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Is it elder rage or intermittent explosive disorder?

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An under-diagnosed rage disorder is more prevalent than previously thought, says a recent study, "The Prevalence and Correlates of DSM-IV Intermittent Explosive Disorder in the National Comorbidity Survey Replication," published online June 1, 2006, in the Archives of General Psychiatry. Intermittent Explosive Disorder could be behind cases of road rage and spousal abuse. Early detection key to treatment. There's also elder rage, that is seen in older adults approaching various forms of dementia where the rage comes first before any memory loss. As the brain shrinks away from the skull or undergoes other changes, impulses can become more difficult to control

In younger people as well as middle-age and older adults, a seldom-studied mental illness called Intermittent Explosive Disorder, characterized by recurrent episodes of angry and potentially violent outbursts--seen in cases of road rage or spousal abuse--has been found to be much more common than previously thought

Depending upon how broadly it is defined, this disorder affects as many as 7.3 percent of adults, or 16 million Americans, in their lifetimes. In a year, Intermittent Explosive Disorder affects nearly 4 percent of Americans, or 8.6 million adults, reports Ronald Kessler, PhD, professor of health care policy at Harvard Medical School (HMS), and colleagues. The study also found that Intermittent Explosive Disorder may predispose people to other mental illnesses and substance abuse.

Intermittent Explosive Disorder attacks are out of proportion to the social stressors triggering them and are not due to another mental disorder or the effects of drugs or alcohol, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). People with this disorder overreact to situations with uncontrollable rage, feel a sense of relief during the angry outburst, and then feel remorseful about their actions.

"Intermittent Explosive Disorder is not a clinical term well-known in society, but the weight of these numbers should help patients and physicians come to recognize the pervasiveness of this disorder and develop appropriate treatment strategies," says Kessler, according to the June 5, 2006 news release, "Under-diagnosed rage disorder more prevalent than previously thought." Kessler is senior author of the study.

The study is based on data from the National Comorbidity Survey Replication (NCS-R), a nationally representative face-to-face household survey of 9,282 American adults, conducted from 2001 to 2003. The NCS-R is carried out in conjunction with the World Health Organization World Mental Health Survey Initiative.

"In the general population, aggressiveness or 'blowing up' is considered bad behavior; people think, 'This person just needs an attitude adjustment.' But Intermittent Explosive Disorder goes beyond that, having strong genetic and biomedical underpinnings," says coauthor Emil Coccaro, MD, the Ellen C. Manning professor and chair of the Department of Psychiatry at the University of Chicago Pritzker School of Medicine. "If people think these explosive outbursts are just bad behavior, they are not thinking of this problem as a serious biomedical problem that can be treated."

Among people with this disorder, 81.8 percent also were diagnosed with depression, anxiety, and alcohol or drug abuse disorders, although the age of onset of Intermittent Explosive Disorder was usually much earlier than that of these other disorders

"This suggests that people with this disorder may be more susceptible to other disorders because of increased stressful life experiences as a result of their disorder, such as financial difficulties or divorce," says Kessler, according to the June 5, 2006 news release, "Under-diagnosed rage disorder more prevalent than previously thought. This raises the possibility that Intermittent Explosive Disorder may be a risk factor for other mental disorders.

To be diagnosed with broadly-defined Intermittent Explosive Disorder, a person must have had three major episodes of impulsive aggressiveness at any time in his life where, according to the study, the person was significantly more angry than most people would have been in the same situation. These outbursts are sudden and include damage to property and/or physical harm (or threat of physical harm) to others.

A narrow definition of Intermittent Explosive Disorder includes three or more of these attacks in one year. In the study, people with narrow Intermittent Explosive Disorder had a more persistent and severe illness, particularly if they attacked both people and property, causing 3.5 times more property damage than other violent Intermittent Explosive Disorder subgroups

The study shows that for both broad and narrowly-defined Intermittent Explosive Disorder, the first episode of rage occurred in early adolescence, around age 13 for males and age 19 for females. "Given its age of onset, identifying Intermittent Explosive Disorder early, determining its causes, and providing treatment might prevent some of the associated secondary disorders, such as anxiety or alcohol abuse," says Kessler.

Although most study respondents with the disorder had seen a professional for emotional problems at some time in their lives, only 11.7 percent had been treated for their anger in the 12 months prior to the study interview. Shame or embarrassment about these violent reactions may prevent people from discussing this disorder with their doctors, says coauthor Maurizio Fava, MD, professor of psychiatry at HMS and Massachusetts General Hospital (MGH). "Clinicians may also be at fault for concentrating on secondary symptoms, such as anxiety or depression, and not asking about outbursts of anger," he says.

Effective treatment for Intermittent Explosive Disorder includes both behavioral and pharmacological interventions (selective serotonin reuptake inhibitors [SSRIs] and mood stabilizers), says Coccaro, according to the June 5, 2006 news release, Under-diagnosed rage disorder more prevalent than previously thought. "Ideally, people should be treated with both medicine and cognitive-behavioral therapy. Medicines increase the threshold at which people will explode, and cognitive-behavior therapy teaches people how to handle feelings of frustration or threat thath often lead to explosive episodes."

A form of cognitive-behavioral therapy involving cognitive restructuring, coping skills training, and relaxation training--a combination known as CRCST--has proven to be effective in treating Intermittent Explosive Disorder, says Coccaro, according to the news release. Coccaro also is director of the University of Chicago's Clinical Neuroscience and Psychopharmacology Research Unit.

Interventions like CRCST are also helpful because they work to teach people to identify triggers that set off attacks of rage, says Fava, according to the news release. Fava also is the associate chief of psychiatry for clinical research at MGH and director of the MGH Depression Clinical and Research Program. These programs can teach people to identify triggers that set off attacks of rage.

"The study clearly shows that we have a problem of low early outreach in addition to a problem of under-evaluated treatment technology for this serious condition," says Kessler, according to the June 5, 2006 news release, Under-diagnosed rage disorder more prevalent than previously thought. "Outreach and treatment intervention studies need to be taken out of the laboratory and into a real-life setting, such as schools. This will help determine the true impact of Intermittent Explosive Disorder on later development and the potential value of early intervention programs in preventing these adverse effects."

This work was funded by the National Institute of Mental Health, the National Institute on Drug Abuse, the Substance Abuse and Mental Health Services Administration, the Robert Wood Johnson Foundation, and the John W. Alden Trust. You can also look at later studies such as "Elevated Plasma Inflammatory Markers in Individuals With Intermittent Explosive Disorder and Correlation With Aggression in Humans " and "Intermittent Explosive Disorder in the National Comorbidity Survey Replication Adolescent Supplement." Or see the abstract of a study or the PDF article, "Prevalence and Correlates of Suicidal Behavior Among Soldiers: Results From the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)," March 03, 2014.

Marriage, stress, and heart disease link?

A national study led by Michigan State University medical sociologist Hui 'Cathy' Liu will explore potential links between marriage and heart disease. Is marriage killing us?— Does the stress of marriage contribute to heart disease, which accounts for one of every four deaths in the United States? Ask yourself whether marriage is stilling, killing, or filling you? Stifling or trifling your goals, purpose, and passion for achievement, creativity, or healthy living?

A new study aims to find out, according to the February 27, 2014 news release, "Is marriage killing us?" Michigan State University's Hui Liu will lead one of the first national interdisciplinary efforts to investigate how biology and social factors interact within marriage to affect cardiovascular health. The study is funded by a $619,645 grant from the National Institute on Aging, which is part of the National Institutes of Health.

"The importance of this study is highlighted by the continued high prevalence of cardiovascular disease in the United States," said Liu, according to the February 27, 2014 news release, "Is marriage killing us?" Liu is a medical sociologist. "We plan to provide nationally representative evidence on how marriage affects cardiovascular health and elucidate the multiple mechanisms in this relationship. The findings will have important implications for health policy and practice." You also may wish to see the August 18, 2008 NY Times article by Eric Nagourney, "Patterns: Improved Health for the Never-Married."

Because most heart disease is preventable, identifying risk factors is crucial to design effective prevention strategies and programs

Many social, psychological, behavioral and biological factors work together to contribute to the risk of heart disease over people's lifetime. The study will focus on people aged 50 and older based on two nationwide datasets from the National Social Life, Health and Aging Project and the Health and Retirement Study.

Scientists have long said marriage is the most important social relationship affecting health during adulthood. Both the stress and support within marriage shape life context, which in turn may affect health, Liu said. For example, a happy marriage may provide social support, which may buffer the negative consequences of stressful life events and in turn enhance physical health.

In contrast, a distressed marriage exposes an individual to stressful interactions that may lead to depression

Depression, in turn, affects health either indirectly, by promoting unhealthy behaviors such as smoking and drinking, or directly, by stimulating the production of stress hormones (e.g., catecholamine, cortisol), which in turn results in increased blood pressure and heart rate, accelerated breathing and constriction of blood vessels. This "fight or flight" process may foster wear and tear on the regulatory mechanisms of the human body and lead to chronic conditions such as heart disease and hypertension.

Liu said the study also will explore potential age and gender differences in the marital links with cardiovascular risk. Her co-researchers include MSU researchers Donna Wang, a physician and professor of medicine; Clifford Broman, professor of sociology; Joseph Lonstein, associate professor of psychology; and Wenjiang Fu, associate professor of biostatistics in the Department of Epidemiology. The team also includes Linda Waite, sociologist at the University of Chicago, and Thomas McDade, anthropologist at Northwestern University.

From marital arts to martial arts?

It's not all wedded bliss: Marital stress can be linked to depression, says new research, "Prolonged marital stress is associated with short-lived responses to positive stimuli," published online since March 24, 2014 in the Journal of Psychophysiology. Marital stress may make people more vulnerable to depression, according to the recent study by University of Wisconsin-Madison researchers and their colleagues. The long-term study shows that people who experience chronic marital stress are less able to savor positive experiences, a hallmark of depression. They also are more likely to report other depressive symptoms.

The findings are important, says study leader Richard Davidson, University of Wisconsin-Madison, William James and Vilas Professor of Psychology and Psychiatry, because they could help researchers understand what makes some people more vulnerable to mental and emotional health challenges. They might also help scientists develop tools to prevent them. For the longitudinal study, researchers recruited married adult participants to complete questionnaires rating their stress on a six-point scale. The research is part of the National Institute on Aging-funded Midlife in the United States (MIDUS) study directed by Carol Ryff, director of the Institute on Aging at the University of Wisconsin-Madison.

Marital stress may make people more vulnerable to depression, according to a recent study by University of Wisconsin-Madison researchers and their colleagues

"This is not an obvious consequence, if you will, of marital stress, but it's one I think is extraordinarily important because of the cascade of changes that may be associated," says Davidson, according to the April 25, 2014 news release, "It's not all wedded bliss: Marital stress linked to depression." Davidson is the founder of the Center for Investigating Healthy Minds at the University of Wisconsin's Waisman Center. "This is the signature of an emotional style that reveals vulnerability to depression."

Led by world-renowned neuroscientist Dr. Richard J. Davidson, the Center for Investigating Healthy Minds conducts rigorous scientific research on healthy qualities of mind such as kindness, compassion, altruism, forgiveness, mindfulness and well-being, as the center's website explains, "Change your Mind. Change the World."

The work of the Center is rooted in the breakthrough insights of neuroplasticity - the discovery that our brains change throughout our lives in response to experience, suggesting that positive changes can be nurtured through mental training. For more information on Dr. Davidson's research, see the article, "From The Midwest To Davos, Richard Davidson Is Starting Conversations On Mindfulness, Happiness, And The Power Of Giving."

In the latest research findings, married people are, in general, happier and healthier than single people, according to numerous studies. But marriage can also be one of the most significant sources of long-lasting social stress. It's not all wedded bliss. The quality of your marriage can affect the quality of your physical and mental health.

The researchers thought chronic marital stress could provide a good model for how other common daily stressors may lead to depression and similar conditions

"How is it that a stressor gets under your skin and how does that make some more vulnerable to maladaptive responses?" says University of Wisconsisn-Madison graduate student Regina Lapate, according to the news release. She is the paper's lead author. For the longitudinal study — part of the National Institute on Aging-funded Midlife in the United States (MIDUS) study directed by Carol Ryff, director of the Institute on Aging at UW-Madison — researchers recruited married adult participants to complete questionnaires rating their stress on a six-point scale.

They were asked questions like how often they felt let down by their partner or how frequently their spouse criticized them. They were also evaluated for depression. Roughly nine years later, the questionnaire and depression assessments were repeated.

In year 11, the participants were invited to the laboratory to undergo emotional response testing, a means of measuring their resilience. Resilience, from an emotional perspective, reflects how quickly a person can recover from a negative experience. The participants were shown 90 images, a mix of negative, neutral and positive photographs such as a smiling mother-daughter pair. The electrical activity of the corrugator supercilii, also known as the frowning muscle, was measured to assess the intensity and duration of their response.

Cultivating a voice of resilience and confidence

As the nickname suggests, the frowning muscle activates more strongly during a negative response. At rest, the muscle has a basal level of tension but during a positive emotional response, the muscle becomes more relaxed. Measuring how activated or relaxed the muscle becomes and how long it takes to reach the basal level again is a reliable way to measure emotional response and the tool has been used before to assess depression.

"It's a nice way to get at what people are experiencing without asking people for their emotional response: 'How are you feeling?'" Lapate says, according to the news release. Prior studies have shown that depressed individuals have a fleeting response following positive emotional triggers. Davidson was interested in not just how much a muscle relaxes or tenses when a person looks at an image but also in how long it takes the response to subside. "If you measure at just one time point, you are losing valuable information," says Lapate, according to the news release.

Davidson and colleagues found the five to eight seconds following exposure to positive images most significant

Study participants who reported higher marital stress had shorter-lived responses to positive images than those reporting more satisfaction in their unions. There was no significant difference in the timing of negative responses. Now, Davidson is interested in how to help people change this weakened ability to enjoy positive experiences, to enable them become more resilient to stress. "To paraphrase the bumper sticker: 'Stress happens,'" says Davidson, according to the news release. "There is no such thing as leading a life completely buffered from the slings and arrows of everyday life."

By understanding the mechanisms that make individuals more prone to depression and other emotional disturbances, Davidson is hoping to find tools — such as meditation — to stop it from happening in the first place. "How we can use simple interventions to actually change this response?" he asks, according to the news release. "What can we do to learn to cultivate a more resilient emotional style?"

Another noteworthy work of research by other scientists that you may wish to see is, "Creative Histories: Memories of Past Lives and Measures of Creativity." Or check out the abstracts of these other studies, "Marital Satisfaction Predicts Weight Gain in Early Marriage," "Older Couples With and Without Cardiovascular Disease: Testing Associations Between and Among Affective Communication, Marital Satisfaction, Physical and Mental Health," and "Marital Distress and the Metabolic Syndrome."

Mindfulness meditation and heart rate study

In another recent study by different researchers, "Mindfulness meditation, well-being, and heart rate variability: A preliminary investigation into the impact of intensive Vipassana meditation," published September 2013 in the International Journal of Psychophysiology, (Volume 89, Issue 3, September 2013, Pages 305–313) researchers found that mindfulness meditation has beneficial effects on brain and body, yet the impact of Vipassana, a type of mindfulness meditation, on heart rate variability (HRV) – a psychophysiological marker of mental and physical health – is unknown.

The researchers in this study hypothesized increases in measures of well-being and HRV, and decreases in ill-being after training in Vipassana compared to before (time effects), during the meditation task compared to resting baseline (task effects), and a time by task interaction with more pronounced differences between tasks after Vipassana training. HRV (5-minute resting baseline vs. 5-minute meditation) was collected from 36 participants before and after they completed a 10-day intensive Vipassana retreat, notes the study's abstract.

Changes in three frequency-domain measures of HRV were analysed using 2 (Time; pre- vs. post-Vipassana) × 2 (Task; resting baseline vs. meditation) within subjects ANOVA. These measures were: normalised high-frequency power (HF n.u.), a widely used biomarker of parasympathetic activity; log-transformed high frequency power (ln HF), a measure of RSA and required to interpret normalised HF; and Traube–Hering–Mayer waves (THM), a component of the low frequency spectrum linked to baroreflex outflow.

As expected, participants showed significantly increased well-being, and decreased ill-being. ln HF increased overall during meditation compared to resting baseline, while there was a time task interaction for THM. Further testing revealed that pre-Vipassana only ln HF increased during meditation (vs. resting baseline), consistent with a change in respiration. Post-Vipassana, the meditation task increased HF n.u. and decreased THM compared to resting baseline, suggesting post-Vipassana task-related changes are characterised by a decrease in absolute LF power, not parasympathetic-mediated increases in HF power.

Such baroreflex changes are classically associated with attentional load, and our results are interpreted in light of the concept of ‘flow’ — a state of positive and full immersion in an activity. These results are also consistent with changes in normalised HRV reported in other meditation studies. For more information, check out that study. On another note, are you interested in psychical research? You may wish to see, "William James and psychical research."

Another study by different researchers found few well-being advantages to marriage over cohabitation

Benefits of marriage reduce over time while cohabiting couples experience greater happiness and self esteem, says that study, according to the January 18, 2013 news release, "Study finds few well-being advantages to marriage over cohabitation." That recent study, published in the Journal of Marriage and Family revealed that married couples experience few advantages for psychological well-being, health, or social ties compared to unmarried couples who live together. While both marriage and cohabitation provide benefits over being single, these reduce over time following a honeymoon period.

"Marriage has long been an important social institution, but in recent decades western societies have experienced increases in cohabitation, before or instead of marriage, and increases in children born outside of marriage," said Dr Kelly Musick, according to the January 18, 2013 news release, "Study finds few well-being advantages to marriage over cohabitation."

Musick is an associate professor of policy analysis and management at Cornell University's College of Human Ecology. "These changes have blurred the boundaries of marriage, leading to questions about what difference marriage makes in comparison to alternatives." You also may wish to check out the abstract of another study by different researchers, "Relationship Churning, Physical Violence, and Verbal Abuse in Young Adult Relationships (pages 2–12)."

Previous research has sought to prove a link between marriage and well-being, but many studies compared marriage to being single, or compared marriages and cohabitations at a single point in time

This study compares marriage to cohabitation while using a fixed-effects approach that focuses on what changes when single men and women move into marriage or cohabitation and the extent to which any effects of marriage and cohabitation persist over time. Dr Musick drew a study sample from the National Survey of Families and Households (NSFH) of 2,737 single men and women, 896 of whom married or moved in with a partner over the course of 6 years. The study focused on key areas of well-being, considering questions on happiness, levels of depression, health, and social ties.

The results showed a spike in well-being immediately following both marriage and cohabitation as couples experienced a honeymoon period with higher levels of happiness and fewer depressive symptoms compared to singles. However, these advantages were short lived.

Marriage and cohabitation both resulted in less contact with parents and friends compared to remaining single – and these effects appeared to persist over time

"We found that differences between marriage and cohabitation tend to be small and dissipate after a honeymoon period. Also while married couples experienced health gains – likely linked to the formal benefits of marriage such as shared healthcare plans – cohabiting couples experienced greater gains in happiness and self-esteem. For some, cohabitation may come with fewer unwanted obligations than marriage and allow for more flexibility, autonomy, and personal growth" said Musick, according to the January 18, 2013 news release, Study finds few well-being advantages to marriage over cohabitation. "Compared to most industrial countries America continues to value marriage above other family forms," concluded Musick. "However our research shows that marriage is by no means unique in promoting well-being and that other forms of romantic relationships can provide many of the same benefits."

Then again, marriage at least in the past allowed a husband to include his wife in health insurance covered by the husband's employer if the wife stayed at home and didn't earn an income from work outside the home. And it entitled her to a part of his pension or to spousal social security retirement income as a safety net, at least in the past and present generation. But marriage is no guarantee of any financial support, especially if the husband takes the children and gives them to his mom to raise because he doesn't respect his wife's cultural traditions, ethnicity, or faith.

On the other hand, moving out when not married for male or female partner doesn't have to mean the other person gets half of your pension, income, or other financial assets when you lived simply as house mates. What it could boil down to is what's the law in your neck of the woods regarding people living together, sharing a house or apartment.

Sometimes a solution to marital issues is separate bedrooms and bathrooms in a residence and chores divided as to who cleans what and when or who cooks what and when. For some couples, there's the rule, "you cook it, you eat it--and eat in silence at different times of the day. And for others, there's a family dinner table. Not every couple has family members able to participate frequently in their lives. And not everyone is happy being married or being single.

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