Someone with Intermittent Explosive Disorder (IED), reacts to situations with unjust episodes of violent behavior and/or aggression. Signs of IED could include road rage, domestic abuse, temper tantrums that include breaking and/or throwing objects and angry outbursts. The individual may cause bodily injuries and damage during their attacks of other people and their possessions. Someone with intermittent explosive disorder will typically express and feel regret, embarrassment and or remorse following their violent outburst. People with IED will typically have some other problem relating to impulsive behaviors or anger that occurs between the episodes of explosive behaviors. Some individuals with IED are able to control their impulsive and aggressive behaviors without acting on the impulse, while others may act on the impulses, in a less destructive manner, such as screaming as opposed to physically attacking someone.
Diagnosis
Intermittent Explosive Disorder falls into a controversial category due to some professionals believing that the symptoms of IED, are symptoms of another diagnosis rather than its own disorder. A dual diagnosis is often given to those with intermittent explosive disorder because it is frequently associated with antisocial disorder, paranoid, narcissistic personality disorder, anxiety disorders, substance abuse and/or mood disorders. IED falls into the Impulse Control Disorders Not Elsewhere Classified category, in the DSM-IV
In order to be diagnosed with IED, the individual must have had a minimum of three explosive episodes that included impulsive aggressiveness that is grossly out of proportion to a precipitating stressor. The individual must have suddenly lost control and hurt someone, threatened to do violent harm or broke something that was of value. The aggressive episodes also could not be attributed to another psychiatric disorder, such as psychotic disorder, antisocial personality disorder and/or conduct disorder. The aggressive episode also could not have been attributed to the effect of street drugs, medications or alcohol and they may not be the result of a head trauma or other medical condition such as Alzheimer’s disease.
Signs & Symptoms
The explosive and eruptive behaviors usually last approximately ten to twenty minutes and most often result in an injury and/or the destruction of property. The explosive episodes may happen in clusters or the person will go for weeks and/or months with no aggressive behavior. IED is seen most often in young men with a history of frequent traffic accidents, sexual impulsivity and/or other vehicle moving violations. The majority of those with IED may have an extreme sensitivity to alcohol. The person may interpret the behavior of others as directed toward them. They may misinterpret ate someone’s friendliness as manipulative or malicious. The person will blame others for provoking their violence and may minimize his/her role in the angry outburst. Many describe the time before an episode as tense or arousal with relief and remorse immediately following the explosive behavior. The aggressive episode could include the following either before or after the episode:
Headache or pressure in the head
Rage
Increase in energy
Irritability
Heart palpitations or tightness in the chest
Shakiness
Tingling in their limbs
Rapid onset of depression
Fatigue
Difficulties in relationships
Loss of employment
Social impairment
Financial problems
Legal problems
Frequent hospitalizations from injuries due to fights/accidents
Risk Factors/Causes
Various factors could increase the risk of developing intermittent explosive disorder including, a history of substance abuse, another mental health disorder and a history of physical abuse. Although the exact cause of IED has not yet been determined, it is though to be a combination of a variety of environmental and biological factors, such as learned behavior, neurological abnormalities and/or biochemical abnormalities. Many individuals with this disorder were in family situations where physical and verbal abuse as well as explosive behaviors were common. It is also thought that high levels of the hormone, testosterone may be associated with IED.
Treatment
The recommended treatment for IED is a combination of medications and therapy as well as anger management sessions and group counseling. Medications typically include:
Antidepressants such as Prozac or Paxil
Anti-anxiety medications such as valium, xanax and ativan
Mood regulators such as inderal and lithium
Anticonvulsants such as neurontin, laical, dilantin and tegretol
Therapy
Cognitive behavioral therapy (CBT) is the most commonly used therapy in the treatment of IED. CBT helps those with IED to understand and learn to identify the behaviors or situations which trigger their aggression. During therapy the person will also learn ways to manager their anger and control their inappropriate response. CBT teaches the person with IED several exercises to utilize for the prevention of aggression, such as relaxation techniques and effective ways to verbalize their thoughts and feelings.
References
Psychology Today: Intermittent Explosive Disorder http://www.psychologytoday.com/conditions/intermittent-explosive-disorder
Psych Center: Intermittent Explosive Disorder http://psychcentral.com/disorders/sx51.htm
Mayo Clinic: Intermittent Explosive Disorder http://www.mayoclinic.com/health/intermittent-explosive-disorder/DS00730
Franz, Janie. “Intermittent Explosive Disorder.” Gale Encyclopedia of Children’s Health: Infancy through Adolescence. 2006. Retrieved November 28, 2010 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3447200315.html
