Since we’ve been weathering these “storms” from LuLu lately, I started looking for more information. Somewhere in the back of my mind I remember reading about “rage storms” in connection to Tourette’s. So I logged on to the Tourette’s Plus website. While Dr. Packer is quick to point out there is no research that indicates children with Tourettes are prone to rage attacks, there is growing anecdotal evidence that children with co-morbid conditions do seem to be the ones exhibiting the rage attacks. Tourette’s itself doesn’t seem connected to these types of rage attacks. But people who have Tourette’s Plus (plus perhaps more) seem to be likely candidates.

Dr. Packer’s article, Overview of Rage Attacks, talks in great detail about Intermittent Explosive Disorder and its DSM criteria. She has a different take on IED than our RAD blogger, Nancy does. But she makes a similar point that IED seems to be a diagnosis that doesn’t match the reality of what happens to people actually having these rage attacks. And, as Nancy states in her blog, IED is just a list of symptoms. (In fact, that’s what the DSM is – symptoms that are grouped into disorders – symptoms that often overlap. But then the DSM and how we diagnose psychiatric and neurological disorders is a whole topic unto itself.)

Dr. Packer cites a study that equates rage attacks with panic attacks and points out their similarities. Here’s the quote that struck me from that 1999 Fava and Rosenbaum study:

Anger attacks are sudden intense spells of anger that resemble panic attacks but lack the predominant affects of fear and anxiety associated with panic attacks. Anger attacks typically occur in situations in which an individual feels emotionally trapped and experiences outbursts of anger. Dysregulated anger is a state in which the behavior must be provoked in order to be observed. Thus, an anger attack is a combination of predisposition--or some enduring state of vulnerability--and provocation.

Hmmm…”individual feels emotionally trapped…” That’s LuLu to a tee. “Thus an anger attack is a combination of predisposition – or some enduring state of vulnerability – and provocation.” And the school wonders why I think provoking her behaviors to do a behavior analysis is a bad idea? How about because with her enduring state of vulnerability you will ALWAYS get an anger attack? How about because she is easily dysregulated? Shouldn’t we instead be looking for a way to lessen the dysregulation?

Can she learn NOT to have a rage attack?

Not according to the reading I’m doing. She can learn to recognize situations that trigger the attacks and avoid them or self-calm prior to the escalation. But in Dr. Packer’s article the advice is to ride the storm out. Punishment is not recommended (although making restitution and amends with those caught in the storm IS recommended once the storm is over.)

I found it insightful that Dr. Packer says “Attempts to talk with the child during or right after a "rage attack" are usually nonproductive and can actually "rekindle" the problem.” Yep, don’t I know this! Just reviewing her own behavior can trigger another storm.