Intermittent explosive disorder (IED) is a mental disorder characterised by recurring periods of impulsive, aggressive, and violent behaviour. Individuals with IED frequently struggle with regulating their anger and may overreact to little irritations or disappointments.1
The Diagnostic and Statistical Manual of Mental Disorders (DSM) describes IED as:
- The occurrence of discrete episodes of failure to resist aggressive impulses that result in serious assaultive acts or property destruction
- The degree of aggressiveness expressed during an episode is grossly out of proportion to any provocation or precipitating psychosocial stressor
A diagnosis of IED is made only after other mental disorders have been ruled out, such as psychotic disorder, personality disorders, attention deficit hyperactivity disorder or a manic episode. The violent episodes are not caused by the direct physiologic effects of a substance (e.g. drug abuse or medicine) or a general medical condition such as Alzheimer's disease. IED severely affects daily normal function.2
There are a number of risk factors known despite the fact that the precise causes of IED are not well understood. Things like biological factors, traumatic events like abuse or accidents, and being short-tempered all play an important role in developing IED.
Causes of intermittent explosive disorder
The DSM Ill does not propose any cause to explain IED in general, but it does include physical causes as well as psychological elements:
- Biological factors: IED may be caused by genetic or biological factors. According to certain research, the illness may be brought on by changes in particular brain regions such as grey matter and neurotransmitter imbalances such as serotonin lower than normal levels
- Environmental factors: Childhood trauma, including physical or emotional abuse, neglect, or witnessing violence, can raise the chance of IED development. Living in a violent environment, experiencing persistent stress, or experiencing traumatic events can all exacerbate the disease
- Co-existing mental health conditions: People with IED frequently have additional mental health issues, such as ADHD, depression, anxiety disorders, or substance use problems. The degree of explosive outbursts may be impacted by the interaction of these disorders with IED symptoms3
According to the DSM Ill, "an underlying physical disorder, such as a brain tumour or epilepsy, may cause this syndrome in rare cases." Any procedure that generates brain malfunction has the potential to predispose you to the illness. Perinatal trauma, infantile seizures, head trauma, and encephalitis are examples of such injuries.
The IED definition of persistent, recurring aggression suggests that exposure to several traumatic events as a child can also predispose you to the disease.
Signs and symptoms of intermittent explosive disorder
Intermittent explosive disorder's aggressive outbursts often have little to no early signs, a short time frame and a fast onset of action.
You may exhibit the following symptoms if you have IED:
- Aggressive episodes that last less than 30 minutes
- After being irritated, aggressive outbursts occur rapidly, even with minor provocation
- Verbal or physical aggression: you may become verbally abusive, shout, or scream
- Becoming destructive during episodes of intense anger
- Emotional distress after an outburst, such as guilt, remorse, or embarrassment1
Management and treatment for intermittent explosive disorder
The treatment goal of intermittent explosive disorder is to reduce the intensity and frequency of aggressive outbursts and gain control over aggression. Here are some approaches for managing intermittent explosive disorder:
- Psychotherapy: Cognitive behavioural therapy (CBT) is used to identify triggers, create coping mechanisms, and alter thought processes and aggressive behaviours. In addition, classes on stress management and relaxation exercises may also be used4
- Programs for managing anger: Group therapies that concentrate on managing anger can offer assistance and teach people with IED how to identify their anger triggers, use effective communication tactics, and use relaxation techniques to regulate their anger in a healthier way
- Approaches for reducing stress: People with IED may benefit from learning and using methods to reduce stress. These might involve practising regular physical activity, deep breathing techniques, mindfulness meditation, or progressive muscle relaxation
- Medications: IED symptoms can be managed with the use of certain prescription drugs:5
- Antidepressants - mainly selective serotonin reuptake inhibitors (SSRIs)
- Mood stabilisers
- Anti-anxiety medication
To make a diagnosis of intermittent explosive disorder and rule out other physical or mental health illnesses that could be causing your symptoms, a licenced psychologist who is experienced in diagnosing IED should be consulted. They may perform:
- A physical examination: To rule out any underlying medical disorders that might be causing the symptoms
- A psychological assessment: To analyse a person's symptoms, past, and general mental health, a mental health practitioner may conduct interviews and use a variety of assessment methods
The DSM-5, released by the American Psychiatric Association, contains the diagnostic criteria for IED. The healthcare professional will consult this manual while determining the diagnosis of IED.
The DSM-5 lays out specific requirements that must be satisfied for a person to be diagnosed with any particular mental disease. The DSM-5's diagnostic criteria for IED are as follows:
- Verbal or physical aggression toward other people, animals, or property occurring twice weekly on average for 1 month. Alternatively, three episodes involving physical assault against other people or destruction of property during the adult lifetime
- The degree of aggressiveness expressed is grossly out of proportion to the provocation or any precipitating psychosocial stressors
- The aggressive behaviour is generally not premeditated (i.e. is impulsive) and is not committed to achieve some tangible objective (e.g. money, power, intimidation)
- The aggressive behaviour causes either marked distress in the individual or impairment in occupational or interpersonal functioning
- The aggressive behaviour is not better accounted for by another mental disorder (e.g. depression, manic/psychotic disorder, ADHD); a general medical condition (e.g. head trauma, Alzheimer’s disease); or due to the direct physiological effects of a substance6
There are a number of risk factors known, even though the precise causes of IED are not well understood. The following are some typical risk factors for intermittent explosive disorder:
- Biological factors, mainly genetic
- Traumatic events: People who have gone through or witnessed traumatic experiences, such as physical or sexual abuse, violence, or accidents, may have a higher chance of acquiring IED
- Abuse of drugs: Abuse of drugs, especially alcohol and stimulants, has been linked to a higher risk of IED. Addiction can worsen violent tendencies, weaken inhibitions, and impair judgment
- Impaired coping skills: IED development may be influenced by difficulties controlling stress, frustration, rage, or other negative emotions. Explosive outbursts may be caused by inadequate coping mechanisms and an inability to express emotions correctly
IEDs do not directly result in physical problems, but they can have a variety of psychological, social, and legal effects.
- Relationship problems: short temper and frequent explosive outbursts can negatively impact relationships with family, friends, coworkers etc
- Legal problems: IED-related impulsive aggression can result in legal issues like assault accusations, property damage, or other criminal violations
- Occupational difficulties: People with IED may suffer disputes with co-workers, bosses, or customers because of unpredictable conduct, which can interfere with employment and career prospects
How can I prevent intermittent explosive disorder?
While there is no definite method of preventing IEDs, there are numerous tactics that may aid in the management and reduction of the frequency and intensity of explosive incidents:
- Cognitive therapy
- Anger management therapy
- Identifying triggers
- Improving communication skills
- Avoiding substance abuse
How common is intermittent explosive disorder?
According to researchers, intermittent explosive disorder affects ~7.3% of the population.
What can I expect if I have intermittent explosive disorder?
If you have intermittent explosive disorder, you may experience:
- Unpredictable and intense anger
- Emotional distress
- Relationship problems
- Legal issues
- Occupational difficulties
When should I see a doctor?
If you feel you have intermittent explosive disorder or are having recurring episodes of impulsive and angry outbursts, you should get professional help from a mental health specialist. Here are some warning signs that it's time to contact a doctor:
- If your outbursts of rage are frequent, severe, and involve inflicting injury to yourself or others
- If your angry outbursts are interfering with your everyday life, relationships, employment, or academic performance
- If you are suffering significant feelings of guilt, humiliation, or remorse as a result of your outbursts, or if you are having difficulty managing your emotions in general
IED is a psychiatric disorder characterised by recurrent episodes of impulsive, aggressive, and violent behaviour. Individuals with IED have difficulties managing their anger and frequently have disproportionately violent outbursts. These outbursts might include physical or verbal violence toward others, as well as property damage. The specific causes of IED are unknown, although a mix of genetic, environmental, and neurological variables are thought to play a role in its development. Cognitive behavioural therapy, anger management techniques, meditation and medication like antidepressants, anti-anxiety medicines, antipsychotics, and mood stabilisers are all used to overcome the symptoms of intermittent explosive disorder.
- Coccaro EF. Intermittent Explosive Disorder as a Disorder of Impulsive Aggression for DSM-5. American Journal of Psychiatry. 2012 Jun;169(6):577–88.
- McElroy SL. Recognition and treatment of DSM-IV intermittent explosive disorder. The Journal of Clinical Psychiatry. 1999;60 Suppl 15:12–6.
- Fanning JR, Pasetes L. Chapter Nine - Psychological Trauma and Intermittent Explosive Disorder [Internet]. Coccaro EF, McCloskey MS, editors. ScienceDirect. Academic Press; 2019 [cited 2023 Jun 27]. p. 157–82. Available from: https://www.sciencedirect.com/science/article/pii/B9780128138588000097
- McCloskey MS, Noblett KL, Deffenbacher JL, Gollan JK, Coccaro EF. Cognitive-behavioural therapy for intermittent explosive disorder: A pilot randomized clinical trial. Journal of Consulting and Clinical Psychology. 2008;76(5):876–86.
- Olvera RL. Intermittent Explosive Disorder. CNS Drugs. 2002;16(8):517–26.
- Coccaro EF. Intermittent explosive disorder: development of integrated research criteria for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Comprehensive Psychiatry. 2011 Mar;52(2):119–25.