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London - Anger is an all-too-common emotion we tend to blame on the frustrations of everyday life. But emerging research suggests angry outbursts and even children’s tantrums are actually medical conditions that can be treated with drugs - in some cases, even aspirin.
A recent study found that angry people may be suffering from an excessive inflammatory response in their bodies - in other words, there is a physiological reason why they lose their cool.
Inflammation is the body’s normal response to injury and infection. It produces substances called cytokines, which trigger the immune system.
But in some people, the inflammatory response does not subside when danger has passed. Instead, it becomes chronic, with the result that high levels of cytokines keep circulating in their blood.
Now a US study suggests this inflammation may make people prone to outbursts of screaming rage. Researchers at Chicago University tested the blood of 70 people with intermittent explosive disorder (IED) - a psychiatric diagnosis for being very short-fused.
The condition, characterised as ‘a failure to resist aggressive impulses’, has only recently been identified. But according to a study by Harvard Medical School and the University of Chicago, published in 2006, up to three million Britons may suffer from it.
The latest study, published two weeks ago, found that people with the disorder had significantly raised levels of cytokines, compared with those not prone to outbursts.
The findings ‘suggest a direct relationship between plasma inflammatory processes and aggression in humans’, said the researchers, writing in the respected journal JAMA Psychiatry. In other words, the inflammation may be making people angry.
If it does trigger anger, the research suggests that rather than trying to calm yourself down, an aspirin could theoretically quell outbursts before they happen.
This is because aspirin blocks the chemical processes of inflammation, as do non-steroidal drugs such as ibuprofen.
However, as Professor Emil Coccaro, chairman of the University of Chicago’s psychiatry and behavioural neuroscience department, who led the latest research, admits: ‘We don’t know yet if the inflammation triggers aggression or aggressive feelings set off inflammation, but it’s a powerful indication that the two are biologically connected.’
Critics point out that this latest study is too small to tell us anything useful. But IED is not the only example where an inconvenient emotion is labelled as a mental ailment that should be medicated away.
An article just published in the British Medical Journal warned that half of the five million people in the UK diagnosed with mental illnesses such as depression or anxiety may just be a little sad.
Author Chris Dowrick, Liverpool University’s professor of primary medical care, claims: ‘Over-diagnosis is now more common than under-diagnosis.’
The move concerns experts. ‘It is tempting to treat things that are part of normal everyday life as medical illnesses, because we often want to believe that professionals have the answers,’ says Anne Cooke, a clinical psychologist and lecturer at Canterbury Christ Church University.
‘That’s why we like it when someone in a white coat says they have the answer to problems such as anger.’
But, she warns, this can leave us feeling worse than before we got a diagnosis. ‘It means we don’t look for ways in which we can help ourselves to solve such problems, such as getting social support by talking to friends and loved ones.’
Furthermore, ‘thinking of yourself as mentally ill may well be a huge blow to your self-confidence. You may conclude there is little you can do to help yourself except to keep taking the tablets’.
Pills are now being prescribed to help with children’s tantrums. The latest edition of the ‘psychiatrists’ bible’, the Diagnostic and Statistical Manual (or DSM-V) has introduced a new illness, called disruptive mood dysregulation disorder, to cover intensive temper tantrums in children aged six to ten.
This is defined as severe temper outbursts at least three times a week, or feeling sad, irritable or angry almost every day.
Many parents may consider this to be a part of childhood. But British psychiatrists are taking this new diagnosis seriously.
For example, a report by Dr Argyris Stringaris, a clinical senior lecturer at King’s College London’s Institute of Psychiatry, estimated that up to 3 per cent of children could be diagnosed - that’s 360 000 British under-18s.
But not everyone is convinced. Psychiatrist Dr Allen Frances, who chaired the task force for the previous edition of the Diagnostic and Statistical Manual, says the new disorder may ‘exacerbate the already excessive and inappropriate use of medication in young children’.
Dr Frances, emeritus professor of psychiatry at Duke University, North Carolina, explains: ‘My fear is that normal children with temper tantrums will be misdiagnosed and given inappropriate medicine.’
Studies show that potential side-effects of drugs given to treat such conditions include obesity, raised cholesterol levels and a significantly raised risk of diabetes.
Meanwhile, social-anxiety disorder, as it’s known, would once have been classed as mere shyness, but according to psychiatrists, 10 per cent of Britons now suffer from the apparently crippling condition.
Last year, the National Institute for Health and Care Excellence (NICE) gave the condition an official stamp of approval and published Britain’s first clinical guidelines for treating shyness.
It defines the condition as ‘persistent fear of or anxiety about one or more social or performance situations that is out of proportion to the threat posed by the situation’.
But when Professor Brian J. Cox, a psychiatrist at the University of Manitoba, Canada, studied adults diagnosed with severe social-anxiety disorder, only half said they were particularly shy.
Instead, as Professor Cox wrote in the New England Journal of Medicine in 2008, the patients had other problems - such as low self-esteem. He concluded: ‘It is important not to view shyness in young people as a form of mental disease.’
Yet figures compiled for Good Health by independent health data firm IMS Health show NHS spending on prescriptions for social phobia more than doubled from 1997 to 2002, to £189 million. Side-effects for the drugs include nausea, lost libido, agitation, insomnia and even suicidal thoughts.
Dr Maureen Baker, chairwoman of the Royal College of GPs, complains that family doctors are increasingly facing patients who demand drugs for everyday emotional problems.
‘GPs often find themselves under pressure to prescribe,’ she says. ‘Awareness campaigns that promote low-value treatments, without fully informing patients about side-effects or non-medicine alternatives, contribute to this.’
Dr Baker says family doctors would love to talk patients through lifestyle diagnoses such as shyness and bereavement, but time pressures often make this impossible.
It seems therefore that we may be doomed to people increasingly excusing their bad behaviour as a ‘medical condition’ and demanding expensive drugs to treat it - rather than taking the old-fashioned route of learning restraint.
And if that makes you feel rather hot under the collar, you probably won’t find any relief by taking an aspirin.