Intermittent explosive disorder
What is it?
- Intermittent explosive disorder is characterized by repeated episodes of aggressive, violent behavior in which you react grossly out of proportion to the situation. Road rage, domestic abuse, and angry outbursts or temper tantrums that involve throwing or breaking objects may be signs of intermittent explosive disorder (IED).
- People with intermittent explosive disorder may attack others and their possessions, causing bodily injury and property damage. Later, people with intermittent explosive disorder may feel remorse, regret or embarrassment.
- If you have this anger disorder, treatment may involve medications and psychotherapy to help you control your aggressive impulses.
Explosive eruptions, usually lasting 10 to 20 minutes, often result in injuries and the deliberate destruction of property. These episodes may occur in clusters or be separated by weeks or months of nonaggression.
Aggressive episodes may be preceded or accompanied by:
- Increased energy
- Chest tightness
- Headache or a feeling of pressure in the head
The exact cause of intermittent explosive disorder is unknown, but the disorder is probably caused by a number of environmental and biological factors.
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.
There may also be a genetic component, causing the disorder to be passed down from parents to children.
Additionally, there may be differences in the way serotonin, an important chemical messenger in the brain, works in people with intermittent explosive disorder. Higher levels of the hormone testosterone have been associated with intermittent explosive disorder.
A number of factors increase your risk of developing intermittent explosive disorder:
- Having another mental health problem. People with other mental illnesses — such as mood or anxiety disorders — may be more likely to also have intermittent explosive disorder.
- A history of substance abuse. People who abuse drugs or alcohol have an increased risk of intermittent explosive disorder.
- Age. Intermittent explosive disorder is most common in people in their teens and 20s.
- Being male. Men are far more likely to have intermittent explosive disorder than are women.
- A history of physical abuse. People who were abused as children have an increased risk of intermittent explosive disorder.
- The violent behavior that is part of intermittent explosive disorder is not always directed at others. People with this condition are also at significantly increased risk of harming themselves, either with intentional injuries or suicide attempts.
- Those who are also addicted to drugs or had another serious mental disorder, such as depression, are at the greatest risk of harming themselves.
- People with intermittent explosive disorder are often perceived by others as always being angry. Other complications of intermittent explosive disorder may include job loss, school suspension, divorce, auto accidents or incarceration.
To be diagnosed with intermittent explosive disorder, your doctor will ask you about your behavior to see if you meet the criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM) for intermittent explosive disorder. This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.
DSM criteria include:
- Multiple incidents in which the person failed to resist aggressive impulses that resulted in deliberate destruction of property or assault of another person.
- The degree of aggressiveness expressed during the incidents is completely out of proportion with the precipitating event.
- The aggressive episodes aren't accounted for by another mental disorder and are not due to the effects of a drug or a general medical condition.
Other conditions that must be ruled out before making a diagnosis of intermittent explosive disorder include delirium, dementia, borderline personality disorder, antisocial personality disorder, schizophrenia, a manic episode, substance abuse or withdrawal, head trauma, seizures, or intoxication.
People with intermittent explosive disorder may also show some minor irregularities in neurological signs and electroencephalograms (EEGs). An EEG is a noninvasive test that measures the electrical activity in your brain.