What is Intermittent Explosive Disorder?
Intermittent explosive disorder (IED), sometimes called rage disorder, is an impulse-control disorder characterized by outbursts of anger, aggression, and violent behavior. The aggressive episodes generally come on suddenly and last a half-hour or less, and the behavior is out of proportion to any provocation that might have occurred.
Symptoms of IED usually begin early in life, typically in the early teens. However, much younger children may sometimes exhibit symptoms, and the behavioral pattern often lasts throughout the patient’s life. IED can affect anyone, but the disorder occurs in men twice as often as women.
Symptoms of IED
Common symptoms of IED include:
- Outbursts of rage
- Chronic irritability
- Racing heartbeat
- Racing thoughts
- Increased energy level
- Tightness in the chest
- Making threats
- Being aggressively argumentative
- Assaulting people or animals
- Throwing things or damaging property
Associated Psychiatric Disorders
IED often occurs at the same time as other mental disorders. Commonly associated psychiatric disorders include:
- Major depression or anxiety
- Substance abuse disorder
- Bipolar disorder
- Post-traumatic stress disorder (PTSD)
- Antisocial personality disorder
- Borderline personality disorder
- Attention-deficit/hyperactivity disorder (ADHD)
When IED is co-morbid (meaning it exists at the same time) with other disorders, the symptoms of IED often begin before the signs of the other disorder(s). People who have IED combined with other conditions also tend to be more aggressive than those with only IED.
What Causes Intermittent Explosive Disorder?
The precise cause of IED is unknown, but it seems to be a product of both environmental and genetic factors. Some potential factors that increase the risk of IED include:
- Early environment. Most people with IED come from childhood households in which aggressive and violent behavior was typical.
- Childhood abuse, verbal or physical
- Genetics. People with a family history of IED are at higher risk of having the disorder themselves.
- Brain chemistry. The neurotransmitter serotonin may play a role in IED.
- Brain structure. The part of the brain that regulates emotion may be underdeveloped in people with IED.
- History of other psychiatric disorders
Is Intermittent Explosive Disorder Hereditary?
Scientists believe that IED has a genetic component because the disorder tends to run in families. However, research has not yet identified any specific genes or genetic mutations consistently associated with IED. Instead, the disorder likely occurs due to a complex combination of genetic predisposition and external environmental factors.
How Is Intermittent Explosive Disorder Detected?
The consequences of IED are often serious both for the person with the disorder and those around them, making prompt diagnosis and treatment vital. Evidence that IED might precede other co-morbid psychiatric disorders also increases the importance of early detection and treatment.
Early signs of IED include:
- Frequent temper tantrums or fights
- Poor impulse control when angry
- Disproportionate reaction to frustration
- Throwing or breaking things
- Violent behavior toward people or animals
How Is Intermittent Explosive Disorder Diagnosed?
A medical professional will compare the patient’s symptoms, behavior, and history to the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to diagnose IED.
To qualify for a diagnosis of IED, the patient must meet the DSM-5 criteria:
- Verbal or physically aggressive outbursts (without physical assault or property damage) occur, on average, twice a week over three months, or three episodes involving physical assault or property damage occur in a 12-month period.
- The aggressive episodes are out of proportion to any provocation or stress.
- The outbursts cannot be explained by another psychiatric or physical disorder.
- The outbursts are not premeditated or aimed at another goal (for example, intimidation).
- The outbursts cause the patient distress, impair their normal functioning, or result in legal or financial consequences.
- The patient is at least six years old.
PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.
How Is Intermittent Explosive Disorder Treated?
Treatment of IED typically includes both medication and psychotherapy. Common treatments and therapies include:
- Antidepressant medications
- Anti-anxiety medications
- Mood stabilizing medications
- Anticonvulsant medications
- Anger management therapy
- Behavioral modification therapy
- Group counseling
- Relaxation therapy
How Does Intermittent Explosive Disorder Progress?
The long-term consequences of IED are significant and include a wide range of potential physical, psychological, social, and legal complications. Long-term problems associated with IED include:
- Interpersonal relationship problems, including divorce and estrangement from family and friends
- Poor performance at school or work
- Injuries related to violent episodes
- Accidents caused by poor impulse control
- Legal issues, including those stemming from violent behavior
- Financial problems
- Depression or anxiety
- Substance abuse
- Physical complications such as high blood pressure, heart disease, stroke, ulcers, and diabetes
- Suicide or self-harm
How Is Intermittent Explosive Disorder Prevented?
Some behavior-modification techniques may help a person with IED control or prevent their aggressive outbursts. Potentially helpful strategies include:
- Learn better communication skills.
- Remove yourself from frustrating situations or environments.
- Don’t use alcohol or drugs.
- Learn and use relaxation techniques.
- Follow the treatment plan prescribed by your healthcare providers.
- Caregiver Tips
Intermittent Explosive Disorder Caregiver Tips
The top priority for someone involved with a person suffering from IED is keeping themselves and their loved ones safe from the aggressive behavior. Steps you can take to protect yourself include:
- Understand that the aggressive behavior is not your fault, and you are not a deserving target.
- Make sure that family and friends know about the abusive behavior, and have a plan for letting them know when you’re in danger.
- Have an escape plan, including having a bag packed and knowing where you will go in an emergency.
- Keep firearms and other weapons out of your home and away from the abuser.
- Seek the help and advice of support resources such as a domestic abuse hotline or a local women’s shelter.
Most people with IED also suffer from other brain and mental health-related issues, a situation called co-morbidity. Here are a few of the disorders commonly associated with IED:
- Personality disorders, including borderline personality disorder and antisocial personality disorder, are common in people with IED.
- IED is often associated with post-traumatic stress disorder (PTSD) or bipolar disorder.
- Many people with IED also have a substance abuse disorder.
- People with IED are at increased risk of anxiety and depression.
- Brain Science
Intermittent Explosive Disorder Brain Science
Researchers have found evidence that the aggressive behavior of people with IED may be rooted in structural and chemical factors that make their brains work differently.
- One study used magnetic resonance imaging (MRI) to compare the brains of people with IED to those without the disorder. The researchers found that in people with IED, a brain structure called the frontolimbic region was smaller than in healthy people. This part of the brain helps regulate emotions, and there was a direct correlation between smaller brain volume in that area and the aggressive behavior of people with IED.
- Other studies have found that low levels of the brain chemical serotonin might play a role in aggressive behavior. Researchers have discovered that serotonin deficits seem to impair communication between the brain’s emotional center (the amygdala) and the frontal lobes, the part of the brain responsible for higher-level thought processes such as problem-solving. Thus, it is possible that low serotonin levels could make it difficult for people with IED to respond to emotional stimuli appropriately.
Intermittent Explosive Disorder Research
Title: A Cognitive Bias Modification RCT for Aggression
Stage: Not Yet Recruiting
Principal investigator: Michael S. McCloskey, PhD
The objective of the proposed study is to test a computerized cognitive bias modification program (CBM) to treat attention and interpretive biases in patients with Intermittent Explosive Disorder, a disorder characterized by habitual engagement in aggressive behavior. The efficacy of the CBM program will be assessed via a small randomized controlled trial comparing CBM to a computerized control condition. This training program would consist of a four-week regimen of twice-weekly, 30-minute sessions (8 sessions total), during which individuals would learn to: (a) focus attention away from threatening words toward neutral words [attention bias], and (b) to disambiguate ambiguous interpersonal scenarios using more benign, rather than threatening, interpretations [interpretive bias]. Participants will be asked to complete behavioral measures of attention bias and interpretive bias and self-report measures of anger/aggression, interpretive bias, emotion regulation, and life satisfaction at baseline (pre-training), post-training, and 1-month follow-up.
Title: Safety, Tolerability, and Activity of SRX246 in Adults With Intermittent Explosive Disorder (AVN009)
Atlanta Center for Medical Research
This exploratory Phase II study has been designed to examine the safety and tolerability profile and to compare the activity of the novel V1a vasopressin antagonist (SRX246) against placebo in adults with DSM-5 Intermittent Explosive Disorder (IED).
Adult Male and Female subjects with a current DSM-5 diagnosis of IED will be enrolled. All subjects will undergo systematic diagnostic assessment for DSM-5 Axis I and II disorders. Subjects with DSM-5 IED (without current, co-morbid, DSM-5 Major Depression) whose: (a) Life History of Aggression (LHA) score is > 12, (b) Overt Aggression Scale Modified (OAS-M) “Irritability” score is > 6 and, (c) screening OAS-M “Aggression” score is > 15, will be entered into a two-week baseline lead-in phase.
After the lead-in phase, study subjects who continue to meet OAS-M criteria will be randomized to one of the two (2) treatment conditions and stratified by gender. Equal numbers of males and females are assigned to SRX246 and Placebo Groups. Those who do not meet the criteria will exit the protocol at that time. Treatment Conditions: (a) 8-week course of SRX246 (4 weeks at 120 mg bid, and four weeks at 160 mg bid) or (b) 8-week course of Placebo, followed by a one-week “taper” to withdraw subjects from study medication.
IED subjects in all conditions will have structured diagnostic interview sessions and questionnaires administered throughout the trial. Blinding to treatment conditions will be maintained by using different personnel for these activities. Analysis of a change from baseline in the diagnostic measures will be performed.
Title: A Comparison of Fluoxetine and Divalproex for the Treatment of Intermittent Explosive Disorder
Principal investigator: Emil F. Coccaro, MD
University of Chicago
IED is a condition characterized by a failure to resist aggressive impulses. IED is a behaviorally defined condition for which effective treatments have not been identified. Research suggests that serotonin (5-HT), a chemical that helps regulate mood and emotions, may play a role in the response to pharmacological IED treatments. This study will examine the relationship between 5-HT receptors and response to treatment with fluoxetine or divalproex. In addition, this study will examine people with IED and those without the condition to determine whether there are differences in their 5-HT receptor and transporter systems.
Participants in this study will be randomly assigned to receive either fluoxetine, divalproex, or placebo for 12 weeks. Scale ratings will be used to assess the aggression levels of participants. Biologic evaluations of the 5-HT system will be conducted throughout the study.