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

What Is Intermittent Explosive Disorder?

Regularly 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 come under intermittent explosive disorder. The episodes are often unprecedented, sudden in nature, and early in onset. 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.

This 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 an energy shift. 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 intermittent explosive disorder are similar to other mental illnesses, such as mood disorders, in particular bipolar disorder. The episodes of 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 are the Causes and risk factors of 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 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 include 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.

Risk Factors -

The risk of developing intermittent explosive disorder is higher in individuals with a history of these conditions.

• Physical Abuse: Experiencing abuse as a child, being bullied, or undergoing other traumatic or distressing events can elevate the risk of developing intermittent explosive disorder.

• Other Mental Health Conditions: Having disorders like antisocial personality disorder or borderline personality disorder can heighten the risk of intermittent explosive disorder. Other conditions involving disruptive behaviors, such as attention-deficit hyperactivity disorder (ADHD), as well as problems with alcohol and drug use, can also be risk factors.

What Are the Symptoms and Signs of Intermittent Explosive Disorder?

The primary sign of intermittent explosive disorder is recurrent anger outbursts that are disproportionate to the triggering event or situation. Individuals with IEDs recognize that their anger is excessive but feel unable to control their actions during these episodes.

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

• Rage.

• Irritation.

• Tensed muscles.

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

• Tremors.

• Palpitations.

• Tightening of the chest.

• Temper tantrums.

• Illogical shouting bouts.

• Getting into unexplained fights.

• Vandalism.

• Racing and impulsive thoughts.

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

• 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 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 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 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:

  • Antidepressants (especially tricyclic antidepressants).

  • Selective serotonin reuptake inhibitors (SSRIs) (such as Fluoxetine).

  • Mood stabilizers (such as Valproic acid and Carbamazepine).

  • Antipsychotic drugs (like Loxapine and Levomepromazine).

  • Antianxiety drugs.

  • 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.

What Is the Prognosis for Intermittent Explosive Disorder?

Individuals with intermittent explosive disorder often experience lower life satisfaction and a reduced quality of life. This condition can significantly impact health and lead to serious personal and relationship issues.

Cognitive therapy and medication can effectively manage IEDs. However, research indicates that IED is often a long-term condition, persisting for 12 to 20 years or even a lifetime. Individuals with IEDs are at a higher risk for self-harm (self-injury) and suicide. Therefore, it is crucial to seek medical help promptly if you or a family member may have intermittent explosive disorder.

How Can Intermittent Explosive Disorder Be Prevented?

For individuals with intermittent explosive disorder, prevention is often not entirely within their control unless treatment is sought from a mental health professional.

After beginning treatment, adherence to the plan and application of acquired techniques is important. If any medication is prescribed, follow the directions for taking it. Avoid using alcohol or drugs.

When feasible, individuals should try to remove themselves from or steer clear of situations that trigger episodes. Additionally, setting aside time to reduce stress might assist in managing stressful or frustrating situations more effectively in the future.

How Can Individuals Care for Themselves if They Have Intermittent Explosive Disorder?

Ways to manage intermittent explosive disorder:

• Prioritize Self-Care: Focus on maintaining a healthy lifestyle by eating well, exercising regularly, and ensuring an adequate amount of sleep. These practices can promote emotional stability and overall well-being.

• Modify Learned Behaviors: While change can be challenging, implementing the coping strategies learned in therapy can help cultivate healthier behaviors and coping mechanisms.

• Enhance Communication Skills: Practice active listening and refrain from impulsive reactions. Taking a moment to understand the other person's perspective before responding can foster better communication and conflict resolution.

• Adopt Relaxation Techniques: Incorporate relaxation methods into your daily routine, such as deep breathing exercises and meditation. These practices can help alleviate stress and promote emotional regulation.

• Establish a Consistent Routine: Maintain a regular daily schedule to provide structure and stability, which can contribute to emotional balance. Consistent sleep and wake times, as well as planned activities, can enhance emotional stability.

• Minimize Stressful Situations: Reduce exposure to stressors by managing workloads and social commitments. Identify and avoid triggers that exacerbate symptoms, and incorporate stress-relieving activities into daily life.

• Avoid Substances: Limit or avoid the consumption of alcohol and recreational drugs, as they can negatively impact mood and impulse control, exacerbating symptoms of intermittent explosive disorder.

Conclusion:

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. However, it is not possible to prevent or manage episodes of IED without professional help.