“Temper’s the one thing you can’t get rid of by losing it.” – Unknown

Intermittent Explosive Disorder (IED) is a disorder of behavior characterized by repeated episodes of extreme anger, oftentimes to the point of violence, way out of proportion to the actual situation.  It is formally categorized as an impulse control disorder (as are pathological gambling, pyromania, and others).  Individuals with IED may attack others, as well as objects, causing significant bodily injury and property destruction.  These explosive episodes typically last from ten to twenty minutes, and may occur in clusters or can be separated by weeks, or even months, of well-controlled behavior.  Temper tantrums, road rage, domestic abuse and anger outbursts involving throwing and/or breaking things may well be signs of IED.  Following the violent outbursts many who suffer from IED feel deep regret, remorse and embarrassment.

According the current standard psychiatric diagnostic manual the formal diagnosis of IED is made when a person has demonstrated at least three episodes of marked impulsive aggressiveness which is “grossly out of proportion to any precipitating psychosocial stressor,” at any time throughout their life.  The individual has to have “all of a sudden lost control and broke or smashed something worth more than a few dollars…hit or tried to hurt someone…or threatened to hit or hurt someone.”  The disorder typically begins during adolescence and often precedes a later diagnosis of depression, anxiety, alcohol and drug abuse disorders by increasing stressful life experiences, such as divorce and financial challenges.  People with IED are often viewed by others as always being angry.  These individuals are also at increased risk of school suspension, job loss, divorce and incarceration as a result of their disorder.  The violent behavior is also not only directed at others.  In fact, those who suffer from IED are at considerably increased risk of harming themselves either by intentional injuries or actual suicide attempts.

There are a number of signs and symptoms that may accompany or precede episodes of aggression in Intermittent Explosive Disorder including:

• Rage
• Tremors
• Irritability
• Chest tension
• Palpitations
• Escalating levels of energy
• Headache
• Tingling

Although the actual cause of Intermittent Explosive Disorder is not known it is likely the result of a number of biological and environmental factors.  A majority of individuals suffering from IED have grown up in families where verbal and physical abuse was commonplace and explosive behavior witnessed on a somewhat regular basis.  Exposure to this type of violence at an early age, and on a rather routine basis, makes it more likely for these children to demonstrate very much the same behaviors as they grow up.  Additionally, there may be a genetic component in part contributing to the disorder being handed down through the generations.  There may also be a difference in the way serotonin, a widely found neuro-chemical messenger, works in the brain of people afflicted with this disorder.  There has also been some association identified between higher levels of testosterone and the presence of IED.

A 2006 study found that over 80 percent of patients diagnosed with IED also had one of these other diagnoses, yet less than 30 percent received any sort of treatment for their anger problems.  The lead author of the study, Ronald Kessler, Ph.D. from Harvard Medical School, further interpreted the results to suggest that early treatment intervention addressing the patient’s anger may well prevent some of the co-occurring psychiatric disorders from developing.  Another study of over 9,200 adults, funded by the National Institute of Mental Health (NIMH), found that depending upon how broadly Intermittent Explosive Disorder is defined may affect as many as 7.3% of those studied – 11.5 to 16 million Americans – in their lifetimes.  Twelve-month occurrences were reported at a level of 3.9%.

Several factors have been identified that may increase the risk of developing Intermittent Explosive Disorder:

• A history of childhood physical abuse
• A history of substance (drugs and/or alcohol) abuse
• Age – IED is most commonly diagnosed in teens and 20s.
• Men are much more likely to be diagnosed with IED
• The presence of another serious mental health disorder

The key to preventing Intermittent Explosive Disorder is early diagnosis and effective intervention.  Given its rather early age of onset identifying kids in some sort of school-based program related to violence prevention and then providing early treatment might well diminish the outward manifestations of the disorder.

The treatment of Intermittent Explosive Disorder is best attained with the combination of psychiatric medication and cognitive behavioral therapy (CBT).  The CBT works by helping the patient recognize the explosive impulses in the hope that the identification and awareness can help in controlling the rage episodes, as well as addressing the emotional stress that goes along with the outbursts.  Cognitive Relaxation and Coping Skills Therapy (CRCST), a form of CBT, has shown some early study success in treating IED in both individual and group setting.

Psychiatric medication, primarily selective serotonin reuptake inhibitors (SSRIs) and mood stabilizers have shown to lessen the overt symptoms of IED.  Anti-anxiety medications have also been shown to help diminish tension and may also be helpful in controlling explosive outbursts.

If left untreated, IED typically worsens to the point where the person’s life, and the lives of those around them, is seriously affected.  With medication and psychotherapy one can escape the serious consequences of this disorder and live a more stable and rewarding life.  So, if you believe a friend or loved one may be afflicted with Intermittent Explosive Disorder, encourage them to seek appropriate psychiatric treatment.  There are many highly qualified and capable psychiatrists, psychologists, and therapists with the Tri-Counties area that can effectively assist those suffering from this disorder.