Losing It

I hate myself when it happens. Comes out of nowhere. This force in me erupts if someone looks at me the wrong way, threatens me, violates the pact. Never again. When I was young my older brother burned cigarette holes in my blanket, threw books at my head, told me I was fat and stupid. The more upset I got, the more he'd laugh. I'd leave the house, head to the park, hitchhike somewhere. Or stay in my room, but there were no working locks on our doors. He'd barge in. My parents said I was exaggerating when I told them. They were rarely there.

I am better now at being cool, letting it roll off, and mostly I can, but this superior at work was devious. She claimed that a project I designed and developed for months was her doing after it was well received. I called her out, confronted her privately, and she twisted the story. She just blatantly lied about her role—to my face, to herself, in the actual conversation between us. It was shocking. Like gaslighting. I lost it, slammed a book on the desk, called her a —. That she had blithely invented a new reality, that she could do this, that others would trust her, was more than I could bear. Now, I am being accused of abuse and harassment. I lost it. I totally lost it. There was nothing I could do to right it. And now I will likely lose my job."

The above fictional narrative is based on a composite of histories of intermittent explosive disorder (IED), a disorder of aggression that involves a rageful, sudden, and extreme response to a provocation. Though the inciting incident may be deeply offensive and deserving of pushback, losing control is usually not an ideal response. Both the provocateur and the person who explodes, suffer the consequences of escalation. Ideally, one can learn to Identify anger, contain it, and channel it productively.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) lays out six criteria for a diagnosis of IED:

• Recurrent outbursts and an inability to control impulses, including verbal aggression such as tantrums or arguments or physical fighting. Altercations occur twice a week-for at least three months. Destruction of property or physical injury do not occur. (High frequency/low-intensity outbursts.)
• Three severe assaultive episodes that involve injury or destruction within a year-long period including destroying an object, animal, or individual. (High-intensity/low-frequency outbursts.)
• Aggressive behavior is disproportionate to the magnitude of the psychosocial stressors.
• The outbursts are not premeditated and serve no premeditated purpose.
• The outbursts cause distress, impaired functioning, or financial or legal consequences.
• The individual must be at least six years old.
• The recurrent outbursts are not attributable to another mental disorder or substance use.

Possible Reasons for Violent Outbursts

• Altered Mind. Violence, outbursts, and aggression are not always due to IED. Some people can be violent due to a psychotic episode. Certain substances or illnesses can cause paranoia, command hallucinations, or other distorted thoughts. If a person imagines they are being threatened, they could become violent in self-defense. If treated, the violence abates. The illness or temporarily altered mind leads to behavior change.
• Buried Trauma or Biology. A low frustration tolerance can be part of one's personality. This can be due to biology, environmental influence, or trauma. Buried trauma can erupt like a tsunami when triggered. Individuals might respond suddenly and aggressively due to an undigested wound, or a sense of helplessness. It is reactive rather than proactive and unconscious rather than calculated. A desperation to manage humiliation and preserve dignity in the face of a perceived or real insult can be overwhelming.
• Psychopathic Traits. Those driven to gratify violent impulses for personal pleasure are in another category. Some psychopathic individuals perform sadistic acts to feel vitalized, in control, or even purposeful. Such offenders may not have a premeditated target, but are predatory and act on opportunities that arise. Examples might include molesting a woman walking on an isolated street, or kidnapping a child on a bike. A lack of conscience and the drive to gratify impulse, regardless of how it hurts another, is hard to remedy.

Understanding motivations and underlying phenomena help one ascertain the right diagnosis. IED as a personality style versus violence associated with psychosis or psychopathy require very different interventions.

For Those With IED

IED is treatable. Injustices are inevitable, so developing the skill of emotional regulation is useful. It can offer a sense of power, control and self mastery, and allow for other positives such as better relationships and productive work. Treatment can include talk therapies such as CBT or psychotherapy and medication. As always, care requires an individualized, as well as evidence-based approach. Details that stand out or seem strange in a person's story can be keys to a buried injury. With ample time, deep listening and a safe environment, one can get better.

To find a therapist, visit the Psychology Today Therapy Directory.