Understanding Intermittent Explosive Disorder And Its Treatment

Anger is a natural human emotion that may occur in response to irritating or enraging events. For some, anger responses may be unpredictable or cause problems in relationships, work, and home life. When these interruptions to life occur because of anger, it can be valuable to reach out for support. 

Intermittent explosive disorder (IED) causes explosive outbursts of anger frequently accompanied by violence and disproportionate responses to the issue or situation at hand. During an intermittent explosive disorder episode, punching, kicking, screaming, or throwing objects may occur, and these actions might escalate into physical aggression and violent behavior.

Being at the receiving end of this type of explosive rage can be scary, and the risk factors can feel frightening for those who live with this condition.

An individual diagnosed with intermittent explosive disorder can seek the support of a mental health professional to treat their condition, especially if the symptoms escalate to violent behavior and aggression like physical fights. If left untreated, intermittent explosive disorder can lead to physical or emotional danger.

As with many mental health conditions, learning about your symptoms and the treatments approved for your condition can be beneficial.

Intermittent explosive disorder (IED) causes and risk factors

If you haven't heard of intermittent explosive disorder or know little about it, you may be curious about its causes. Understanding the motives behind the rage outbursts that often occur with this mental health condition can be challenging. Often, symptoms of intermittent explosive disorder result from a build-up of stress throughout an extended period of persistent stressors, anxiety, or fear.

Below are some of the most common causes of intermittent explosive disorder (IED), including both genetic factors and environmental factors.

Mental health conditions 

Environmental, genetic, and other mental health disorders or conditions may contribute to intermittent explosive disorder. Sometimes, differences in brain structure may play a role in the development of mental health disorders. Below are a few of the mental illnesses that may be associated with intermittent explosive disorder and may accompany an intermittent explosive disorder diagnosis: 

• Mood disorders (like depression or bipolar disorder)
• Personality disorders (like borderline personality disorder, antisocial personality disorder, and narcissistic personality disorder)
• Conduct disorder
• Substance use disorders
• Attention-deficit/hyperactivity disorder (ADHD)

It can be beneficial to moderate or avoid mood-altering substances, including recreational drugs, when you have a diagnosis of intermittent explosive disorder (IED).

Military experience

While a direct cause has not been correlated with intermittent explosive disorder, the rate of those diagnosed with the condition has been discovered to be high in military personnel. It is often believed that while the military is trained to focus and sustain life in highly stressful situations, it leaves participants ill-equipped for civilian life afterward.

When living in a heightened state of awareness, one's stress level increases and may cause significant reactions to minor occurrences when returning from service. As rage and outbursts can also be a symptom of post-traumatic stress disorder (PTSD) in Veterans, it may be possible that intermittent explosive disorder is a co-occurring diagnosis with PTSD for these people. However, rage is not only a symptom of intermittent explosive disorder. Conditions like depression and PTSD can also cause the same traits of extreme irritability, anger, and rage. It can be important to get the proper treatment for these other disorders as well.

Traumatic childhood experiences

As intermittent explosive disorder (IED) can be connected to PTSD and traumatic experiences, it may also be common in those who grow up in a household with high tension, traumatic events, or stress.

Children exposed to war, domestic violence, and child abuse may be at risk of developing intermittent disruptive disorder. They may also have difficulty identifying and understanding their anger, which can manifest in many ways and with little or no warning.

Intermittent explosive disorder in children

In infants and toddlers, early signs of developing intermittent explosive disorder include temper tantrums, biting, kicking, or other aggressive impulses. Pre-teens and teenagers may exhibit violence towards siblings or parents, illegal behaviors, or school fights. They may be observed getting into verbal arguments or breaking objects during an explosive episode as well. Children often do not understand that they feel anger and may not know how to label it or control their feelings. However, intermittent explosive disorder often stems from something in the individual's past or upbringing. 

The symptoms of intermittent explosive disorder affect family and friends in the lives of the diagnosed from an early age and warrant rapid treatment for the verbal and physical symptoms as early as possible.

Professionals can identify what is causing these children to act out such anger and how to help them to choose more appropriate ways to exhibit their feelings. If a therapist specializing in intermittent explosive disorder diagnoses and treats the disorder early in a person's life, there may be more hope for recovery. 

Intermittent explosive disorder is similar to another disorder called disruptive mood dysregulation disorder, or DMDD. The difference between the two is that for those with intermittent explosive disorder diagnosed, the bouts of impulsive aggression come and go, but with DMDD, the underlying rage is always present.

While the nature of intermittent explosive disorder makes the cause challenging to identify, it can be essential to recognize the signs and symptoms and take proper measures to receive treatment from a professional. Symptoms of intermittent explosive disorder affect not just the person living with the disorder, but also everyone around them, so it can be crucial to seek treatment, whether through talk therapy or clinical psychiatry.

Intermittent explosive disorder diagnoses

As approved by the American Psychiatric Association, the Diagnostic and Statistical Manual of Mental Disorders includes intermittent explosive disorder as a mental disorder in its fifth edition. According to the DSM-5, there are several intermittent explosive disorder symptoms and diagnostic criteria. 

Some of the traits among people with intermittent explosive disorder include but are not limited to the following: 

These angry and aggressive outbursts can result in abusive behaviors, physical fights, destruction of property, physical assault, road rage, car accidents, dangerous behavior, health risks, impaired personal relationships, or lashing out toward strangers, potentially causing them physical harm.

During times of anger, the ability to reason about actions and the ability to control behaviors may be reduced in people with intermittent explosive disorder. This, paired with the increased energy that can come with angry outbursts, can mean that there are higher chances of someone getting hurt because of an outburst and the explosive behavior that can come with it.

People with intermittent explosive disorder can experience mental health symptoms that are potentially mild, like chest tightness but are also at increased risk for sudden anger outbursts, leading to more complex situations like physical abuse and physical injury. Some people are also at an increased risk for intermittent explosive disorder subtypes requiring specialized treatment. It can be crucial to receive a proper diagnosis and begin treatment as soon as possible if you believe you may be living with intermittent explosive disorder or want to better control aggressive behavior. 

Intermittent explosive disorder treatment 

There are several ways to get intermittent explosive disorder treated, including the following options. 

One of the most common is medications which may lower impulsivity and improve mood. If someone is feeling happier and less impulsive, they may be less likely to respond to inciting events with anger and rage. Medical treatments like mood regulators may help someone feel in control of their body and mind and more able to cope around family, friends, coworkers, and the general population.

Before starting, changing, or stopping a medication, consult a medical professional like a psychiatrist or primary care physician. 

Counseling with a mental health professional

Medication may sometimes mask the root cause of intermittent explosive disorder. For that reason, therapy is often recommended as a component of intermittent explosive disorder treatment. While there might be a genetic component to intermittent explosive disorder, behavioral changes like using relaxation techniques can alleviate significant distress and anger outbursts. A licensed therapist can teach an individual to practice relaxation techniques that lower blood pressure, and regular relaxation training can be highly beneficial.

Therapy sessions can also account for biological factors by training the brain. By speaking with their therapist, one can understand the root causes of anger and what might cause it, along with coping skills for moments of rage. In doing this, a client may recognize that rage can be unhealthy. Afterward, other treatments like anger management or cognitive-behavioral therapy (CBT) can be utilized. 

Studies have led to various tools for therapists to teach someone with intermittent explosive disorder to alleviate the aggressive episodes accompanying the chronic disorder.

Therapists can help clients establish why anger is present and how to dissipate it. Additionally, they can help with breathing exercises and other stress management techniques.

Inpatient treatment 

In severe cases of intermittent explosive disorder, an inpatient stay at a mental health facility may be appropriate, as medical attention may be warranted. This may be the case if an individual has been attempting suicide.* The client can be monitored and given appropriate medication and treatment there while staff help keep them and others safe. While admitted, the client may receive anger management services, therapy services, and sessions with a psychiatrist. Once the client is stabilized, they can be released to practice their newly learned skills while continuing outpatient therapy.

Benefits of treatment for IED

Treatment of intermittent explosive disorder can be crucial for many clients. If left untreated, individuals may experience difficulties within the legal system, physical violence in relationships, and damaged relationships with family and friends.

Sudden anger can lead to verbal outbursts, the use of mood-altering substances not prescribed by a doctor, physical abuse, and dangerous activity like road rage, self-harm, or suicidal ideation and attempts. 

By accepting an intermittent explosive disorder diagnosis and seeking professional treatment, an individual can begin a treatment plan and get on the path to living a happy, healthy, and productive life. Family and friends can also help by being supportive and involved with treatment. With a social support system involved, the person diagnosed with intermittent explosive disorder may begin work on impulse control, communication skills, and relaxation techniques like deep breathing to work through their explosive episodes.

Many people can benefit from anger management techniques, not just those diagnosed with intermittent explosive disorder. Techniques like emotional regulation skills and cognitive restructuring can also be taught to children and adolescents so that they can better accept challenges that may occur in their lifetime. 

Professional support for intermittent explosive disorder

An increasing body of evidence points to online therapy as a beneficial form of treatment for those experiencing emotional control issues arising from intermittent explosive disorder and other mental health conditions.  

Cognitive behavioral therapy

Cognitive-behavioral therapy works by helping individuals reframe the negative thought patterns that can often lead to unwanted feelings and behaviors, such as severe, problematic anger so that inciting situations and interactions are more manageable. In one meta-analysis of CBT-based anger management, researchers looked at the interventions' effectiveness in reducing recidivism among adult men, concluding that anger management therapy is effective in reducing recidivism risk, especially regarding violent crime. 

Online therapy

Online therapy proves equally effective in supporting people living with anger management challenges. In a recent study published by the Center for Psychiatry Research at Karolinska Institute in Sweden, researchers demonstrated how a four-week internet-administered CBT course achieved positive results for people struggling with anger and aggression. The 234 participants were assigned to mindful emotion awareness, cognitive reappraisal, and a combination of the two modes. All treatments were associated with decreased rates of self-reported anger and aggression.

Online therapy is a flexible and effective option if you or someone you know exhibits signs and symptoms of intermittent explosive disorder. The ability to schedule appointments from the comfort of your own space may be particularly beneficial if you're concerned about anger in an uncontrolled environment. Through a platform like BetterHelp, you can connect with one of over 30,000 licensed mental health professionals specializing in unique areas of mental health based on your needs, preferences, and location. With more options than those in your area, you may be more likely to find someone specializing in your condition.