Intermittent Explosive Disorder (IED)

What is Intermittent Explosive Disorder (IED)?

Intermittent explosive disorder, also known as IED, is a mental health condition that causes sudden and persistent episodes of aggression that are impulsive in nature. IED is set apart from other types of anger or aggression in that the behavior of someone with IED is not appropriate for the situation at hand. Individuals with IED are unable to control their impulses to express aggression, which can make this condition difficult to manage.

Symptoms and behavioral signs of IED

The core features of this condition include anger, aggression, and impulsivity. These can take the form of several emotional and behavioral symptoms, which include: ^[3]

• Physical aggression aimed at property, other individuals, or both
• Verbal abuse, which may include threatening others
• Acting in an angry, impulsive manner with intense and frequent outbursts
• Engaging in self-harm behaviors

During outbursts, individuals experience emotional symptoms (with a highly irritable mood and strong feelings of rage) and physical symptoms (tremors, muscle tension, chest tightness, sweating, tachycardia, and headaches). After outbursts, individuals experience feelings of shame, embarrassment, and guilt.

Causes and risk factors

Research suggests that IED is at least partly a genetic condition. Individuals who have first-degree relatives (e.g., parents or siblings) with this condition are at a significantly higher risk of developing IED than individuals without this history. Neglect, trauma, abuse, and other types of adverse childhood events also raise someone’s risk of developing IED. ^[4]

There has been some research looking into the connection between substance use disorder (SUD) and IED. While substance use does increase someone’s risk of displaying aggressive behavior, it does not necessarily raise someone’s risk of developing IED. ^[5] However, evidence does show that individuals with IED are more likely to develop substance use disorders than the general population. ^[5] In fact, one study showed that daily and weekly substance consumption increased alongside the severity of someone’s IED-related aggression. ^[6] While there is a strong link between these two conditions, one does not definitively cause the other.

Diagnosis

Mental health professionals must complete a psychiatric evaluation before diagnosing someone with IED. This includes taking someone’s medical history and discussing the person’s functioning and behavior. It is important for providers to be thorough while taking a patient’s history, as someone cannot receive a diagnosis of IED if they have aggressive and impulsive outbursts attributed to another condition. ^[3][6]

Mental health professionals utilize the IED criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) to determine whether or not the patient’s clinical presentation matches. This is the most definitive way to diagnose IED.

Effects of IED on relationships and daily life

Complications & comorbidities

Individuals with IED are at a heightened risk of co-occurring psychiatric and medical conditions. If IED is not treated, it can make it more difficult to properly manage other conditions, such as depression, anxiety, hypertension, and cardiovascular conditions. ^[3] While people with IED typically display aggression in an outward manner, they may engage in self-harm behaviors in an attempt to control their impulses. ^[2]

Treatment options

Individuals with IED are most often advised to participate in psychotherapy to help manage their condition. Cognitive-behavioral therapy (CBT) can help individuals learn to manage their impulses and develop healthier behaviors. CBT concepts (such as cognitive restructuring) can help those with IED shift their outlook on difficult situations that may lead to anger. CBT also teaches problem-solving and coping skills to help manage anger when emotional tension begins to build.

Group therapy may be particularly useful for adolescents and young adults who have difficulty with social skills as a result of their condition. Family therapy is beneficial for children and adolescents with IED. This form of therapy can help parents, caregivers, and siblings learn about the condition itself as well as communication styles and parenting techniques to help with the therapeutic process.

Evidence shows that pairing this treatment with medication is also quite effective. In terms of medications, individuals may be prescribed selective serotonin reuptake inhibitors (SSRIs). Other options include mood stabilizers, which can help individuals with severe aggression experience a more balanced mood. Some individuals may also benefit from anti-anxiety medications to assist with irritable moods that may trigger aggression.

Coping and anger management techniques: How to calm down with IED

A major focus of treatment for IED is anger management training to help individuals control their impulses in a healthy manner. As mentioned earlier, CBT is helpful for individuals with IED. This modality uses cognitive and behavioral techniques together to create healthier skills for living. This is applicable to anger, along with many other mental health concerns. These are some behavioral approaches to assist with anger management:

• Stepping away: Sometimes it helps to remove yourself from a situation temporarily and allow yourself time and space to calm down. This is a proactive way to counter impulses before they arise, so it’s best done in advance before tension builds too much.
• Relaxation techniques: There are a host of options in this category that can be used to center the body and mind together. Some examples include progressive muscle relaxation, deep breathing, guided imagery, and meditation.
• Physical activity: All forms of exercise assist in releasing endorphins to help boost mood. However, your mental health professional may recommend that individuals with IED stay away from exercises, such as boxing and karate, as these may make it more difficult to fight aggressive impulses.

Conversely, these are some cognitive approaches geared toward anger management:

• Adjust negative thoughts: If you have negative beliefs about the world or other people, they may fuel irritability and anger. You can prevent mental tension from building by shifting these thoughts to those that are more positive or realistic.
• Look at situations differently: Try to adopt a different perspective when you are in certain situations. For example, instead of making assumptions that someone’s actions were the result of bad intentions, try to understand that things don’t always work out the way you want.
• Identify triggers: By recognizing what around you tends to cause irritability and difficult feelings, you can learn to avoid certain situations or prepare yourself with strategies to manage those feelings.

How to support someone with IED

One of the best ways to support someone with IED is to learn about the condition. This not only helps bring awareness to intermittent explosive disorder, but also helps a person’s loved ones gain a better understanding of them.

In addition, loved ones of those with IED should exercise patience and support them in their therapy journey. This may include participating in family therapy with them or simply encouraging them to talk about what they are learning.

Recovery & long-term outlook with treatment

With comprehensive treatment, people with intermittent explosive disorder can learn to manage their impulses in a way that allows them to do well in academic, occupational, and social settings. It is important to actively participate in and adhere to IED treatment in order to have a good prognosis. Individuals with IED also benefit from social support (such as reliable friends and family) to assist them in learning to live with their condition.