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Explosive rage triggered by seemingly minimal provocation and accompanied
by physical or verbal aggression occurs in two groups of conditions: functional
psychoses and personality disorders on the one hand, and neurological and metabolic
diseases on the other. The term dyscontrol syndrome is sometimes used
for symptoms arising from poor impulse control, whether the cause is organic or
functional. It is an important cause of wife and child battery, senseless assaults,
motiveless homicides, self-injury, dangerously aggressive driving, domestic infidelity,
divorce, and (in children) educational and social difficulties. Even if the violence
is only verbal, it can destroy domestic relationships and wreck careers. All these
disasters, including homicide, are represented in the cases of organic dyscontrol
listed in this report.
first hint of this relationship was given by Boerhaave who noted that in rabies,
which involves the brainstem and hippocampus, the patient may gnash his teeth
and snarl like a dog, and in 1892 Gowers spoke of them as exhausted by attacks
of fury. In the same year Goltz reported that in dogs the removal of a large
portion of the forebrain gave rise to savage behavior in response to minor provocation.
Since then it has been shown that electrical stimulation of the amygdala can produce
either rage or tameness, depending upon the precise placement of the electrodes,
and that in man and animals explosive rage can be abolished by bilateral amygdalotomy.
In the cat, damage to the ventromedial nucleus of the hypothalamus producesafter
a delay of many weeksa permanently savage animal; paradoxically, electrical
stimulation of the same nucleus can elicit aggressive behavior. In man, tumors
of the third ventricle and other midline structures can give rise to either rage
or profound apathy, and pathological aggression can be abolished by bilateral
postero-medial hypothalamotomy. Tumors of the corpus callosum which spread to
involve the overlying cingulate gyri usually cause apathy, but explosive rage
can occur if the septal area is involved. Bilateral cingulotomy can control aggressive
behavior. Repeated attacks of rage were the outstanding feature of a case of a
cyst of the septum pellucidum described by Leslie.
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