Intermittent Explosive Disorder
Intermittent explosive disorder (IED) falls in the category of impulse-control disorders. The condition is characterized by a failure to resist aggressive impulses, resulting in serious assaults, property destruction, or frequent verbal aggression in the form of temper tantrums or tirades. 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 late childhood or adolescence, the disorder often precedes—and may predispose for—later depression, anxiety and substance abuse disorders. Conservative estimates suggest that intermittent explosive disorder can be found in 2.7 percent of the general population.
Most patients are young men with a history that will often involve frequent traffic accidents, moving violations, and possibly sexual impulsivity. These patients may exhibit extreme sensitivity to alcohol.
Intermittent explosive disorder is marked by several discrete episodes of failure to resist aggressive impulses. The outbursts generally last less than half an hour and can result in serious assaultive acts or destruction of property.
The degree of aggressiveness expressed during episodes is grossly out of proportion to any psychosocial precipitants. To be diagnosed with IED, an individual must have displayed verbal or physical aggression toward property, animals, or other people approximately twice weekly for a period of three months. This type of aggression does not necessarily have to result in damage to property or injury in animals or other people. A person can also be diagnosed with IED who has three aggressive outbursts that result in damage to property or physical assault that involves injury within a 12-month period. In general, such outbursts are brief and impulsive, not premeditated.
In order for an IED diagnosis, the aggressive episodes may not be 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. They also may not be 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 or 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, racing thoughts during the aggressive impulses and acts, and the rapid onset of a 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.
The disorder may have serious consequences for everyday functioning. It may result in job loss, school suspension, divorce, difficulties with interpersonal relationships or other impairment in social or occupational areas, accidents (such as vehicular), hospitalization due to injuries from fights or accidents, financial problems, incarcerations, or other legal problems.
Intermittent explosive disorder appears to result from a combination of biological and environmental factors. Most people with the disorder grew up in families where explosive behavior and verbal and physical abuse were common. Being exposed to such violence at an early age makes it more likely for children to develop the same traits as they mature. There may also be a genetic component through which the susceptibility to the disorder is passed from parents to children.
The majority of cases occur in persons younger than 35 years of age. There is some evidence that the neurotransmitter serotonin may play a role in this disorder.
The disorder is probably more common than realized and may be an important cause of violent behavior. Some studies have found that intermittent explosive disorder is more common in men.
Lives have been torn apart by intermittent explosive disorder, but treatment can help affected individuals control the aggressive impulses.
Treatment typically involves medication and psychotherapy, including behavioral modification; in fact, studies show that a combination of both approaches offers the best prognosis. Group counseling and anger management programs can also be helpful. Relaxation techniques have been found to be useful in neutralizing anger.