Intermittent Explosive Disorder - Causes, Symptoms, Complications, and Treatment

What Is Intermittent Explosive Disorder?

On a regular basis losing calm and composure once in a while is a normal phenomenon. However, throwing temper tantrums, losing their calm, showing violent behavior, and attacking or abusing others verbally or physically comes under intermittent explosive disorder. The episodes are often unprecedented, sudden in nature, and are early in onset. The intermittent explosive disorder is an uncharted mental disorder flagged off by unwarranted anger episodes. It is often described as flying into a rage for no (specific) reason.

The intermittent explosive disorder is a lesser-known behavioral disorder. Impulsive aggression is not premeditated. Often in impulsive aggressive cases, the person suffering reports behavior changes just before an outburst, such as sudden tension in the muscles, mood changes, and a shift in the energy. The disorder has been recently added to the diagnostic and statistical manual of mental disorders (DSM-5) under the category of disruptive, impulse-controlled, and conduct disorders.

The disorder is not easily diagnosable, as some of the characteristic features of the intermittent explosive disorder are similar to other mental illnesses, such as mood disorders, in particular bipolar disorder. The episodes of the intermittent explosive disorder are brief as they last from minutes to hours at maximum, with a wide spectrum of clinical features like profuse sweating, tightening of the chest, and palpitations. The episode, as much as being unprecedented, is still remorseful, as the person suffering has full control over their reactions and emotions.

What Causes Intermittent Explosive Disorder?

The exact cause behind the intermittent explosive disorder is yet to be found. However, certain other causes like genetic and environmental factors or a combination of these factors are probable causes behind the development of the intermittent explosive disorder.

Some of the causes are:

• Hormonal level (low serotonin levels in the brain).

• Sex (males are at higher risk of developing intermittent explosive disorder).

• Positive history of trauma (history of sexual, verbal, or physical abuse).

• Other mental illnesses such as attention-deficit hyperactivity disorder or anxiety disorder.

• Portrays symptoms of antisocial personality disorder.

• Signs and symptoms of borderline personality disorder are present.

• Positive familial history (genetic factor).

• Depression.

• Substance dependence or abuse.

What Are the Symptoms of Intermittent Explosive Disorder?

The intermittent explosive disorder shows an array of signs and symptoms except for the marked characteristic features. Some of the symptoms are:

1. Rage.

2. Irritation.

3. Tensed muscles.

4. Fluctuation in energy levels (usually high levels of energy).

5. Tremors.

6. Palpitations.

7. Tightening of the chest.

8. Temper tantrums.

9. Illogical shouting bouts.

10. Getting into unexplained fights.

11. Vandalisms.

12. Racing and impulsive thoughts.

13. Getting physical with others (slapping, punching, shoving, or pushing).

14. Assaulting others (including animals).

How to Diagnose Intermittent Explosive Disorder?

The diagnostic and statistical manual of mental disorders, fifth edition (DSM-5), has established a diagnostic criterion to officially diagnose cases of the intermittent explosive disorder. Criteria for diagnosis are-

Recurrent outbursts demonstrating the inability to control impulses should include either-

• Criteria A1: Verbal aggression (temper tantrums, argumentations, and fights) or physical aggression (occurring twice in a week or in three months). It does not include vandalism or any physical injury.

• Criteria A2: Three episodes (outbursts) that include injury or destruction of property within a year.

• Criteria B: Aggressive behavior (in the same magnitude as that of psychosocial stressors).

• Criteria C: Outbursts are not premeditated (serve no purpose).

• Criteria D: The outbursts lead to impairment or dysfunctional cognitive thinking or behavior and lead to consequences.

• Criteria E: The minimum age of the person suffering should be six years.

• Criteria F: The outbursts cannot be explained by other mental illnesses or other medical conditions, including substance misuse or dependence.

What Is the Treatment for Intermittent Explosive Disorder?

Behavior for the intermittent explosive disorder is symptomatic and is based on the severity of the disorder. The treatment plan employed for intermittent explosive disorder includes medicinal therapy and psychotherapy. The treatment plan for IED is-

• Psychotherapy: Consulting a psychologist, a psychiatrist, or a counselor for the symptoms of the intermittent explosive disorder is an essential part of the treatment. Psychotherapy helps with managing the symptoms in day-to-day life. Different psychotherapies involved in the treatment plan are cognitive-behavioral therapy (CBT), cognitive relaxation and coping skills therapy (CRCST), cognitive restructuring, and exposure therapy.

• Medicinal Therapy: Medicines are prescribed to undermine aggression and rage. The episodes are structured without a logical explanation, and hence the episodes of anxiety, violence, rage, and depression need to be managed. Medicines prescribed in case of intermittent explosive therapy are:

1. Antidepressants (especially tricyclic antidepressants).
2. Selective serotonin reuptake inhibitors (SSRIs) (such as Fluoxetine.
3. Mood stabilizers (such as Valproic acid and Carbamazepine).
4. Antipsychotic drugs (like Loxapine and Levomepromazine).
5. Antianxiety drugs.
6. Anticonvulsive drugs (such as Gabapentin and Lithium).

What Are the Complications of Intermittent Explosive Disorder?

People suffering from intermittent explosive disorder are at great risk of developing other mental and physical illnesses. Conditions or complications develop when an individual avoids getting treatment. Some of the complications are:

• Depression.

• Anxiety disorders.

• Attention-deficit hyperactivity disorder (ADHD).

• Impulsive and risk-taking behavior.

• Eating disorders.

• Headaches (often acute in onset but chronic as an illness).

• Hypertension.

• Diabetes.

• Heart diseases.

• Risk of getting a stroke.

• Chronic body ache.

• Stomach ulcers (due to increased stress).

• Suicidal tendencies.

Conclusion:

The intermittent explosive disorder consists of repeated and sudden episodes of impulsive, aggressive, and violent behavior or angry verbal or physical outbursts wherein the person reacts in a gross and proportioned manner. These intermittent and explosive outbursts cause them to suffer a great deal of distress and negatively impact their relationships, including both personal and professional life. IED is a chronic disorder that continues for years, although the severity of outbursts and episodes may decrease with age. Treatment involves medicinal therapy and psychotherapy to help manage aggressive impulses. Many people who suffer from IED choose to avoid treatment. But it is not possible to prevent or manage episodes of IED without professional help.