The impulse-control disorder known as intermittent explosive disorder (IED) is characterized by an inability to control one’s aggressive impulses, which can result in frequent “explosions”—incidents of verbal aggression in the form of tantrums, threats, tirades, or physical attacks on other people and their property, resulting in harm to people’s bodies and damage to their property.

Symptoms

The intermittent explosive disorder is characterized by recurrent, distinct periods during which a person cannot control violent impulses or wildly excessive responses compared to any provocation. Typically lasting less than 30 minutes, these outbursts are quick, spontaneous, and unplanned yet may end in significant violence or property damage.

A person must have demonstrated verbal or physical hostility against things, animals, or other people at least twice per week for at least three months to be diagnosed with IED. Aggression need not always result in the destruction of property or harm to persons or animals. A person may also be given an IED diagnosis if they have fewer but more severe episodes, namely three such incidents during a 12-month period that result in injury to others or damage to property.

For an IED diagnosis to be given, the aggressive episodes must not be better explained by another illness, such as attention-deficit/hyperactivity disorder, antisocial personality disorder, borderline personality disorder, psychotic disorder, a manic episode, or psychotic disorder. Additionally, they could not be brought on by a general medical condition like head trauma or Alzheimer’s disease or the immediate physiological consequences of a substance like a drug of abuse or prescription medicine.

With episodes lasting for several years, the intermittent explosive disorder tends to be chronic. As a result, the condition may seriously affect a person’s daily life, resulting in things like job loss, school suspension, divorce, irreparable harm to other close relationships, accidents (like car accidents), hospitalization for injuries, financial difficulties, or incarceration or other serious legal issues. Self-harm or suicide thoughts may sometimes be more likely in people with IEDs.

When do IED symptoms start to show up?

In late childhood or adolescence, intermittent explosive disorder symptoms often first appear. Most incidences affect adults under the age of 35.

Intermittent explosive disorder: How prevalent is it?

Many experts think IEDs may be far more widespread and an underrecognized source of aggressive behavior. Earlier estimates had estimated that intermittent explosive disorder might be discovered in around 2.7 percent of the general population.

According to one National Institute of Mental Health (NIMH) research, up to 16 million Americans, or 7.3 percent of adults, may be affected by IED, broadly defined. Those who experience frequent, devastating IED episodes may experience 43 attacks on average throughout a lifetime.

Who is most susceptible to IED?

Intermittent Explosive Disorder is more often diagnosed in males than in women. The past medical history of a patient often reveals incidents of “road rage”-related traffic accidents, movement offenses, and sometimes impulsive sexual behavior. Alcohol sensitivity may be quite high in people with IED.

What other ailments might exist with or overlap intermittent explosive disorder?

Due to a higher risk of stressful life events like divorce or unemployment, IED often precedes and may predispose a person to depression, anxiety, and drug misuse problems. According to National Institutes of Health studies, only 29% of people with those diagnoses ever obtain treatment for their anger, even though roughly 82 percent of persons with IED also have one of these other illnesses.

Although research has revealed minimal overlap between IED and other illnesses linked to impulsive aggression, such as antisocial and borderline personality disorders, anger outbursts are commonly reported in individuals with bipolar disorder.

What does an IED sufferer experience just before an episode?

People who have intermittent explosive disorder sometimes talk of having strong urges to behave aggressively before actually doing so. Their bouts may be accompanied by agitation or wrath, heightened vigor, frenzied thinking, and, shortly after the actions, a sudden onset of depression and exhaustion. Some people may also claim that sensations like tingling, trembling, palpitations, chest tightness, headaches, or hearing an echo often precede or follow violent episodes.

How does the physical health of someone with intermittent explosive disorder differ?

According to several studies, those who have violent anger episodes are more likely to experience significant health issues. According to one research, those who often have “anger outbursts” are more likely to get heart attacks and strokes, particularly after an outburst. Stress-related increases in blood pressure and vascular resistance seemed to be the source of this. Over time, the relatively frequent anger outbursts experienced by someone with IED might result in an accumulation of risk, even if any one episode of rage is unlikely to increase one’s health risk considerably.

Causes

A combination of biological and environmental variables is believed to be the root cause of the intermittent explosive disorder. A hereditary component may increase the susceptibility to the disease passed on from parents to their children. Additionally, some data suggests serotonin may contribute to the development of IED. But many persons with the condition have experienced violent behavior and mental and physical abuse growing up in their homes. According to a study, growing up among such violence increases one’s likelihood of acquiring the same tendencies as an adult; in other words, the conduct may be learned, at least in part.

How can brain imaging reveal intermittent explosive disorder?

People with intermittent explosive disorder may vary from other people in terms of the structure and function of their brains. According to certain studies,  IED has been related to decreased white matter integrity and lower grey matter volume in the connections between the frontal lobe and other brain areas. These findings imply that IED is connected to brain serotonin pathways’ abnormalities. This deficiency may be linked to diminished social cognition and more challenging emotion regulation.

Treatment

While challenging, IED treatment may also be quite beneficial, especially if it begins as soon as possible, and can ultimately aid people in limiting and controlling their violent impulses. For instance, school-based violence prevention initiatives may enable early detection of IED instances and treatment that could avert related psychopathology.

Psychotherapy and medicine are often used in conjunction for treatment since studies have shown that this combination provides the most significant results. Cognitive behavioral therapy may assist people in identifying their impulsive behaviors and creating coping strategies, such as learning to relax during an episode to control their wrath. Programs for managing anger and group therapy may both be beneficial.

According to studies, people with intermittent explosive disorder may benefit from therapy that includes antidepressants, benzodiazepine family anti-anxiety medications, anticonvulsants, and mood stabilizers. Clinicians must consider the possibility of comorbidity between IED and disorders like anxiety or depression in their treatment plans, mainly if medication is involved.