Ahmed Zayed, MD
While it is normal to become irritated at some things occasionally, anger that becomes overwhelming and triggers impulsive and aggressive behavior may indicate an underlying condition known as intermittent explosive disorder.
Intermittent explosive disorder (IED) is a mental disorder characterized by sudden anger outbursts, unexpected aggression, or violence in which an individual’s triggered reaction is out of proportion to the actual situation.
People with IED may throw tantrums, pick fights, and verbally or physically assault those around them. IED sufferers also report feeling completely out of control over their emotions. Some symptoms of intermittent explosive disorder are feelings of rage, racing thoughts, increased energy, irritability, chest tightness, and tremors.
A combination of psychotherapy and medication is often used in treating intermittent explosive disorder.
What are the symptoms of Intermittent Explosive Disorder?
Signs that are indicative of the condition may manifest in behavioral and psychological ways. The symptoms of intermittent explosive disorder are listed below.
Feelings of rage may be experienced by a person with intermittent explosive disorder over trivial things, but they may also have sudden anger for no reason. Rage is a commonly reported symptom that may occur before or during an episode of IED.
Irritability may precede or accompany an IED episode. Individuals who suffer from the condition may experience extreme anger over little things like human contact, or even with no particular reason at all. An irritable mood may also cause a person with intermittent explosive disorder to strongly react to a situation that is often not worthy of the reaction.
3. Increasing sense of tension
An increasing sense of tension is felt by an individual who suffers from IED, and they believe that the only way to release this built-up pressure is through an explosive outburst of anger.
4. Racing thoughts
Racing thoughts are rapid thought patterns that can be overwhelming and may signal an IED disorder episode. The racing thoughts may feel intense and must be controlled in order to minimize aggressive outbursts.
5. Increased energy
High-intensity negative emotions like anger activate the body’s built-in stress response and can cause an adrenaline surge that boosts one’s energy. In the case of someone with intermittent explosive disorder, this pent-up energy will only be released when the person has engaged in unhelpful angry behavior.
During an episode of intermittent explosive disorder, high levels of adrenaline and cortisol are produced. As these hormones flood the body, muscles may tense up, resulting in involuntary shaking and tremors.
A surge of adrenaline can be generated by a strong emotion such as anger. For an individual with rage disorder, the kind of blood-boiling anger they experience triggers an adrenaline rush. This results in vigorous blood pumping in the heart, causing it to beat more rapidly than usual.
8. Chest tightness
Extreme anger can cause elevations in blood pressure and heart rate, making the heart work harder and leading to chest tightness. Being extremely angry for no reason can also cause chest pain at times as the blood vessels narrow, decreasing blood flow to the heart.
9. Temper tantrums
Most people associate temper tantrums with children, but adults who suffer from anger disorders such as IED can also throw a fit and become extremely aggressive and irate. An adult temper tantrum may manifest in many ways, including a silent fit, ranting, shouting, angry crying, or assaulting.
Shouting, yelling, or raising one’s voice in anger can be used to cope with frustrations and release the built-up negative energy one can no longer handle. However, for someone with intermittent explosive disorder, shouting can be accompanied by violence or rage attacks and can look like an emotional meltdown.
11. Being argumentative
An individual who suffers from IED may start heated verbal arguments, which can include shouting, threatening, and insulting others. Intermittent explosive disorder medication such as antidepressants and mood stabilizers may help tamp down verbal aggression.
12. Getting into fights
One of the most common intermittent explosive disorder symptoms is engaging in verbal or physical fights with others. During high-intensity episodes, altercations may involve physical violence and cause injury to other people or even animals.
13. Threatening others
Outward aggression may include verbal threats against people or even animals to express their anger. Medication for intermittent explosive disorder that helps reduce this symptom are mood stabilizers such as lithium and carbamazepine.
14. Assaulting people or animals
Physical assault against people or animals is a symptom that may be indicative of what is IED disorder and how serious the condition is. During outbursts, people with IED may take out their anger on people and animals by physically assaulting them or punching, shoving, or taking out a weapon to cause harm.
15. Damaging property
One physical symptom of intermittent explosive disorder is showing aggression toward personal or private property that results in its destruction. Individuals with IED may start breaking objects, kicking or throwing things, or slamming doors during an episode. Prompt IED treatment helps decrease the intensity and frequency of symptoms like anger outbursts.
What are the causes of Intermittent Explosive Disorder?
The causes of intermittent explosive disorder include genetics, brain structure and chemistry, experiencing or witnessing childhood trauma and abuse, and co-occurring mental health disorders.
IED can run in families, and evidence exists that around 44% to 72% of the likelihood of developing the condition is genetic. Brain structure and chemistry also play a role in the development of intermittent explosive disorder.
Neuroimaging studies suggest that individuals with IED have lower gray matter volume in parts of the brain that regulate emotions. They also have lower than normal levels of serotonin, which affect the brain’s response to anger.
Experiencing or witnessing verbal and physical abuse during childhood makes it more likely for some people to develop the condition in adulthood. Lastly, having other mental health conditions that are frequently comorbid with intermittent explosive disorder such as antisocial personality disorder, attention deficit hyperactivity disorder, and borderline personality disorder also increases the chances of a person engaging in impulsive or aggressive behavior.
How is Intermittent Explosive Disorder diagnosed?
Intermittent explosive disorder is diagnosed by performing a physical exam, conducting a psychological evaluation, and consulting the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for IED.
First, the doctor may do a physical examination that could include lab tests in order to rule out other potential causes of an individual’s aggressive behavior. Other conditions that could cause symptoms similar to the signs of IED are other psychological disorders, substance abuse, or a head injury.
If no other health issues have been revealed after carrying out the physical exam, the doctor or mental health professional may then proceed to conduct a psychological evaluation, which is a series of tests used to check or observe a patient’s symptoms, thought processes, behaviors, and emotions.
After enough information has been gathered about the mental state of the afflicted person, the DSM-5 criteria for intermittent explosive disorder will then be assessed by the mental health professional who will make the final diagnosis if the patient is indeed having problems with impulsive aggression.
One’s best chances on how to prevent intermittent explosive disorder mainly depend on whether they seek treatment from a professional. Although the condition has no cure and individuals with the disorder often feel as if they have no control over themselves, intermittent explosive disorder treatment may help prevent a situation from escalating by changing how people respond to anger.
Who is at risk of Intermittent Explosive Disorder?
People who are at risk of intermittent explosive disorder include males, those who have a history of physical abuse, individuals who grew up in an abusive household, and those who have co-occurring psychological disorders.
Evidence exists that males are more likely to receive an IED diagnosis than females at some point in their lives. Experiencing abuse as a child also increases one’s risk of developing the disorder.
Additionally, individuals who were exposed to verbal or physical abuse by being in an abusive household are more likely to suffer from IED as adults. Those who have mental health disorders that cause disruptive behaviors, such as attention-deficit hyperactivity disorder (ADHD), borderline personality disorder, and antisocial personality disorder are at an increased risk of also having intermittent explosive disorder.
What are the possible treatments for Intermittent Explosive Disorder?
IED is often treated by using more than one approach. The possible treatments for intermittent explosive disorder are listed below.
- Therapy: The most commonly used type of therapy for intermittent explosive disorder is cognitive-behavioral therapy (CBT). CBT helps individuals identify their behavioral triggers and learn techniques to manage their responses. Therapy can be done individually or in groups, and its cost generally ranges from $65 to $250+ per hour. However, these rates could be lower for those who have insurance.
- Medication: Medications that help reduce impulsive behavior or aggression in people with IED include antidepressants like selective serotonin reuptake inhibitors (SSRIs), mood stabilizers, antipsychotics, and antianxiety drugs. The cost of medications for IED treatment range from $10 to $100 for a month’s supply. However, prices may vary based on a patient’s insurance and whether the generic or a brand-name medicine was prescribed.
- Alternative treatments: Alternative treatments for intermittent explosive disorder mainly involve making lifestyle changes such as adopting a healthy diet, getting a full night’s sleep, exercising regularly, practicing mindfulness techniques, and seeking treatment for substance use disorder. Although there is little evidence about the effectiveness of lifestyle adjustments in treating IED, these interventions could still make emotional management easier and they are not likely to have negative side effects.
Is Intermittent Explosive Disorder easy to treat?
No, intermittent explosive disorder is not easy to treat. If a person tries to deal with the condition by themselves, it may be extremely challenging because they have no control over their outbursts and they may also be dealing with the lingering effects of unresolved childhood trauma.
That said, the best way to cope with the symptoms of IED is by seeking out professional help from a mental health professional and following their treatment plan. One should avoid missing therapy sessions and practice taking their medications as prescribed by the doctor. After all, intermittent explosive disorder in adults is most often treated with a combination of medication and therapy.
AHMED ZAYED, MD
Ahmed Zayed, MD, is a physician, an author, and a fitness lover, and he has a deep-seated desire to assist others in leading happier and more fulfilling lives.
Dr. Ahmed Zayed, who received his degree in medicine and surgery from the University of Alexandria, is committed to sharing his expertise with his audience and believes that readers deserve accurate information.
Dr. Zayed has the ability to explain difficult ideas in a way that a layperson can understand while still incorporating a scientific perspective into the discussions that surround those ideas.