Anger Issues: Intermittent Explosive Disorder and Carlos Zambrano

We're not diagnosing him with Intermittent Explosive Disorder (IED), unless he assaulted someone physically, but this is as good a time as any to differentiate between IED and other impulse control problems. Sometimes a person can have impulse control problems, like Mr. Zambrano apparently has had, and not a full-blown diagnosis.

The damage can be devastating, no matter, and to thousands, disappointing, assuming that person represents a professional baseball team like the Chicago Cubs.

Carlos Zambrano of the Chicago Cubs is taking his anger management classes seriously, as well he should, for cursing out his teammates.

Being a Chicagoan, a town of two major league teams, baseball comes up in therapy every once in awhile, usually during small talk. And when it leads to talk about a certain player behaving like a 4-year old (famous for their tantrums, 4-year olds), when the talk is about anger management, the consensus of opinion tends to be:

What kind of a role model is this? How can an athlete speak this way to his teammates? In public?

The reaction is one of utter dismay and disgust-- not all that different than the dismay and disgust we sometimes feel for parents who get into brawls with other parents at Little League or soccer games. Mr. Zambrano was suspended for over a month after a dugout outburst aimed at teammate Derrek Lee and others.

We don't know why the Cubs pitcher had (has?) an anger management problem, but anger is everywhere in human relationships. It's usually a sign of frustration. We struggle to say it nice, but not everyone can express feelings with words that are meaningful, yet tame (what we call assertiveness), with just the facts, no irritability or blame. Anger, when it is expressed with negative emotion, emotion that signals hatred or disgust, with words that shame another, is a form of violence, even when there's no physical injury.

We call it emotional injury, or verbal abuse when words hit as hard as a fist. A therapist looks deep for personality disorders, Antisocial Personality Disorder or Borderline Personality Disorder-- these types of differential diagnoses, including those listed in "C" below.

When it's the fist that lets loose, then sometimes a diagnosis can be as serious as Paranoid Schizophrenia. But usually what we have is Intermittent Explosive Disorder, 312.34.

Here's what the diagnostic bible, the DSM IV-TR has to say about it. The DSM IV-TR will be the DSM V in the next couple of years. But until it is, this is what we've got:

A. Several discrete episodes of failure to resist aggressive impulses that result in serious assaultive acts or destruction of property.

B. The degree of aggressiveness expressed during the episodes is grossly out of proportion to any precipitating psychosocial stressors.

C. The aggressive episodes ar not better accounted for by another mental disorder (e.g. Antisocial Personality Disorder, a Manic Episode, Conduct Disorder, or Attention-Deficit/Hyperactivity Disorder) and are not due to the direct physiological effects of a substance (e.g. a drug of abuse, a medication) or a general medical conditin (e.g., head trauma, Alzheimer's disease).

Even kids can be diagnosed with this disorder. When they seem to have it, a good physical/psychological evaluation is a must.

Linda Freedman