Anger and rage in children: Bad behavior or something more?

COURTESY TO THE BELLINGHAM HERALDMay 26, 2013 

There's a crying need for affordable children's psychiatric services here in Whatcom County and around the country. And since May is Mental Health Month, it's a good time to consider how crucial it is for the parents of troubled children and teens to get as much information as possible about mental illness and seek professional help if necessary.

Consider the case of Kate, a 34-year-old single parent: the angry outbursts and unpredictable behavior of her 14-year-old son, Jackson, had thrown her entire family into chaos.

Jackson's anger had always been more intense than the situation called for, but after he turned 13, his behavior changed radically. Arguing gave way to shouting matches and he would explode into tirades over little things -- when the Internet went down for even a few minutes or if his sister took long in the bathroom.

Jackson had become bullying and controlling of others. He routinely challenged his mother, swearing at her and shoving her out of the way. He started having uncontrollable tantrums and outbursts of rage, usually when told "no." He threatened his siblings, hurled things across the room, smashed the walls. Nothing Kate tried seemed to help -- neither rewarding his good behavior nor attaching consequences to the bad.

One night, as they headed home from the movies, Jackson angrily demanded to be taken to MacDonalds. Kate, who had dinner ready at home, told him no, noting that she had already spent $40 on movie tickets and snacks. Jackson started yelling and demanded that she turn the car around -- "or else!" Kate pulled over and in his rage, Jackson deeply scratched her. Kate felt angry, fearful and deeply hurt. In the end, she agreed to take him to MacDonalds.

Kate recognized the situation was out of control. What had made her son act this way? Was he just going through a phase? Was she a bad parent? Where could she get help? How could she and her other children deal with him?

Kate ultimately sought help from a mental health professional. Jackson was diagnosed with bipolar disorder and is now receiving appropriate medication and talk therapy. Kate is participating in the sessions, learning coping strategies. Jackson seems much more like his genuine self and the other children are less fearful. While the difficulties are not entirely over, their home is peaceful once again.

BAD BEHAVIOR OR BIPOLAR DISORDER?

Bipolar disorder is a mental illness characterized by extreme emotional swings, from depression to mania or hypomania, during which an individual becomes overly optimistic or active, and often behaves recklessly. In children and teens, mania or hypomania may manifests as extreme irritability and anger that is more intense than the situation calls for.

Children or teens with bipolar disorder may experience extreme emotions, hyperactivity, sleeping too little or too much. They may become manipulative or violent, prone to destructive rages and tantrums. These outbursts generally are not premeditated, but can be triggered by some seemingly minor incident. Often these outbursts are followed by remorse and guilt. They may feel helpless and out of control.

Bipolar disorder is difficult to diagnose in children and teens because between the outbursts of rage, there can be long periods of time that seem normal. Some parents initially assume these tantrums are a "normal" part of growing up. But hurling objects, raging and threatening others are unacceptable no matter what the circumstances. Verbally or physically abusing someone -- especially other children -- is not normal behavior.

HOW PREVALENT IS BIPOLAR DISORDER?

According to a 2011 study by the National Institutes of Mental Health, one in 10 Americans suffer from bipolar disorder. Fewer than half of those diagnosed sought treatment with a mental health professional.

Individuals with bipolar disorder have a significantly higher risk of committing suicide than individuals with other psychiatric disorders, according to a study by Jacques Baillargeon, Ph.D, published in the Journal of the American Academy of Psychiatry and the Law.

Though the risks are higher, families can learn, as Kate and Jackson did, how to manage and live with this condition.

SEEKING HELP

It's important for children or teens who may be manifesting symptoms of bipolar disorder to get diagnosed early and get treatment.

They must learn to recognize oncoming anger attacks and deal with them appropriately. Young people cannot do this by themselves: Like Jackson, they need the help of their parents, the guidance of a mental health professional and the support of the entire community.

ABOUT THE AUTHOR

Jan Bodily is executive director of the Whatcom Counseling and Psychiatric Clinic, a non-profit agency that provides affordable mental health services for the people of Bellingham and Whatcom County. For information go online to whatcomcounseling.org.

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