The physician's unique role in preventing violence: a neglected opportunity?
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The physician’s unique role in preventing violence: a neglected opportunity? John C Umhau1*, Karysse Trandem2, Mohsin Shah3 and David T George1
Abstract Background: Episodes of explosive rage and violence comprise a symptom complex which can have a devastating effect on a person’s life. In the community this behavior is seen as workplace violence, domestic abuse and road rage, while in the clinical setting, this behavior is rarely mentioned by patients, despite evidence that it can signify an important biological disorder that may afflict more than three percent of the population. Discussion: Patients are often reluctant to seek help for episodic attacks of rage, especially attacks which are accompanied by physical violence. Although, in the past, clinicians have had few treatment options to offer, recent neuroscience advances have created new possibilities to understand and help patients with this neglected problem. No formal medical guidelines for treating violence exist; however, many patients can be helped by diagnosis, referral and treatment. Treatment can include pharmaceuticals and nutrients, as well as referral for anger management or behavioral therapy. Summary: The astute clinician has an opportunity to positively impact an important problem through the diagnosis and treatment of patients with symptoms of intermittent explosive disorder. Keywords: aggression, alcoholism, psychopharmacology, violence, domestic abuse, prevention, neurobiology, treatment, domestic violence
* Correspondence: [email protected] 1 Laboratory of Clinical and Translational Studies, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism, 10 Center Drive, Building 10-CRC Hatfield Center, Room 1-5330, Bethesda, MD, 20892-1108, USA Full list of author information is available at the end of the article
Background The symptom complex characterized by repeated episodes of explosive rage and violence, disproportionate to any provocation, is rarely a patient’s chief complaint, but it is a common problem none the less. For the afflicted individual, such a complaint may have profound effects on their self-esteem, their interpersonal relationships, and even on their ability to function in society. While some violence can be premeditated, goal directed or related to antisocial, callous unemotional traits, it is rather the category of violence described as affective aggression, (that is, reactive, defensive or hostile aggression) associated with fear and threat which will be the focus of this paper [1]. For most clinicians, the clinical perspective of violence as seen with Intermittent Explosive Disorder, specified by DSM-IV to encompass “several discrete episodes of failure to resist aggressive impulses that result in serious assaultive acts or destruction of property”, with the further specification that “the degree of aggressiveness expressed during the episodes is grossly out of proportion to any precipitating psychological stressors” [2], provides a framework for addressing this issue from a c
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