Intermittent Explosive Disorder: Why IED Isn't About Anger Issues (2022)

If you notice that your anger is greatly affecting you or others, and you can’t control it, intermittent explosive disorder (IED) may be one possible explanation.

Intermittent explosive disorder is a formal mental health diagnosis characterized by outbursts of intense anger or aggression that would be considered disproportionate to the situation at hand.

Perhaps you feel as if anger is controlling you despite your efforts to manage it. Maybe your loved ones have expressed concern about your impulsive aggression. Some people may have told you that you have “anger issues.”

During an episode of intermittent explosive disorder, you may:

  • lash out verbally
  • become physically violent
  • destroy property

Whatever the case may be, if you feel you need support in managing anger outbursts, there are several treatment options for IED, and help is available.

Possible examples of intermittent explosive disorder behavior

  • driving someone off the road for cutting you off
  • flipping a table when you feel criticized by your partner
  • screaming at a co-worker for correcting you in a meeting
  • punching a hole in the wall when your roommate wakes you up

In order to reach a diagnosis of IED, a mental health professional would explore if you meet these criteria:

  • at least three incidents of verbal aggression in the past 3 months or,
  • three incidents of destructive physical aggression in the last 12 months

If the episodes of verbal or physical aggression are considered nondestructive or nondamaging, the mental health professional will try to establish if they’ve occurred an average of twice weekly for the last 3 months.

Difference between IED and DMDD

The symptoms of disruptive mood dysregulation disorder (DMDD) are similar to those of IED, but that diagnosis is specifically reserved for children above the age of 6 and under the age of 18, according to the National Institute of Mental Health (NIMH).

Other signs you may be living with intermittent explosive disorder include:

  • fighting often without cause
  • hurting people or animals
  • engaging in physical assault
  • kicking in doors
  • punching walls
  • road rage incidents
  • temper tantrums
  • throwing or breaking objects
  • verbal tirades
  • yelling and screaming

For some people living with IED, these symptoms may seem to appear with little or no warning, like a wire has been tripped, and tend to go away after 30 minutes or so.

“Anger issues“

The term “anger issues” not only oversimplifies IED, but it’s laden with stigma.

Like any other mental health condition, intermittent explosive disorder is complex. It’s not as simple as just failing to control your anger.

Instead, it may be helpful to think of IED as a biological adaption to previous stress or trauma, like an overreactive fight response.

It can be your brain’s way of automatically responding to information that it deems threatening. It’s just trying to protect you, and this is the way it’s learned to do so until now.

Yes. Intermittent explosive disorder is a formal diagnosis in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) under the category of disruptive, impulse control, and conduct disorders.

This diagnosis may be given to folks who experience difficulty controlling the expression of their emotions, even when it causes harm to themselves or others.

Impulse control disorder includes conditions like:

  • pathological gambling (PG)
  • kleptomania (KM)
  • trichotillomania (TTM)
  • intermittent explosive disorder (IED)
  • pyromania

If your brain were a car, think of impulse control as the brake system. Impulse control is the cognitive function that creates space between how you feel and the action you want to take.

For those who live with impulsive control disorders like IED, the impulse to act overrides this brake system and pushes on the gas pedal instead.

Like many mental health conditions, intermittent explosive disorder may be caused by a combination of psychosocial stressors, genetics, and life experiences.

Research shows that IED is linked to:

  • being exposed to multiple traumatic events
  • physical abuse in childhood
  • personality disorders
  • post-traumatic stress disorder (PTSD)

Trauma can lead to changes in the brain.

Researchers have noted that PTSD can cause reductions in gray matter, specifically.

Gray matter is what helps you control your emotions and memories, among other functions.

So far, research suggests that those who live with IED have a lower volume of gray matter and increased activity in the amygdala (the brain’s fire alarm) than folks not living with IED.

There’s no medication for anger. In fact, the Food and Drug Administration (FDA) has not approved any treatment for IED. Researchers are still trying to pin down the ins and outs of this condition.

However, other traditional therapies may help you manage IED symptoms.

Psychotherapy

Research for cognitive behavioral therapy and IED looks promising so far, though more studies are needed.

Cognitive behavioral therapy (CBT) can help you identify distressing thought patterns and learn how they may be impacting your behaviors. You may also learn coping skills, relaxation techniques, and communication skills.

Dialectical behavioral therapy (DBT) may also be a useful option. One study found that this modality was effective in treating explosive anger in those with borderline personality disorder, a mental health condition that’s also related to trauma.

Anger management training

Some research suggests that emotional regulation training and anger management classes can improve symptoms of IED.

These courses may help you learn how to respond to a situation in a less distressing way while directly communicating your feelings.

A therapist may be able to refer you to anger management training or support groups in your area. Several online options include certifications and other courses on anger management.

Medication

Although there’s no medication for “anger,” a few pharmaceutical options could help.

A mental health professional may want to address overlapping symptoms that may be contributing to your emotional regulation challenges.

Not all cases are the same, and medication isn‘t recommended for everyone.

Some common options your health professional may discuss with you include:

  • antidepressants
  • anti-anxiety medications
  • antipsychotic medications
  • mood stabilizers

Deep brain stimulation

One small study found that stimulating the part of the brain (called the hypothalamus) that’s responsible for regulating basic functions like temperature, hunger, and thirst could improve symptoms of IED for some people, with continued success after 3, 6, and 12 months.

Deep brain stimulation (DBS) is a surgical procedure that implants a device to send out electrical currents in a certain region of your brain.

Lifestyle adjustments

Researchers have yet to really dig into how lifestyle changes may impact IED, but there are several evidence-based strategies that could help you manage your emotions.

These include:

Yoga and meditation

While more research is needed in this area, one study found that children with a range of conditions, including IED, showed decreased impulsivity after participating in early-morning yoga sessions.

Yoga can also help reduce markers for stress associated with the fight, flight, or freeze response, like lowering your blood pressure and reducing your heart rate.

Over time, research shows that mindfulness-based activities like yoga and meditation can also increase the volume of gray matter in the brain, which (as discussed earlier) is commonly lower in those living with trauma and IED.

When anger becomes difficult to control, it may be a symptom of IED, an impulse control disorder.

While researchers don’t yet know what causes this condition, it appears to be a combination of genetic and environmental factors, specifically related to trauma. It is much more complex than just “anger issues.“

IED treatment may include the help of a trusted therapist, medication, lifestyle adjustments, and self-care strategies.

It may take time and some hard work to rewire your brain and develop new coping skills, but healing is indeed possible.

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