Intermittent explosive disorder
Intermittent explosive disorder
Intermittent explosive disorder is characterized by repeated episodes of aggressive, violent behavior in which you react grossly out of proportion to the situation. Road rage, domestic abuse, and angry outbursts or temper tantrums that involve throwing or breaking objects may be signs of intermittent explosive disorder (IED).
People with intermittent explosive disorder may attack others and their possessions, causing bodily injury and property damage. Later, people with intermittent explosive disorder may feel remorse, regret or embarrassment.
If you have this anger disorder, treatment may involve medications and psychotherapy to help you control your aggressive impulses.
Explosive eruptions, usually lasting 10 to 20 minutes, often result in injuries and the deliberate destruction of property. These episodes may occur in clusters or be separated by weeks or months of nonaggression.
Aggressive episodes may be preceded or accompanied by:
The exact cause of intermittent explosive disorder is unknown, but the disorder is probably caused by a number of environmental and biological factors.
Most people with this disorder grew up in families where explosive behavior and verbal and physical abuse were common. Being exposed to this type of violence at an early age makes it more likely for these children to exhibit these same traits as they mature.
There may also be a genetic component, causing the disorder to be passed down from parents to children.
Additionally, there may be differences in the way serotonin, an important chemical messenger in the brain, works in people with intermittent explosive disorder. Higher levels of the hormone testosterone have been associated with intermittent explosive disorder.
A number of factors increase your risk of developing intermittent explosive disorder:
The violent behavior that's part of intermittent explosive disorder is not always directed at others. People with this condition are also at significantly increased risk of harming themselves, either with intentional injuries or suicide attempts.
Those who are also addicted to drugs or had another serious mental disorder, such as depression, are at the greatest risk of harming themselves.
People with intermittent explosive disorder are often perceived by others as always being angry. Other complications of intermittent explosive disorder may include job loss, school suspension, divorce, auto accidents or incarceration.
Preparing for your appointment
If you're concerned because you're having repeated emotional outbursts, you can talk with your primary care doctor, or you may want to make an appointment with someone who specializes in treating emotional disorders, such as a psychiatrist, psychologist or social worker.
Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
Preparing a list of questions can help you make sure you cover everything that's important to you. For intermittent explosive disorder, some basic questions to ask your doctor include:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
What to expect from your doctor
Tests and diagnosis
To be diagnosed with intermittent explosive disorder, your doctor will ask you about your behavior to see if you meet the criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM) for intermittent explosive disorder. This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.
DSM criteria include:
Other conditions that must be ruled out before making a diagnosis of intermittent explosive disorder include delirium, dementia, borderline personality disorder, antisocial personality disorder, schizophrenia, a manic episode, substance abuse or withdrawal, head trauma, seizures, or intoxication.
People with intermittent explosive disorder may also show some minor irregularities in neurological signs and electroencephalograms (EEGs). An EEG is a noninvasive test that measures the electrical activity in your brain.
Treatments and drugs
There's no one treatment that's best for everyone with intermittent explosive disorder. Treatment generally includes medication and individual or group therapy.
Many different types of drugs are used to help control intermittent explosive disorder, including:
Individual or group therapy sessions also can be helpful. A commonly used type of therapy, cognitive behavioral therapy, helps people with intermittent explosive disorder identify which situations or behaviors may trigger an aggressive response. And, more importantly, this type of therapy teaches people with intermittent explosive disorder how to manage their anger and control their typically inappropriate response using relaxation exercises.
Coping and support
Controlling your anger
Coping well with anger is a learned behavior, just as behaving badly when you get frustrated is a behavior you have to unlearn. Cognitive behavioral therapy or anger management will help you recognize what pushes your buttons and how to respond in ways that work for you instead of against you.
In the meantime, work with your doctor on developing a plan of action for when you feel yourself getting angry. For example, if think you might lose control, try to remove yourself from that situation. Go for a walk or call a trusted friend to try to calm down. If you can't find a way to calm down on your own, you can go to your local emergency room and ask for help.
If your loved one won't get help
Create an escape plan
Help is available
Last Updated: 2010-06-10
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