Intermittent explosive disorder (IED): What to know about it?

Intermittent explosive disorder (IED) refers to recurrent aggressive outbursts and violent behavior. It belongs to impulse control disorders. The most common symptoms of IED include episodes of rage and aggression, damage to property, and even physical assault. 

The exact cause of IED is unclear, but studies show it has a genetic component. Environment and the presence of other mental health problems and substance abuse are also common causes of IED disorder.

Characteristics of IED involve recurrent episodes that cannot be explained by other mental or physical health problems. Also, the angry outbursts aren’t premeditated. 

However, IED has a major impact on both the physical and mental health of an individual. Fortunately, the condition is manageable with a combination of therapy and medications.

Risk factors for IED include family history, being a male, young age, history of mental health disorders, and substance abuse. Childhood trauma is a major predictor of IED.

What is Intermittent explosive disorder?

Intermittent explosive disorder is one of several impulse control disorders. This condition is indicated by sudden outbursts of aggression, rage, and violence. A person with IED responds to certain triggers in an excessively aggressive manner, but their behavior isn’t planned. They react with fits of rage and aggression impulsively. 

Some examples of IED include domestic abuse, road rage, and temper tantrums. This disorder causes significant distress in a person’s life and affects loved ones too. Also, IED has a harmful impact on physical health.

What is the cause of Intermittent explosive disorder?

The exact cause of the explosive anger disorder is unclear. A combination of different factors could play a role in its development. These include environment, genetics, and differences in how a person’s brain works.

This disorder may begin in childhood or adolescence. Growing up in households where a child is subjected to or witnesses explosive behaviors and physical or verbal abuse can contribute to the development of IEDs. Children in those households may also develop post-traumatic stress disorder (PTSD). This is particularly important since PTSD and IED can correlate, according to a study from Comprehensive Psychiatry. 

Additionally, the explosive disorder has a genetic component, and it can also develop due to differences in the function, structure, and chemistry of the brain. Some people have abnormalities in the brain areas that regulate inhibition and arousal. Persons with IED also have differences in levels of the neurotransmitter serotonin, which is composed differently in this disorder. 

What are the effects of Intermittent explosive disorder?

The main effects of intermittent explosive disorder are listed below.

• Strained relationships with friends, family, coworkers 
• Incarceration and legal problems
• Child or domestic abuse
• Suicidal thoughts and tendencies
• Self-harm
• Self-loathing and low self-esteem
• Substance abuse such as alcohol addiction and/or drug addiction
• Problems at work, school, and home

What are the characteristics of Intermittent explosive disorder?

Characteristics of intermittent explosive disorder revolve around failure to control aggressive impulses. The main characteristics of intermittent explosive disorder are listed below.

• Verbal or physical aggression: toward people, animals, and property for three months. In this case, physical aggression doesn’t cause physical assault, damage, destruction of property, or injury to people and animals.
• Behavioral outbursts: three outbursts within 12 months that result in physical injuries to people and animals and damage to the property.
• Exaggeration: magnitude of aggression is excessively out of proportion to the stressor that caused it.
• No premeditation: aggressive outbursts are recurrent but not premeditated; they are primarily anger- or impulse-based.
• No link to other mental health disorders or physical conditions: aggressive outbursts aren’t better explained by the presence of other mental health illnesses such as bipolar disorder, depression, and others. Also, it is impossible to attribute them to other medical conditions such as head trauma or Alzheimer’s disease.

Many mental health disorders and even some physical conditions can include episodes of aggressiveness. The intermittent explosive disorder has characteristics that are specific to patients with this condition. These characteristics also include:

• Verbal and physical aggression that may or may not cause physical injuries to people and animals and damage to the property
• Intense aggressiveness even when the cause of the outburst isn’t that serious
• Aggressive outbursts aren’t planned; a person doesn’t act this way to show dominance or to intimidate someone and achieve a certain goal
• Symptoms can’t be explained by other mental health problems
• Aggressive outbursts cause significant distress in a person’s quality of life

What are the signs and symptoms of Intermittent explosive disorder?

Signs and symptoms of intermittent explosive disorder manifest themselves through aggressive episodes and explosive verbal and behavioral outbursts. These episodes occur “out of the blue” with little to no warning and last less than 30 minutes. In other words, a person with an IED gets angry for no reason. The most common intermittent explosive disorder symptoms are listed below.

• Rage and irritability
• Increased energy levels
• Road rage
• Chest tightness and heart palpitations
• Tremors and tingling
• Racing thoughts
• Tirades, rampages, and temper tantrums
• Yelling and shouting
• Heated and intense arguments
• Assaulting people or animals
• Threatening others
• Physical fights and altercations such as slapping, shoving, pushing
• Aggressive behaviors such as damaging property, breaking plates, and punching walls
• Domestic violence
• Headache or head pressure

In some cases, IED episodes occur frequently, but sometimes they’re weeks or months apart. In between episodes of severe aggression, a person with IED may have less severe verbal outbursts. Men and women with rage disorder might experience a sense of emotional detachment like patients with borderline personality disorder, according to Healthline. In other words, we can categorize symptoms of intermittent explosive disorder into the following groups:

• Behavioral symptoms: temper tantrums, rampages, tirades, yelling and shouting, heated and intense arguments, physical assault, domestic violence, road rage
• Physical symptoms: adrenaline rush, headache/head pressure, heart palpitations, chest tightness, muscle tension, tingling, tremors
• Cognitive symptoms: racing thoughts, low frustration tolerance, lack of control over one’s thoughts
• Psychosocial symptoms: rage, irritability, emotional detachment.

How to overcome Intermittent explosive disorder?

In order to overcome the intermittent explosive disorder, a proactive approach is necessary. There best ways to overcome explosive mood disorder are listed below.

• Avoiding recreational drugs and alcohol
• Trying relaxation techniques such as deep breathing, meditation, yoga
• Stepping away from triggers or responding to them in a healthier manner
• Getting enough sleep
• Regular exercise
• Stress management
• Creating a plan of action with a therapist for situations when a person feels they’re getting angry

Besides the doctor-recommended treatment, patients with IED can make simple adjustments in daily life that will help them overcome their disorder. These adjustments that help overcome IED include:

• Relaxation techniques and practices
• Healthy lifestyle measures
• Improving reaction to triggers of aggressiveness
• Improving communication skills
• Learning to process and channel negative moods and emotions such as anger without harming oneself and others.

What are the risk factors for Intermittent explosive disorder?

The biggest risk factors for intermittent explosive disorder are listed below.

• History of other mental health disorders 
• History of physical abuse
• Being a male
• History of substance abuse
• Having experienced emotional trauma
• Exposure to explosive behaviors in childhood

Generally speaking, everyone can develop intermittent explosive disorder, but some people are at a higher risk than others. The most significant risk factors for this disorder, according to Psychological Medicine, include:

• Gender (male)
• Young age
• Being unemployed
• Divorced or separated relationship status
• Having less education
• Having other types of substance abuse, such as alcoholism 
• Presence of other mental health disorders, including depression, ADHD, borderline personality disorder, and antisocial personality disorder.

What are the statistics on Intermittent explosive disorder?

The statistics of explosive personality disorder reveal as many as 7.3% of adults in the United States are affected. According to the National Institutes of Health depending on how broadly the condition is defined, up to 7.3% or 11.5 to 16 million adults in the U.S. have IED.

The reality is that the prevalence of IED isn’t well established primarily because most studies followed the American Psychiatric Association’s DSM-IV instead of DSM-V (Diagnostic and Statistical Manual, Fifth Edition). 

The lifetime prevalence of IED in the general adult population is 1% to 4%, while 12-month prevalence ranges from 1% to 3%.

According to a study from Epidemiology and Psychiatric Sciences, the lifetime prevalence of intermittent explosive disorder in all countries was 0.8%. Of these, 73% of people experienced anger attacks that damaged property and harmed other individuals.

How do you treat Intermittent explosive disorder?

Treatment of intermittent explosive disorder involves a combination of therapy and medications. 

The main objective of therapies is to help patients adopt coping mechanisms that will allow them to react to negative stimuli in a healthy manner. They also learn how to deal with intermittent explosive disorder and identify negative thoughts and patterns in order to replace them with positives. 

The most effective therapy for IED is cognitive-behavioral therapy (CBT). This type of behavioral therapy works by helping patients identify the situations and behaviors that trigger fits of anger or aggressive responses. At the same time, patients learn to manage their anger and control inadequate responses through relaxation techniques, cognitive restructuring, and improving problem-solving and communication skills. In other words, they learn how to avoid getting mad for no reason.

A study from the Journal of Consulting and Clinical Psychology confirmed the benefits of CBT in the treatment of intermittent explosive disorder. The positive effects of cognitive-behavioral therapy were maintained at the three-month follow-up as well. Moreover, the Brazilian Journal of Psychiatry published a study that found CBT led to a significant reduction in all anger scales in persons with intermittent explosive disorder.

Psychotherapy sessions in the intermittent explosive disorder treatment are performed in an individual or group setting. Speaking of groups, anger management programs and support groups are useful for the treatment of IEDs. Patients get to share their experiences with their disorder and support others while also receiving their help and support.

Patient education is a significant component of the treatment of this disorder. For that reason, healthcare professionals strive to educate patients on what is IED disorder in order to understand it better and acknowledge problematic behaviors that can be managed adequately. 

While there is no specific intermittent explosive disorder medication, healthcare professionals may prescribe drugs to treat underlying mental health problems. These medications usually include antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, and anticonvulsant mood stabilizers such as phenytoin, oxcarbazepine, and carbamazepine.

Some patients also try alternative therapies such as acupuncture and acupressure. Keep in mind that alternative therapies aren’t a replacement for IED medical approach or doctor-recommended treatment.

How is an Intermittent explosive disorder diagnosed?

Intermittent explosive disorder is diagnosed when a patient meets criteria from DSM-5 that revolve around aggression, physical assault, and damage to property. In order to rule out other mental health disorders or physical conditions, the doctor carries out a physical exam and psychological evaluation. 

The main purpose of a physical exam is to eliminate physical problems such as substance abuse that could induce some symptoms similar to those of IED. The physical exam may include a blood test or other laboratory tests as well.

During the psychological evaluation, the healthcare professional talks with the patient about their thoughts, symptoms, feelings, and behavior patterns.

Who is most likely to have Intermittent explosive disorder?

Men are more likely to have intermittent explosive disorder than women. The average age of onset of IED is 17 years, but it ranges from 13 to 23 years in different countries. Persons who grew up in an unstable home are more likely to have an IED. For example, some people were exposed to aggressive behavior and verbal or physical abuse in childhood.

Unemployed persons have higher odds of developing IED as well as men and women who are divorced or separated. Moreover, individuals with other mental health problems and persons with substance use disorders are also at risk of developing IED.

According to a study from the Journal of Psychiatric Research, intermittent explosive disorder has a strong genetic component and is not always the artifact of co-morbidities. That means a person is more likely to have this condition if their family member also had it.

What other conditions are possible to co-occur with Intermittent explosive disorder?

Other conditions that tend to co-occur with intermittent explosive disorder are listed below.

• Attention deficit hyperactivity disorder (ADHD)
• Anxiety 
• Antisocial personality disorder
• Borderline personality disorder
• Substance abuse disorder
• Conduct disorder
• Oppositional defiant disorder (ODD)
• Bipolar disorder
• Depression 
• Post-traumatic stress disorder (PTSD)

This anger disorder can contribute to or worsen many other conditions. The most common co-morbidities include:

• Anxiety disorders
• Mood disorders
• Behavioral and personality disorders

What is the relation between Intermittent explosive disorder and childhood trauma?

The relation between intermittent explosive disorder and childhood trauma is that the latter is a major risk factor for developing recurrent aggressive outbursts in adulthood. Childhood trauma is strongly associated with anger disorders, a study from Psychiatry Research confirms.

The first signs of the intermittent explosive disorder may occur in childhood, which correlates with reactions to trauma due to exposure to aggressive behaviors or being subjected to physical or verbal abuse. 

Children learn and develop interpersonal relationships and how to process and manage their emotions properly. Trauma in childhood disrupts this process. As a result, the affected children don’t learn to manage their emotions or respond to negative stimuli in a healthy manner. They also don’t develop the communication skills necessary for interpersonal relationships.