Advocacy & Safety - 16 million might have road rage disorder

Study: 16 million might have road rage disorder (http://www.cnn.com/2006/HEALTH/06/05/road.rage.disease.ap/index.html)
Doctors say condition is far more common that they thought

I guess they never asked anyone who rides a bike.

i'm glad it's getting more attention. i've always thought it was a serious problem because i noticed some of my well mannered friends would turn into complete animals on the road when someone cut them off. real scary dr. jekyll and mr. hyde type behavior.

it's not a disorder to be angry if you're late for work and the jackass in front is driving in an idiotic and incompetent manner

:lol:

There was one good thing about driving a big cube truck. Being somewhat above it all, I rather felt like Jane Goodall watching all the chimps. You will all be pleased to know that on more than one occasion I used the 5 tonnes of steel to guard cyclists from insane motorists. :)

it's not a disorder to be angry if you're late for work and the jackass in front is driving in an idiotic and incompetent manner

You were late before you left... driving like an idiot does not compress time.

holy crap !

Disorder? I thought it was simply a case of people failing to learn patience and anger management. Why is everything now a disorder? "I'm sorry, officer, but you see, I have this disorder..."

I think the REAL proplem is that people don't want to admit that sometimes you just have to grin and bear it. You also have to accept that your lousy behavior just might be YOUR fault.

God bless!
Wayne J.

p.s. The "You" is used impersonally. No person in particular is targeted.

Another new disorder is the irrational belief that every behavior pattern is a new disorder.

although i do agree that everyone has to be responsible for themselves and learn to control their anger, something like this could rank with alcoholism or any number of things. and who knows, maybe if enough research is done there could be a treatment.

all i know is that some people do have a real problem with road rage. talk to the guy who blocked two lanes of traffic only to jump out of his truck with a bat and threaten to kill me all because i didn't accelerate "fast enough" from the red light. that's beyond just being an jerk or having a bad temper, it could lead to someones death someday. and if 16million people have issues like this i think it's definitely worth studying.

Disorder? I thought it was simply a case of people failing to learn patience and anger management. Why is everything now a disorder? "I'm sorry, officer, but you see, I have this disorder..."

I think the REAL proplem is that people don't want to admit that sometimes you just have to grin and bear it. You also have to accept that your lousy behavior just might be YOUR fault.

God bless!
Wayne J.

p.s. The "You" is used impersonally. No person in particular is targeted.


Oh gosh I can see it now...

Scene opens:

Quiet sunrise, birds singing, rays of light beaming from the horizon...
(camera pans down to little car just putting along on lonely road... camera pulls out to see lonely road intersecting with major 16 lane interstate in the distance)

(voice over) "The little yellow pill... ask for it.... "

256 lines of very fine print quickly scroll past the screen informing us of all kinds of side effects and possible conflicting medical and chemical issues...

Music up.

(voice over) "The little yellow pill... for those moments... "

(camera in, long shot, pans over the smoky, noisy, crowded, freeway... and zooms out)

Fade to dark.

Brand logo fades in... "Noragia" tm.

end

Road Rage, er, Intermittent Explosive Disorder. The counselor is in, coin please. <grin>

I'm a clinical mental health counselor, surprised that this was pathologized. Acting badly isn't always a mental health issue.

Interesting that the acronym will become IED for intermittent explosive disorder.

Well, referrals are always welcome, I suppose I could carry my business card with me and hand it out to t he clowns that hollar when they pass. Do you think they'll appreciate my consideration?

<grin>

I'm sorry I ran over the cyclist, Your Honour, you see it's not my fault, I have this disorder...

I'm sorry I ran over the cyclist, Your Honour, you see it's not my fault, I have this disorder...

I have ADHD. As far as I know, it doesn't excuse me from showing up at work on time, paying my bills etc.

something like this could rank with alcoholism or any number of things. and who knows, maybe if enough research is done there could be a treatment.

There is a treatment and it isn't a pill. It's called Cognitive Behavioral Therapy. You change your behaviors by changing the way you think about whatever it is you're having the problem with. Most people do it without even knowing it, but it seems some of us chimps need the extra help with it. No drugs, no talking about you're horrible childhood, no being in therapy forever, and it actually seems to work. The only catch is you have to want to make it work and you have to study and practice, just like school.

They have types of CBT for all sorts of issues, including anger management.

If this merits its own disorder classification in the DSM-IV, limited culpability in the courtroom is soon to follow...

"Your honor, my client deserves a slap on the wrist and treatment, he has a disease, a disorder recognized by the medical community...."

I have a disorder...
I 'suffer' from it...
I'm a victim...

Oh gosh I can see it now...

(voice over) "The little yellow pill... for those moments... "

Brand logo fades in... "Noragia" tm.



Hey! I work for big pharma, and that offended me! Now I'm gonna have to go take one of my company's pills! ;)

P.S. We often run contests to name our next big drug to go to market. Can I use this one?

Road rage is not a disorder, it's an excuse for the weak who know right from wrong but don't want that responsibility. It's also a good reason to negate an offenders driving privileges, permanently, if the excuse is used in court when a charge has been laid. It's akin to saying "I've proved myself a threat to others, but I cannot or will not be held responsible" for which the only proper response is "You may not drive"

Hey! I work for big pharma, and that offended me! Now I'm gonna have to go take one of my company's pills! ;)

P.S. We often run contests to name our next big drug to go to market. Can I use this one?

Sure, just send me a bottle and a slingshot... so I can put those pills to work where needed. :D

I have ADHD. As far as I know, it doesn't excuse me from showing up at work on time, paying my bills etc.

That cuz YOU don't use it as a crutch... and Thank you :)

My money's on genec's commercial ;)

It does seem that FAR too many folks look for excuses to avoid being accountable…

There was a thead that ran to a link a while ago called, Aggressive Driving is Emotionally Impaired Driving
http://www.bikeforums.net/showthread.php?t=145333&highlight=emotionally+impaired+driving
here's the paper http://www.drdriving.org/courses/conference_paper.htm

Mars also posted a thread called, Insight into the aggressive drivers where he said, My research is in disorders that cause disruptive and aggressive behavior. I thought maybe some of you might find it useful to consider some of this information in trying to understand the motivations and thoughts of truly aggressive drivers.
http://www.bikeforums.net/showthread.php?t=104771&highlight=agressive

Here's a blurb from the original article, see below. Working in psychiatric research, my bias is that these disorders are real. Psychiatric problems are not diagnosed by blood tests or looking at tissue samples, but by interviewing subjects about their behaviors. Of course, it depends on people being honest about their behavior. But the fact that such a large percent of a population sample admitted to these behaviors is astounding! I calculated that if 5% of drivers have this diagnosis, and each cyclist encounter with a driver is considered an independent event, it only takes about 100 encounters until you are essentially guaranteed to meet up with one or more of these IED drivers. That's not to say they are actively angry during the encounter, but then count up "contentious" encounters, and it doesn't take long to reach 100, especially if you ride daily in traffic. To me, this helps explain those periodic unpleasant episodes with drivers who explode at the slightest provocation. Bill H.



"Intermittent explosive disorder (IED), as operationalized in DSM-IV, is characterized by recurrent episodes of serious assaultive acts that are out of proportion to psychosocial stressors and that are not better accounted for either by another mental disorder or by the physiological effects of a substance with psychotropic properties. Despite the fact that IED, or some version of this diagnosis, has always been included in the DSM, changes in criteria in the various editions over the years have resulted in relatively little being known about the incidence or prevalence of IED either in clinical samples or in the general population. In DSM-III, for example, IED could not be diagnosed in patients with generalized aggression or impulsivity. Given that most individuals with serious aggressive outbursts also have generalized aggression or impulsivity, this restriction resulted in a significant underestimation of the IED syndrome in DSM-III.1 While this problem was remedied in the DSM-IV, other uncertainties remain, such as the nature and threshold frequency of aggressive acts needed to meet criteria for a diagnosis of IED. "

The Prevalence and Correlates of DSM-IV Intermittent Explosive Disorder in the National Comorbidity Survey Replication
Ronald C. Kessler, PhD; Emil F. Coccaro, MD; Maurizio Fava, MD; Savina Jaeger, PhD; Robert Jin, MS; Ellen Walters, MS
Arch Gen Psychiatry. 2006;63:669-678.

Here's how they diagnosed this thing:

DIAGNOSTIC ASSESSMENT

The NCS-R diagnoses are based on version 3.0 of the World Health Organization Composite International Diagnostic Interview (CIDI),8 a fully structured lay-administered diagnostic interview that generates diagnoses according to both International Statistical Classification of Diseases, 10th Revision9 and DSM-IV10 criteria. DSM-IV criteria are used in the current report. The diagnoses include the 3 broad classes of disorder assessed in previous CIDI surveys (anxiety disorders, mood disorders, and substance disorders) plus a group of disorders that share a common feature of difficulties with impulse control (IED and 3 retrospectively reported childhood-adolescent disorders—oppositional defiant disorder, conduct disorder, and attention-deficit/hyperactivity disorder). Diagnostic hierarchy rules and organic exclusion rules were used in making diagnoses. As detailed elsewhere,11 blind clinical reinterviews using the Structured Clinical Interview for DSM-IV (SCID)12 with a probability subsample of NCS-R respondents found generally good concordance between DSM-IV diagnoses based on the CIDI and the SCID for anxiety, mood, and substance use disorders. The CIDI diagnoses of impulse control disorders were not validated because the SCID contains no assessment of these disorders.

DSM-IV criterion A for IED requires "several discrete episodes of failure to resist aggressive impulses that result in serious assaultive acts or destruction of property." This criterion was operationalized in the CIDI by requiring the respondent to report at least 1 of 3 types of anger attacks: (1) "when all of a sudden you lost control and broke or smashed something worth more than a few dollars;" (2) "when all of a sudden you lost control and hit or tried to hurt someone;" and (3) "when all of a sudden you lost control and threatened to hit or hurt someone." Three or more lifetime attacks were required to operationalize the DSM-IV requirement of "several" attacks. We also created a narrow definition of lifetime IED that requires 3 attacks in the same year. Although this temporal clustering is not included in DSM-IV, there is precedent for its use in clinical studies of IED.2 Building on this distinction, 12-month prevalence was defined using 3 successively more stringent requirements. The broad definition required 3 lifetime attacks and at least 1 attack in the past 12 months. The intermediate definition required 3 lifetime attacks in the same year and at least 1 attack in the past 12 months. The narrow definition required 3 attacks in the past 12 months.

DSM-IV criterion B for IED requires that the aggressiveness is "grossly out of proportion to any precipitating psychosocial stressor." This criterion was operationalized in the CIDI by requiring the respondent to report either that they "got a lot more angry than most people would have been in the same situation" or that the attack occurred "without good reason" or "in situations where most people would not have had an anger attack."

DSM-IV criterion C for IED requires that the "aggressive episodes are not better accounted for by another mental disorder and are not due to the direct physiological effects of a substance or a general medical condition." This criterion was only partially operationalized in the CIDI. Two sets of questions asked if anger attacks usually occur either when respondents have been drinking or using drugs or when they are in an episode of being sad or depressed. Positive responses were followed with probes about whether the attacks ever occurred at times other than when the respondent was under the influence of alcohol or drugs or depressed. If not, the case was considered to be due to substance use disorder and/or depression. A third set of questions asked about organic causes as follows: "Anger attacks can sometimes be caused by physical illnesses such as epilepsy or a head injury or by the use of medications. Were your anger attacks ever caused by physical illness or medications?" Positive responses were followed with probes that inquired about the nature of the illness and/or medication and whether the respondent ever had attacks other than during the course of the illness or under the influence of the medication. If not, the case was considered to be due to an organic cause.

Although the CIDI did not include parallel questions that excluded respondents whose anger attacks occurred in the course of bipolar disorder (BPD), we imposed a post hoc rule to make this exclusion based on evidence that IED has a particularly strong relationship with BPD.13-15 This rule excluded cases from a diagnosis of IED if they met lifetime criteria for mania or hypomania, reported that the ages at onset and recency of their IED fell within the ages at onset and recency of their mania or hypomania, and reported that the number of years they experienced manic or hypomanic episodes was greater than or equal to the number of years they had anger attacks. This rule artificially rules out the possibility of comorbidity between IED and BPD. However, we judged this bias to be the lesser of 2 evils in comparison with the possibility of overestimating the prevalence of IED by failing to exclude anger attacks due to BPD.

...so, the best way to react to an aggressive driver is to not meet him (isn't it nearly always a him?) with the same aggression?

I've always just let it go, but it's hard not to do anything, somehow, these actions can't go unchallenged.

I have ADHD. As far as I know, it doesn't excuse me from showing up at work on time, paying my bills etc.

First, my comment was obviously meant with humour.

Secondly, of the people I know with ADHD or ADD (not everyone has hyperactivity as a symptom, particularly among adults), a few feel that the diagnosis did more harm than good. One in particular felt that it was more helpful for her to think of it as a personality quirk than a medical condition. Similarly some people feel that diagnosing a learning disability at the drop of a hat isn't helpful, particularly when some people fall into the "normal, but less common" learning patterns.

There is a tendency today to label everything as a medical disorder. That's a double-edged sword. The label can bring understanding, treatment and/or coping techniques. It can also bring dismissal, excuses, stigma, and a loss of sense of control over one's life.

Did anyone think about switching to Decafe ?

Did anyone think about switching to Decafe ?

You know, I've been wondering if some of these prescription drugs being advertised these days might have something to do with the increase in Starbucks openings. Meds for intestinal problems (too much caffeine can do this) and meds for insomnia, primarily.

I'm a therapist too. My guess is that many with road rage could be diagnosd with narcissistic personality disorder. The trigger of their rage is some other driver/rider whom they perceive to be impeding their progress or intruding in their space. "How dare they get in my way like that?!!" The overblown response is classic narcissistic rage, violent and irrational.

Diagnosis & treatment with therapy or drugs is lots of fun but in the meantime, since a number of professionals would like it to be diagnosed, it can be.

That's all that is necessary for a DMV to treat the problem, correct? If you're blind, you are not licensed to drive. Prone to seizure? No license for you! Diagnosed by a medical professional or an admitted, self-diagnosed "victim" of Road Rage? License Revoked.

The next time someone you know becomes or almost becomes the victim of a poor hapless Road Rage sufferer you know what to do. Sue them for allowing themselves on the road at all with a dangerous mental condition.

You'd be doing the right thing, healing, in fact curing, the pitiful "victim" of Road Rage. No car, no symptoms.

16 million more who need a head doctor.
16 Million more buying prescriptions on our dime.
16 million now entitled to yet another legal defense charade.
Another 16 million who will be convinced that there is an excuse for everything.
Another 16 million denials of personal responsibility.
:mad:

I'm a therapist too.

It's always interesting to find out what members do when you have some idea of how their minds work from their posts.

Sometimes, it makes sense. Sometimes it's suprising.

It makes sense in Roodys case.

I'm a therapist too. My guess is that many with road rage could be diagnosd with narcissistic personality disorder. The trigger of their rage is some other driver/rider whom they perceive to be impeding their progress or intruding in their space. "How dare they get in my way like that?!!" The overblown response is classic narcissistic rage, violent and irrational.

Thanks for posting. If you can make a general statement, how far does this behaviour have to extend before you would say a person has this disorder? I'm so used to the "my way/my road" etc. mindset that I wasn't seeing the "my" as a symptom.

SamHouston has the right perspective on this one. Don't treat this 'disorder' as an excuse, treat it as a leigitmate reason to revoke one's driver's license. In addition, treat it as evidence of criminal negligence if someone 'suffering' from this ever injures another party in a road rage incident.

Then we might see some results.

Too bad these folks cannot legally self medicate outside of California.

That's all that is necessary for a DMV to treat the problem, correct? If you're blind, you are not licensed to drive. Prone to seizure? No license for you! Diagnosed by a medical professional or an admitted, self-diagnosed "victim" of Road Rage? License Revoked.



nice. and i agree completely.

Thanks for posting. If you can make a general statement, how far does this behaviour have to extend before you would say a person has this disorder? I'm so used to the "my way/my road" etc. mindset that I wasn't seeing the "my" as a symptom.
Narcissism is classified as a personality disorder, meaning that it endures over the person's lifespan, and it affects several areas of his/her life and functioning. There seem to be feelings of inadequacy underlying the exaggerated sense of self-worth. Medication is probably not going to be very useful in treating NPD. Short term cognitive therapy may help the person change behavior patterns, including the rage reactions. Long term psychodynamic therapy sometimes works to change underlying defecits in the personality.

Narcissism is classified as a personality disorder, meaning that it endures over the person's lifespan, and it affects several areas of his/her life and functioning. There seem to be feelings of inadequacy underlying the exaggerated sense of self-worth. Medication is probably not going to be very useful in treating NPD. Short term cognitive therapy may help the person change behavior patterns, including the rage reactions. Long term psychodynamic therapy sometimes works to change underlying defecits in the personality.

Thanks.

Baby steps.

Narcissism is classified as a personality disorder, meaning that it endures over the person's lifespan, and it affects several areas of his/her life and functioning. There seem to be feelings of inadequacy underlying the exaggerated sense of self-worth. Medication is probably not going to be very useful in treating NPD. Short term cognitive therapy may help the person change behavior patterns, including the rage reactions. Long term psychodynamic therapy sometimes works to change underlying defecits in the personality.

Is it a very common disorder?
Do you think too much caffeine could mimic the symptoms once in a while?

I remember a news story on television in which they hooked up a "normal" driver to a blood-pressure and heart-rate monitor. He was fine until he turned onto the freeway on-ramp, then his heart rate and blood-pressure shot up. The strange thing was that he didn't realize it until he saw the monitor.

Adrenaline can do a lot of strange things to a person's emotions.

Is it a very common disorder?
Do you think too much caffeine could mimic the symptoms once in a while?
I don't know the rates, but not too common as a full blown disorder. But it seems that many of us can have a touch of it from time to time, inspiring sayings like "The whole world doesn't revolve around you, you know."

Caffeine....that is a drug that increases arousal. An optimal amount increases feelings of well being, makes one more alert and improves both motor and cognitive performance. In general, I think it's good for cagers to drink caffeine in moderation.

However, larger doses cause feelings of jitteriness, nervousness and anxiety. I've never really seen it make people angry, have you? I mean i think of a coffee house as being a pretty peaceful place, with friendly chatty people.

I didn't mean to say that narcissism is the only, or even the main cause of road rage. But my speculation is that it might be a cause of some of the worst rage, especially in repeat offenders.

Eveyone should be mandated to listen to classical music. It'll be cheaper then couch-pyscho-analyst-rage-road-syndrome therapy.

Driving in California turned me against motorist earlier in life than my observations from a bike saddle.
HOw many times obscene gestures or aggressive driving made me afraid for my life. In fact I hope I feel safer being in the bike lane seperated from the nuts by that white line. I like to think I am not competing for their space in their race to where ever.
Once coming down a mountain east of San Clemente , some wacko gave us the finger as he passed us on a double line. We were going a minimum of 35 mph in a 50 on a blind curve.
But, we were cussing them a little later. Traffic backing up about 15 minutes later. Pretty sure it was the same white pick up that had crashed up ahead.
I once recall a Los ANgeles radio station offered some shrink air time during peak traffic hours. Not a bad idea. Maybe all radio stations should be required to air this content during rush hour.

I remember a news story on television in which they hooked up a "normal" driver to a blood-pressure and heart-rate monitor. He was fine until he turned onto the freeway on-ramp, then his heart rate and blood-pressure shot up. The strange thing was that he didn't realize it until he saw the monitor.

Adrenaline can do a lot of strange things to a person's emotions.

I had a morning doctor's appt once and had to drive there in rush hour traffic. Not used to the stress of driving, nurse took my blood pressure and it was sky high. The doctor was about to put me on medication and I had to talk her out of it and explain about the stressful car commute. We agreed on no more morning appts. Thanks God for bicycle commuting!

Hey! I work for big pharma, and that offended me! Now I'm gonna have to go take one of my company's pills! ;)

P.S. We often run contests to name our next big drug to go to market. Can I use this one?

Speaking of drug naming contests, I entered one to name a mythical IED drug here:

http://www.naparstek.com/2006/06/intermittent-explosive-disorder.php

Put Klonopin In Everyones Coffee And The Problem Will Go Away

....There is a tendency today to label everything as a medical disorder.....
It is interesting how this disorder afflicts Americans so much more often than it affects people in other countries with frustrating road conditions (e.g. India) or even the other parts of the industrialized world that I've seen. It is also interesting that the epidemic seems to be getting worse with time.

I can accept that some people have screwed up body chemistry or wiring that makes them exhibit severe emotional reactions to minor events. However, sometimes it's just time to call a spade a spade. There are a lot of immature and self centered individuals out there who think they should be able to fly off the handle just because the world isn't just the way they want.

It is interesting how this disorder afflicts Americans so much more often than it affects people in other countries with frustrating road conditions (e.g. India) or even the other parts of the industrialized world that I've seen. It is also interesting that the epidemic seems to be getting worse with time.

I can accept that some people have screwed up body chemistry or wiring that makes them exhibit severe emotional reactions to minor events. However, sometimes it's just time to call a spade a spade. There are a lot of immature and self centered individuals out there who think they should be able to fly off the handle just because the world isn't just the way they want.

We name it and make it a disorder because, for the time being in this country we can afford to. Those in the business, and it is just business, who invent these things and fashion the treatments will eventually exploit us to the point that affordability will no longer apply. This invented condition will work for attorneys, doctors and pharmaceutical perveyors but generally not for the rest of us.

But, what the heck? Take a pill and sue someone, you are not at all responsible for doo doo.

It's all about unkept promises...
When they bought their car, they believed they would immediately be better looking, have a more attractive mate, and would glide thru dramatic landscapes at 90mph.