Intermittent Explosive Disorder

The impulsive, aggressive episodes that characterize IED can take many forms. Some behaviors that might be signs of IED include:

• yelling and shouting
• intense arguments
• temper tantrums and rampages
• threats
• road rage
• punching walls or breaking plates
• damaging property
• physical violence, such as slapping or shoving
• fights or brawls
• domestic violence
• assault

These spells or attacks often occur with little to no warning. They are short-lived, rarely lasting longer than half an hour. They may appear alongside physical symptoms, such as:

• increased energy (adrenaline rush)
• headache or head pressure
• heart palpitations
• chest tightness
• muscle tension
• tingling
• tremors

Feelings of irritation, rage, and loss of control are commonly reported before or during the episode. People with IED might experience racing thoughts or a sense of emotional detachment. Immediately after, they might feel tired or relieved. People with IED often report feelings of remorse or guilt following an episode.

For some individuals with IED, these episodes occur on a regular basis. For others, they occur after weeks- or months-long stretches of nonaggressive behavior. Verbal outbursts may occur between acts of physical violence.

The new edition of the Diagnostic and Statistical Manual (DSM-5) includes updated diagnostic criteria for IED. The new criteria distinguish between:

• more frequent episodes of verbal aggression without physically harming people or property
• less frequent acts of destructive or assaultive behavior that causes serious harm to people or property

A disorder characterized by impulsive and aggressive behavior has appeared in all editions of the DSM. However, it was first called IED in the third edition. Prior to the third edition, it was believed to be rare. With updated diagnostic criteria and advances in IED research, it’s now believed to be much more common.

In 2005, a study found that 6.3 percent of 1,300 people seeking care for a mental health issue met the criteria for DSM-5 IED at some point in their lifetime. In addition, 3.1 percent met the criteria for a current diagnosis.

A 9,282-person study from 2006 found that 7.3 percent met the DSM-5 criteria for IED at some point in their lifetime, while 3.9 percent met the criteria in the past 12 months.

Little is known about what causes IED. The cause is likely a combination of genetic and environmental factors. Genetic factors include genes passed from parent to child. Environmental factors include behaviors that a person is exposed to as a child.

Brain chemistry may also play a role. Studies suggest that repeated impulsive and aggressive behavior is associated with low serotonin levels in the brain.

You might be at an increased risk of developing IED if you:

• are male
• are under the age of 40
• grew up in a verbally or physically abusive household
• experienced multiple traumatic events as a child
• have another mental illness that causes impulsive or problematic behavior, such as:
  • attention-deficit hyperactivity disorder (ADHD)
  • antisocial personality disorder
  • borderline personality disorder

There are a number of treatments for IED. Most of the time, more than one treatment is used.

Therapy

Seeing a counsellor, psychologist, or therapist alone or in a group setting may help a person manage symptoms of IED.

Cognitive behavioral therapy (CBT) is a type of therapy that involves identifying harmful patterns and using coping skills, relaxation techniques, and relapse education to deal with aggressive impulses.

A 2008 study found that 12 weeks of individual or group CBT reduced IED symptoms including aggression, anger control, and hostility. This was true both during treatment and after three months.

Medication

There are no specific medications for IED, but certain medications may help to reduce impulsive behavior or aggression. These include:

• antidepressants, in particular selective serotonin reuptake inhibitors (SSRIs)
• mood stabilizers, including lithium, valproic acid, and carbamazepine
• antipsychotic drugs
• antianxiety drugs

Research on medication for IED is limited. A 2009 study found that the SSRI fluoxetine, more commonly known by its brand name Prozac, reduced impulsive-aggressive behaviors among people with IED.

It can take up to three months of treatment to experience the full effects of SSRIs, and symptoms tend to reappear once medication is stopped. In addition, not everyone responds to medication.

Alternative treatments

Few studies have explored the effectiveness of alternative treatments and lifestyle changes for IED. Still, there are a number of interventions that aren’t likely to have a negative impact. Some of these include:

• adopting a balanced diet
• getting enough sleep
• staying physically active
• avoiding alcohol, drugs, and cigarettes
• reducing and managing sources of stress
• making time for relaxing activities, such as listening to music
• practicing meditation or other mindfulness techniques
• trying alternative therapies, such as acupressure, acupuncture, or massage

IED can impact your close relationships and everyday activities. Frequent arguments and more aggressive behavior can make it difficult to maintain stable and supportive relationships. Episodes of IED can cause significant harm within families.

You might also experience consequences after behaving aggressively at work, school, or on the road. Loss of a job, expulsion from school, car accidents, and financial and legal repercussions are all possible complications.

People who have IED are at an increased risk of having other mental and physical health issues. Some of these include:

• depression
• anxiety
• ADHD
• alcohol or substance misuse
• other risky or impulsive behaviors, such as problem gambling or unsafe sex
• eating disorders
• chronic headaches
• high blood pressure
• diabetes
• heart disease
• stroke
• chronic pain
• ulcers
• self-harm and suicide

Many people who have IED don’t seek treatment. But it’s nearly impossible to prevent episodes of IED without professional help.

If you suspect that you have IED, make an appointment with a doctor or other mental health professional. If you feel you might harm yourself or someone else, call 911 immediately.

If you’re in a relationship with someone whom you suspect has IED, you can ask your loved one to seek help. However, there are no guarantees that they will. IED shouldn’t be used as an excuse for aggressive or violent behavior toward you.

Make protecting yourself and your children your first priority. Learn how to prepare for an emergency and find help by calling The National Domestic Violence Hotline at 800-799-SAFE (800-799-7233) or visiting their website.