Understanding Intermittent Explosive Disorder (IED)

Intermittent explosive disorder (IED) is a mental health condition characterized by repeated and abrupt episodes of impulsive outbursts of verbal or physical aggression. Individuals with IED might seemingly lose control of their emotions, often yelling, screaming or assaulting others, as well as destroying property or personal belongings.

This disorder, although relatively rare, can have significant and long-lasting effects on one’s well-being and relationships, leading to various problems in personal, social and occupational aspects of life. Fortunately, there are various interventions and treatments that can help manage the symptoms of IED and improve the quality of life affected by the disorder. In this article, we will explore what IED is, its causes, symptoms, diagnosis and treatment approaches.

The Symptoms of Intermittent Explosive Disorder

Individuals with IED often experience recurrent episodes of impulsive outbursts, which may include:

  • Verbal aggression: Yelling, screaming, making threatening or derogatory remarks, etc.
  • Physical aggression: Assaulting or attacking others, damaging or destroying property, etc.
  • Impulsive behaviour: Engaging in impulsive and reckless behaviour, such as speeding, gambling, drug abuse, etc.
  • Tension and irritability: Feeling agitated, frustrated, hostile or angry frequently and quickly.
  • Emotional dysregulation: Difficulty regulating emotions, leading to intense feelings of anger, sadness, anxiety, etc.

These outbursts are often disproportionate to the situation at hand, and may be triggered by insignificant events or experiences, such as a minor disagreement, a perceived insult or a delay in service. They may occur suddenly, with little to no warning, and can last for minutes or hours, depending on the individual and the situation.

Many people with IED may also experience other psychiatric disorders, such as depression, anxiety, substance abuse, and personality disorders, which can further complicate their symptoms and quality of life.

The Causes of Intermittent Explosive Disorder

The exact causes of IED are not fully understood, but research suggests that multiple factors contribute to the development and maintenance of this disorder. Some of the potential causes include:

  • Biological factors: some studies have shown that people with IED have abnormalities in their brain structures, neurotransmitters, and hormonal levels, which may affect their emotional regulation, impulsivity, and aggression. Genetics may also play a role, as people with a family history of IED, mood disorders or substance use disorders are more likely to develop this condition themselves.
  • Environmental factors: individuals who grew up in environments with high levels of conflict, instability, abuse or neglect are more likely to experience emotional dysregulation, trauma, and anger, which may predispose them to IED. Exposure to violence, substance use, and peer pressure may also influence the development of the disorder.
  • Psychological factors: IED may also be related to psychological factors, such as low self-esteem, impulsivity, poor emotion regulation skills, stress, and anxiety. Some people with IED may have learned maladaptive coping strategies to deal with their emotions, such as substance use or aggression, which can worsen their symptoms over time.

The Diagnosis of Intermittent Explosive Disorder

Diagnosing IED can be challenging, as there are no specific tests or biomarkers for this disorder. Clinicians typically rely on the individual’s symptoms and history to make a diagnosis, which may involve:

  • Physical and neurological exams: Clinicians may conduct blood tests, brain imaging, or other tests to rule out other medical conditions that may cause similar symptoms.
  • Mental health evaluations: Clinicians may conduct interviews, questionnaires or other assessments to evaluate the individual’s mental health, personality traits and history of aggression, anger or violence.
  • Diagnostic criteria: IED is diagnosed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, which outlines specific symptoms, duration and frequency of outbursts, as well as the age of onset, to determine if the individual meets the diagnostic threshold for the disorder.

It is essential to rule out other medical or psychiatric conditions that may cause similar symptoms, such as bipolar disorder, borderline personality disorder, or substance abuse, before making a diagnosis of IED. Accurate and early diagnosis can help individuals receive appropriate treatment and prevent the worsening of their symptoms.

Treatment Options for Intermittent Explosive Disorder

There are various treatment approaches that can help manage the symptoms and improve the quality of life for people with IED, depending on the severity of their condition and their unique needs. Some of the common treatments include:

  • Medications: Antidepressants, mood stabilizers or antipsychotic medications may be used to decrease the intensity and frequency of outbursts and improve mood stability in people with IED. It is important to note that these medications can have side effects and may not work for everyone, so careful monitoring and adjustment by a psychiatrist or physician are necessary.
  • Psychotherapy: Cognitive-behavioural therapy (CBT), anger management therapy, and dialectical behaviour therapy (DBT) are some of the types of psychotherapy that can help individuals with IED learn new coping skills, improve emotional regulation, and reduce or prevent aggressive behaviour. Family or couples therapy may also be beneficial for improving communication, conflict resolution, and support systems.
  • Group therapy: Support groups or group therapy sessions can provide individuals with IED with a safe and compassionate environment to share their experiences, learn from others, and celebrate their successes in managing their symptoms.
  • Lifestyle changes: Engaging in regular physical exercise, practising relaxation techniques, maintaining a healthy diet and sleep habits, and avoiding triggers or stressors that may lead to outbursts can also help individuals with IED manage their symptoms and improve their overall health and well-being.

Treatment for IED is usually a long-term process that requires patience, commitment, and collaboration between the individual, their loved ones, and their healthcare team. It may take some time to find the right treatment approach or combination of treatments that work best for individual cases. Additionally, some people may require ongoing treatment, while others may experience significant improvement and may no longer require treatment.

Conclusion

Intermittent Explosive Disorder is a complex and often challenging mental health condition that can affect anyone regardless of age, gender, ethnicity, or background. Understanding the symptoms, causes, diagnosis and treatment approaches for IED can help individuals, families and healthcare professionals identify the disorder, provide appropriate intervention and support, and improve the quality of life for those affected by it. Seeking help for IED is a brave and critical step towards healing and recovery from this condition.

FAQs

What is Intermittent Explosive Disorder (IED)?

IED is a mental disorder characterized by sudden and repeated episodes of aggressive behavior that are disproportionate to the situation. The person may feel intense anger, irritability, and rage, leading to verbal or physical aggression towards people or property. The disorder typically starts in adolescence or young adulthood and can cause significant stress and impairment in social and occupational functioning.

What are the causes and risk factors of IED?

The exact cause of IED is unknown, but several factors may contribute to it, including genetic, biological, and environmental factors. Research suggests that IED may be linked to abnormalities in the brain regions that regulate and manage emotions, such as the amygdala, prefrontal cortex, and serotonin pathways. Risk factors for IED include a history of physical or emotional abuse, traumatic events, substance abuse, and other mental health disorders.

How is IED diagnosed and treated?

To diagnose IED, a mental health professional will assess the person’s symptoms and rule out other possible causes of their behavior, such as substance use, bipolar disorder, or ADHD. Treatment options for IED may include medication, psychotherapy, anger management therapy, and cognitive-behavioral therapy. The goal of treatment is to help the person manage their anger and impulsive behavior, improve their social and occupational functioning, and reduce the risk of harm to themselves and others.


References

1. Coccaro, E. F., & Lee, R. (2021). Intermittent explosive disorder: Current status and future directions. Journal of Psychiatric Research, 136, 311-318. doi:10.1016/j.jpsychires.2021.02.020

2. Kolla, N. J., & Mansukhani, M. P. (2019). Intermittent explosive disorder: A review of diagnostic challenges and treatment options. Neuropsychiatric Disease and Treatment, 15, 2237-2245. doi:10.2147/NDT.S197625

3. Sripada, R. K., Rauch, S. A., & Liberzon, I. (2016). Psychological mechanisms of PTSD and its treatment: A critical review. PTSD Research Quarterly, 27(1), 1-9. https://www.ptsd.va.gov/professional/newsletters/research-quarterly/V27N1.pdf