Driven to destruction: Are road rage perpetrators victims of psychiatric distress? CrossCurrents Summer 2004

CrossCurrents

by Nate Hendley

You're driving down the road, minding your own business. Suddenly, another driver tries to cut in front of you. You slam on the brakes and grind to a halt, narrowly missing a collision. You honk your horn at the driver, since he seems oblivious. Already shaken by the near fender bender, you're totally unprepared for what happens next. The driver who cut you off gets out of his car, waving his fists and screaming obscenities. Far from being apologetic, he blames you for the accident and looks ready to fight. He bangs his fist against your side window and continues to yell at top volume.

The above scenario is a classic example of what has become known as road rage. But why do some drivers simply write off sloppy drivers as an annoyance, while others fly into a rage over a motorist going 80 kilometres per hour in the fast lane? Are perpetrators of road rage more likely than their peaceable fellow motorists to have mental health issues?

Dr. Reginald Smart, a senior scientist at the Centre for Addiction and Mental Health in Toronto, thinks there might be a connection. He and his colleagues Mark Asbridge, Robert Mann and Edward Adlaf published an article in a 2003 issue of the Canadian Journal of Psychiatry (CJP) that may be the first of its kind in the world to examine psychiatric distress among road rage perpetrators and victims.

The study defined road rage as "a situation where a driver or a passenger attempts to kill, injure or intimidate a pedestrian or another driver or passenger or to damage their vehicle in a traffic incident." Road rage could range from insults and obscene gestures to physical assaults and even death. Thirty-nine per cent of men and 27 per cent of women surveyed said they had committed an act of road rage in the previous year. Forty-nine per cent of men and 44 per cent of women said they had been victims.

In terms of the psychology of road rage, the study found that perpetrators scored high on indices of depression, anxiety and stress. It also revealed that many perpetrators have exceptionally high levels of aggression, for little or no apparent reason. "People involved in frequent road rage probably have a lot of tension, stress and anxiety in their lives," says Smart. "When they get onto the road and get involved in some minor incident, they fly off the handle in a way that regular people don't. Frequent road ragers are people with a lot of impulse control problems," he adds.

A link between road rage and higher rates of anger comes as no surprise. Existing research, including a new study by Galovski and colleagues in an upcoming issue of Behaviour Research and Therapy, has established that court-referred and self-referred aggressive drivers show high levels of intermittent explosive disorder as well as considerable other psychopathology.

Dr. Laurence Jerome, who runs a private psychiatric practice in London, Ontario, has also examined the mental health of people who commit road rage. He believes some perpetrators may have attention deficit hyperactivity disorder (ADHD), which, he says underlies impulsive disorder in adults.

Several existing studies examining the link between psychiatric distress and road rage have looked beyond anger. In a study published in Social Psychiatry and Psychiatric Epidemiology in 2001, Dr. Grace Fong and colleagues examined self-reported road rage and psychiatric morbidity among attendees at general practice clinics in the United Kingdom. The study found that perpetrators had increased aggression scores and psychiatric morbidity. There was also a strong association with illicit drug use. The authors concluded that road rage "may be indicative of a broader level of psychiatric and social dysfunction."

Another study in a 2001 issue of Applied Psychophysiology and Biofeedback found that people who consider themselves aggressive behind the wheel have stronger physiological responses to stress than less-aggressive drivers. Dr. Edward Blanchard and colleagues at the Center for Stress and Anxiety Disorders at the State University of New York at Albany reported that aggressive drivers responded to stressful stimuli with greater increases in muscle tension and blood pressure than their calmer peers. This work suggests that individual differences in responses to challenging or emotionally difficult situations may partially determine whether drivers react with anger or defensiveness while driving.

So what can be done to treat perpetrators of road rage? Jerome suggests that stimulant medication that help improve the driving skills of people with ADHD may lower the incidence of road rage.

A study published in 2002 in Behavior Research and Therapy examined other therapeutic approaches. It found that relaxation therapy and cognitive-relaxation therapy lowered driving anger and hostile and aggressive forms of expressing driving anger, as well as increasing adaptive ways to express driving anger. Both interventions also lowered trait anger.

Smart wants the legal system take a more proactive stance on the issue. "Courts could mandate that people have psychiatric examinations or have to enter therapy if they are frequent road ragers," he says.

While research seems to be unearthing a link between road rage and mental health problems, it has thus far left one major issue unresolved. "We know that road ragers have psychiatric distress," says Smart. "What we're not sure of is whether road rage causes psychiatric distress or if psychiatric distress causes road rage. We need more detailed studies."

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