Intermittent Explosive Disorder

Intermittent Explosive Disorder (IED) is a chronic mental health condition characterized by repeated episodes of aggressive, violent behaviour or angry verbal outbursts in which people react grossly out of proportion to the situation. Although these explosive outbursts can be directed towards people, they can also involve property damage. The disorder typically manifests during the late childhood or adolescent years and can continue into adulthood. The underlying causes of IED are not entirely understood but involve a combination of environmental, biological, and genetic factors. Symptoms often include tirades, temper tantrums, and physical aggression, which are unpremeditated and not aimed at achieving a tangible objective, such as intimidating or stealing. The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), estimates that 2.7% of individuals may be affected by IED during their lifetime. Effective treatment usually comprises a combination of cognitive-behavioural therapy (CBT) and medications. These interventions aim to help the individual control their impulses, reduce aggressive outbursts, and manage any other contributing mental health conditions.

If you suspect you or someone else is experiencing Intermittent Explosive Disorder, it is crucial to seek immediate medical attention by calling emergency services or consult with a Psychologist.

Causes

Although the exact causes of Intermittent Explosive Disorder are not completely understood, it is generally thought to result from a complex interaction of several factors: • Biological: Neurotransmitters, the chemicals that help transmit signals in the brain, may be involved in controlling aggression and may be imbalanced in people with IED. Brain imaging studies have suggested that abnormalities in the prefrontal cortex, which is involved in behaviour control, may also be associated with the disorder. • Genetic: There is evidence to suggest that IED may run in families, indicating a potential genetic component. Individuals with a family history of mood disorders, particularly those that involve aggression or impulsive behaviour, may be at a higher risk of developing IED. • Environmental: Environmental factors such as exposure to violence, having experienced physical or emotional trauma, or having been raised in a family environment where explosive behaviour was a common response to stress, may predispose someone to IED.

Risk Factors

Certain factors may increase the risk of developing IED or influence the severity of the symptoms: • Age: IED usually begins in the early teens, with the onset rarely occurring after age 40. • Sex: Males are more often diagnosed with IED than females. • Childhood Trauma: Experiencing physical abuse or other traumatic experiences during childhood is linked with the development of IED. • Other Mental Health Disorders: The presence of co-occurring mental health disorders, such as ADHD, borderline personality disorder, or antisocial personality disorder, can increase the likelihood of IED. • Substance Abuse: Substance abuse does not cause IED, but individuals with IED may also misuse substances, which can exacerbate symptoms. • Family History: As with many mental health disorders, having a first-degree relative with IED or other mood disorders may raise the risk of developing the condition. Risk of Complications: The outbursts associated with IED can have serious consequences, including injury to oneself or others, development of other mental health conditions like anxiety or depression, problems with interpersonal relationships, job loss, and legal issues. The disorder can result in significant distress and impairment in social, occupational, and other important areas of functioning.

Symptoms

Intermittent Explosive Disorder (IED) is a psychiatric condition characterized by recurrent outbursts of anger and aggression that are disproportionate to the situation at hand. Understanding the symptoms of IED is crucial in identifying and managing this disorder effectively. One of the key symptoms of IED is recurrent, impulsive episodes of verbal or physical aggression. These episodes are often triggered by minor frustrations or perceived slights, and can result in serious consequences for both the individual with IED and those around them. Individuals with IED may also experience an intense buildup of tension or irritability prior to an outburst, followed by a sense of relief after the aggressive episode has occurred. This cycle can create significant distress and impairment in daily functioning. It is important to note that these aggressive outbursts are not premeditated or planned, but rather occur impulsively in response to triggers. Additionally, individuals with IED may feel remorseful or guilty after their outbursts, further adding to their emotional burden. Recognizing these symptoms is crucial for early intervention and treatment. If you or someone you know is experiencing recurrent episodes of anger and aggression that seem disproportionate to the situation at hand, it may be important to seek professional help from a mental health provider who can provide a proper diagnosis and develop an appropriate treatment plan tailored to individual needs.

Diagnosis

Diagnosing Intermittent Explosive Disorder involves a comprehensive clinical evaluation. Health professionals will usually follow these steps: • Psychiatric Assessment: This includes a discussion of the individual's history of outbursts, including the triggers, frequency, duration, and severity of the episodes. The healthcare provider will also inquire about thoughts and feelings before, during, and after the outbursts. • Physical Examination: Although there are no laboratory tests to specifically diagnose IED, a physician may perform a physical exam and request laboratory tests to rule out other health conditions that could be contributing to the behaviour. • Review of Symptom Criteria: Clinicians refer to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for IED. Key diagnostic criteria include recurrent behavioural outbursts representing a failure to control aggressive impulses as evidenced by either of the following: verbal aggression or physical aggression toward property, animals, or other individuals, twice weekly on average, for a period of three months; or three outbursts involving damage or destruction of property and/or physical assault involving physical injury against animals or other individuals within a 12-month period. • Differential Diagnosis: IED must be distinguished from other mental health disorders, personality disorders, or medical conditions that may also involve aggressive outbursts. Substance abuse, neurological disorders, and other psychiatric diagnoses such as bipolar disorder, ADHD, and conduct disorder must be considered and ruled out.

Treatments

Treatment for IED generally involves a combination of psychotherapy, medication, and education about the disorder: • Psychotherapy: The most common form of therapy is cognitive-behavioural therapy (CBT), which helps patients identify the thoughts that precede the aggressive acts, improve impulse control, and learn alternative ways to respond to anger and frustration. Other forms of therapy may include dialectical behaviour therapy (DBT) and anger management. • Medications: While there are no medications specifically approved for IED, various drugs may be used off-label to help control symptoms, such as: • Antidepressants: SSRIs (Selective Serotonin Reuptake Inhibitors) may help manage the mood swings and reduce aggressive behaviour. • Mood Stabilizers: Medications such as lithium can help stabilize mood and may be beneficial in reducing irritability and aggression. • Anticonvulsants: Some anticonvulsants are used for their mood-stabilizing effects. • Antipsychotics: In some cases, especially when symptoms are severe, atypical antipsychotics may be prescribed. • Education: Educating the individual with IED and their family about the disorder is crucial. Understanding the condition can help with self-monitoring and management of outbursts and improve compliance with treatment strategies.

Preventive Measures

While it may not be possible to prevent IED, some strategies can help minimize the impact and reduce the risk of episodes: • Early Intervention: Early identification and treatment can reduce the frequency and severity of outbursts. • Stress Management: Techniques such as meditation, deep breathing exercises, and progressive muscle relaxation can help manage stress levels, which can potentially trigger outbursts. • Develop Healthy Relationships: Engaging in healthy relationships and building a strong support network can provide emotional support and help reduce feelings of anger and frustration. • Exercise: Regular physical activity can be a healthy way to deal with stress and reduce potential triggers for outbursts. • Avoid Substance Abuse: Since substance abuse can trigger or exacerbate episodes, avoiding alcohol and drugs is a critical preventive measure. • Sleep Hygiene: Adequate and regular sleep can help regulate mood and decrease irritability, potentially reducing the risk of an outburst. By incorporating these therapeutic and preventive measures, individuals with IED can work towards reducing the impact of the disorder on their lives. It is important for individuals to maintain an ongoing relationship with their healthcare provider to adjust treatment plans as needed and to address any emerging issues.

Do's & Don’t's

If you suspect you or someone else is experiencing Intermittent Explosive Disorder, it is crucial to seek immediate medical attention by calling emergency services or consult with a Psychologist.