Just before the highway on-ramp, you let a car in ahead of you, being the nice guy that you are. You expected a gesture of gratitude, but received none. Additionally, the driver seemed to intentionally slow down, forcing you to apply the brakes. You become infuriated how can people be so rude? You tailgate to let this arrogant idiot know how you feel. This doesn't seem to satisfy you, so you honk your horn, flash your lights, make a gesture with your middle finger and curse as you pass the car on the left. Things go south from here. The other driver is even less courteous than you are, and attempts to run you off the road. When you pull off to the side of the road to calm down, you see the driver has stopped ahead of you, is getting out of the car and is walking towards you with something in his hand. Is this guy psycho or simply an Adam Henry?
According to the American Institute for Public Safety, aggressive driving is responsible for two-thirds of all auto fatalities, or 27,000 deaths per year. This is four times as many deaths than are attributable to DUI with a blood alcohol content of greater than 0.08. Half of all drivers who are subjected to aggressive driving behavior on the road respond with aggression of their own.
A lot of individuals have an impulse to "flip off" or curse at an annoying driver; however, most of us can refrain from this behavior, or at least prevent further escalation. Others act with varying degrees of aggression or violence. What causes an individual to go from calm to ballistic while moving at 90 feet per second? Psychiatric experts suggest that road rage is caused by a mental illness called Intermittent Explosive Disorder (IED). IED is an impulse control disorder that leads to uncontrolled explosive outbursts of aggressive and/or violent behaviors. These outbursts are not proportional to the provocation; in fact, they can even happen without any provocation. For those who suffer from IED, the most minor traffic incident can drive them into rage that is difficult to control. The disorder affects approximately 16 million Americans (between 5% and 7% of the population).
Intermittent Explosive Disorder
IED is in the same class of psychiatric disorders as kleptomania, pyromania, and compulsive gambling. A diagnosis is made after all other possible diagnoses have been ruled out. Criterion for the disorder include discrete episodes when the individual fails to resist aggressive impulses, which results in serious assaultive acts or destruction of property. Secondly, the degree of the aggression during these episodes is grossly out of proportion to any precipitating psychosocial stressors. The disease is considered severe if individuals experienced at least three of these rage attacks in one year. Statistically, individuals with IED average 56 lifetime attacks, which result in an average of $1,600 worth of property damage, and in 23 incidents where someone required medical attention. The first episode of rage usually occurs in early adolescence, around age 13 for males and age 19 for females. The majority (over 80%) of individuals with IED have at least one additional mental disorder, most commonly generalized anxiety, a mood disorder, alcohol abuse, and/or attention deficit disorder.
During a rage attack the individual may experience racing thoughts, arousal, and a heightened level of energy. The individual may threaten or actually harm another person, and/or may purposefully break or damage an object of value. Immediately after the attack he/she may feel a sense of relief. Other physical symptoms include tightness in the chest, palpitations, tingling sensations, tremor, hearing echoes, or a feeling of pressure inside the head. This is typically followed by fatigue, depression, embarrassment, regret and remorse.
Individuals with IED believe that others are basically hostile and untrustworthy. They feel that force is the only way to gain the respect of others. They interpret others' behavior as directed specifically against themselves, and frequently misinterpret the motives of others as manipulative or malicious. They will blame spells or attacks of violence on another individual, denying or minimizing their own role in the situation.
The problem behavior isn't continuous. It occurs in an episode or series of episodes. The reaction time is within seconds to hours after perceiving provocation. Rage attacks are time limited and usually only last 10 to 20 minutes; and then the behavior ceases automatically. In between periods of rage the individual may show absolutely no signs of impulsivity or aggression.
Complications of IED
Intermittent explosive disorder may result in job loss, school suspension, divorce, difficulties with interpersonal relationships, impairment in social or occupational areas, accidents, hospitalization, injury, financial problems, incarcerations, or other legal problems. Individuals with IED do not only turn their violence onto towards others; one in six will engage in acts of self aggression, including suicide.
Diagnosis and Treatment for IED
Intermittent explosive disorder is characterized by repeated episodes of aggressive, violent behavior in which an individual reacts grossly out of proportion to the situation. IED is really a diagnosis of exclusion. Before a diagnosis of IED can be made, psychiatric professionals must rule out other possible causes for aggressive episodes, which include; personality disorders (psychopathic), psychosis, manic episodes, ADHD, substance abuse, brain injury, dementia, or other medical conditions.
The goal of treatment is to help the individual control aggressive impulses. People with intermittent explosive disorder may have an imbalance in the amount of serotonin and testosterone in their brains. A combination of medications and behavior modification therapy has been effective treatments for the disorder. Many different types of drugs are used to help control intermittent explosive disorder, including: anti-anxiety (Ativan), anticonvulsants (Tegretol), antidepressants (Paxil), and/or mood stabilizers (Lithium) may be prescribed. Rage management group counseling has also been helpful for many people with IED.
Is road rage a mental illness? It certainly can be a symptom of an intermittent explosive disorder, as can domestic violence. IED can be successfully treated with medication and therapy. However, not every case of road rage is an instance of IED, and not everyone with IED engages in road rage. There is a difference between an anger disorder and plain old ugly anger.
There is an inherent danger in assigning a diagnosis to every societal abhorrent behavior. Defining aggressive behavior as a mental illness has been the basis of several defense cases in an attempt to devolve a perpetrator's responsibility. Are all bullies mentally ill? Serial killers? Spousal abusers? Child molesters? Or are they just really bad people? Having an impulse control disorder is not an excuse to victimize another individual. Get professional treatment, or face the consequences of your aggressive behavior.
Signs of road rage and how to avoid it
Aggressive and violent drivers are dangerous whether they are mentally ill or not. The Florida Department of Highway Safety and Motor Vehicles offers some strategies to stay safe on the road.
The following are possible signs of road rage or aggressive driving:
- Generally aggressive driving, including sudden acceleration, braking, and closely tailgating
- Cutting off other drivers, or preventing other vehicles from merging
- Hitting the horn or flashing lights
- Shouting obscenities, or threats
- Hand gestures
- Intentionally causing a crash between vehicles
- Getting out of a vehicle in an attempt to start a confrontation
- Threatening to use or using a weapon
- Throwing objects from a moving vehicle
Ways to Avoid Road Rage
- Keep a cool head
- Avoid eye contact
- Never make obscene gestures
- Do not use your vehicle to intimidate others
- Get out of the left lane for other fast moving vehicles
- If you witness something you think is road rage, call police
- Do not become frustrated or stressed out if you do, remove yourself from the situation
- Never get behind the wheel if you are tired or irritable
- Avoid confrontation