Intermittent Explosive Disorder: A Complete Guide

Do you ever feel impulsive or aggressive? Do have screaming fits of rage out of proportion to the situation? Do you engage in physical or verbal violence? If you answered yes to any of these questions, you could be suffering from an intermittent explosive disorder—a behavioral disorder that causes explosive episodes of unwarranted anger. Becoming aware of the symptoms, pathophysiology, and the risk factors for the intermittent explosive disorder are essential to managing the condition.

Intermittent Explosive Disorder
Intermittent Explosive Disorder

What is Intermittent Explosive Disorder?

Intermittent explosive disorder is a mental health condition characterized by episodes of violent, impulsive, angry outbursts without provocation. It can be classified as an impulse control disorder because someone with the disorder cannot resist aggressive urges. Children, adolescents, and 7.3% of American adults suffer from it throughout their lifetime.

During an episode, individuals lose control of their emotions. Many with an attack and threaten others, animals, or objects. Their violence may pose injury to themselves or property. Episodes last 30 minutes or less. Some have episodes frequently, while others have sporadic episodes. Although the outbursts provide relief from their frustrations at the moment, they feel remorse for their behavior afterward.

Behavioral Symptoms of Intermittent Explosive Disorder

The primary symptoms are behavioral. Before an outburst, mood swings are commonly reported. Irritability, easy frustration, and a strong sense of loss of control proceed the following signs and symptoms of an outburst:

  • Rage
  • Anger
  • Irritability
  • Threatening others
  • Increased energy
  • Temper tantrums
  • Assaulting people and/or animals
  • Racing thoughts
  • Emotional detachment
  • Attempted suicide
  • Acts of self-harm
  • Poor concentration
  • Shame and guilt

The behavioral changes in an episode lead to a variety of emotional, social, and cognitive repercussions. Individuals are prone to inflicting damage on the property of others, frequent fighting, difficulty with academics, and road rage.

Physical symptoms of Intermittent Explosive Disorder

While the symptoms are mainly psychological due to impulsive violent behavior, physical symptoms manifest when the autonomic nervous system is activated by the release of adrenaline. Physical symptoms are:

  • Tremors
  • Chest tightness
  • Palpitations
  • Fatigue
  • Pressure in head
  • Hearing changes
  • Muscle tension
  • Tingling
  • Headache

Causes of Intermittent Explosive Disorder

Scientists have yet to locate a gene that causes it, so the overall origin is unknown. It is thought to occur from a combination of genetic, environmental, and physical risk factors.

Those with a first degree relative are at risk of developing the condition. Witnessing violence at an early age (i.e. fights between parents and siblings) or experiencing a traumatic event also makes one susceptible. Males are diagnosed more than females.

Brain Abnormalities in Intermittent Explosive Disorder

Neuroscientists from the University of Chicago (2016) confirmed that individuals with it have less white matter volume in the superior longitudinal fasciculus. The superior longitudinal fasciculus is the area of the brain that connects the frontal lobe to the parietal lobe, which is crucial for emotion, decision making, and understanding the consequences of actions. White matter abnormalities decrease the connectivity of the brain. When proper signals are miscommunicated, the result is sometimes intermittent explosive behaviors. Variances in the brain’s neurotransmitters (i.e. serotonin), the brain’s chemical messengers, influence behavior in it too.  

Disorders Related to Intermittent Explosive Disorder

Symptoms are challenging to pinpoint because of the significant overlap between additional mental health disorders. According to the Cleveland Clinic, 82 percent have an underlying mental condition.  

Bipolar Disorder

Bipolar disorder is a mental condition causing extreme shifts in mood, energy, and activity levels throughout depressive lows alternating with manic highs. Studies found a subset of intermittent explosive patients with bipolar mania who demonstrated a favorable response to mood stabilizing drugs, suggesting an association with the two conditions (McElroy).  

Depression

Depression is persistent sadness occurring longer than 2 weeks. Feelings of hopelessness, insomnia, and a loss of interest in activities are also signs of this serious mental disorder. Major depressive disorder is intermittent explosive disorder’s most frequent co-morbid condition. Researchers proved that patients with depression and this disorder had higher assault scores and increased hostile behavior (Medeiros, Seger, Grant, & Tavares, 2018). Managing depression symptoms is important for controlling intermittent explosive disorder.

Substance Abuse, Alcoholism, and Addiction

Substance abuse disorders are a pattern of drug and alcohol use that interferes with daily life—work, relationships, and health. Dependence on substances increases the risk of aggressive behavior. The exact correlation is not understood, but experts hypothesize that individuals resort to drugs and alcohol to cope with their intermittent explosive behaviors.

Attention Deficit Hyperactivity Disorder (ADHD)

Attention deficit hyperactivity disorder is a neurodevelopmental disorder causing inattention, hyperactivity, and impulsiveness. It also affects impulse control. Those with ADHD tend to have problems regulating emotions, which includes anger. In severe cases, the inability to control anger leads to intermittent explosive disorder.

Anxiety Disorders

Anxiety disorders are a group of mental illnesses sharing symptoms of restlessness, worry, and over-concern out of proportion to the situation which impedes functioning. This disorder predisposes one to anxiety. Adolescents with anxiety have a 22.9% higher prevalence of anger attacks (Keyes, 2017). Examples include panic attacks, post-traumatic stress disorder, and obsessive-compulsive disorder—the latter being particularly prevalent amongst those with this disorder.

Oppositional Defiant Disorder (ODD)

Oppositional defiant disorder is a childhood behavioral disorder. Children with ODD are defiant, disobedient, and hostile towards authority figures, parents, teachers, and peers. It differs from intermittent explosive disorder in the fact that outbursts may not consist of explosive rages, but patterns of anger, arguing, and vindictiveness instead. It is not rare for a child to have both disorders.

Personality Disorders

Personality disorders have a strong relationship with this disorder. However, professionals argue if a diagnosis of intermittent explosive disorder is accurate if outbursts are the result of a personality disorder like antisocial personality disorder, borderline personality disorder, or schizophrenia.

Intermittent Explosive Disorder in Adolescence

It is most common in younger individuals. 14 is the average age of diagnosis. The beginning signs typically appear in childhood after 6 years of age and continue throughout adolescence. To receive the necessary professional treatment, behaviors should not be dismissed as teenage rebellion.

Parenteral involvement is important in adolescent cases of intermittent explosive disorder. Parents must be cautious in their responses, as negative beliefs about parenteral punishments can fuel explosive behaviors. In comparison to adults with the disorder, adolescents are increasingly susceptible to engaging in risky behaviors. They are also at a greater risk for suicide during this sensitive developmental period.

Intermittent Explosive Disorder in Adolescence
Intermittent Explosive Disorder in Adolescence

Intermittent Explosive Disorder Diagnosis

Diagnosing this disorder relies on medical history, psychiatric history, and physical and psychological examinations. The purpose of the examination is to rule out physical or mental conditions that mimic the symptoms of an outburst.

Mental health professionals diagnose it using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The following DSM-5 criteria are based on the failure to resist aggressive impulses manifested in one of two ways:

  • Verbal aggression such as temper tantrums, arguments, or fights; or physical aggression directed at people, animals, or property that occurs twice per week for three or more months. Physical aggression does not damage property or physically injure people or animals.
  • Three behavioral outbursts within a 12 month span resulting in damage or destruction of property and/or physical assault that physically injures people or animals.

Outbursts are out of proportion to the situation, cause distress that impairs functioning, cannot be premeditated, or explained by another mental disorder. The diagnostic criteria only applies to patients who are over 6 years of age.

Intermittent Explosive Disorder Treatment

Intermittent explosive disorder has no cure. Management of symptoms is achievable through cognitive behavioral therapy and pharmaceutical regimens.

Medications

Although there are no medications specifically intended for intermittent explosive disorder, pharmaceutical medications decrease the intensity of outbursts, as well as impulsive behavior and aggressive tendencies.

  • Antidepressants—Selective serotonin reuptake inhibitors (SSRIs) are a class of antidepressant drugs that increase the amount of serotonin in the brain.
  • Anticonvulsant mood stabilizers—Lithium, valproic acid, and carbamazepine are prescribed to reduce the incidence of outbursts.
  • Antianxiety—Antianxiety medications like benzodiazepines treat secondary anxiety disorders and are best used in acute outbursts.
  • Antipsychotics—Antipsychotic drugs target anger and aggression.

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy is the main type of psychotherapy implemented in intermittent explosive disorder treatment. Cognitive-behavioral therapy works on the principle that unhelpful thinking patterns influence problematic behaviors.

For treating this disorder, a therapist assists patients in identifying triggers for their outbursts. Therapy teaches strategies for an individual to control their anger like relaxation training and cognitive restructuring. A study published in the Journal of Consulting and Clinical Psychology (2008) states that cognitive-behavioral therapy reduced aggression, anger, hostile thinking, and depressive symptoms while improving anger control in those with this disorder. Family members or teachers may be a further asset to cognitive behavioral therapy, as they provide the opportunity to practice effective communication.

Coping Mechanisms

While medications and therapy are essential components to intermittent explosive disorder treatment, coping mechanisms are just as therapeutic. Lifestyle adjustments promote a healthy wellbeing, which has positive benefits on symptoms.

A balanced diet and getting enough sleep at night are great starting points in adopting a healthy lifestyle. Next, incorporating exercise is fundamental. Physical activity triggers the release of endorphins and neurotransmitters that decrease aggressive impulses. Engaging in meditation is perfect for being proactive in intermittent explosive disorder management.

References

Keyes, K. M., McLaughlin, K. A., Vo, T., Galbraith, T., & Heimberg, R. G. (2016). ANXIOUS AND AGGRESSIVE: THE CO-OCCURRENCE OF IED WITH ANXIETY DISORDERS. Depression and anxiety, 33(2), 101–111. doi:10.1002/da.22428

McCloskey, M. S., Noblett, K. L., Deffenbacher, J. L., Gollan, J. K., & Coccaro, E. F. (2008). Cognitive-behavioral therapy for intermittent explosive disorder: A pilot randomized clinical trial. Journal of Consulting and Clinical Psychology, 76(5), 876-886. http://dx.doi.org/10.1037/0022-006X.76.5.876

McElroy SL (1999). Recognition and treatment of DSM-IV intermittent explosive disorder. Journal of Clinical Psychiatry, 60, 12–16.

Medeiros, G.C., Seger, L., Grant, J.E., & Tavares, H. (2018). Major depressive disorder and depressive symptoms in intermittent explosive disorder. Psychiatry Research, 262, 209-212.  https://doi.org/10.1016/j.psychres.2018.02.001

University of Chicago Medical Center. (2016, July 6). People with anger disorder have decreased connectivity between regions of the brain: Less integrity and density in the ‘information superhighway’ of the brain can lead to impaired social cognition. ScienceDaily. Retrieved July 28, 2019 from www.sciencedaily.com/releases/2016/07/160706175333.htm