What Is Intermittent Explosive Disorder?
Everyone gets angry. But even if you occasionally explode, that is not necessarily a symptom of intermittent explosive disorder (IED), a behavioral disorder characterized by frequent fits of rage that are out of proportion.
Reviewed on May 1, 2019
What is Intermittent Explosive Disorder?
IED is a behavioral disorder characterized by repeated episodes of explosive rage that is disproportionate to the triggering situation, according to the Child Mind Institute. These episodes are normally intense and brief, lasting less than 30 minutes each. According to the Mayo Clinic, symptoms of IED might include:
- temper tantrums
- heated arguments
- slapping, shoving or pushing
- physical fights
- property damage
- threats or assaults to people or animals
These episodes are generally neither premeditated nor executed with a tangible objective, according to the Child Mild Institute. Instead, the person is unable to resist angry impulses. People with IED may describe feeling out of control. Some say there is a build up of tension in the head and chest prior to an episode. Once the episode has passed, they may feel a sense of relief and fatigue. They may also feel regret, remorse, or embarrassment.
In addition to rage, individuals with IED may experience increased energy, racing thoughts, tremors or a tingling feeling, and heart palpitations during the episode, according to the Mayo Clinic.
IED is a chronic condition, however the frequency and severity of episodes may decrease with age. Approximately 5 to 7 percent of Americans will experience IED at some time in their life, according to Harvard Health. It can severely interfere with daily life and cause problems in family and social relationships, as well as academic performance. Because of the potential for harm to themselves and others, IED patients often suffer medical and financial repercussions. The financial burden from property damage can add up quickly.
IED Risk Factors
On average, IED symptoms begin to appear by age 13 for males and by age 19 for females, according to Harvard Health. The majority of those diagnosed with IED are male. The exact cause of IED is not understood, however, the Child Mild Institute says the risk factors include:
- A prior history of physical and emotional trauma or abuse
- Biological family members with the disorder
- A history of other mental health disorders, such as borderline personality disorder or antisocial personality disorder
According to Psychology Today, “Most people with this disorder grew up in families where explosive behavior and verbal and physical abuse were common. Being exposed to this type of violence at an early age makes it more likely for these children to exhibit these same traits as they mature.”
When diagnosing IED, medical professionals should rule out other potential causes of explosive behavior, such as brain trauma, substance abuse, and other psychiatric illnesses.
People with IED are also at risk of developing other mental health conditions such as anxiety, depression, and substance abuse. They have a higher risk of self-harm and suicide, according to the Child Mild Institute.
There are two main types of treatment used for IED, according to the Child Mild Institute.
Therapy and counseling may include both the patient and his or her family. One of the mainstays of treatment is cognitive behavior therapy (CBT). During these sessions, therapists work to teach skills that can be applied throughout the person’s life. These include:
- Learning to recognize triggers and minimize their effect
- Recognize the warning signs of rage and create a plan of action
- Learn relaxation and problem-solving techniques
- Develop healthy outlets for anger
- Increase tolerance for frustration
- Improve communication skills
Counseling may also help the person to deal with past physical or emotional trauma, which may reduce some of the symptoms of IED.
The U.S. Food and Drug Administration has not approved any medications to specifically treat IED, however some off-label medications have been found to help its symptoms. These include some antidepressants, anti-anxiety medications, anticonvulsants, and mood stabilizers, according to the Child Mild Institute.
Many people with IED resist seeking treatment, according to Harvard Health. Fewer than 20 percent of those with IED are treated and many wait a decade or more after the initial symptoms appear to reach out for help. Some are diagnosed and treated for IED after seeking treatment for a different condition, such as substance abuse or depression. Some are treated for IED only after their violence escalates to a point where they are ordered by a court to receive treatment, or because their families insist on treatment as a condition of continuing to live in the family home.