EPISODIC DYSCONTROL - A STUDY OF 130 VIOLENT PATIENTS

• NCJ Number: 55215
• Journal: American Journal of Psychiatry Volume: 127 Issue: 11 Dated: (MAY 1971) Pages: 1473-1478
• Author(s): G BACH-Y-RITA; J R LION; C E CLIMENT; F R ERVIN
• Date Published: 1971
• Length: 6 pages
• Corporate Author: American Psychological Assoc
• Publication Format: Article
• Language: English
• Country: United States of America
• Note: READ AT THE 123RD ANNUAL MEETING OF THE AMERICAN PSYCHIATRIC ASSOCIATION, SAN FRANCISCO, CALIFORNIA, MAY 11-15, 1970

Annotation

A 2-YEAR STUDY OF 130 CLINIC PATIENTS WHOSE MAJOR COMPLAINT WAS OUTBURSTS OF VIOLENT BEHAVIOR, USUALLY ASSOCIATED WITH ASSAULTS ON OTHER PERSONS, IS REPORTED.

Abstract

THE PATIENTS, WHO DID NOT INCLUDE PERSONS WHO WERE OBVIOUSLY SCHIZOPHRENIC OR WHOSE CONDITION REQUIRED IMMEDIATE HOSPITALIZATION, WERE OF THE FOLLOWING TYPES: (1) 7 WITH UNDIAGNOSED TEMPORAL LOBE EPILEPSY, (2) 20 WITH SEIZURE-LIKE OUTBURSTS INVOLVING ALTERED STATES OF CONSCIOUSNESS, (3) 57 WITH DIFFUSE VIOLENCE--OUTBURSTS AIMED AT VARIED TARGETS AND OFTEN ASSOCIATED WITH HIGH LEVELS OF ANXIETY, (4) 25 WHOSE VIOLENT OUTBURSTS WERE PRECIPITATED BY MODERATE DRINKING, AND (5) 11 WITH REPETITIVE VIOLENCE DIRECTED AT A SPECIFIC PERSON (OR ANIMAL). IN MANY CASES, THE PATIENTS' LIVES MIRRORED THEIR BACKGROUNDS. FAMILY HISTORIES OF VIOLENCE AND ALCOHOLISM WERE COMMON. MANY OF THE PATIENTS WERE VERY DEPENDENT, OUTWARDLY HYPERMASCULINE MEN WHOSE POOR EGO DEFENSES AND INABILITY TO DEAL WITH STRESS BROUGHT ON LOSS OF CONTROL AND DISORGANIZED BEHAVIOR, USUALLY IN THE FORM OF ALL-OR-NOTHING ASSAULTS IN WHICH THEY COULD EXERCISE NO CONTROL OVER THE DEGREE OF DAMAGE OR INJURY THEY INFLICTED. IN ADDITION TO THE HIGH INCIDENCE OF ABNORMAL PSYCHIATRIC HISTORIES, THE GROUP ALSO INCLUDED MANY PERSONS WITH NEUROLOGICAL DISODERS. THEIR DIFFICULTIES PROBABLY WERE THE RESULT OF WHAT IN CHILDREN IS TERMED MINIMAL BRAIN DAMAGE. A STRIKING FINDING WAS THAT MANY OF THE PATIENTS HAD SOUGHT HELP IN CONTROLLING THEIR VIOLENT IMPULSES, BUT USUALLY IN VAIN. EXPERIENCE IN DIAGNOSING AND TREATING THESE PATIENTS INDICATES THAT THEIR PROBLEMS STEM FROM MULTIPLE CAUSES. FINDINGS OF SEVERE PSYCHOPATHOLOGY SHOULD NOT PRECLUDE A NEUROLOGICAL EXAMINATION, NOR SHOULD FINDINGS OF STRUCTURAL IMPAIRMENT, ABNORMAL ELECTROENCEPHALOGRAMS, OR HISTORIES OF SEIZURES NECESSARILY EXCLUDE PSYCHIATRIC MANAGEMENT. CASE REPORTS, A TABLE, AND A LIST OF REFERENCES ARE INCLUDED. (LKM)