What is Intermittent Explosive Disorder?
Classified as an impulse control disorder in the Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), intermittent explosive disorder (IED) occurs when an individual reacts to a minor stressful situation in an overly aggressive manner, such as through a physical attack, violent threats or the deliberate destruction of property. 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.
Intermittent explosive disorder appears to occur quite often. According to the National Comorbidity Survey conducted in 2001-2003 by the National Institute of Mental Health (NIMH), approximately 7.3 percent of adults, or almost 16 million people in the U.S., have suffered from intermittent explosive disorder at some point in their lives, depending on the definition used. However, there is much controversy amongst mental health professionals about whether IED is a separate disorder or if it is a symptom of other mental disorders.
Curing Intermittent Explosive Disorder: Available Treatment Options
Unfortunately, curing intermittent explosive disorder is not possible, but there are good treatment options that can help control the disorder, reduce the amount of attacks, and improve quality of life. The first step in treating IED is to be examined by a physician to rule out any other factors that could be contributing to the attacks, such as other mental disorders that cause violent outbursts, substance abuse and/or neurological issues involving head trauma, seizures, or inflammation. Once an individual has been diagnosed with IED, the best course of action for treatment is a combination of psychotropic medications and psychotherapy.
Medications Used in Treating IED
The most common medications used to treat intermittent explosive disorder are selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Paxil, Lexapro and Zoloft. SSRIs are very effective because they prevent the brain from reabsorbing serotonin, which is a neurotransmitter. Serotonin is primarily responsible for regulating mood and low levels of serotonin can negatively alter an individual’s mood. By increasing the serotonin level, brain cells are better equipped to send and receive messages, resulting in positive mood changes. SSRIs have few side effects and only appear to affect serotonin and not other neurotransmitters.
Anticonvulsants, which are generally used to treat seizures due to epilepsy and bipolar disorder, can also be used either alone or in combination with other medications to help control the violent outbursts associated with IED. These medications include Tegretol, Dilantin and Neurontin.
Another effective medication option is to use anti-anxiety medications from the benzodiazepine family, such as Valium, Ativan and Xanax. Medicines from this family of drugs are known as central nervous system (CNS) depressants as they are used to slow down the nervous system and activity in the brain to help control feelings of anxiety and panic. Mood regulators like lithium also affect the central nervous system by lessening atypical activity in the brain which results in more control over the individual’s emotions.
The Use of Therapy to Control IED Impulses
Cognitive behavioral therapy (CBT) appears to be the most effective type of therapy for treating individuals with IED. This very structured type of therapy is a collaborative effort between the therapist and the patient that is designed to be short-term and focuses specifically on the disorder itself by challenging the patient’s belief system. Once that belief system is tested, behavior becomes easier to change because the patient is no longer holding on to their previously rigid beliefs.
Specifically, CBT helps the patient identify the situations or behaviors that trigger an aggressive response through recognizing and modifying inappropriate thinking, behavior, and emotions. Once these triggers are identified, the therapist assists the patient in establishing the necessary skills for adjusting their beliefs, recognizing their irrational thought processes, and developing more flexibility in coping with stressful situations, thus positively changing their response to stressful situations.
Other therapy options include marital counseling, family counseling, anger management classes, and substance abuse counseling. These can help the individual further understand what motivates them to overreact so aggressively. Also, diagnosing and treating IED may be more successful if the disorder is caught early, which is very possible since it tends to occur during the teen and early adulthood years.
The Necessity of Treatment for IED
Although curing intermittent explosive disorder is not possible, treatment is essential. If left untreated, bouts of IED can lead to harm to others, arrests for assault or destruction of property, suicidal thoughts or acts, loss of jobs, loss of relationships and/or divorce, car accidents, school suspensions, and possibly imprisonment.
Treatment is even more necessary if individuals experience three episodes within one year as they tend to have a more persistent and severe form of the disorder, especially if both people and property were their targets during an attack. According to the NIHM, nearly 4 percent of adults fall into this category and were responsible for 3.5 times more property damage than any other group with IED. Also, this group had an average of 43 attacks over their lifetime. This level and intensity of attacks is connected with extensive functional impairment and requires intensive intervention through medication and therapy.
NB: The content of this article on curing intermittent explosive disorder is for information purposes only and is not intended to replace sound medical advice and opinion.
Mayo Clinic website, https://www.mayoclinic.com/health/intermittent-explosive-disorder/DS00730
Mayo Clinic website, https://www.mayoclinic.com/health/ssris/MH00066
National Institute of Mental Health (NIMH) website, "Intermittent Explosive Disorder Affects Up to 16 Million Americans", https://www.nimh.nih.gov/science-news/2006/intermittent-explosive-disorder-affects-up-to-16-million-americans.shtml
National Institute of Mental Health (NIMH) website, https://www.nimh.nih.gov/health/publications/mental-health-medications/complete-index.shtml
PubMedHealth.com website, https://www.ncbi.nlm.nih.gov/pubmedhealth/s/drugs_and_supplements/a/
WebMD.com website, https://www.webmd.com/depression/guide/cognitive-behavioral-therapy-for-depression