Intermittent explosive disorder (IED) is one of the more dangerous mental health disorders as it can lead to physical violence towards other people.
It is characterized by recurring episodes in which a person is unable to withstand the urge to engage in impulsive, aggressive, and even violent behavior.
Other signs of this disorder include explosive verbal outbursts. These outbursts are usually completely out of proportion with whatever scenario provokes them. A person with IED is highly likely to be incarcerated for things such as destruction of property, domestic violence, and homicide.
Road rage and domestic violence are also common behaviors for some with IED. It’s a chronic disorder, but it doesn’t necessarily get worse as a person gets older. If it continues into old age, it’s likely the IED-related episodes will be less severe.
IED has no cure. It can, however, be treated through medication management and psychotherapy.
If you want to know more about intermittent explosive disorder (and I know that you do), then I suggest you keep reading.
Early Onset of Intermittent Explosive Disorder
The onset of IED more often than not happens during a person’s adolescence. A child with IED will exhibit symptoms such as extreme irritability, the inability to calm down, and becoming enraged with or without provocation.
It can be easy to dismiss the signs at an early age as “kids being kids” or “they’re just letting off some steam.” It may also be easy to dismiss the signs of IED because the episodes aren’t always complete rage-fests. That’s why it’s called intermittent explosive disorder.
In between the extreme outbursts are milder outbursts. These milder outbursts can include temper tantrums, tirades, and even extreme verbal fights, but they don’t become physically abusive or destructive.
The less often extreme outbursts can be very scary as they may involve the destruction of property, burning items, violent acts toward animals including torture, and physical violence towards people.
Not only can this behavior have a negative physical effect on the people on the opposite end, but it can also have psychological effects that are even worse.
Teenagers with IED have reported that before an episode they can feel extreme amounts of tension in their heads and chests. Once the tension becomes too much, there is an explosive episode that can last up to 30 minutes!
Acts of violence can ensue, but it’s not premeditated violence. It’s almost like the person is being controlled by their rage as they are not engaging in violence for financial gain or vigilante justice.
Symptoms of Intermittent Explosive Disorder
There are many behaviors that could be signs of IED. They include:
- Punching holes through walls
- Throwing dishes
- Threats of physical violence including homicide
- Temper tantrums
- Blinding rage
- Road rage
- Intense arguments
- Destroying property
- Bar fights
- Domestic violence
- Saying hurtful things or extreme insults
- yelling and shouting
- intense arguments
- temper tantrums and rampages
- road rage
- punching walls or breaking plates
- damaging property
- physical violence, such as slapping or shoving
- fights or brawls
- domestic violence
These behaviors can come out of left field with no warning. There may or may not be a triggering situation that provokes an IED outburst.
It is likely that physical symptoms will accompany the explosive behaviors listed above. Some of these are:
- A sudden surge of energy (adrenaline)
- Severe headaches
- Increased heart rate and heart palpitations
- Muscle tension
- Tingling of the extremities
- Tightness in the chest
- Violent tremors
People suffering from IED usually have racing thoughts that get exponentially worse right before an explosive episode. They may also experience emotional blunting or detachment; however, feelings of guilt and remorse may also follow.
The most severe physically violent outbursts may happen once every few months. However, between these episodes, it’s likely for less severe outbursts to occur (like someone becoming verbally abusive towards those around them).
There are genetic, environmental, and physical risk factors that can lead to intermittent explosive disorder. Let’s take a closer look at these 3 risk factors.
We know that as children move into adolescence, hormones are all over the place. Physiological changes affect everyone differently during their developmental years, which means essentially all people are at risk for having IED.
However, if you have people in your family, especially your immediate family, who have suffered or currently do suffer from IED, you are at a much higher risk.
Environments are an important factor to consider, extremely important in fact. Stressful environments can put children and young adults at risk for developing IED.
If there is sexual abuse in their environment, then chances are they will develop feelings of shame and overwhelming guilt. When the sexual abuser is a family member, it can make things even more confusing.
If abuse happens, other family members may look the other way because they don’t want to confront the issue.
If a young person is a victim of sexual abuse and it is not addressed, they are more likely to mimic their abuse by abusing other kids their age. This may be an attempt to displace feelings of guilt and shame.
Young people that are sexually abused tend to stuff their emotions. Emotions can’t be stuffed forever, and there is an explosion. These explosions can cause rage-filled episodes which set the stage for IED.
If a young person’s family has unhealthy coping mechanisms for stress such as abusing drugs and alcohol, they are for sure at a higher risk for developing IED.
The frontal lobes of the brain are where the ability to control impulses resides. There seem to be some abnormalities in these lobes as well as the limbic system in those who have IED.
You may be familiar with the word serotonin. Serotonin is a hormone that helps with mood stability. It also affects our ability to feel happy and at ease. It plays a huge role in the healthy communication between nervous system cells.
However, inadequate amounts of serotonin can lead to depression. It seems that there are also abnormalities in the way serotonin works in the brains of those with IED. Brain glucose metabolism levels also seem to be lower.
Diagnosis of Intermittent Explosive Disorder
The Diagnostic Statistical Manual (DSM-5) has an updated criteria for IED that makes the distinction between:
- The more frequent occurrence of verbally aggressive behavior which doesn’t include physical harm to living beings (people, animals, etc.) or damage of property.
- The less frequent occurrences of extreme assaultive or destructive behavior that seriously harm living beings and/or property.
A disorder that includes aggressive and impulsive behavior has always appeared in the DSM. However, it wasn’t until the 3rd edition that it was labeled IED. It used to be thought of as a rare disorder. More recent findings would indicate the contrary.
A study done in 2005 showed that over 6% of a group of 1300 people had IED at some point in their life. At least 3% had current symptoms of the disorder.
You can be diagnosed with IED if twice a week for 3 months you displayed aggressive verbal or physical behavior towards people, animals, and property. However, this behavior doesn’t always have to cause physical harm to others or damage to property for it to fit the criteria for IED.
You can also be diagnosed with IED if you have 3 explosive episodes that cause harm or damage property within a year’s time.
If other mental health disorders are more prevalent than IED, you will be diagnosed with those disorders instead. These disorders include attention-deficit/hyperactivity disorder, conduct disorder, borderline personality disorder, antisocial personality disorder, and more.
You may not be diagnosed with IED if your explosive episodes are a result, for example, of something like methamphetamine intoxication or substance withdrawal.
Treating Intermittent Explosive Disorder
There are different ways to treat IED, and more often than not, more than one method is needed.
Cognitive behavioral therapy (CBT) can be extremely helpful to someone who is dealing with IED. Combining personal and group therapy is an extremely effective approach for managing the symptoms of IED.
Before you can get help for IED, you have to become aware that you have it. Knowing this, you can then look for signs that an explosive episode is on its way. At this moment you can apply relaxation techniques and coping strategies that can prevent a volatile situation from occurring.
There is no specific medicine for IED. However, medicine may be prescribed to help reduce aggressive or impulsive behavior.
Some of these medications include benzodiazepines, antipsychotic drugs, SSRI antidepressants, and mood stabilizers such as lithium.
The only thing is that some of these drugs can take months before you can see that they actually work. That means there is a lot of trial and error going on when trying to find the best medication for a person with IED.
Although it may not be a fix-all, engaging in self-care behavior can help with intermittent explosive disorder.
These behaviors include:
- getting enough sleep
- going to the gym
- eating a healthy diet with plenty of fresh fruit and vegetables
- avoiding the use of drugs and alcohol
- listening to classical music
- getting massages
Are You Affected by IED?
IED doesn’t just affect the person who has it —everyone around them is also deeply affected. It can ruin relationships, affect someone’s ability to keep a job, keep someone from being an effective parent, etc.
Leave a comment if you or someone you know has been affected by intermittent explosive disorder.