Intermittent explosive disorder

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updated June 10, 2008

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Intermittent explosive disorder

Filed under: Boomer's Health
Road rage. Domestic abuse. Angry outbursts or temper tantrums that involve throwing or breaking objects. Sometimes such erratic eruptions can be caused by a condition known as intermittent explosive disorder (IED).

Intermittent explosive disorder is characterized by repeated episodes of aggressive, violent behavior in which you react grossly out of proportion to the situation. 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.

Intermittent explosive disorder occurs most often in young men and may affect as many as one in 14 U.S. adults. If you have this anger disorder, treatment may involve medications and psychotherapy to help you control your aggressive impulses.

Symptoms

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:

Tingling
Tremor
Palpitations
Chest tightness
Head pressure
Hearing an echo

Causes

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.

Risk factors

People with other mental health problems — such as mood disorders, anxiety disorders and eating disorders — may be more likely to also have intermittent explosive disorder. Substance abuse is another risk factor.

People with traits that are common to personality disorders — such as dramatic, antisocial, paranoid or narcissistic behavior patterns — may be especially prone to intermittent explosive disorder. As children, they may have exhibited severe temper tantrums and other behavioral problems, such as stealing and fire setting.

Tests and diagnosis

To be diagnosed with intermittent explosive disorder you must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DMS), published by the American Psychiatric Association.

Criteria for intermittent explosive disorder to be diagnosed include:

Multiple incidents in which the person failed to resist aggressive impulses that resulted in deliberate destruction of property or assault of another person.
The degree of aggressiveness expressed during the incidents is completely out of proportion with the precipitating event.
The aggressive episodes aren't accounted for by another mental disorder and are not due to the effects of a drug or a general medical condition.

Other conditions that must be ruled out before making a diagnosis of intermittent explosive disorder include delirium, dementia, oppositional defiant disorder, antisocial personality disorder, schizophrenia, panic attacks, substance withdrawal or intoxication.

People with intermittent explosive disorder may have an imbalance in the amount of serotonin and testosterone in their brains. They may also show some minor irregularities in neurological signs and electroencephalograms (EEGs).

Complications

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.

A study in the journal Psychiatry Research found that 16 percent of those with intermittent explosive disorder had engaged in acts of self-aggression. More than 12 percent of people in the study reported that they had attempted suicide. Those who were also addicted to drugs or had another serious mental disorder, such as depression, were at greatest risk of harming themselves.

Other complications of intermittent explosive disorder may include job loss, school suspension, divorce, auto accidents or incarceration.

Treatments and drugs

Many different types of drugs are used to help control intermittent explosive disorder, including:

Anticonvulsants, such as carbamazepine (Tegretol), phenytoin (Dilantin), gabapentin (Neurontin) and lamotrigine (Lamictal)
Anti-anxiety agents in the benzodiazepine family, such as diazepam (Valium), lorazepam (Ativan) and alprazolam (Xanax)
Mood regulators, such as lithium and propranolol (Inderal)
Antidepressants, such as fluoxetine (Prozac) and paroxetine (Paxil)

Group counseling sessions, focused on rage management, also have proved helpful. Some people have found relaxation techniques useful in neutralizing anger.

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Intermittent explosive disorder

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