Intermittent Explosive Disorder Symptoms, Diagnosis, Causes, Risk Factors, Co-Occurring Disorders, Complications & Treatment
What is Intermittent Explosive Disorder?
Intermittent explosive disorder (IED) is an impulse-control disorder characterized by sudden episodes of unwarranted anger. The disorder is typified by hostility, impulsivity, and recurrent aggressive outbursts. People with IEDs essentially “explode” into a rage despite a lack of apparent provocation or reason. Individuals suffering from intermittent explosive disorder have described the feeling as losing control of their emotions and becoming overcome with anger.
People with IEDs may threaten or attack objects, animals, and other humans. IED is said to begin during the early teen years typically, and evidence has suggested that it has the potential of predisposing individuals to depression, anxiety, and substance abuse disorders. The intermittent explosive disorder is not diagnosed unless a person has displayed at least three episodes of impulsive aggressiveness.
Individuals with IED have reported feeling a sense of relief once they have released the tension that built up due to their rage. However, once the comfort wears off, some people report experiencing remorse or embarrassment. While IED can be highly disruptive to an individual’s life and the lives of those around them, IED can be managed through proper treatment, education about anger management, and possibly through the use of medication.
Intermittent Explosive Disorder Symptoms
The impulsive, aggressive episodes that characterize IED can take many forms. Some behaviors that might be signs of IED include:
- Yelling and shouting
- Intense arguments
- Temper tantrums and rampages
- Road rage
- Punching walls or breaking plates
- Damaging property
- Physical violence, such as slapping or shoving
- Fights or brawls
- Domestic violence
These spells or attacks often occur with little to no warning. They are short-lived, rarely lasting longer than half an hour. They may appear alongside physical symptoms, such as:
- Increased energy (adrenaline rush)
- Headache or head pressure
- Heart palpitations
- Chest tightness
- Muscle tension
Feelings of irritation, rage, and loss of control are commonly reported before or during the episode. People with IED might experience racing thoughts or a sense of emotional detachment. Immediately after, they might feel tired or relieved. People with IED often report feelings of remorse or guilt following an episode.
For some individuals with IED, these episodes occur regularly. Others appear after weeks- or months-long stretches of nonaggressive behavior. Verbal outbursts may occur between acts of physical violence.
Diagnosis for IED
The new edition of the Diagnostic and Statistical Manual (DSM-5) includes updated diagnostic criteria for IED. The new standards distinguish between:
- More frequent episodes of verbal aggression without physically harming people or property
- Less frequent acts of destructive or assaultive behavior that causes serious harm to people or property
A disorder characterized by impulsive and aggressive behavior has appeared in all editions of the DSM. However, it was first called IED in the third edition. Before the third edition, it was believed to be rare. However, with updated diagnostic criteria and advances in IED research, it’s now considered to be much more common.
In 2005, a study  found that 6.3 percent of 1,300 people seeking care for a mental health issue met the criteria for DSM-5 IED at some point in their lifetime. In addition, 3.1 percent met the criteria for a current diagnosis. A 9,282-person from 2006 found that 7.3 percent met the DSM-5 criteria for IED at some point in their lifetime, while 3.9 percent met the requirements in the past 12 months.
Causes & Risk Factors for Intermittent Explosive Disorder
The cause of the intermittent explosive disorder is a combination of multiple components, including genetic factors, physical factors, and environmental factors. The following are some examples of these varying factors:
- Genetic: It has been hypothesized that the traits that this disorder is composed of are passed down from parents to children; however, there is presently no specific gene identified as having a significant impact on the development of IED.
- Physical: Research has suggested that intermittent explosive disorder may occur due to abnormalities in the areas of the brain that regulate arousal and inhibition. Impulsive aggression may be related to abnormal brain mechanisms that inhibit or prohibit muscular activity through serotonin. Serotonin, which sends chemical messages throughout the brain, may be composed differently in people with intermittent explosive disorder.
- Environmental: The environment in which a person grows up can significantly impact whether or not they develop symptoms of IED. It has been hypothesized that people who grow up in homes subjected to harsh punishments are more likely to create IEDs. The belief is that these children will follow the example set by their parents and will act out aggressively – their initial reaction to something negative that they encounter. Another theory is that if children endure harsh physical punishments, they may find a sense of redemption in putting others through the same form of physical pain.
- Being male
- Exposure to violence at an early age
- Exposure to explosive behaviors at home (e.g., angry outbursts from parents or siblings)
- Having experienced physical trauma
- Having experienced emotional trauma
- History of substance abuse
- Certain medical conditions
Effects of Intermittent Explosive Disorder
IED can lead to devastating consequences for those with the disorder, but this depends on the person’s specific symptoms and behaviors. The following are examples of effects that untreated intermittent explosive disease can have on individuals:
- Impaired interpersonal relationships
- Domestic or child abuse
- Legal problems
- Drug or alcohol addiction
- Trouble at work, home, or school
- Low self-esteem and self-loathing
- Suicidal thoughts and behaviors
Intermittent Explosive Disorder & Co-Occurring Disorders
The symptoms of intermittent explosive disorder often directly mirror symptoms of various other diseases. Some of the most common mental disorders that co-occur with IED can include:
Treatment for Intermittent Explosive Disorder
There are several treatments for IED. Most of the time, more than one treatment is used.
Seeing a counselor, psychologist, or therapist alone or in a group setting may help a person manage symptoms of IED.
Cognitive-behavioral therapy (CBT) involves identifying harmful patterns and coping skills, relaxation techniques, and relapse education to deal with aggressive impulses.
A 2008 study found 12 weeks of individual or group CBT reduced IED symptoms, including aggression, anger control, and hostility. This was true both during treatment and after three months.
There are no specific medications for IED, but certain medications may help reduce impulsive behavior or aggression. These include:
- Antidepressants, in particular, selective serotonin reuptake inhibitors (SSRIs)
- Mood stabilizers, including lithium, valproic acid, and carbamazepine
- Antipsychotic drugs
- Anti anxiety drugs
Research on medication for IED is limited. However, a 2009 study  found that the SSRI fluoxetine, more commonly known by its brand name Prozac, reduced impulsive-aggressive behaviors among people with IED.
It can take up to three months of treatment to experience the full effects of SSRIs, and symptoms tend to reappear once the medication is stopped. In addition, not everyone responds to the drug.
Few studies have explored the effectiveness of alternative treatments and lifestyle changes for IED. Still, several interventions aren’t likely to have a negative impact. Some of these include:
- Adopting a balanced diet
- Trying alternative therapies, such as acupressure, acupuncture, or massage
- Practicing meditation or other mindfulness techniques
- Avoiding alcohol, drugs, and cigarettes
- Reducing and managing sources of stress
- Making time for relaxing activities, such as listening to music
- Getting enough sleep
- Staying physically active
What are the Complications?
IED can impact your close relationships and everyday activities. Frequent arguments and more aggressive behavior can make maintaining stable and supportive relationships difficult. In addition, episodes of IED can cause significant harm within families.
You might also experience consequences after behaving aggressively at work, school, or on the road. Possible complications are losing a job, expulsion from school, car accidents, and financial and legal repercussions.
People with IED are at an increased risk of having other mental and physical health issues. Some of these include:
- Chronic headaches
- High blood pressure
- Heart disease
- Chronic pain
We Level Up FL Treatment Center provides world-class care with round-the-clock medical professionals available to help you cope. In addition, we work as an integrated team providing information about Intermittent explosive disorder and other aspects of treatment. Make this your opportunity to reclaim your life. Call today to speak with one of our treatment specialists. Our specialists know what you are going through and answer any of your questions.
Many people who have IED don’t seek treatment. But it’s nearly impossible to prevent episodes of IED without professional help.
If you suspect that you have IED, contact us today here at We Level Up.
Your call is private and confidential, and there is never any obligation.
 NCBI – https://www.ncbi.nlm.nih.gov/pubmed/16259534
 Research Gate – https://www.researchgate.net/profile/Emil_Coccaro/publication/23302088_Cognitive-Behavioral_Therapy_for_Intermittent_Explosive_Disorder_A_Pilot_Randomized_Clinical_Trial/links/02e7e51a503efd4b00000000.pdf
 Psycnet – http://psycnet.apa.org/record/2009-11988-005
 NCBI – ncbi.nlm.nih.gov/pubmed/16259534
 NCBI – https://www.ncbi.nlm.nih.gov/pubmed/16259534