Intermittent Explosive Disorder

An inability to resist aggressive urges may be an indication of intermittent explosive disorder. Individuals with this disorder often seriously damage property or assault others, usually in stark contrast to the provocation involved in a situation.


Intermittent Explosive Disorder falls in the category of Impulse-Control Disorders. The condition is characterized by failure to resist aggressive impulses, resulting in serious assaults or property destruction. Examples of this behavior include threatening to or actually hurting another person and purposefully breaking or damaging an object of value.

The degree of aggressiveness expressed during an episode is grossly out of proportion to any provocation or situational stress. The individual may describe the episodes as "spells" or "attacks" in which the explosive behavior is preceded by a sense of tension or arousal and followed immediately by a sense of relief. Often genuine regret is expressed after the outburst. Later the individual may also feel upset, remorseful or embarrassed about the behavior.

Typically beginning in the early teens, the disorder often precedes - and may predispose for - later depression, anxiety and substance abuse disorders. Nearly 82 percent of those with IED also had one of these other disorders, yet only 28.8 percent ever received treatment for their anger.

Most patients are young men and history will often involve frequent traffic accidents, moving violations and possibly sexual impulsivity. These patients may exhibit extreme sensitivity to alcohol. This disorder is a controversial category because some clinicians believe that it is only a symptom of other diagnoses rather than a disorder on its own.


Intermittent Explosive Disorder is marked by several discrete episodes of failure to resist aggressive impulses that result in serious assaultive acts or destruction of property.

The degree of aggressiveness expressed during the episodes is grossly out of proportion to any precipitating psychosocial stressors. To be diagnosed with IED, an individual must have had three episodes of impulsive aggressiveness "grossly out of proportion to any precipitating psychosocial stressor," at any time in their life, according to the standard psychiatric diagnostic manual. The person must have "all of a sudden lost control and broke or smashed something worth more than a few dollars...hit or tried to hurt someone...or threatened to hit or hurt someone."

Additionally, the aggressive episodes are not better accounted for by another mental disorder (such as Antisocial Personality Disorder, Borderline Personality Disorder, a Psychotic Disorder, a Manic Episode, Conduct Disorder, or Attention-Deficit/Hyperactivity Disorder) and are not due to the direct physiological effects of a substance (such as a medication or a drug of abuse) or a general medical condition (such as head trauma, Alzheimer's disease)

Individuals with Intermittent Explosive Disorder sometimes describe intense impulses to be aggressive prior to their aggressive acts. Explosive episodes may be associated with affective symptoms such as irritability or rage, increased energy, and racing thoughts during the aggressive impulses and acts, and rapid onset of depressed mood and fatigue after the acts. Some individuals may also report that their aggressive episodes are often preceded or accompanied by symptoms such as tingling, tremors, palpitations, chest tightness, head pressure, or hearing an echo. This disorder may result in job loss, school suspension, divorce, difficulties with interpersonal relationships or other impairment in social or occupational areas, accidents (such as in vehicles), hospitalization because of injuries from fights or accidents, financial problems, incarcerations or other legal problems.


The cause of intermittent explosive disorder appears to be a combination of biological and environmental factors. Lives have been torn apart by this disorder, but medications can help control the aggressive impulses.

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 this disorder to be passed down from parents to children.

The majority of cases occur when the individual is between late adolescence and late twenties. There is some evidence that the neurotransmitter serotonin may play a role in this disorder.

Although the prevalence of intermittent explosive disorder is unknown yet considered rare, the disorder is probably more common than realized and may be an important cause of violent behavior. Intermittent explosive disorder is more common in men.


Treatment could involve medication or therapy including behavioral modification, with the best prognosis utilizing a combination of the two. Group counseling and anger management sessions can also be helpful. Relaxation techniques have been found to be useful in neutralizing anger.

Studies suggest that patients with intermittent explosive disorder respond to treatment with antidepressants, anti-anxiety agents in the benzodiazepine family, anticonvulsants and mood stabilizers.


  • Diagnostic and Statistical Manual of Mental Disorders
  • DSM-IV™ Made Easy: The Clinician's Guide to Diagnosis
  • Kessler RC, Coccaro EF, Fava M, Jaeger S, Jin R, Walters E. The prevalence and correlates of DSM-IV intermittent explosive disorder in the National Comorbidity Survey Replication. Archives of General Psychiatry. 2006 Jun; 63(6):669-78
  • NIMH (2006).
  • Olvera R. L. (2002). Intermittent explosive disorder: epidemiology, diagnosis and management. CNS Drugs. 16(8):517-26.
Last reviewed 11/24/2014