Intermittent Explosive Disorder: Clinical Anger Issues

Do know someone who occasionally seems to explode with anger and even aggression? Of perhaps you sometimes feel full of rage that seems disproportionate to the situation, but is also difficult to control? Such symptoms may be signs of intermittent explosive disorder. This is a little known mental health condition that requires psychological treatment to eliminate the symptoms and improve functioning:

Intermittent Explosive Disorder: What Does It Mean?

The primary symptom of intermittent explosive disorder is repeated and sudden impulsive episodes of anger, aggression, and even violence. There may be yelling and throwing or breaking objects. The reaction may be in response to some situation, but it is typically out of proportion to that situation. This may appear in incidents of road rage and even domestic abuse. In younger people, this might appear like a temper tantrum. Such behaviors often cause problems at home, work, and school.

Stats: How Many Suffer from This Disorder?

Intermittent explosive disorder is diagnosed in approximately 7.3% of adults and is more common among men. Approximately 67.8% of these individuals have some history of direct aggression towards people or objects. Most have a history of exposure to violence, abuse, or other traumas.

What Causes Intermittent Explosive Disorder?

Intermittent explosive disorder has no one known cause. Research suggests several biological and environmental factors may contribute to the development of it. Biological factors include genetic predisposition and brain chemistry, with certain neurochemical imbalances playing a role. Environmental factors may include growing up in a family where they witnessed explosive behavior and/or experienced physical abuse. Seeing such violence makes it more likely a person will replicate it.

Signs and Symptoms of Intermittent Explosive Disorder

As noted, the primary symptom of intermittent explosive disorder is the episodes of anger and aggression. These episodes typically occur with impulsively from the person. The episode may seem quite sudden and there is usually no warning that any such behaviors are about to occur. On average, the episodes will last less than 30 minutes. An episode could occur frequently or rather infrequently, even weeks or months apart. Episodes may also occur to varying degrees.

What are the Common Behaviors/Characteristics?

Individuals with intermittent explosive disorder may seem irritable all the time. People who interact with that person might come to view them as chronically angry. Even when not in an explosive episode, these individuals might appear impulsive and aggressive.

Just prior to an episode there might be increased irritability and rage. The person may experience racing thoughts and excess energy. They may also have physical symptoms such as tingling or tremors, palpitations, and chest tightness.

During an explosive episode, the person may demonstrate verbal tirades, heated arguments, shouting, and physical violence. Such violence might include shoving, pushing, and slapping. This could potentially escalate to a full physical fight and property damage.

Individuals with intermittent explosive disorder may feel some relief after the episode. They may also be quite tired. Later, there may be feelings of embarrassment, regret, and remorse.

Testing: What are the Diagnostic Criteria Per the DSM-5

If you are concerned about your own behavior or the behavior of a loved one, then you will want to seek help or encourage that person to seek help. Visiting a mental health provider is recommended. Typically, the provider will want a physical exam to rule out physical problems and substance abuse as a cause. Then, a psychological evaluation will be used to identify the relevant symptoms, thoughts, feelings, and behavior. This information will be used to make a formal mental health diagnosis. To assign a diagnosis, mental health professionals must use the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5), which presents these criteria to define conduct disorder:

  • Several discrete episodes of failure to resist aggressive impulses that result in serious assaultive acts or destruction of property.
  • The degree of aggressiveness expressed during the episodes is grossly out of proportion to any precipitating psychosocial stressors.
  • The aggressive behavior is not better account for by another mental disorder.

If an individual meets the criteria, then the diagnosis of intermittent explosive disorder may be assigned.

Intermittent Explosive Disorder and Other Conditions

When making any diagnosis, a mental health professional must also rule out other similar conditions:

Intermittent Explosive Disorder vs Conduct Disorder

Individuals with conduct disorder may show aggression and outbursts like those seen in intermittent explosive disorder. However, the latter condition tends to have more impulsive outbursts, while conduct disorder includes behaviors that are more often planned or premeditated. Conduct disorder also includes many other symptoms required for diagnosis.

Intermittent Explosive Disorder vs Oppositional Defiant Disorder

Oppositional defiant disorder is most often seen in children. Just as the name implies, these children tend to be oppositional and defiant towards authority figures. They may also seem irritable. Like intermittent explosive disorder, it is an impulse control disorder. However, in intermittent explosive disorder there are more outbursts of anger and aggression.

Related Conditions

Intermittent explosive disorder might sometimes appear like a manic episode. The distinction might be the degree of anger that is expressed in an explosive episode, whereas in manic episodes there may be more euphoria. Intermittent explosive disorder may also appear like borderline personality disorder. In individuals with borderline personality disorder, there is difficulty managing emotions. However, this condition is accompanied by many other symptoms that are not necessarily seen in intermittent explosive disorder.

Intermittent Explosive Disorder in Adults/Children

Intermittent explosive disorder is believed to typically begin during the teen years. However, in children, such symptoms may just seem like temper tantrums and may go undiagnosed. It is once the teen years occur that the behaviors seem less appropriate and more concerning to parents.

Example Case of Intermittent Explosive Disorder

Consider this example of IED to see if it reminds you of yourself or someone you know:

Rick often finds himself easily frustrated. Sometimes that frustration is so strong it feels like a rage. He often gets angry in traffic and is known for his expressive road rage, which typically includes yelling and some cursing. When he is frustrated at home he might yell and may even hit things. One time he punched a hole in the wall. These behaviors always sudden and impulsive.

How to Deal/Coping with Intermittent Explosive Disorder

Individuals with intermittent explosive disorder may not initially see themselves as having any problem. During the explosive episodes they are usually acting impulsively and without giving their actions much thought. After the episodes they may regret them. They may also struggle with the consequences of their actions such as impaired interpersonal relationships and legal problems.

Look Out for These Complications/Risk Factors

Many people develop intermittent explosive disorder as a result of being exposed to violence or experiencing other traumatic events. Although these experiences are difficult to entirely prevent, therapy to address the lingering feelings from such experiences and their current effects may be helpful in reducing the intermittent explosive disorder symptoms.

Additionally, people with intermittent explosive disorder are also more likely to have other mental conditions including antisocial personality disorder, borderline personality disorders, and ADHD. The symptoms of those disorders can exacerbate the symptoms of intermittent explosive disorder. Again, therapy can help to teach people how to manage all their symptoms.

The symptoms of intermittent explosive disorder can also be exacerbated by low mood and anxiety, so these conditions would need to be similarly managed. Individuals with intermittent explosive disorder are more likely to abuse alcohol and drugs, which is problematic because substances can also make it more difficult to control the behaviors associated with the disorder.

Those who have the disorder often have difficult relationships with others because of their episodes, which can later them feeling isolated and depressed. The disorder is associated with health problems, including high blood pressure and heart problems. A history of intermittent explosive disorder is also associated with self-harm and suicidality, which necessitate treatment.

Intermittent Explosive Disorder Treatment

Individuals who have intermittent explosive disorder need to manage the disorder by taking measures to prevent the problematic episodes. Therapy is essential for learning methods to manage the disorder. In therapy you might learn new ways of thinking, new ways to solve problems, new ways to communicate, and new ways to relax. These skills can help to prevent and manage explosive episodes.

Possible Medications for Intermittent Explosive Disorder

Depending on the specific symptoms and circumstances, various medications might be prescribed to help manage intermittent explosive disorder. Certain antidepressants, anticonvulsant mood stabilizers, and other drugs may all be considered by your providers.

Home Remedies to Help Intermittent Explosive Disorder

Intermittent explosive disorder is not typically addressed well with just home remedies. Therapy is needed to learn how to manage anger and how to express emotions in better ways. Once those approaches are learned in therapy, it will be key to practice them at home. Other helpful measures will include avoiding substances and practicing general relaxation techniques.

Living with Intermittent Explosive Disorder

Individuals who have intermittent explosive disorder may experience some distress if they feel regret or remorse for their actions. They may also experience distress in response to the consequences of those actions (such as loss of relationships and/or effects on their workplace standing). Others who interact with the individual may also experience distress, especially if that person does become violent. It can be helpful for loved ones to also receive therapy and identify steps they will be able to take to keep themselves safe during those explosive episodes.

Insurance Coverage for Intermittent Explosive Disorder

Mental health and medical providers consider intermittent explosive disorder a mental health condition. When someone has this condition and receives a formal diagnosis, it is likely that health insurance will cover any necessary counseling or therapy. Call your insurance company to ask about it. Your provider’s office may also be able to assist with checking about coverage.

How to Find a Therapist

If you are concerned about your own or someone else’s emotional outbursts, you might start by asking your medical provider to refer you to a mental health provider. You can also search online for therapists in your location, using the name of your city/state. You can research providers online and even read reviews to ensure your prospective therapist seems like the right fit.

What Should I be Looking for in an LMHP?

When seeking out a mental health provider for intermittent explosive disorder, you will certainly want to make sure that they are trained and licensed in their respective field. You will also want to find a provider who is specially trained to work with emotional disorders. It is even better if they specifically have experience working with intermittent explosive disorder.

Questions to ask a Potential Therapist

When meeting with a potential therapist, ask about their training and experiences working with intermittent explosive disorder. You may also want to ask about their typical approach to therapy and how they would plan to address your symptoms. You may also want to ask how they plan to measure progress and how long they anticipate the course of therapy might last.

Intermittent Explosive Disorder Resources and Support Helpline

There are resources online regarding intermittent explosive disorder that may be helpful:

  • Psychology Today is a website with a search tool for local mental health providers.
  • SAMSHA has a provider locator to find local and low-cost treatment options.

If you have questions about your mental health or the mental health of a loved one, consider contacting the National Alliance on Mental Illness Helpline or the SAMSHA Helpline. If you have symptoms that seem difficult to live with and experience suicidality, consider calling the Suicide Prevention Lifeline. If you are in a relationship with someone who has intermittent explosive disorder and have experienced domestic violence or abuse, consider using the domestic violence hotline for support.

Although the symptoms of intermittent explosive disorder can be difficult to deal with and may have repercussions for your life, it is a diagnosable condition and help is available. Consider seeking therapy and other mental health support so that you can improve your life and your relationships.

author avatar
Angel Rivera
I am a Bilingual (Spanish) Psychiatrist with a mixture of strong clinical skills including Emergency Psychiatry, Consultation Liaison, Forensic Psychiatry, Telepsychiatry and Geriatric Psychiatry training in treatment of the elderly. I have training in EMR records thus very comfortable in working with computers. I served the difficult to treat patients in challenging environments in outpatient and inpatient settings
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