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Intermittent Explosive Disorder: Clinical Anger Issues

Intermittent explosive disorder is a psychological disorder which is characterized by repeated and sudden episodes of aggressive and violent behavior or verbal outbursts which are grossly disproportionate to the inciting situation.


Intermittent Explosive Disorder: What Does It Mean?

A key component of intermittent explosive disorder is that the explosive behavior and outbursts are associated with significant emotional distress on the individual, impacting negatively on social activities including work and schooling, as well as their interpersonal relationships. Typical signs of intermittent explosive disorder include domestic abuse, temper tantrums, road rage, and domestic abuse.

Stats: How Many Suffer from this Disorder?

Several population surveys have revealed a lifetime prevalence of intermittent explosive disorder of approximately 1 to 5 percent. The disorder has a mean age of onset of 14 to 18 years and it is most commonly seen in the young male adult population. It is said to affect 1 in 12 teenagers. Additionally, studies reveal that more than 80% of people who have intermittent explosive disorder also suffer from another psychological disorder most commonly substance abuse disorders and bipolar disorder.


What Causes Intermittent Explosive Disorder

Although the exact cause of intermittent explosive disorder is unclear, an interplay of factors may be responsible for its development.

Genetics – There may be a genetic predilection to this disorder. Studies have revealed that people with a family history of intermittent explosive disorder are more likely to develop the disorder than other people.

Brain biological factors – Certain chemical imbalances in the regions of the brain responsible for emotions may contribute to the development of intermittent aggressive disorder.

Environmental factors – Growing up in an environment where parents or siblings constantly display aggressive behavior or verbal abuse may increase one’s risk of having the disorder. In addition, a childhood history of child abuse may contribute to the risk of the disorder.


Signs and Symptoms of Intermittent Explosive Disorder

Symptoms of this disorder manifest abruptly without any warning and usually last for about 30 minutes or less. Intermittent explosive disorder varies in severity between individuals. In some individuals, the episodes may occur in frequent intervals or may be separated by longer intervals of normal behavior.

What are the Common Behaviors/Characteristics?

Symptoms of aggressive episodes include:

  • Irritability
  • Rage
  • Tremors
  • Racing thoughts
  • Increased energy
  • Palpitations
  • Restlessness

The behavioral outbursts may include the following and are often out of proportion to the inciting situation.

  • Temper tantrums
  • Shouting
  • Physical fights and assault
  • Damage to own or else’s property
  • Making threats
  • Heated arguments
  • The episode is usually followed by a period of relief or tiredness, after which the individual may feel embarrassed and remorseful.


Diagnostic Criteria for Intermittent Explosive Disorder

According to the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5), the criteria for the diagnosis of intermittent explosive disorder include:

  • Recurrent outbursts that demonstrate an inability to control impulses, including either of the following:
    • Verbal aggression (tantrums, verbal arguments or fights) or physical aggression that occurs twice in a week-long period for at least three months and does not lead to the destruction of property or physical injury (Criterion A1)
    • Three outbursts that involve injury or destruction within a year-long period (Criterion A2)
  • Aggressive behavior is grossly disproportionate to the magnitude of the psychosocial stressors
  • The outbursts are not premeditated and serve no premeditated purpose
  • The outbursts cause distress or impairment of functioning, or lead to financial or legal consequences
  • The individual must be at least six years old
  • The recurrent outbursts cannot be explained by another mental disorder and are not the result of another medical disorder or substance use

It is noteworthy that DSM-5 now includes two separate criteria for the types of aggressive outbursts

  • Criterion A1: Episodes of verbal and/or non-damaging, nondestructive, or non-injurious physical assault that occur, on average, twice weekly for three months. These could include temper tantrums, tirades, verbal arguments/fights, or assault without damage. This criterion includes high frequency/low-intensity outbursts.
  • Criterion A2: More severe destructive/assaultive episodes which are more infrequent and occur, on average, three times within a twelve-month period. These could be destroying an object without regard to value, assaulting an animal or individual. This criterion includes high-intensity/low-frequency outbursts.


Intermittent Explosive Disorder and other Conditions

The symptoms of intermittent explosive disorders often overlap with several others and it is essential to differentiate them clinically.


Intermittent Explosive Disorder vs. Conduct Disorder

While both disorders have many similarities, conduct disorder is characterized by a repetitive, persistent, and often premeditated behavioral pattern which is characterized by the violation of the basic rights of others or societal values appropriate for the patient’s age. This is not the case in intermittent explosive disorder in which symptoms are largely impulsive and not premeditated. Behavioral characteristics in conduct disorder include aggression to people and animals in form of bullying, threats, and physical assault, and destruction of others’ property with the intention of causing harm. In addition, patients who suffer from conduct disorder also display a violation of age-appropriate norms.


Intermittent Explosive Disorder and Oppositional Defiant Disorder

Both disorders have some similarities, however, oppositional defiant disorder has an earlier onset – usually by the age of 8 years and are usually not characterized by violence or grossly aggressive physical behavior. Oppositional defiant disorder has different diagnostic criteria which includes a recurrent pattern of irritable or angry mood, rebellious behavior, or vindictiveness which lasts at least 6 months. Patients with oppositional defiant disorder are generally irritable and touchy and often annoy others and contravene laid down laws deliberately. In addition, in contrast to intermittent explosive disorder, the behavioral pattern and outbursts are usually premeditated in oppositional defiant disorder.


Related Conditions

Other psychological disorders which may be characterized by aggressive behavior and physical abuse include substance intoxication such as with amphetamine and cocaine, schizoaffective disorder characterized by aggressive behavioral pattern triggered by delusions and hallucinations, and antisocial personality disorder which is characterized by rebellious behavior, lack of remorse, and recalcitrant social irresponsibility.

Intermittent Explosive Disorder in Adults/Children

The disorder typically begins in late childhood or adolescent years, progressing to young adulthood. It is very common in adults below the age of 40.

Example Case of Intermittent Explosive Disorder

A 23-year-old man is brought to the clinic by a group of police officers. He was said to have beat up his wife over an altercation about how he spends his money. His wife noted that he frequently gets angry most times and usually over slight mistakes or disagreements since they got married over a year ago. On that occasion, she had asked him to save some money for the children’s tuition fees since he usually spends a lot of money on luxury and unnecessary fancy possessions. He got so angry after hearing this and he began to beat her and destroy things in the house.

She further noted that every little disagreement pushes him to a violent outburst and he tends to become physical even when she tries to calm him down. She also mentioned that after such episodes, he cries and apologizes only to behave similarly after a couple of days.

Intermittent Explosive Disorder


How to Deal with Intermittent Explosive Disorder

Intermittent explosive disorder is associated with significant emotional distress which impairs social relationships and function. One must look out for the following risk factors to prevent this disorder:

  • History of Physical Abuse – Patients who experience physical abuse or multiple traumatic experiences have a higher risk of developing intermittent explosive disorder.
  • History of other psychological disorders – Certain psychological disorders are associated with an increased risk of intermittent explosive disorder including antisocial personality disorder, attention-deficit/hyperactivity disorder (ADHD), bipolar disorder, and borderline personality disorder.

Look out for These Complications/Risk Factors

Common complications of intermittent explosive disorder which suggest severity of the condition include:

  • Impairment in social relationships – People tend to perceive these patients are aggressive and irritable, therefore, leads to avoidance or combative behaviors from others. This may lead to divorce, family stress, and other related problems.
  • Occupational distress – People with intermittent explosive disorder are usually sources of distress to others at school and their workplaces. This distorts normal flow of activities and may result in loss of job, school suspension, occupational injuries, arrests, and financial problems.
  • Substance Use Problems – People with intermittent explosive disorder often use alcohol and other substances to “cool off” and this, in turn, may lead to exacerbation of symptoms, development of other psychological disorders, and financial problems.
  • Self-harm – People who suffer from this disorder usually pose a threat to their lives and the lives of others.


Intermittent Explosive Disorder Treatment

Treatment for intermittent explosive disorder involves both drug therapy and psychotherapy. However, supportive therapy and lifestyle modifications are useful adjuncts to treatment.

Possible Medications for Intermittent Explosive Disorder

Drug therapy involves the use of drugs such as antidepressants such as selective serotonin reuptake inhibitors including Prozac. Other medications used in the treatment of this disorder include mood stabilizers, antianxiety medications, anticonvulsants, and drugs to treat specific symptoms.

Home Remedies to Treat Intermittent Explosive Disorder

Helpful tips for improving the symptoms of this disorder, in addition to medical treatment and psychotherapy, include:

  • Practice relaxation techniques including yoga, deep breathing exercises, and deep body massages to help you relax.
  • Avoid substances that alter one’s mood such as alcohol, cocaine, marijuana, and other recreational drugs.
  • Change your environment – It may benefit one to leave areas or situations which often push them to violent or aggressive responses and go somewhere relaxing to enable you to rethink your approach to such situations.
  • Foods which help reduce anxiety and improve mood such as green tea, yogurt, dark chocolate, bananas, salmon, and turmeric may be of benefit to people with this disorder.

Insurance Coverage for Intermittent Explosive Disorder

Check your insurance plan benefits for coverage of mental or behavioral health services. You may inquire through your human resources unit for employer-sponsored health coverage for treatment of this condition or contact your health insurance company directly. Also, find out about out-of-pocket costs and deductibles you will pay to access the mental health services under your insurance plan.

How to Find a Therapist

Your primary care physician will refer you to a psychiatrist or clinical psychologist for therapy. You may also ask friends and family for good therapists, or check through online resources and directory to find the right therapist for you.

What should I be looking for in a Licensed Mental Health Professional (LMHP)?

Qualities you should look for in an LMHP include:

  • Good Communication Skills: An effective LMHP should be able to effectively communicate their expert ideas about your symptoms and condition effectively.
  • Empathy: You do not want a counselor who would rush through medical facts without considering your emotional needs. You need an LMHP that is considerate, patient, calm, and compassionate with you.
  • Problem-Solving Skills: Your chosen LMHP must be knowledgeable enough to help you through to a satisfactory resolution of your symptoms. While your relief is not entirely up to your counselor, they must demonstrate ample ability to help manage your symptoms effectively.
  • Good multicultural Relationship: Your counselor must be able to strike a strong patient-therapist relationship with you irrespective of your racial, ethnic, or cultural differences. Therapy must be devoid of such prejudices which may hamper on the effectiveness of treatment.

Questions to ask for Potential Therapist

You should ask a potential therapist the following questions to help you gain more insight into your symptoms and the scope of your treatment options.

  • Why do I have these recurrent angry outbursts?
  • Do I need any medical tests?
  • Is the condition self-limiting or chronic?
  • What is the treatment approach you recommend?
  • Is therapy necessary?
  • How long will therapy be for, it necessary?
  • What medications will I be on?
  • What side effects should I expect from those drugs?
  • Are there effective home remedies I can employ?
  • How will you monitor my treatment progress?
  • Are there any resources or websites you recommend?

Intermittent explosive disorder is a chronic psychological disorder characterized by recurrent episodes of aggressive behaviors or angry outbursts which are often grossly out of proportion to the inciting situation. Intermittent explosive disorder can be managed with medications, psychotherapy, and supportive therapy consisting of home remedies, self-control, and avoidance of mood-altering substances.

Persons living with patients suffering from intermittent explosive disorder should protect themselves from possible violence and harm by involving the police, a mental health care center, or by calling the National Domestic Violence Hotline 1-800-799-SAFE (1-800-799-7233).










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