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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.
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