Intermittent Explosive Disorder

Overview

What is intermittent explosive disorder?

Intermittent explosive disorder is a lesser-known mental disorder marked by episodes of unwarranted anger. It is commonly described as “flying into a rage for no reason.” In an individual with intermittent explosive disorder, the behavioral outbursts are out of proportion to the situation.

How common is intermittent explosive disorder?

It is estimated that between one to seven percent of individuals will develop intermittent explosive disorder during their lifetime.

Who is affected by intermittent explosive disorder?

Intermittent explosive disorder usually begins in the early teens, but can be seen in children as young as six. It is most common in people under the age of 40.

Symptoms and Causes

What causes intermittent explosive disorder?

The cause of intermittent explosive disorder is unknown, but some contributing factors have been identified. They include:

  • A genetic component (occurs in families)
  • Being exposed to verbal and physical abuse in childhood
  • Brain chemistry (varying levels of serotonin) can contribute to the disorder
  • Having experienced one or more traumatic events in childhood
  • A history of mental health disorders, including attention deficit hyperactivity disorder (ADHD), antisocial personality disorder, borderline personality disorder
  • Nearly 82 percent of those with intermittent explosive disorder have also had depression, anxiety or substance abuse disorder

What are the signs of intermittent explosive disorder?

Intermittent explosive disorder manifests itself in what seems like adult temper tantrums. Throwing objects, fighting for no reason, road rage and domestic abuse are examples of intermittent explosive disorder. The outbursts typically last less than 30 minutes. After an outburst, an individual may feel a sense of relief – followed by regret and embarrassment.

What are the symptoms of intermittent explosive disorder?

Individual experiencing intermittent explosive disorder may display one of more of the following symptoms:

  • Rage
  • Irritability
  • Increasing sense of tension
  • Racing thoughts
  • Increased energy
  • Tremors
  • Palpitations
  • Chest tightness
  • Temper tantrums
  • Shouting
  • Being argumentative
  • Getting into fights
  • Threatening others
  • Assaulting people or animals
  • Damaging property

Diagnosis and Tests

How is intermittent explosive disorder diagnosed?

Diagnosis begins with taking the individual’s general medical history, psychiatric history and conducting a physical and mental status exam. To be diagnosed with intermittent explosive disorder, an individual must display a failure to control aggressive impulses as defined by either of the following:

  • Verbal aggression (temper tantrums, verbal arguments or fights) or physical aggression toward property, animals or individuals, occurring twice weekly, on average, for a period of 3 months. The aggression does not result in physical harm to individuals or animals or destruction of property. Or
  • Three episodes involving damage or destruction of property and/or physical assault involving physical injury against animals or other individuals occurring within a 12-month period.

The degree of aggression displayed during the outbursts is greatly out of proportion to situation. In addition, the outbursts are not pre-planned; they are impulse and/or anger based. Also, the outbursts are not better explained by another mental disorder, medical condition, or substance abuse.

Management and Treatment

How is intermittent explosive disorder treated?

Intermittent explosive disorder may best be treated by a combination of cognitive behavioral therapy (which consists of relaxation training, changing the ways you think [cognitive restructuring] and coping skills training) and medications. In particular, fluoxetine is the most studied drug for intermittent explosive disorder. Other drugs that have been studied for the condition or have been recommended if fluoxetine fails include phenytoin, oxcarbazepine or carbamazepine. In general, the classes of medications that can be tried include antidepressants, anticonvulsants, antianxiety and mood regulators.

What are the complications of intermittent explosive disorder?

Intermittent explosive disorder can have a very negative impact on an individual’s health and life. It can lead to trouble in personal relationships and marriages. It can negatively impair a person’s relationships and judgment at work and school. Individuals with intermittent explosive disorder are more likely to have other psychiatric disorders, abuse drugs and alcohol, and engage in self harm. They also are at a higher risk of some medical conditions including stroke, diabetes, chronic pain, ulcers and high blood pressure. For these reasons, it is important to seek medical attention if you think you or someone you know has intermittent explosive disorder.

Prevention

Can intermittent explosive disorder be prevented?

People diagnosed with intermittent explosive disorder will learn a variety of coping techniques in therapy. These can help prevent episodes. They include:

  • Relaxation techniques
  • Changing the ways you think (cognitive restructuring)
  • Communication skills
  • Learning to change your environment and leaving stressful situations when possible
  • Avoiding alcohol and recreational drugs

Outlook / Prognosis

What is the prognosis/outlook for patients who have intermittent explosive disorder?

Having intermittent explosive disorder can predispose an individual to depression, anxiety, and alcohol and drug abuse. It can also lead to severe personal and relationship problems. For that reason, it is essential to seek medical help if you feel you or a family member has intermittent explosive disorder. With cognitive therapy and medication, the condition can be successfully managed. However, according to studies, it is thought that intermittent explosive disorder is a long-term condition, lasting from 12 years to 20 years or even a lifetime.

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