What causes rage episodes?

The following is the second in a three-part series first published on the blog of the Tourette Syndrome Foundation of Canada. Read the first part here.

Some people with Tourette Syndrome+ experience rage episodes or neurological storms. While it may be tempting to think of a neurological storm as a “rage tic” or an “anger tic,” this is inaccurate. Rage episodes are not actual tics. Research suggests that individuals who have TS only (this means that they do not have any co-occurring conditions like ADHD or OCD) rarely, if ever, have rage episodes. Even in TS-only individuals with severe tics, rage episodes are rare.

Rage episodes are most likely to occur when a person has TS+, that is TS and other conditions called co-occurring conditions or co-morbidities. A child or adult who has TS and co-morbidities such as depression, OCD and ADHD is “at the greatest risk” of having a neurological storm. The greater the severity of the symptoms of the co-occurring conditions, the greater the likelihood of the anger attack. In sum, rage episodes are related to co-occurring conditions, not to the tics themselves.

If you think about what a person with say, ADHD, OCD and TS experiences, it is not hard to understand why someone with TS+ is most likely to have a rage episode. Drs. Budman and Bruun explain: “imagine how the impatience associated with ADHD, when combined with the rigidity and need for perfection of OCD [and the symptoms of TS], can cause some to be much less able to regulate their anger.”

How often do rage episodes happen to a person?

Rage episodes fluctuate or “wax and wane” in frequency, but remember, they do not necessarily fluctuate at the same time as the person’s tics. Rage episodes or storms can occur many times a day. They may happen several times a week, or they may occur less frequently.

Rage episodes can happen in any location—school, work, the mall, the library, anywhere. However, they are most likely to happen at home and they are often directed at a family member like a mom or spouse.

Just as tics are more severe when a person with TS is ill or tired, rage episodes are more likely when a person with TS+ is sick or low energy.

The exact biological cause of rage episodes is unknown. Researchers believe that storms are related to brain chemistry, particularly to neurotransmitters like serotonin and dopamine.

One thing researchers do know is that the brain activity associated with violent criminals is very different from the brain activity of someone having a neurological storm.

A person who is prone to rage episodes might have an episode in reaction to something in the person’s environment. These environmental triggers, says Dr. Leslie Packer, include:

  • Anxiety
  • Executive dysfunction
  • Medication side effects
  • Nonverbal learning disability
  • Obsessions
  • Compulsions
  • Difficult temperament
  • Language processing deficits
  • Frustration because of learning disabilities
  • A mismatch between the person’s learning or working style and the demands of the environment
  • A mismatch between the person’s characteristics and their spouse’s characteristics.

Remember: Just because one of the above triggers results in an anger outburst does not mean the person is having a rage episode. Rage episodes usually entail a pattern of recurring explosive outbursts hugely out of proportion to the triggering situation. Often storms look like they came without any warning.

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