought. Recognize that Im a legitimate person with legitimate needs. Not only is that core message not wrong, it is good that angry people care enough to stand up for personal dignity.

Accompanying that desire for respect, though, is a grand pessimism. Because key people demonstrated a lack of trustworthiness, the fledgling rager assumed that the only way to be heard was through intimidation. If you wont take me seriously, I ll show you just how important I am. The use of overwhelming force indicates their fear of truly being taken seriously. They live with the insecurity that if they merely speak in conversational tones (speaking truth in love, as described in Ephesians 4:15), they will be deemed insignificant.

Various adjustments certainly are in order for people who rage. They can be coached, for instance, to lower the decibels when they speak or to remove themselves when they feel pressure building. Certainly the medical approach is invaluable when confronting the matter of impulse control. But to successfully address the problem of excessive, explosive anger, they will need to tend to the hurt of that little child inside. They will need to address the ones who planted the seeds of insecurity through condescending messages (if not in person, at least in their minds). They will need to admit how humiliating it was to feel controlled and to acknowledge how futile it is to attempt to be the one in control. They will need to recognize that posturing for superiority never compensates for the feeling of inferiority. It only masks it.

Strength is displayed in the giving of respect and decency when communicating legitimate anger. This is taught in Ephesians 4:26, 29, which instructs to be angry without sin, letting no unwholesome word proceed from our mouths. Ragers have not yet learned this skill, but they can. Angry people want to be valued and respected as significant persons (a noble desire), but they will have to learn that the receiving of respect from others is in direct proportion to the giving of the same. This form of communication requires advance planning in sober moments of introspection, but as ragers allow their thinking to be anchored in a mind of determination and humility, it can be mastered.

When I spoke with Clark about addressing the little boy inside who was hungry for respect, he reacted with a how did you know that? look. We spoke extensively about the link between his anger and his need for others to pay attention to his pronouncements. He eventually learned that he could manage his anger most effectively, not by overwhelming others, but by being starkly honest about the cry behind the rage.Take help from telephone therapist .

Les Carter, Ph.D., is the best selling author of 20 books, including The Anger Trap and The Anger Workbook. He is a co-founder of Southlake Psychiatric and Counseling Center in Southlake, Texas, and can be reached at drlescarter.com.