Causes

The exact cause of intermittent explosive disorder is unknown, but the disorder is probably caused by a number of environmental and biological factors.

  • Most people with this disorder grew up in families where explosive behavior and verbal and physical abuse were common.
  • Being exposed to this type of violence at an early age makes it more likely for these children to exhibit these same traits as they mature.
  • There may also be a genetic component, causing the disorder to be passed down from parents to children.
  • Additionally, there may be differences in the way serotonin, an important chemical messenger in the brain, works in people with intermittent explosive disorder.
  • Higher levels of the hormone testosterone have been associated with intermittent explosive disorder.

Epidemology

Epidemiologic studies of adults show that intermittent explosive disorder (IED) is a highly prevalent and seriously impairing disorder.

  • Retrospective reports in these studies suggest that IED typically begins in childhood
  • Unfortunately, far too little is known about intermittent explosive disorder–the risk factors, protective factors, how to treat it.
  • McLaughlin et. al. (2012) provided us with more information about the importance of this serious mental health condition:

Using the data from US adolescents in the National Comorbidity Survey Replication Adolescent Supplement, 6483 adolescents ages 13-17 years were interviewed and their parents completed questionnaires.

a United States survey of adolescent (ages, 13-17 years) DSM-IV anxiety, mood, behavior, and substance disorders.

Findings revealed that:

  • Nearly two-thirds of adolescents (63.3%) reported lifetime anger attacks that involved destroying property, threatening violence, or engaging in violence.
  • 7.8% met DSM-IV/CIDI criteria for lifetime IED.
  • Intermittent explosive disorder had an early age at onset (mean age, 12.0 years) and was highly persistent, as indicated by 80.1% of lifetime cases (6.2% of all respondents) meeting 12-month criteria for IED.
  • Injuries related to IED requiring medical attention reportedly occurred 52.5 times per 100 lifetime cases.
  • In addition, IED was significantly comorbid with a wide range of DSM-IV/CIDI mood, anxiety, and substance disorders, with 63.9% of lifetime cases meeting criteria for another such disorder.

These findings have important ramifications for treatment:

  • 37.8% of adolescents with 12-month IED received treatment for emotional problems in the year before the interview
  • only 6.5% of respondents with 12-month IED were treated specifically for anger.
  • Thus, Intermittent explosive disorder is UNDERTREATED, and we know far too little about it.

The Authors of the study concluded

Intermittent explosive disorder is a highly prevalent, persistent, and seriously impairing adolescent mental disorder that is both understudied and undertreated. Research is needed to uncover risk and protective factors for the disorder, develop strategies for screening and early detection, and identify effective treatments

Intermittent Explosive Disorder in the National Comorbidity Survey Replication Adolescent Supplement

Katie A. McLaughlin, PhD; Jennifer Greif Green, PhD; Irving Hwang, MA; Nancy A. Sampson, BA; Alan M. Zaslavsky, PhD; Ronald C. Kessler, PhD

Arch Gen Psychiatry. 2012;():1-9. doi:10.1001/archgenpsychiatry.2012.59

Diagnosis

To diagnose Intermittent Explosive Disorder, a mental health provider will consider whether symptoms fulfill the DSM criteria for intermittent explosive disorder.

  • A clinical interview with a thorough history is completed.
  • People with intermittent explosive disorder may also show some minor irregularities in neurological signs and electroencephalograms (EEGs).

(An EEG is a noninvasive test that looks at the  electrical activity the  brain, by affixing wires to the scalp with an adhesive)

Complications

The violent behavior that’s part of intermittent explosive disorder is not always directed at others.

  • People with intermittent explosive disorder are also at significantly increased risk of harming themselves, either with intentional injuries or suicide attempts.
  • Those who are also addicted to drugs or had another serious mental disorder, such as depression, are at the greatest risk of harming themselves.

People with intermittent explosive disorder are often perceived by others as always being angry.

Other complications of intermittent explosive disorder may include job loss, school suspension, divorce, auto accidents or incarceration.

Coping and Support

For the Person with Intermittent Explosive Disorder:

Controlling your anger

  • If you recognize your own behavior in the description of intermittent explosive disorder, talk with your doctor about what treatments are available to you, or ask for a referral to a mental health professional.
  • Coping well with anger is a learned behavior, just as behaving badly when you get frustrated is a behavior you have to unlearn. Cognitive behavioral therapy or anger management will help you recognize what pushes your buttons and how to respond in ways that work for you instead of against you.
  • In the meantime, work with your doctor on developing a plan of action for when you feel yourself getting angry. For example, if think you might lose control, try to remove yourself from that situation. Go for a walk or call a trusted friend to try to calm down. If you can’t find a way to calm down on your own, you can go to your local emergency room and ask for help.

If your loved one won’t get help

  • Unfortunately, many people with intermittent explosive disorder don’t seek treatment
  • If you’re involved in a relationship with someone who has intermittent explosive disorder, it’s important that you take steps to protect yourself and your children
  • The abuse isn’t your fault. No one deserves to be abused.

Create an escape plan
If you see that a situation is escalating, and suspect your loved one may be on the verge of an explosive episode, try to safely remove yourself and your children from the scene. However, leaving someone with an explosive temper can be dangerous. Consider taking these steps before an emergency arises:

  • Call a domestic violence hot line or a women’s shelter for advice, either when the abuser isn’t home or from a friend’s house.
  • Keep all firearms locked. Don’t give the abuser the key or combination to the lock.
  • Pack an emergency bag that includes items you’ll need when you leave, such as extra clothes, keys, personal papers, medications and money. Hide it or leave the bag with a friend or neighbor.
  • Know where you’ll go and how you’ll get there if you feel threatened, even if it means you have to leave in the middle of the night.

Call for HELP
In an emergency, call 911 — or whatever your local emergency number is — or your local law enforcement agency. The following resources also can help:

  • National Domestic Violence Hotline: 800-799-SAFE (800-799-7233). This hot line is available for crisis intervention and referrals to resources, such as women’s shelters.
  • Your doctor. Doctors and nurses can treat your injuries and let you know what local resources are available to keep you safe.
  • A local shelter or crisis center. Shelters and crisis centers generally provide 24-hour emergency shelter, as well as advice on legal matters and advocacy and support services.
  • A counseling or mental health center. Many communities offer counseling and support groups for people in abusive relationships. Be wary of advice to seek couples or marriage counseling. If violence has escalated to the point that you’re afraid of your partner, this type of counseling won’t be adequate.
  • A local court. Your local court can help you obtain a restraining order that legally mandates the abuser has to stay away from you or face arrest. Local advocates may be available to help guide you through the process.

Symptoms

Explosive eruptions, usually lasting 10 to 20 minutes, often result in injuries and the deliberate destruction of property. These episodes may occur in clusters or be separated by weeks or months of nonaggression.

Aggressive episodes may be preceded or accompanied by:

  • Irritability
  • Increased energy
  • Rage
  • Tingling
  • Tremors
  • Palpitations
  • Chest tightness
  • Headache or a feeling of pressure in the head

Treatment

There is not one treatment that works best for everyone with intermittent explosive disorder.

Treatment generally includes a combination of medication and therapy–and can include either individual or group therapy or both

Medications:

Many different types of medications are used to help control intermittent explosive disorder, including:

  • Antidepressants, such as fluoxetine (Prozac) and paroxetine (Paxil)
  • Anticonvulsants, such as carbamazepine (Tegretol), phenytoin (Dilantin), gabapentin (Neurontin) and lamotrigine (Lamictal)
  • Anti-anxiety agents in the benzodiazepine family, such as diazepam (Valium), lorazepam (Ativan) and alprazolam (Xanax)
  • Mood regulators, such as propranolol (Inderal) and lithium

Therapy:

  • Individual or group therapy sessions also can be helpful
  • A commonly used type of therapy, cognitive behavioral therapy (CBT), helps people with intermittent explosive disorder identify which situations or behaviors may trigger an aggressive response.
  • CBT  teaches people with intermittent explosive disorder how to manage their anger and control their typically inappropriate response using relaxation exercises.