Mental health disorders are often perceived to be rare and can only happen to a few people. Psychiatric disorders are genetically hereditary, environmentally acquired, and could be caused by various psychosocial stressors. Some of these are widespread and well known, but some are not usually discussed and less known. One of these mental disorder is intermittent explosive disorder.

There are about 200 forms of mental disorders that are classified in the Diagnostic and Statistical Manual of Mental Disorders 5th edition. The most commonly discussed are mood disorders, anxiety, and depression. The intermittent explosive disorder is one of those that are infrequently talked about.

Having a mental disorder can be emotionally and mentally draining, both to you and your loved ones. Not knowing anything about the disorder could make you feel worst. Read along with this article and equip yourself with the knowledge of the intermittent explosive disorder and your treatment options on how you can manage those aggressive impulses and outbursts.

Intermittent Explosive Disorder

The intermittent explosive disorder (IED) is defined as the repeated acts of sudden impulsive episodes of aggression and violent behavior. Also commonly known as the “flying into rage for no reason”. It is categorized under “Disruptive, Impulse and Conduct Disorders” of DSM-5 (Diagnostic and Statistical Manual of Mental Disorders).

A person with explosive disorder tends to be irrational and has a disproportionate reaction to situations. Their aggressive impulses and temper tantrums can negatively affect their relationships, social status and can lead to legal consequences.

The intermittent explosive disorder is more of an impulse control defect, and the outbursts premeditated, rapid onset usually lasts for less than 30 minutes. After an episode of rage, the individual would typically feel a sense of relief accompanied by guilt, regret, and embarrassment.

The American Psychiatric Association considers intermittent explosive disorder as a chronic disorder and problematic behavior. The aggressive behavior observed with people with IED can lead to physical injury and assault towards animals and other people.

This condition is typified by impulsivity, hostility, and recurrent outburst. Patients with IED need to “explode” with rage even without provocative reasons to feel relieved. Patients usually described the feeling of losing control over their emotions and how they think.

Patients suffering from IED may threaten or attack others verbally or physically. But IED is not diagnosed unless the person has already displayed not less than three episodes of impulsive aggressiveness.

Pathophysiology Of Intermittent Explosive Disorder

The impulsive behavior and the violent predisposition can be caused by the low serotonin in the brain. This can be indicated with a low concentration of 5-HIAA (serotonin metabolite 5-hydroxyindoleacetic acid) in the Cerebrospinal fluid.

The disorder may also be associated with the lesions of the prefrontal cortex and amygdala, which are both brain areas that control reactions and impulses. The damage can cause improper blood sugar control and decreased brain function, affecting decision-making and planning skills.

Symptoms of Intermittent Explosive Disorder

The aggressive behavior occurs suddenly without warning and lasts for half an hour. The behavioral symptoms usually happen frequently or can also be separated by months or weeks of nonaggression. 

Most patients have fewer verbal outbursts in between episodes of physical impulsive aggression. The aggressive outbursts are accompanied by physical symptoms such as:

  • Irritability
  • Rage
  • Racing thoughts
  • Tremors
  • Tingling sensation
  • Palpitations
  • Chest tightness
  • Shouting

The explosive behavior and the verbal outbursts are disproportionate to the situation and without concern to future consequences, such as:

  • Temper tantrums
  • Being argumentative
  • Physical aggression
  • Damaging property
  • Verbal aggression
  • Physical assault

Diagnostic and Statistical Manual of IED

How is an intermittent explosive disorder diagnosed? The diagnosis begins by taking the patient’s medical history and background. This is done by conducting a mental and physical status exam and psychiatric interview to rule out other mental health disorders.

To be able to diagnose the intermittent explosive disorder, the doctor will first try to rule out substance abuse and or any physical problems that can cause impulsive and aggressive behavior. The psychological evaluation is where the symptoms, feelings, and behavioral patterns are being talked about.

To be diagnosed with IED, a patient must display a failure to control aggressive outbursts that are defined by:

  • Verbal aggression, which includes verbal arguments and temper tantrums, or aggressive acts towards other people, animals, and property for a period of 3 months. The behavioral outbursts may not result in physical damage but can have financial or legal consequences.
  • Three episodes of property destruction or physical assault against animals or other people for a period of 12 months.

The degree of aggressiveness expressed during the outbursts should be greatly disproportionate to the situation and should not be pre-planned. In addition, the said outbursts should not be a result of other substance use disorders or can be explained by other mental health disorders.

In some studies, bipolar disorder is linked to increased agitation and impulsive behaviors. But the aggressiveness is limited to depressive and manic episodes. While with the intermittent explosive disorder, aggressiveness is experienced between positive or neutral moods periods.

The intermittent explosive disorder is defined in the DSM- 5 as a ‘brain disorder’ rather than a ‘personality problem’. Many consider this impulsive behavior as an attitude problem that only needs adjustments. Impulse control disorders, such as IED, can be harmful to oneself and others. It could result in impaired interpersonal relationships, occupational functioning, and other psychiatric disorders.

The degree of aggressiveness during the episode is grossly not appropriate to precipitating psychosocial stressors. Diagnosis of IED is made using the psychiatric interview to behavioral and affective symptoms to the criteria listed in the DSM.

The DSM 4- TR was specific in defining intermittent explosive disorder. The diagnosis requires:

  1. Several episodes of aggressive behaviors that were done impulsively that has resulted in serious damage to others
  2. The level of aggressiveness is grossly inappropriate to the situation and without provocation
  3. The episodes of violence can not be accounted for by other mental illnesses or medical conditions.

Causes and Risk Factors of Intermittent Explosive Disorder

The onset of the intermittent explosive disorder may begin during childhood or teenage years. The exact cause of the disorder is still unknown, but the biological and environmental factors still play an important role in developing the explosive disorder.

Genetic Factors

Just like other mental conditions and illnesses, the intermittent explosive disorder can also have a genetic component to it. The condition can be passed down for generations. People who have parents with a history of IED are proven to be at a higher risk of acquiring impulse aggression.

Environmental Factors

Some people with intermittent explosive disorder grew up in an environment where angry verbal outbursts and physical abuse were common. Experiencing this type of violence during childhood and going through the same traumatic events makes these children more likely to exhibit the same traits as they grow up.

Physical Factors

People with the intermittent explosive disorder have different brain function, chemistry, and structure from others who do not have this mental illness. This made researchers conclude that the differences explain that patients with intermittent explosive disorder behave and process information in a manner that they do since the brain area responsible for outside stimuli, motor function, and elicits anger responses is altered. Emotional complications could also trigger the onset of the intermittent explosive disorder in some people. Some of these are

Problems with Alcohol and Substance Abuse

People with Intermittent explosive disorder are five times greater risk for abusing substances such as alcohol and drugs as the severity of impulsive aggression increases, the levels of weekly and daily substance use increase as well.

Self Harm

Individuals diagnosed with intermittent explosive disorder accompanied by recurrent acts of impulsive aggression usually show evidence of self-harm. Some are due to the anxiety and embarrassment felt after an episode of outburst.

Impaired Interpersonal Relationships

People with intermittent explosive disorder often have episodes of physical aggression that are perceived by others as always being angry. They frequently involve themselves with verbal and physical abuse and actions that can later lead to divorce, family stress, and relationship problems.

Multiple Traumatic Events

Post Traumatic stress disorder is closely related to direct interpersonal aggression and severe outbursts. Patients with intermittent explosive disorder are characterized by impulsive aggressive behavior that helps identify individuals who are at risk for suicidal attempts.

The intermittent explosive disorder can have a negative impact on a person’s health and life. It can cause problems with marriages and personal relationships. It can also impair a person’s judgment at school and work. 

People with intermittent explosive disorders can develop other severe psychiatric illnesses, abuse drugs, and other prohibited substances. They are also at risk for other medical diseases such as chronic pain, hypertension, stroke, and diabetes. Those who are most at risk are:

  • Male gender
  • Children who are exposed to violence at a very early age
  • Exposure to aggressive and impulsive behaviors at home
  • Those who have experienced multiple traumatic events
  • Those who experienced emotional trauma
  • Those with a history of substance abuse
  • Certain medical condition

How to Prevent These Aggressive Impulses

Prevention of symptoms of intermittent explosive disorder is usually out of the patient’s control unless it is done with the help of mental health professional. Combined with therapy, drug treatment, and coping strategies, gaining control of one’s symptoms can be medically possible. Here are some ways to prevent symptoms and development of Intermittent explosive disorder:

Follow the Treatment Plan

By attending therapy sessions and practicing coping skills as advised by your mental health provider, intermittent explosive disorder treatment can be bliss. The doctor may suggest medication maintenance to prevent recurrent episodes of outbursts. 

Practicing Relaxation Skills

Relaxation techniques such as meditation and yoga can help diffuse uncontrollable rage. These exercises also reduce the stress that can be a factor that triggers the intermittent explosive disorder. You allow things to happen whenever you are not stressed. Yoga and meditation may hold the key to a life that has more peace and less anger. When you feel that you no longer have control over your emotions, being aware of your inner self can be beneficial.

Cognitive Restructuring

Try to develop your thinking process positively. Try undergoing cognitive behavioral therapy, where a mental health professional helps you change negative thoughts into more positive ones that will make you see the situation on a brighter side. Changing the way you see and think about a problematic situation using reasonable expectations and rational thoughts can improve how you react to any event.

Learning Ways on How You Can Improve Communication

Try to listen to the message that another person is trying to convey. Resist aggressive impulses and try understanding what the other person is trying to tell you. Then try to think of a more reasonable and positive response rather than saying the first thing that pops into your mind. Listening can also help the other person calm down as well. By taking time to listen can also give you time to think about the situation rationally.

Get Out of the Situation

If it is possible, try to get out or avoid situations that can trigger your aggressive outbursts. Walking away from the situation can help you clear your mind off it. Run some errands or take a walk and try to calm yourself down. Think about what is happening and take time to cool off.

Avoid Drugs, Alcohol, and Other Mood Altering Substances

All kinds of substances that can alter your mood can trigger your explosive disorder; avoid them. These substances can exaggerate your anger. Staying away from them, especially during events that potential conflicts are possible, is best.

Treatment of Intermittent Explosive Disorder

The intermittent explosive disorder can be cured if addressed immediately and with the right treatment. It is best treated by a combination of medications and cognitive behavioral therapy such as relaxation training, cognitive restructuring, and coping skills training.

Common Medications for this Type of Psychiatric Disorders

Fluoxetine is the most commonly used drug for the treatment of the intermittent explosive disorder. There are other types of drugs that are also recommended if fluoxetine fails; these are Phenytoin, Carbamazepine, and Oxcarbazepine. These classes of pharmaceuticals are also used in treating depression, anxiety, and as mood regulators.

Group Therapy

CBT can be effective in group therapy, but learning to interact with others and seeing others’ behavior through group therapy can be helpful and effective in reducing anger episodes.

Prognosis For People With Explosive Disorder

Having intermittent explosive disorder can lead an individual to severe depression and anxiety. It can also cause personal and relationship problems. Seeking medical help from mental health care professionals is important if you or a family member is suffering from this kind of disorder. With medication and proper cognitive behavioral therapy, this disorder can be easily managed. The intermittent explosive disorder is a long-term condition that lasts for 12-20 years, but it is curable.

People who have IED have reported that when they have released their pent-up tensions as a result of rage, they feel relief and calmness. Once the relief wears off, they feel remorse. IED can be disruptive, but it can be managed with the right people and treatment plans, right knowledge, anger management, and medications. 


Is Intermittent Explosive Disorder the Same as Bipolar?

No, intermittent explosive disorder and bipolar disorder are not the same. Individuals with bipolar disorder only show aggressive behavior during manic or depressive episodes, not while in positive or neutral moods. Meanwhile, individuals with the intermittent explosive disorder may show aggressive behaviors even in positive or neutral moods. 

Can You Have Intermittent Explosive Disorder and Borderline Personality Disorder at the Same Time?

Yes, people with borderline personality disorder have an increased risk of developing the intermittent explosive disorder. Other mental health conditions that are manifested by disruptive behaviors like anti-social personality disorder and attention-deficit/hyperactivity disorder (ADHD) also have an increased risk of developing the intermittent explosive disorder. 

How Do You Calm Someone With Intermittent Explosive Disorder?

To calm someone with the intermittent explosive disorder, you can use techniques like active listening, emphatic statements, and emotional detachment. Additionally, Cognitive Behavioral Therapy (CBT) combined with prescription medication of selective serotonin reuptake inhibitors (SSRIs) are proven effective in treating intermittent explosive disorder. 

Is IED an Anxiety Disorder?

Yes, IED may be associated with anxiety disorder. Additionally, emerging evidence shows that IED is a part of substance abuse and conduct disorder. 

Get Help Now!

Rare mental disorders require medical professionals with specialization in this area. Kentucky Counseling Center has counselors with specialized training to deal with these kinds of disorders. You can schedule an appointment with us through our website, Kentucky Counseling Center.

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