The behavioral organization, temporal characteristics, and diagnostic concomitants of “rage” outbursts in child psychiatry in-patients

• Published in: Current psychiatry reports 2009-04, Vol.11 (2), p.127-133
• Main Authors: Potegal, Michael, Carlson, Gabrielle A., Margulies, David, Basile, Joann, Gutkovich, Zinoviy A., Wall, Melanie
• Format: Article
• Language: English
• ISSN: 1523-3812; 1535-1645

Angry outbursts, sometimes called “rages”, are a major impetus for children's psychiatric hospitalization. In hospital, such outbursts are a management problem and a diagnostic puzzle. Among 130 4-to-12 year olds successively admitted to a child psychiatry unit, those having in-hospital outbursts were likely to be younger, have been in special education, have a pre-admission history of outbursts, and a longer hospital stay. Three subsets of behaviors, coded as they occurred in 109 outbursts, expressed increasing levels of anger; two other subsets expressed increasing levels of distress. Factor structure, temporal organization and age trends indicated that outbursts are exacerbations of ordinary childhood tantrums. Diagnostically, children with outbursts were more likely to have language difficulty and a trend towards ADHD. Outbursts of children with anxiety diagnoses showed significantly more distress relative to anger. Outbursts were not especially associated with our small sample of bipolar diagnoses.