Rutgers' Mike Rice Rage: Bad Behavior or a Mental Disorder?

Intermittent explosive disorder can begin young and last a lifetime.

April 4, 2013— -- Throwing balls, kicking players, shouting gay slurs -- all of these outbursts caught on videotape of Rutgers basketball coach Mike Rice reveal the abusive nature of uncontrollable anger.

Rice was fired this week, and faculty and alumni have been in an uproar. But was his angry performance during a men's basketball team practice last year just bad boy behavior or something more diagnosable?

"There is a misconception that getting anger out helps you calm down, but ironically, it makes you more angry," said Camp Hill, Pa., psychologist Pauline Wallin, author of the 2004 book "Taming Your Inner Brat."

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"The angrier you get, it gets increasingly harder as you are pumping more adrenaline, and there is more energy to discharge. Yelling and screaming don't get you calmer, they rile you up."

The university's reputation is still stinging from the 2010 suicide of gay student Tyler Clemente, whose roommate had secretly videotaped the freshman having sex and was convicted of a hate crime..

Today, a group of 13 faculty and alumni demanded that university president Robert Barchi resign, because it took months for him to take action.

Barchi first viewed the video in November and sent Rice to anger management counseling. He fired the coach on April 3, when the video again resurfaced.

Even New Jersey Gov. Chris Christie weighed in on Rice, applauding the firing in the New York Times: "The way these young men were treated by the head coach was completely unacceptable and violates the trust parents put in Rutgers University."

Experts say the most common form of aggressive anger is rage, which is a psychological and physiological response to a stressor event. A person can lose his or her capacity for rational thought. The capacity for rage often begins early in life and continues through adulthood.

A person in rage may also experience tunnel vision, muffled hearing, increased heart rate and hyperventilation. The large amounts of adrenaline and oxygen in the bloodstream may cause a person's extremities to shake.

Psychiatrists say the most extreme form of rage is intermittent explosive disorder, or IED. "It's somebody who really lacks control and is way over the top," said Wallin, who did not speculate on why Rice behaved as he did.

According to the Mayo Clinic, the disorder, which is listed in the DSM-V, involves repeated episodes of "impulsive, aggressive, violent behavior or angry verbal outbursts in which you react grossly out of proportion to the situation."

Recurrent, problematic, impulsive aggression affects 5 to 7 percent of the population, but many Americans do not seek treatment, according to a study published by the American Medical Association.

Research shows that chemical abnormalities are associated with this disorder. People with IED can suddenly explode without provocation.

Examples can include road rage, domestic abuse, throwing or breaking objects, or other temper tantrums. Those affected may attack others, cause bodily injury and property damage. They may also hurt themselves. Later, when they have calmed down, they can feel remorse, regret or shame.Effective treatments can include antidepressants and cognitive behavior therapy.

Wallin admits she is not an expert in IED, but she has witnessed plenty of anger, including physical fights, at sporting events like hockey.

"They are yelling at each other, sitting down and getting rough with each other and all excited with the adrenaline," she said. "The reason they have no control is they are really hyped up. Even the fans love to see the fights."

Experts caution that IED goes outside the bounds of normal anger and is considered an impulse disorder.

Anger is a "normal part of being a human being," said Dr. Joseph Shrand, a psychiatrist at Harvard Medical School and author of "Outsmarting Anger: Strategies for Diffusing Our Most Dangerous Emotion."

"You have to be very cautious not to hide normal behavior behind a psychiatric diagnosis," said Shrand, who runs the High Point Treatment Center in Brockton, Mass., working with troubled and angry youth.

"In this case, what [Rice] is really exposing is a culture where coaches somehow are basically sanctioned and condoned bullies," he said.

"It sheds a spotlight on aggressive and ferocious coaching that [coaches] think is inspiring and motivating," he said. "They are harassing [players] and belittling them -- the complete opposite. We want to inspire kids and remind them they are amazing, not telling them they are good for nothing."

"Anger is an emotion designed to change the behavior of someone else," said Shrand. "You need to respond with respect. When is the last time you got angry at someone treating you with respect?"

Rice is hardly the first coach to exhibit shocking behavior on the basketball court. In 1985, then Hoosiers coach Bobby Knight threw a chair at a referee during an important game. He later said he regretted the bad behavior.

Dr. Redford Williams, director of the Behavioral Medicine Research Center at Duke University Medical School, called the Rice incident "Bobby Knight redux."

"It becomes dysfunctional for sure when you lose your job for your behavior," he said. "It's clear this was above and beyond what is normal for a coach to be doing this toward the people he is working with."

Anger management can work for people like Rice, according to Williams, who has not treated Rice, but saw the videos.

Williams and his wife developed a LifeSkills program that has been shown effective in reducing anger in high school students who are violent offenders. He said the steps could even be useful on the basketball court.

"It teaches the person to increase their awareness of their thoughts and feelings in situations that make them angry," he said.

"First you have to make sure you have the facts -- a kid threw a ball forward, not back to a guard," he said. "You told him to go for the basket at the end of the game and he goes for the basket."

Williams said that instead of an outburst, analyze thoughts first: "What a dumb thing to do. I have feelings of anger and rage that will cause us to lose the game."

Then, said Williams, ask four questions: Is this important? Is what I am thinking appropriate? Is it modifiable? Is it worth it? [I am worth it].

"If you get four yes'es, that means you need to take action, but it doesn't mean you are 007 with a license to kill," he said.

"Guys like the Rutgers coach can learn anger management," said Williams. "It's not rocket science and there's evidence it works."

ABC's medical residents Dr. Thomas Bender and Dr. Viral Patel contributed to this report.