An individual with intermittent explosive disorder (IED) experiences uncontrollable, strong, unexpected outbursts of anger that are out of proportion to the circumstances. This short period of intense anger may be associated with aggressive and violent behavior, along with verbal threats. In this article, we will discuss in detail intermittent explosive disorder to make medical aspirants aware of the symptoms, causes, diagnosis, and treatment for this problem.
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What is Intermittent Explosive Disorder?
Intermittent explosive disorder is a mental health issue that makes people prone to frequent impulses of anger and outbursts that continue for a short period of time. One may become hostile and violent and may shout, brawl, throw or damage objects, mistreat people, and even become involved in road rage. This conduct, both physically and mentally, drains a person and often interferes with their daily lives and interpersonal relationships. There are risks of facing financial and legal troubles as a consequence of this disorder.
Intermittent Explosive Disorder Symptoms
The primary indicator of intermittent explosive disorder is the unexpected eruption of anger that is much more intense than the event that triggered it. Angry outbursts and impulsive assaults may come quickly and without prior warning. These episodes could happen frequently, weeks or months apart, usually lasting for half an hour. The common IED symptoms include the following:
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Strong outbursts of anger
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Verbal altercations in which people may shout or threaten others
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Continue with long and heated arguments.
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Physically hurting humans or animals by pushing, slapping, or punching
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Damaging objects by throwing, kicking, or breaking
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Involve in physical fights at home or even on the roads.
If you have the intermittent explosive disorder, just before this episode of aggressive bouts, you may experience the following feelings:
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Fury
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Intolerance
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More energy and stress
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Discomfort
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Trembling
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Increase in heart rate
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Tightness in the chest
Individuals with IED sometimes realize that their outbursts of rage are inappropriate, but they feel incapable of controlling themselves during the episodes. After the outburst, they may feel relieved and exhausted, and afterwards, they might experience a sense of regret, embarrassment, or guilt for the things they committed.
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Intermittent Explosive Disorder Causes
The specific causes of IEDs are still unknown to experts. However, scientists believe that genetic, biochemical, and environmental variables have a role in the development of intermittent explosive disorder. A few factors increase the likelihood of being affected by this mental issue, which are explained below.
Genetic Factors
Intermittent explosive disorder often tends to progress through inheritance. Acquiring genes that increase the risk of developing the illness is possible. Research suggests that around 72% of IED diagnoses are related to family history.
Environmental Factors
Individuals who grew up in an environment where IED behaviours such as aggressive outbursts and verbal and physical abuse were prevalent are more likely to act similarly in later parts of their lives. Childhood traumatic experiences may also elevate the risk of developing the issues.
Biological Factors
Research indicates that patients suffering from IED have certain patterns of brain morphology and functions that are different from those of someone without an IED. Studies reveal that reduced levels of the neurotransmitter hormone serotonin in individuals can also be a cause of intermittent explosive disorder.
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Intermittent Explosive Disorder Consequences
The IED can lead to various adverse consequences, as mentioned below.
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Relationship issues:
Verbal and physical assaults as an outcome of intermittent explosive disorder often led to family tension and relationship issues with others.
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Workplace or education problem:
IED-related behaviours at the workplace or school may result in suspension or disciplinary actions.
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Self-harm:
People having intermittent explosive disorder can tend to harm themselves out of anger and frustration.
Intermittent Explosive Disorder Diagnosis
There are no diagnostic tests available for the identification of intermittent explosive disorder in a person. The diagnosis is mainly based on your response to the questions asked by a qualified mental health practitioner, like a psychiatrist or psychologist. They will assess your mental health conditions by acquiring information on your relationships, family history, employment or school environment, and the medical and mental health histories of you and your family.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) published by the American Psychiatric Association, a person suffering from IED must have demonstrated a failure to control their violent impulses in one of two ways, as explained below.
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High-frequency/low-intensity episodes:
These instances can happen often but may not be so severe. There are signs of aggressive behaviour, either physically or verbally, against people, animals, or property at least twice a week that have been exhibited for the previous three months. This type of IED does not result in any harm or damage to people or property.
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Low-frequency/high-intensity episodes
: These are more extreme cases of IED with severe aggression and a violent attitude toward people, animals, or objects causing physical harm or damage. These can occur three to four times a year.
In any of these cases, the strong expressions appear suddenly and spontaneously and are typically more intense than the situation demands.
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Intermittent Explosive Disorder Treatment
The treatment for intermittent explosive disorder focuses on eliminating symptoms like angry outbursts or a decrease in the severity and frequency of rage and violence. Psychotherapy, often known as talk therapy, is commonly used to treat intermittent explosive disorder. Its main goal is to modify the mental processes that lead to anger and aggression. Medicines can be part of the treatment according to your age and symptoms. These are discussed in detail below:
Talk Therapy
It is a systematic treatment procedure where the therapist or psychologist examines your ideas and feelings more closely to assess how your thoughts influence your behaviour. An effective way to deal with this problem is cognitive behavioural therapy (CBT), which helps individuals adopt healthy thought patterns and habits and eliminate undesirable notions and actions.
By helping individuals with IEDs handle stressful situations in their daily lives, CBT may help to restrain aggressive impulses that could otherwise lead to intermittent explosive disorder. The CBT includes the following methods of treatment:
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Determine the triggers
: Find out what actions or circumstances can make someone react aggressively.
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Use relaxation methods
: You may maintain calm by regularly practising yoga, deep breathing, or relaxation exercises.
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Develop positive approaches
: This process, also known as cognitive restructuring, involves learning to handle a challenging circumstance with freshly developed ideas and a positive attitude.
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Apply situational techniques:
Find assertive rather than aggressive ways to resolve a frustrating problem. Even if you don’t find immediate solutions, a strategy might help you redirect your efforts.
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Practising coping skills:
helping the patient learn coping strategies in a situation that triggers IED and practice appropriate responses by opening up healthy communication.
Medication
Intermittent explosive disorder may be treated with a variety of medications. Doctors may prescribe antidepressants that fall under the category of selective serotonin reuptake inhibitors (SSRIs). If necessary, anticonvulsants, mood stabilizers, or antianxiety medications can be applied. Certain individuals require long-term medication to control explosive outbursts.
Lifestyle Changes
Part of the treatment for IED may include the following lifestyle changes:
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Self-care:
Take care of yourself by maintaining a healthy diet, exercising, and getting enough sleep to ensure a stable mood and physical and mental well-being.
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Modify learned habits
: Though change is difficult, you can develop new, healthy habits and coping techniques.
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Avoid stressful circumstances
: Avoid individuals and situations that make you anxious or stressed, and relax.
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Avoid mood-changing substances
: Avoid alcohol and drugs that can affect your mood and ability to regulate your reactions.
Intermittent explosive disorder is an abnormal condition that reduces individuals’ ability to tolerate frustration and stress and results in intense fury and aggressive actions. With proper treatment that mainly involves controlling the thought process and coping strategies, one can learn how to get control over it.
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