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Natalie: Is raging more common in men or women, or does it occur at about the same rate in each population?

Dr. Potter-Efron: Men vs. Women. Probably the rates are about the same. Since men are stronger, they may be more dangerous when raging, but some women are amazingly powerful when raging and weapons increase the risk.

Natalie: Let's imagine a hypothetical client who comes to you and says, "My rages are ruining my life. I can't control them. They've nearly ruined my marriage and gotten me fired from jobs." What's the first thing you do with this client to get his rages under control?

Dr. Potter-Efron: a) I have questionnaires in my book, Rage: A Step-by-Step Guide to Overcoming Explosive Anger, that help people identify that they rage, what kind of rages they have, and the details of specific rages. Getting as much information as possible as quickly as you can is the first step.

b) Ask the rager what he or she has done in the past to stop or lessen rages. They probably know from past experience what works best (For instance, getting away for a couple days or going to an AA meeting or taking a medicine).

c) Get that person to promise to do whatever works immediately, reminding them of the risks if they fail to do so. Find out if they really can and will take these immediate safety measures.

d) If there is any doubt, get them to agree to an emergency referral to a psychiatrist for appropriate medications.

e) All that buys time to develop a longer-term game plan.

Natalie: In addition to the four types of rage we've already discussed, you include a chapter called "Seething Rage, Personal Vendettas, and Rampage." This title calls up scenes from the frightening news stories we've all seen about a disgruntled employee or an angry ex-spouse who seemingly "snaps" and unleashes a torrent of violence. How do you prevent this kind of rage?


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Dr. Potter-Efron: Seething rages are like underground fires. People seethe often without anybody realizing how furious about life they are. Then they sometimes explode in a hail of gunfire, going on Columbine and Virginia Tech type rampages. The best approach here is to get people to discuss their resentments before they build up into hatreds. Seethers need help learning to let go of the past and get into the present. Forgiveness work helps with some people but it is a long-term process. Also, like impotent ragers, they need to direct their fury in some effective direction such as politics or advocacy.

Natalie: Last year a study came out about that concluded that intermittent explosive disorder is more common than previously thought. What is IED, how many ragers actually have it, and why is there controversy surrounding this diagnosis?

Dr. Potter-Efron: IED stands for intermittent explosive disorder, said to effect perhaps 7% of the population over a lifetime. It is the only diagnostic category for anger and violence in the psychological diagnostic book (The DSM-4) and so has become kind of a garbage can. IED fits best for people who usually are in control but periodically "melt down." That's what most ragers do so it's the best single diagnosis for rage.

Natalie: What role does substance abuse play in rage?

Dr. Potter-Efron: I have one client now who got drunk 3 days in a row and had the only 3 rages of his life on those days. However, usually there's not that clear-cut a link. Instead, intoxication lowers internal restraints against raging and clouds one's judgment at the same time. Long-term use might contribute to brain damage that then increases the likelihood for rage.

Natalie: Thank you Dr. Potter, now we're going to get some questions from the audience.

lisa8467: Are some people genetically predisposed to rage disorders, or is it a learned behavior?

Dr. Potter-Efron: Some people are probably more genetically susceptible. Some people endure brain damage later in life and I think it can be a learned behavior if modeled by parents and reinforced strongly.

notgoodenough: I don't have rage, but I seem to be angry all the time. I yell at people for no reason. I was wondering what I can do to stop being angry?

Dr. Potter-Efron: First, make a promise to yourself to stop yelling, shouting, etc. -- Not a promise to try but a promise to act. Then learn all you can about the details of how you get mad. Change even one thing in the pattern (first I do this, then this, then this, etc.). And that's a good start. Find people you trust and are calm and act "as if" you were them.

Cali: I am very obsessive. This leads to extreme anger, but not necessarily rage. My medications help to a point. Is there anything else I can do to help keep this under control?

Dr. Potter-Efron: Cognitive thought challenging works best with obsessing. You have to find a real positive thought that you can insist goes into your brain. The positive thought then helps dislodge the obsessive one.

felinine: My rage seems to build up from anger to rage. How can I spot the build up and stop it?

Dr. Potter-Efron: There are always clues that a rage is building up. Physical (breathing...) Mental ("I can't take it") Spiritual even (What's happening to me?). Get all the information you can about how the pattern builds up. Take a time out before you blow, not after. Enlist support from trusted others who will tell you that you are starting to lose control and listen to them when they tell you.