Rage: Overcoming Explosive Anger Online Conference Transcript

Dr. Ronald Potter-Efron: Rage- Overcoming Explosive AngerDr. Ronald Potter-Efron, MSW, Ph.D., author of: "Rage: A Step-by-Step Guide to Overcoming Explosive Anger" discusses the differences between rage and anger, what causes someone to go into a rage and how to control your anger (anger management).

Natalie is the HealthyPlace.com moderator.

The people in blue are audience members.


Natalie:Good Evening. I'm Natalie, the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "Rage: Overcoming Explosive Anger". Our guest is Dr. Ronald Potter-Efron, MSW, Ph.D., author of: "Rage: A Step-by-Step Guide to Overcoming Explosive Anger ". He is a psychotherapist in private practice in Eau Claire, WI, who specializes in anger management, mental health counseling, and the treatment of addictions.

Good evening and welcome Dr. Potter-Efron.

Dr. Potter-Efron: Hello and thanks for the invitation.

Natalie: In your book, Rage you say that rage is not just extreme anger. What is it, then, and how do you differentiate it from intense anger?

Dr. Potter-Efron: The two are quite different in several ways:


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First, anger is goal directed. By that, I mean that an angry person wants something specific. Rage is threat-directed. The individual believes he or she is threatened and is trying to relieve the threat.

Second, rage is a Dr. Jekyll and Mr. Hyde experience. The person having it feels like the rage is happening without his or her consent. There's a sense of disbelief, a "what is happening here to me" event.

Third, ragers sometimes lose conscious awareness of their activity. They have rage blackouts that last from seconds to hours. This doesn't happen with anger.

Fourth, ragers often lose control of themselves in amazing ways. It's not unusual, for instance, for them to report that it took seven grown men to pull them away from the person they were attacking. I've even had 120 women tell me this.

Natalie: A section of your book is entitled "The Raging Brain," and in it you talk about the differences between the brains of ragers and non-ragers. Explain this.

Dr. Potter-Efron: Think of all of us having less than perfect brains but some brains are even less perfect than others. Three type of brain problems may be associated with raging, but none all the time. These are:

  1. Damage to the temporal lobes on the sides of the brain. These are easily injured. Damage can lead to instant total meltdowns seemingly triggered by nothing at all. Best medication for this is anti-convulsants such as Tegretol (Carbamazepine).
  2. Under-functioning pre-frontal lobes. This affects a person's problem-solving ability and makes them more likely to blow up in total frustration.
  3. Over-functioning anterior cingulated gyrus. This leads to obsessive thought processes, an inability to let go of insults that can slowly or quickly build up to a rage episode.

Natalie: That's very interesting. What are some of the psychological and emotional factors involved in rage, and are there common experiences that ragers report having in childhood or in their early lives?

Dr. Potter-Efron: Each type of rage has its own psychological issues so let me defer on that question until later when we discuss the 4 types of rage.

Children can and do rage, probably more than adults, because they have relatively poor controls over their anger. Let's make a distinction between a goal-directed tantrum ("I want that ice cream cone!) and a true rage ("I can't stop screaming even though I don't know why I'm doing this"). And, of course, early childhood traumatization, sensitizes children to become adults who rage.

Natalie: You talk about the four different kinds of rage. What are they?

Dr. Potter-Efron: Survival rage. A response to a threat to physical survival such as rape, assault, etc. Here's an example. A client of mine was about to be beaten by his father when he was 16 years old. The last thing he remembers is screaming "NO." Two hours later he awoke from his rage state to discover his father lying unconscious (not dead) on the floor. His father weighed over 250 pounds.

Impotent rage. The threat here is to the human need for control over one's life. Frustration builds when someone feels helpless to alter significant problems. One example could be finding out your child has terminal cancer.

Shame-Based rage. Now the threat is to one's respected place in the community (and to self-respect). Some people react with rage to times when they feel disrespected.

Abandonment rage. This time the threat is the loss of an intimate relationship. "I can't live without you" leads to jealousy and desperate attempts to maintain a relationship.


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.


toughgal: How do I somehow break the cycle and stop that anger before it starts, and if it DOES start how do I get my husband to point it out to me so that I can stop it?

Dr. Potter-Efron: I can't answer the first part because I don't know you. Regarding the next question, the 2 of you need to be a team. Raging is really dangerous and destructive. You need his help but you also need to make sure you listen to him, not punish him, for telling you what he sees.

jbrinar: Besides the obvious of giving them clues and letting them know it is building up, what can you do for a child's rage that gets so out-of-control they put holes in walls and break things? The rage is so built up, they will not listen to rationality.

Dr. Potter-Efron: Children who rage mostly need protection while they are having the rage. You have to intervene very early as you probably know, before they lose control. I suggest a set few phrases that you say only when they are beginning to lose it, along with a clear direction when you say it. That helps cut down their confusion. Very simple couple word phrases.

lyda027: Can you talk about instant rage seemingly from nowhere?

Dr. Potter-Efron: Some rages seem to appear from nowhere for absolutely no reason. If that happens consistently, I think you must consider medications. If you can't see it coming, you can't stop it. But also keep looking for cues, subtle cues, that you're beginning to lose control.

Kimby: My boyfriend has shame based rage, I think, and is very controlling. What is the most effective treatment for this type of rage/behavior?

Dr. Potter-Efron: Shame-based rage centers on clients taking in five critical messages about themselves: I am good, I am good enough, I belong, I am lovable, I exist. The last is ultimately the most important and the most difficult to achieve. The best thing you can do is to consistently let that person know you hold him/her in respect because respect is what shame-based ragers yearn for.

Hippy. How do we get rid of the rage that has been held inside for years? Feel fearful to even disagree with another person. What if it ever comes out?

Dr. Potter-Efron: You're describing a seething rage. Try letting a little bit of it out in a very safe place. With friends or therapists perhaps. Often the fear of having a rage is worse then the rage would be if you let it emerge.

angelicababy: What is the best way to deal with someone who is clearly in the midst of having a raging fit?

Dr. Potter-Efron: Safety is the only consideration. Talk is useless. Just try to keep the rager and yourself safe. Call 911 if need be and you can. Wait to talk until after the rage has been spent.

amayzingme: What type of medication works well with rage?


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Dr. Potter-Efron: Several sometimes work. Anti-convulsants like Tegretol (Carbamazepine) are most common. Also SSRI antidepressants and also Ritalin (Methylphenidate)-like medications for people who need help keeping their frontal lobes working right.

Natalie: Our time is up tonight. Thank you, Dr. Potter-Efron, for being our guest. We appreciate you coming and speaking to us about rage and anger.

Dr. Potter-Efron: Thank you. It was an honor.

Natalie: I encourage everyone to sign up for our newsletter. It's free and we'll notify you of events happening on the HealthyPlace.com website: and you can sign up for the first and only social network for people with mental health conditions as well as their family members and friends.

Thank you everybody for coming. I hope you found the chat interesting and helpful. For more information on the rage and how to control it, you can purchase Dr. Potter-Efron's book Rage: A Step-by-step Guide to Overcoming Explosive Anger.

We also have another transcript from an earlier chat: Anger Management for Uncontrollable Anger, Explosive Rage.

Good night everyone.


Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.

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Last Updated: 03 September 2014

Reviewed by Harry Croft, MD

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