Rage attacks are sudden, uncontrollable outbursts of extreme anger and distress, that may be accompanied with violent actions, and verbal insults.
It is important to know that not everyone with Tourette Syndrome or PANS / PANDAS has rage attacks, and that those who have rage attacks are not naturally violent people and have no reason to be feared. Rage attacks are unlikely to happen when a person is around a lot of people, and a person may be more violent towards themselves than towards others. People with Tourette Syndrome and PANS / PANDAS are NOT bad people, nor are we dangerous. Our symptoms can sometimes just be misunderstood.
During a Rage Attack, A Person May:
Say things that they do not mean
It is important to know that rage attacks are a neurological symptom, and NOT an indication that a person is 'badly behaved'; rage attacks do not reflect a person's true character. The kindest and most caring person could have the most aggressive rages.
Some people refer to rage attacks as neuro storms, as they are just that - neurological storms. The rage attacks are involuntary and have a neurological basis.
Rage Attacks Can Be Experienced Differently By Different People:
Although rage attacks usually are not the same as tics, they are just as involuntary as the tics. During a rage attack a person loses control of their rational thinking and actions, and is likely to do things that they do not mean. Although the typical consensus is that rage attacks are anger based, a small percentage of people may actually have tic rages. This is where the rage attacks ARE tics, they can be exclusively tic based. For example, a person may have an episode of hitting, biting, scratching, throwing, and yelling tics, which may resemble an anger based rage, but is not one. In a tic rage, a person is usually not actually angry, their tics are just making them perform violent actions uncontrollably. However, the majority of rages are anger based, but this doesn't make them any less involuntary.
Discipline is Unlikely to Help or Prevent Rage Attacks:
Punishing a person after a rage attack is unlikely to be helpful, as it will not prevent the attacks. Rage attacks are a neurological symptom that can come in episodes, like seizures or tic attacks, therefore disciplining someone for something that is involuntary is unlikely to be helpful, and may just end up destroying a person's self-esteem.
If a person is made to feel 'naughty' or 'bad' for something that they cannot control, then this can break down someone's confidence and sense of self-worth. People may feel unworthy of love as they may feel like they are a 'bad person' who is 'mean' and 'lacks self-discipline', when this is false. The person has a neurological condition which causes these outbursts which are out of a person's control and say nothing about who they are as a person.
Rage Attacks Can Occur More In One Environment Than Another:
Some people report that they experience rage attacks more in the home environment than the school or work environment. This does NOT indicate that there is anything wrong with the home environment, it is more likely that the person experiences more rages at home as they are holding it all in whilst in school, so that it all explodes once a person gets home. In school, a person may be afraid of being judged by their peers and teachers, or they may be afraid of being punished for a symptom. Therefore, people are more likely to let it all out once they are at home, because they love their parents and know that they will be able to support them and won't judge them.
Triggers For Rage Attacks:
Different people report different triggers for their rage attacks. Although a rage attack may appear to be triggered by something very small, that is unlikely to be the root trigger. That 'small' thing could just be what sent the person 'over the edge', when they were already distressed.
Rage Attack Triggers Can Include:
Food Dye Sensitivity - Many people with Tourette Syndrome or PANS/PANDAS report that food dye consumption can lead to explosive outbursts and symptom exacerbation. Certain food dyes may be worse for people than others. Certain natural food dyes such as Annatto can have a huge detrimental effect on some people.
Tic Suppression - Holding in tics can be extremely uncomfortable for an individual and can make symptoms worse later on. For some people, the tic urge may accumulate and become physically intolerable for some people, this could make a person appear snappy and pressured, as their body may feel as if it is filled to the brim with pressure and tension. This can then explode out as a rage attack.
OCD rituals not being fulfilled - Many people with Tourette Syndrome or PANS/PANDAS have OCD, and when a ritual goes unfilled, such as when working on Exposure therapy, it may lead to an increased level of anxiety and discomfort, which can then trigger a rage attack.
Hidden learning difficulties - Learning difficulties such as dyscalculia can be common in people with Tourette Syndrome, and a decline in maths ability can be a symptom of PANS/PANDAS. This could make math classes at school, or the need to do mathematics at work, incredibly frustrating and anxiety provoking for some people. This could lead to rage attacks. As well as this, a person may judge themselves as 'not being smart' if they struggle with something like this. This could then lower someone's self-esteem and cause more frustration, which may lead to more rage attacks.
Fight or Flight Response - It is possible that extreme anxiety or fear, triggering a fight or flight response, could trigger rage attack-like traits.
Being in a flare, triggered by an infectious or non-infectious trigger, for those with PANDAS or PANS. Note that this can be mixed with other triggers, food dye sensitivity may trigger rages for a person with PANS/PANDAS when in a flare or not, but especially when in a flare.
An object being moved, or things being in the 'wrong place', if someone has OCD or OCD traits.
Under Stimulation or Over Stimulation - If a person has co-occurring ADHD or ADHD traits, then it is possible that they may need more stimulation than the average person. This may seem counterintuitive, but some people with ADHD traits find that they need more stimulation, in order to calm the over activity in their body and mind. It is as if the hyperactivity is a sort of coping mechanism for feeling chronically under-stimulated. This is why some people may need something that is stimulating for them, such as listening to fast paced music (as long as this doesn't exacerbate the tics), exercising, dancing, fidgeting, moving around, etc.
However, some people may have sensory processing issues, which may cause them to be more over-stimulated. It is also possible that some people with hyperactivity will need a calmer environment, with less stimulation or excitement, as everyone is different and everyone's brain has different needs.
Under-stimulation may trigger rage attacks as someone may become so antsy and irritable due to not being able to get the stimulation which their body and brain needs. Over-stimulation may trigger rage attacks as people may get overwhelmed by all of the sensory input which their brain cannot process.
How To Support Someone Having A Rage Attack:
When the attack is happening, try to refrain from reasoning with the individual. During a rage attack, a person cannot process what you are saying to them. They cannot take it in. It will only frustrate and overwhelm them further, which could prolong the attack and make it more intense.
Ensure that the individual is not hurting themselves.
Only restrain the person if necessary, and do it in a safe way!
Once the attack has passed, reassure them that they are still a good person, and that you still love them no matter what. Reassure them that you know that they cannot control their rage attacks.
If needed, give the individual some space after the attack, as long as they are not at risk of causing any harm to themselves. Some people need a bit of personal space or alone time after a rage attack, and they may appear to 'zone out'. If the person experiences bouts of unresponsiveness, then rule out absence seizures.
Be kind to the person. Comfort them when the attack is over and when they are ready for contact with others. A person will often feel extremely guilty and shameful after a rage attack, so let them know that it is okay.
Remember that a person having a rage attack likely knows that the actions they uncontrollably perform in the attack are not appropriate, but they cannot control it. Therefore, for a person who understands this, telling them that what they did isn't appropriate is not going to help, as they already know this.
Take threats of suicide and self-harm seriously.
Do not punish an individual for having a rage attack. It is possible to help them know that they can be held accountable for their actions, by allowing them to help out with fixing or replacing anything they have broken, but this can only be done if the person is well enough and if the rages aren't so frequent that things get broken all the time.
Try not to take what a person in a rage attack says personally. Many people having a rage attack will say things such as "I hate you!", "You did this to me", or "I wish you were dead!" A person doesn't mean it when they say these things during a rage attack. It can be hard not to take personally, but a person doesn't mean it.
Stay calm. The person in a rage attack needs you to be calm, soothing and caring. If you are stern or strict, the person is likely to be more anxious and this can make it worse.
Some people find distraction or calming techniques helpful, but sometimes people are too deep into the rage attack for this to work.
After a rage attack, take care of a person, get them what they need, and let them rest. Rages are exhausting.
Never make threats like "if you do this again we will take away your TV". This is likely to make a person more anxious and is very unlikely to reduce the rage attacks.
How To Prevent Rage Attacks:
Avoid triggers, look into potential dietary triggers.
Remind the person to set boundaries, take things easy, and look after themselves. Reducing stress may be beneficial.
Some people may find it helpful to learn calming techniques or ways to redirect rages, but this may not have any beneficial effect for some people.
Reduce or stop tic suppression.
Seek the help of a professional for interventions such as medication that may reduce rages. Do not be afraid to go the natural root, as a naturopath may be able to find some root biochemical triggers.
If you have PANS/PANDAS, reduce the likelihood of going into a flare by practicing reasonable infection avoidance techniques, such as requiring that Strep cases are reported in school, and any surface which the student with Strep or another triggering infection has touched must be decontaminated to avoid the student with PANS/PANDAS from coming into contact with the pathogen.
See what the individual's sensory needs are, and meet them.
Ensure that the person is getting the appropriate accommodations in school and in the workplace.
Facts About Rage Attacks:
● People with PANS / PANDAS may have very dilated pupils when in a rage attack.
● Rage Attacks can be tic based or anger based, both are uncontrollable.
● Rage Attacks are common symptoms of Tourette Syndrome and PANS/PANDAS.
● Rage Attacks are neither the fault of the individual or the parents of the individual.
● Rage Attacks are NOT bad behaviour, they are a neurological symptom. Rages do NOT reflect a person's personality. A person likely knows that what they do in a rage attack is inappropriate, but they are NOT choosing to do it.
Disclaimer: I am NOT a medical professional, this is NOT to be used as a substitute for diagnosis or treatment from a qualified physician, this is to be used for educational purposes only. For medical advice, please see a medical practitioner. I do NOT claim to treat, cure or mitigate any condition.