Angry outbursts, sometimes called rages, are a major impetus for the psychiatric hospitalization of children. In hospitals, 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 had a preadmission history of outbursts, and to have 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 toward attention-deficit/hyperactivity disorder. 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.
Bibliographical noteFunding Information:
Dr. Carlson has received grant funding from the National Institute of Mental Health. Dr. Potegal’s contribution to this study was supported by grants from the National
The study reviewed in this paper was funded by an individual initiated award from Janssen Pharmaceutica to Dr. Carlson. Dr. Carlson serves as a consultant to and has received grant funding from Janssen Pharmaceutica, Bristol-Myers Squibb, Otsuka Pharmaceutical Company, Eli Lilly and Company, Validus Pharmaceuticals, and Sanofi-Aventis. No other potential conflicts of interest relevant to this article were reported.