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The Limbic System

RAGE BEHAVIOR

Juvenile rage has been the subject of great concern in recent years. Childhood violence has become more lethal as youths gain access to guns and use the Internet to develop their bomb-making skills. The nation’s concern about juvenile violence has outstripped our knowledge of the cause and cure of this distressing trend. However, our CNS neuropsychiatry group has specialized in the assessment and stabilization of child and adolescent rage behavior. We may not have the answer to all childhood violence, but we are well on the way to understanding how to manage juvenile rage behavior.

Dictionary definitions of "RAGE BEHAVIOR" generally refer to several characteristics of this unique form of anger. It is often described as "sudden" and "violent". The most frequent description is of an "explosive episode". In popular literature we read the terms "going postal" and "road rage". In these descriptions there is the clear implication that rage behavior represents discrete and time limited episodes during which the individual loses control of his or her anger and displays an intense and destructive fury. Sometimes the term "blind rage" is used to suggest that the person’s reason and rationality are suspended during these violent "anger attacks".

Scientific definitions present some of these same concepts. There is a long history, in science, of classifying aggressive acts as either impulsive or premeditated. Impulsive aggression (rage) is characterized as reflecting a "hair trigger" response that results in an agitated state and culminates in an aggressive act. During this brief episode, interpersonal communication and information processing are both inefficient. The term "hot under the collar" refers to the high degree of emotional charge associated with impulsive aggression. In contrast, premeditated aggression is consciously executed, generally planned, and not highly emotional. The expression "in cold blood" refers to this lack of emotionality in premeditated aggression.

Therefore, both the popular literature and the scientific literature describe "RAGE BEHAVIOR" as impulsive and explosive, occurring in discrete episodes (sometime out of character) and showing a highly emotional, agitated state with little thinking and no planning. Picture the cartoon character, The Incredible Hulk, who is not much of a thinker or talker but who displays a highly emotional, furious temper.

The psychiatric literature does not often use the term "rage" but defines a form of violent aggression called Intermittent Explosive Disorder. Two of the criteria are (1) discrete episodes of impulsive aggression resulting in serious assaultive or destructive behavior (2) the degree of aggression is out of proportion to the provocation. This condition, which is more common in males, tends to appear in late adolescence or during young adulthood. It has been compared to "Running Amok" (reported in Asian countries), which is "...a single episode of acute, unrestrained violent behavior for which the person claims amnesia." It is interesting to note that in many cases of rage behavior, the agitated person will later have very poor memory of the violent episode. The episodes may be described as "spells" or "attacks". Sometimes there are warning signs that precede the explosive episode (e.g.; a sense of tension or arousal).

The recent rash of school shootings can be categorized as either impulsive or premeditated violence. The Littleton, Colorado gunmen showed premeditated aggression, having planned their violence for a year. They acted like predators, cold and calculating, in killing their victims. The Jonesboro, Arkansas shootings were also premeditated and carried out in a cold fashion. In stark contrast, many of the copycat attempts seem to be more impulsive and explosive, showing no planning, with behavior that is more like true rage.