Anger that is inappropriate, intense or uncontrolled (APA, 2000) — the quality of anger central to the definition of rage – is among the DSM-IV criteria for borderline personality disorder (BPD). Not all individuals with BPD experience rage, nor is rage the only intense, dysregulated emotional experience associated (BPD). Not all individuals with BPD experience rage, nor is rage the only intense, dysregulated emotional experience associated with the disorder. Yet, because relationships are deeply desired by individuals with BPD, and because high-quality relationships have been associated with improvements in the course of the disorder (e.g., Gunderson et al., 2006; Zanarini, Frankenburg, Hennen, Reich, & Silk, 2005), the destructive effects of rage on the stability of both personal and therapeutic relationships make it a particularly devastating symptom. For example, in a population survey of couples, BPD symptom severity was associated with the perpetration of marital violence and increased probability of marital dissolution (Whisman & Schonbrun, 2009
It is intense anger directed outward toward another thing or person. Sometimes it is directed inward and will manifest in self-injurious behavior. Most often borderline rage is directed at the person you care most about — the person you want most to love you. This sets up an almost endless tug of war between the person diagnosed with BPD and their loved one. In some cases, borderline rage can be directed at anyone in the room; any convenient target, that is. These bouts of intense anger are quite often sparked by the person’s desire to be close to their loved one but being afraid to trust them enough to allow them to be close enough to care, and thus reject them.
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- Dressing, speaking, or acting in an odd or peculiar way
- Being suspicious and paranoid
- Being uncomfortable or anxious in social situations due to their distrust of others
- Having few friends and being extremely uncomfortable with intimacy
- Tending to misinterpret reality or to have distorted perceptions (for example, mistaking noises for voices)
- Having odd beliefs or magical thinking (for example, being overly superstitious or thinking of themselves as psychic)
- Being preoccupied with fantasy and daydreaming
- Tending to be stiff and awkward when relating to others
- Coming across as emotionally distant, aloof, or cold
The most commonly used psychiatric diagnoses for aggressive, angry or violent behavior are Oppositional Defiant Disorder, Attention-Deficit/Hyperactivity Disorder and Conduct Disorder (in children and adolescents), Psychotic Disorder, Bipolar Disorder, Antisocial, Borderline, Paranoid and Narcissistic Personality Disorder, Adjustment Disorder with Disturbance of Conduct, and Intermittent Explosive Disorder. This latter diagnosis is an impulse control disorder characterized by repeated “failure to resist aggressive impulses that result in serious assaultive acts or destruction of property.” Of all the DSM-IV-TR diagnoses, this one comes closest to accurately describing the escalating explosions of violence we are witnessing today. It is a classic anger disorder. According to a recent study by sociologist Ronald Kessler at Harvard Medical School, this anger disorder is on the rise, and may be present in more than fifteen million Americans. And this is only the proverbial tip of the iceberg.