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What is Intermittent Explosive Disorder?
Intermittent explosive disorder (IED) occurs when an individual reacts to a seemingly insignificant incident in an overly aggressive way, such as physically attacking another person, making violent threats or deliberately destroying property. This disorder is also known as episodic dyscontrol syndrome or “rage attacks”. According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), intermittent explosive disorder is considered an impulse control disorder, which means the individual is not able to control themselves from committing a harmful act against themselves, someone else or something.
Similar to obsessive compulsive spectrum disorders in which individuals feel compelled to act on their impulses regardless of consequences, individuals with this disorder report feeling unable to control their aggressive impulses and “lose control” in response to any type of frustration or stress.
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Children with Intermittent Explosive Disorder: Signs and Symptoms
The DSM-IV-TR states that certain criteria must be met for a diagnosis of IED, however, this criteria only applies to adults. Applying the accepted criteria from the DSM-IV-TR of intermittent explosive disorder to children can be a little more difficult because children have significant differences in developmental and cognitive abilities from adults.
Also, children are not always able to explain some of the physical symptoms that are typically associated with adult IED, such as irritability or feelings of rage, increased energy or “racing thoughts”, tingling or tremors, heart palpitations or tightness in the chest, and headaches or pressure in the head. As a result, other signs and symptoms need to be observed to help determine if a child should be diagnosed with IED.
Children with IED tend to have very low tolerance levels for frustration and become aggressively angry very quickly with little to no obvious provocation. These episodes, referred to as “spells” or “attacks”, can last as long as 30 minutes and generally lead to exhaustion and sleepiness. During an attack, the child can react so violently that they may injure themselves or others around them, even family members and younger siblings. After an attack, the child expresses sadness and regret about their behavior and may not even understand why they became so angry. Some may not even remember the attack at all.
Intermittent explosive disorder in children goes far beyond a temper tantrum. A child throws a temper tantrum in order to gain whatever it is they want. In other words, they are goal-oriented and the tantrum will stop if the child does not receive the intended attention or object. However, children with intermittent explosive disorder are acting out to release pent-up tension and aggression and will do so with or without an audience.
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Causes of Intermittent Explosive Disorder in Children
The true cause of intermittent explosive disorder is unknown, but it is believed that some combination of biological and environmental factors is to blame. Biological causes include some type of dysfunction in neurotransmitters, such as serotonin; higher than normal levels of testosterone; or some type of abnormality in the limbic system, which controls emotions, or the frontal lobes, which control impulses.
According to the Encyclopedia of Mental Disorders, positron emission tomography (PET scans) of some individuals with IED show lower levels of brain glucose metabolism than normal while electroencephalograms (EEGs) of other individuals show atypical high-amplitude brain wave forms. Environmental factors such as prenatal exposure to drugs and/or alcohol and certain types of head trauma, such as seizures, infections, or inflammation may also lead to the development of IED in children.
Certain emotional or psychological experiences may also contribute to the development of IED in children as there is a definite correlation between individuals with impulsive control disorders and family histories of substance abuse, physical and mental abuse, violence and mood disorders. Also, IED in children may be a comorbid condition with disorders such as Tourette’s, OCD, ADHD, epilepsy, and Oppositional Defiant Disorder. Further testing would need to be conducted to determine if a child also suffers from one of these other disorders.
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Treatment Options for Children with Intermittent Explosive Disorder
Unfortunately, intermittent explosive disorder cannot be cured, but there are good treatment options available to help control the disorder and reduce the amount of attacks. For adults with IED, a combination of psychotropic medication and individual and/or group therapy is used for treatment. For children with this disorder, therapy is the recommended option and medication is only used in the most severe cases. Medications that can be used for children include anticonvulsants such as Depakote or Tegretol, and antipsychotics like Risperdal.
Cognitive behavior therapy appears to be the most effective type of therapy for treating children with intermittent explosive disorder because it helps them to recognize the situations or behaviors that are triggering the aggressive responses as well as developing better ways to respond to those situations when they arise. Also, cognitive behavior therapy teaches them how to control their anger through relaxation exercises, thus also managing their overly inappropriate responses.
Another form of therapy that works well on children with intermittent explosive disorder is play therapy. Play therapy is very effective in helping children who are having developmental difficulties because children are better able to express their thoughts and feelings through play than they are through verbal communication. A therapist observes the patterns of play and begins to identify how the child uses the toys to express themselves. Once these patterns have been identified, the therapist helps the child to make sense out of his or her play.
Anger management classes are recommended as they can also help temper attacks. And family counseling may be necessary to help other family members cope with the issues that arise from dealing with a child with intermittent explosive disorder, especially if there are younger siblings.
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Encyclopedia of Mental Disorders website, http://www.minddisorders.com/Flu-Inv/Intermittent-explosive-disorder.html
Encyclopedia of Mental Disorders website, http://www.minddisorders.com/Ob-Ps/Play-therapy.html
Mayo Clinic website, http://www.mayoclinic.com/health/intermittent-explosive-disorder/DS00730
Naplenews.com website, "Intermittent explosive disorder: Understanding this scary, little-known disorder and how it affects our kids"' http://www.naplesnews.com/news/2010/dec/13/intermittent-explosive-disorder-affects-children/
WebMD.com website, http://www.webmd.com/depression/guide/cognitive-behavioral-therapy-for-depression