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Intermittent explosive disorder (IED) is a mental health disorder that generates disproportionately rapid and powerful bouts of anger. These outbursts may involve verbal or physical aggression or threats.

Individuals with IED are typically unable to manage their rage, and sudden outbursts of anger can occur without notice. Consequently, IEDs can disrupt everyday life and cause great grief to victims and their loved ones.

Even though there is no universal treatment for IED, physicians can offer effective therapies and drugs to manage the condition and enhance the quality of life.

This article covers in greater depth the characteristics of IED, along with their history, causes, risk factors, and long-term consequences.

Intermittent explosive disorder, often referred to as “getting mad over little things disorder” is a behavioral disorder marked by exaggerated, sudden explosive angry outbursts and/or violence, frequently to the point of wrath (e.g., screaming, impulsive shouting, excessive reprimanding escalated by inconsequential events). Impulsive aggressiveness is characterized by a disproportionate response to any perceived or actual provocation. Some individuals have described experiencing affective mental and/or behavioral shifts before an outburst, like mood changes, tension, changes in energy, etc.

The disease is now designated as a “Disruptive, Impulse-Control, and Conduct Disorder” in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). The disorder is difficult to diagnose and frequently co-occurs with other psychiatric conditions, especially bipolar disorder.

People with IED say that their outbursts are brief (lasting shorter than an hour), with a variety of physical manifestations (stuttering, sweating, twitching, chest tightness, and palpitations) recorded by one-third of one cohort. Reportedly, aggressive behaviors are typically accompanied by a sense of relief and, in some cases, joy, but are frequently followed by regret.

Approximately 80 percent of patients with IED also have another mental health condition, the most prevalent of which are anxiety disorders, intellectual disabilities, externalizing disorder, bipolar disorder, and autism.

In the first version of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-I), impulsive aggressiveness was described as a passive-aggressive personality type (aggressive type). This concept was defined by a persistent response to frustration manifested as excitability, aggression, and exaggerated sensitivity to external stimuli, manifested by outbursts of wrath or physical or verbal aggression that deviate from the individual’s typical behavior.

In the 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), it was for the first time classified as an intermittent explosive disorder under Axis I. Nevertheless, several studies viewed the criterion as inadequately operationalized. Approximately 80 percent of those currently diagnosed with the illness would have been eliminated.

In the DSM-IV, the criteria for IED were enhanced but needed objective standards for the severity, frequency, and character of hostile acts. Consequently, some researchers adopted an alternative set of criteria for doing research, termed the IED-IR (Integrated Research). The intensity and recurrence of aggressive behavior needed for the diagnosis were operationalized, the aggressive actions were considered necessary to be impulsive, subjective anguish or distress was considered necessary to precede explosive outbursts, and the criteria permitted co-occurring diagnoses with antisocial personality disorder and borderline personality disorder. These study criteria served as the foundation for the DSM-5 diagnostic criteria.

The latest release of the DSM (DSM-5) classifies the disease under “Disruptive, Impulse-Control, and Conduct Disorders.” In the DSM-IV, physical aggressiveness was needed to fulfill the conditions for the disorder. However, in the DSM-5, non-destructive/non-injurious physical aggression and verbal aggression have been added to the criteria. Additionally, the listing was modified to provide frequency criteria. In addition, angry outbursts must now be impulsive and must cause the individual significant impairment, distress, or negative consequences. The minimum age for receiving the diagnosis is six years old. The text further explained the relationship between the disease and other conditions, including disruptive mood dysregulation disorder and ADHD.

Intermittent explosive disorder is characterized by a series of angry outbursts that are disproportionate to the situation or event that triggered them. Individuals with IED are conscious that their outbursts of rage are unacceptable, but they feel unable to control their behavior during episodes.

The aggressive outbursts:

  • Show impulsivity (not planned).
  • Happen soon after becoming provoked.
  • Last no more than thirty minutes.
  • Cause significant anxiety.
  • Create difficulties at school, job, and/or home.

Some of the manifestations of explosive anger include:

  • Temper outbursts.
  • Verbal disagreements, including yelling and/or intimidating others.
  • Assaulting someone or something physically, like pushing, punching, slapping, or using a weapon to harm.
  • Property damage and things, including kicking, throwing, or destroying objects and banging on doors.
  • Domestic violence.
  • Highway rage

The episodes of rage may be modest or severe. They may result in injuries severe enough to necessitate hospital treatment or even death.

If you have IED, you may experience the following just before an outburst of anger:

  • Rage.
  • Mood swings
  • A growing feeling of stress.
  • Mental agitation
  • Communication issues.
  • Increased vigor
  • Tremors.
  • Palpitations
  • Chest discomfort.

You may experience relief after an outburst, accompanied by remorse and humiliation.

Before or during an episode, irritability, rage, and a sense of helplessness are frequently observed. Individuals affected by IED may suffer racing thoughts or emotional detachment. Immediately following, people may feel exhausted or relieved. People with IED frequently experience emotions of regret or guilt after an episode.

Many people with IED experience these episodes frequently. For others, they come following weeks or months of nonaggressive conduct. There may be verbal outbursts between incidents of physical aggression.

Researchers are still working to pinpoint the precise origin of the intermittent explosive disorder, although they believe genetic, biochemical, and environmental variables have a role:

Genetic factors: IED is more prevalent within biological families. Parents with the intermittent explosive disorder are more like to transfer it to their kids. According to studies, between 44 and 72 percent of the probability of having impulsive violent conduct is genetic.

Biological factors: According to studies, the structure and function of the brain are affected by IED. For instance, magnetic resonance imaging (MRI) studies of the brain reveal that it affects the amygdala, which is involved in emotional processing. In addition, research indicates that the level of serotonin (a hormone and a neurotransmitter) is below normal in IED patients.

Physical and verbal abuse. Childhood abuse and/or witnessing the violence of blood relatives during childhood may contribute to the development of IED. Childhood exposure to one or more traumatic incidents also appears to play an impact.

Risk Factors for IED

Some research indicates that those who are at a greater risk for developing IED are:

  • are males
  • are 13 to 23 years old
  • are jobless
  • are separated or divorced
  • have gone through multiple horrific experiences as a child
  • grew up in a home where they were verbally, physically, or sexually abused

In addition, those with various mental health disorders have a greater likelihood of having IED. These diseases include attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder, and conduct disorder which are characterized by troublesome or impulsive behaviors (ODD).

People who underwent childhood abuse or repeated traumatic incidents have a higher risk of developing the intermittent explosive disorder.

A person with IED is not always more prone to obtain another mental health diagnosis and vice versa. However, the comorbidity rate is significant. Both directions of causation are possible, and the relationship between IED and other mental health disorders is still a matter of discussion.

People with IED are also more likely to develop a substance use disorder, consider suicide or consider self-harm.

Individuals with intermittent explosive disorder are at a higher risk for:

Weak or damaged interpersonal relations. Others frequently regard them as always being furious. They may engage in physical and verbal abuse regularly. These behaviors can result in relationship issues, divorce, and family hardship.

Conflict at work, at home, or in school. Other potential repercussions of IED are job loss, school suspension, automobile accidents, financial difficulties, and legal issues.

Mood problems. With intermittent explosive disorder, mood disorders like anxiety and depression are common.

Alcohol and other substance abuse problems. Substance abuse and alcoholism frequently co-occur with IED.

Physical health problems. Common medical disorders include diabetes, high blood pressure, ulcers, stroke, cardiovascular disease, and chronic pain.

Self-harm. Intentional injury or suicide attempts sometimes occur.

Even though IED and bipolar disorder may present similarly, they are distinct conditions.

IED is often misdiagnosed, resulting in inadequate therapy, and therefore it is advantageous to grasp what IED is not. First, it is not bipolar disorder: Some study indicates that IED and bipolar disorder co-occur at high rates, however, they are not identical. For instance, a person with bipolar disease has significantly more mood problems than a person with IED. However, both conditions may include brain regions that control the management of violent conduct and aggression from the top down.

The co-occurrence rate of both conditions is approximately 60 percent, meaning that more than half of IED patients may have both.

Mental health specialists must also rule out other potential explanations of the behavior to diagnose IED. For instance:

Disruptive mood dysregulation disorder (DMDD). As stated previously, IED is characterized by brief, spontaneous episodes as opposed to persistent and pervasive emotions, which may suggest a mood problem such as DMDD.

Trauma-related stress disorder (PTSD). Additionally, aggressive conduct can be a sign of PTSD, although PTSD is not taxonomic. The co-occurrence of these two conditions may result in worse consequences.

Rageaholism. Rage addiction is a phenomenon in psychology but it is not recognized as a medical diagnosis.

Disorders of personality:  Mental health problems such as borderline personality disorder and antisocial personality disorder are likewise not taxonomic, but rather dimensional. A person with IED may also have a personality problem, but these are different diagnoses.

Oppositional defiant disorder (ODD). An individual with ODD may lose their temper and experience psychosocial consequences, but their hatred is often directed against authoritative figures.

Attention deficit/hyperactivity disorder (ADHD). ADHD may induce effective energy and lability, although it does not cause major aggressiveness.

It can be difficult to determine if you have IED, however, there are indications that you should seek professional help for your angry outbursts. They include:

Following your explosion of anger, you feel exhausted, guilty, or ashamed of your behavior.

You are frequently provoked by similar events, like being publicly disciplined or told what is what.

During angry episodes, you cause physical harm to yourself, others, or property.

During the event, you cannot think rationally or consider any implications.

Once you start having an episode, you feel as if you have no authority over your behavior.

Your anger frequently impacts your professional and personal connections.

If you or your kid may have IED, it is essential to consult a healthcare professional. They will most likely refer you to mental health expert with expertise in IED.

A qualified mental health practitioner, like a psychologist, psychiatrist, or clinical social worker, can diagnose IED premised on the diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders by the American Psychiatric Association.

They do so by conducting a comprehensive interview and discussing symptoms. They inquire to provide insight into

  • Particular medical history and family history of mental health conditions.
  • Relationship background.
  • Education or employment history.
  • Impulse control.

Your mental health expert may also consult with your friends and family to gather additional information about your actions and past.

To be diagnosed with intermittent explosive disorder, you must exhibit one of the following inability to control aggressive impulses:

Low Intensity/High-Frequency episodes: Verbal aggressiveness (tantrums, verbal disagreements, or fights) or physical hostility toward property, animals, or people, occurring on average twice per week for three months. The hostility does not result in physical harm to humans or animals or property destruction.

High intensity/how frequency episodes: Three incidents of property damage or destruction and/or physical assault resulting in physical injury to animals or other persons within 12 months.

The level of violence exhibited during the outbursts must be grossly disproportionate to the circumstances. Moreover, the eruptions are not premeditated. They are founded on impulse and/or rage. In addition, your mental health expert will determine if the outbursts are explained better by another mental health issue, physiological illness, or substance abuse disorder.

To get an IED diagnosis, a person must be at least 6 years old, but the disorder is typically first detected in late childhood or adolescence.

  1. Understanding intermittent explosive disorder (IED), Thriveworks. Available at: https://thriveworks.com/blog/intermittent-explosive-disorder-defuse-angry-outbursts.
  2. Intermittent explosive disorder. Psychology Today. Sussex Publishers. Available at: https://www.psychologytoday.com/intl/conditions/intermittent-explosive-disorder.
  3. Intermittent explosive disorder: Symptoms & treatment. Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/diseases/17786-intermittent-explosive-disorder.
  4. Intermittent explosive disorder: Causes, symptoms, and treatment. Medical News Today. MediLexicon International. Available at: https://www.medicalnewstoday.com/articles/intermittent-explosive-disorder#causes-and-risk-factors.
  5. Intermittent explosive disorder. Wikipedia. Wikimedia Foundation. Available at: https://en.wikipedia.org/wiki/Intermittent_explosive_disorder.

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