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

University of Virginia: Alcohol and Lacrosse:

Let's not be surprised that 8 out of 41 players on the roster of the University of Virginia lacrosse team have a history of trouble with the law-- and it's all about alcohol.

If you've ever treated athletes, you know that they work hard, or they should, and they play hard, which they shouldn't. And if you're talking young athletes, the play can be really reckless. We wise up as we age, most of us.

But athletes, like everyone else, cure their social anxiety and their awkwardness with America's favorite drug. They say they're partying, but it's more than that. To give an athlete the benefit of the doubt, we might suggest that competition raises anxiety, and anxiety raises the number of Saluts, Cheers, and L'chaims!

And drinking, let's face it, is culturally sanctioned, for the most part, and the legal age a very hard law to enforce.

George Huguely is among the players at U-Va who had previous alcohol-related offenses while enrolled in school. He's accused of murdering Yeardley Love, who broke up with him a couple of weeks ago. Huguely is reported to have been pulled off of Ms. Love in an altercation at a party only two months ago.

He allegedly shook her, banged her head against a wall repeatedly until she died on May 3, 2010.

None of the other guys on the team did anything to compare to it. Their arrests are not as exciting:

underage alcohol possession,
fake ID's
and DUI's

If you drink enough, you don't know what you're capable of, really.

Could we diagnose Mr. Huguely based upon the things we hear in the news? He couldn't handle rejection. He had a previous episode with a police officer, so violent he had to be subdued by taser. He swore, spat out vulgarities and racial epithets at the officer.

To be sure we'll hear words like borderline pop up in future news stories. And Borderline Personality Disorder. Narcissistic Personality Disorder, too.

The Washington Post tells us that two players of the eight were found not guilty, while six were convicted or pleaded guilty of these lesser alcohol-related crimes.

So there's some history here of disrespect for drinking laws among athletes, nothing unusual for college students in general. Now that a college athlete who abuses alcohol has implicated himself in a murder, social scientists everywhere are scratching their beards (chins) thinking of every possible variable associated with such a crime.

I'd just go with alcohol, keep it simple.

But there are those jealous, violent tendencies we're hearing about, and you can't just dismiss them. After the incident with the police officer, Huguely

received a 60-day suspended sentence, six months' supervised probation and a fine, according to court records. He was ordered to complete 50 hours of community service and 20 hours of substance abuse education, which he finished in July, the records show.

He needed therapy, too. Had he known more about handling rejection, abandonment, he might not have lost control. Had he been flagged for "instability", challenged about his "flare ups", had he been forced into therapy, and sure, anger management, Yeardley Love would be alive today.

Monday morning quarterback.

If you learn anger management but don't cut out the alcohol, and you have an anger management problem, mysteriously, no matter how good the anger management course, you still won't get a grip. And if you only go after the alcohol, if that's all you treat, if you're an angry alcoholic you'll be an angry dry drunk, with no personality change.

The police want to know whether officials knew about the team's "hard party" reputation, or Huguely's earlier arrest for a drunken, violent confrontation with a female police officer. University President John T. Casteen III knew nothing about the encounter, and tells us that officials at the school will now check students against public records each semester.

We're also told that Athletic Director Craig Littlepage affirms that when the school is made aware that an athlete has had trouble with police, that matters are handled according to "long-standing policies."

Perhaps reexamine those.

Many schools have programs now, usually that first week of school, during orientation, to educate kids, disseminate policies. They show cool movies about alcohol overdoses and rape. They're pretty good, too. I've seen them. They should be mandatory.

Words like expulsion need to be batted around, but there are softer words, too, we can talk about. But probation and community service don't cut it. Alcohol treatment and therapy, now you're getting somewhere-- with anger management.

Make it a package deal.

It's good that student records will be cross-checked with public records from now on. What they're going to do with the matches, we'll have to wait and see.

Linda Freedman, PhD

Internet Safety

A person doesn't want to exaggerate a problem, that's for sure, but you can't really underscore the "dangers" on the Internet. All you need is one enemy, one person who doesn't like you, who is angry at you, who is jealous of you, and your life is open season. Fiction becomes reality.

In other words, it's easy to trash people online. So a professional like me is going to tell kids, adults, too, that although it feels good to get attention, to have your name up in lights, 400 friends, your own website, a blog, six tweet accounts. . . be careful what you wish for.

Fame can be a real pain.

danah boyd did her dissertation research on social media and found the following 'truths' about what we put out on the Internet.

Searchability- anyone can find it, whatever it is you put up. Actually, sometimes a person has to do a little digging, but there's a copy somewhere of everything digital. For most of us, it's a 'So what?' We haven't written anything we're ashamed about, or posed without our clothes on. One embarrassing night out, and you really don't know who was taking your picture, and who will want to see it.

Persistence- it doesn’t go away. That's why it's searchable, obviously.

Replicability- any fourth-grader can copy and paste, reproduce anything. Some of us get very good at snagging things for free, in fact. (I personally prefer to take my own photographs or buy them at istockphoto.com

Invisible audience-- we have no idea who's looking at our picture or what we wrote on our blogs.

We have to add to danah's list, dis-inhibition, a function of anonymity. Those who think they're anonymous on the web loosen up, say things they wouldn't ordinarily say. But find me one person who is really anonymous. I dare you. This person doesn't exist.

And we have IP addresses, by the way.

There. You have three slides from a 60 slide powerpoint program on the subject. You think there's nothing to worry about?

I did an Internet Safety workshop last week for high school kids, expect to do many, many more. 'm so glad I got this thing going. Terrified, but glad.


Linda Freedman