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Spotlight on Intermittent Explosive Disorder

written by: Stephanie Torreno • edited by: Diana Cooper • updated: 7/19/2011

Many people have heard of road rage, in which a driver flies off the handle over a minor traffic incident. Most may dismiss this dangerous behavior as a personality flaw, but it could be caused by intermittent explosive disorder. Read about the condition, its symptoms and its causes in this guide.

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    The Condition of IED

    A driver gets out of his car, screaming and hitting other cars in the middle of traffic. A husband loses his temper and beats his wife, then apologizes profusely and promises it will not happen again. These examples may not just be incidences of people who cannot calm their out-of-control tempers. Individuals with these bouts of rage may have an anger disorder known as intermittent explosive disorder, or IED. As an impulse control disorder, IED is on the spectrum of obsessive compulsive disorder (OCD).

    Individuals with IED have repeated episodes of angry, violent behavior in which they may physically hurt others and damage property or other valuable possessions. IED is characterized by an inability or failure to control aggressive impulses. The degree of aggressiveness is totally disproportionate to any provocation or stressful situation. Typically, an episode, or “spell" or “attack," lasts between ten minutes to an hour, and begins when an individual feels heightened energy, or sudden tension and arousal. After these episodes, the person usually experiences an immediate sense of relief. These individuals then likely feel guilt, remorse or embarrassment.

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    Symptoms of IED

    Episodes of aggression may be clustered or be separated by weeks or months of non-aggressive behavior. Symptoms preceding or accompanying aggressive spells include:

    • Increased energy
    • Tingling in the hands or feet
    • Headache or pressure in the head
    • Ringing in the ears
    • Chest tightness or heart palpitations
    • Tremors or uncontrollable shaking
    • Hearing an echo or having blurred vision
    • Irritability
    • Strong, uncontrollable feelings of anger and rage
    • Possible damage to property or bodily injury associated with the violent episode
    • Experiencing guilty feelings, regret or shame after the episode ends
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    Causes and Facts About IED

    Although the exact cause of IED is unknown, the disorder is most likely a combination of environmental and biological factors. The majority of individuals with this disorder grew up in families where they regularly witnessed or themselves experienced severe physical and verbal abuse and other explosive behavior. Young children who are exposed to these types of behavior are more likely to display the same behaviors in adolescence and adulthood. In other words, the genetic component that may exist in this disorder may cause parents to pass the disorder to their children.

    Another cause of IED may be differences in the way the neurotransmitter serotonin functions in individuals with the disorder. These people have also been shown to have increased levels of the hormone testosterone. Several factors make people more likely to develop IED, including having another mental health condition, such as mood or anxiety disorders. A history of alcohol or other drug abuse increases the risk of IED, too. The disorder is more common in men than in women, and more commonly affects individuals in their teens and 20s.

    Interestingly, people with this disorder are at a much higher risk of hurting themselves through intentional injuries or suicide attempts than harming others. Self-injuries and attempts to kill themselves significantly rise if individuals are addicted to drugs, or have depression or another serious mental disorder. Job loss, suspension from school, divorce, traffic accidents and criminal behavior are other difficulties associated with IED.

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    Diagnosis and Treatment of IED

    A diagnosis of IED is made by mental health professionals who rule out other disorders, such as delirium, dementia, borderline personality disorder, antisocial personality disorder, manic episodes or schizophrenia. Drug abuse or any physical problems, such as head trauma or seizures which could contribute to the condition, must also be dismissed. Individuals who have recurrent aggressive or violent episodes and cause injury or property damage may receive a diagnosis of IED, particularly when the degree of rage is out of proportion to the situation. Professionals will take a thorough family medical history and detailed accounts of explosive episodes.

    Intermittent explosive disorder can be treated with both therapy and medications. Cognitive-behavioral therapy and individual psychotherapy can help the individual address the root cause of the anger and rage. Patients learn to recognize triggering situations and to prevent aggressive outbursts and violence by using new and more positive coping skills. Learning to cope with anger, and unlearning to explode with feelings of rage, are vital parts of therapy. Group or family therapy can begin to restore broken relationships and improve understanding and communication among relatives and friends.

    Medication may be used in conjunction to therapeutic efforts, depending upon the needs of the patients. Anti-depressants and selective serotonin reuptake inhibitors (SSRIs) may be prescribed when patients experience underlying symptoms of depression. Mood stabilizers or anti-convulsive medication may be used to improve impulse control, which may curb violent episodes. Finally, anxiolytics may help relieve the tension that leads to episodes, and increase tolerance for situations that may provoke anger and rage.

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    References

    Collective Social Services. http://regionalcenter.org/mental-health/intermittent-explosive-disorder

    Mayo Clinic. http://www.mayoclinic.com/health/intermittent-explosive-disorder/DS00730

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