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The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, lists intermittent explosive disorder (IED) as a mental health issue (DSM-5). Conduct disorder, Oppositional defiant disorder (ODD), Pyromania, and Kleptomania are among the five impulse control disorders. Explosive anger disorder patients are unable to control their violent outbursts, which usually occur abruptly and are directed at someone close to them. In the US, roughly 16 million people suffer from the illness. It usually begins at a young age, around the age of 12, and appears to be more prevalent in men than in women.

In IED episodes, there is sudden anger for no reason. These episodes are out of proportion to the actual danger, and they don’t serve any aim, such as gaining a benefit or overpowering someone. A person with IED who yells at their current or former partner, for instance, isn’t trying to manipulate their partner’s behavior through aggression. The enraged episode serves no discernible function.

Witnesses may perceive these outbursts as unreasonable “freak-outs.” Physical aggressiveness, violent threats, or verbal abuse are all possibilities. They normally last around 30 minutes and are followed by feelings of regret, humiliation, and discomfort. Employment and relationships can suffer as a result of the condition. IED, on the other hand, is extremely durable. While someone with the illness is receiving therapy, those closest to them can assist in de-escalating IED episodes.

Here are some of the important facts and statistics related to Intermittent Explosive Disorder.

  • Depending on the criterion set utilized, two observational studies of clinical populations estimated the lifetime prevalence rate of IED to be 4 to 6 percent.
  • A Ukrainian study reported similar lifetime IED rates (4.2 percent), indicating that the 4–6 percent lifetime prevalence rate of IED is not confined to American populations.
  • In these trials, the prevalence of IED at one month and one year was 2.0 percent and 2.7 percent, respectively.
  • Extrapolating to the national scale, 16.2 million Americans will have been exposed to IED disorder in their lifetimes, with as many as 10.5 million in any given year and 6 million in any given month.
  • In a 2005 investigation of a clinical population, the prevalence rate of IED was determined to be 6.3 percent.
  • Men appear to have a larger prevalence than women.
  • A 67.8 percent of IED respondents in the United States had been involved in direct interpersonal violence, 20.9 percent in threatening interpersonal aggression, and 11.4 percent in object aggression.
  • In their worst year, participants expressed indulging in 27.8 high-severity hostile behaviors, with 2–3 outbursts requiring medical attention. The average cost of property damage caused by angry outbursts was $1603 over a lifetime.
  • According to a study published in the Journal of Clinical Psychiatry in March 2016, there is a link between infections with the parasite Toxoplasma Gondii and mental violence like IED.

The diagnosis process starts with a review of the patient’s general medical and mental health histories, as well as a mental and physical state examination. An individual with the intermittent explosive disorder must have a failure to regulate aggressive tendencies as characterized by one of the following:

Verbal or physical hostility toward property, humans, or animals, occurring two times weekly on average for a period of three months. Animals or individuals are not physically harmed or property is destroyed as a result of the violence. Or

Within 12 months, three instances involving property destruction or damage and/or violent assault involving physical harm to animals or other people.

The level of aggressiveness expressed during the outbursts is disproportionately high in comparison to the scenario. Furthermore, the outbursts are not premeditated; they are founded on impulse and/or rage. Furthermore, the outbursts cannot be explained by any other mental illness, health problem, or substance addiction.

IED can be scary. Expressing your anxiety or trying to fight back when experiencing an active IED incidence, on the other hand, might sometimes unsettle the person even more. Calm and composure are required for effective de-escalation. Attempt to withdraw from your personal sentiments as much as possible during the incident. Acknowledge that the IED user’s behavior is out of their power.

IED patients may have extremely strong emotions, underdeveloped defense mechanisms (such as denial and projection), and inadequate reality checking. All of this can make dealing with them logically nearly impossible. As a result, you defuse. Here are a few specific de-escalation tactics that could be effective in dealing with someone who has an episode of an IED outburst:

  • Instead of demeaning the person, use gentle wording.
  • Stay near enough to create rapport without invading the person’s personal space.
  • To reinforce the person’s sense of autonomy, use collaborative problem-solving techniques. “What could we do to rectify this?” for instance.
  • Delivering ultimatums or engaging in power conflicts is not a good idea.
  • Accept the person’s rage. They can express their emotions as long as they don’t hurt themselves or others.
  • Suggestions for face-saving options to their rage, such as a cooling-off period
  • Use effective listening abilities to demonstrate that you’re interested in what you’re hearing.
  • Make compassionate statements, such as “It seems like you’re in a lot of pain.”
  • Don’t rehash what occurred or who is to blame. Continue to think about potential solutions.
  • Use a calming tone of voice and purposefully tranquil body language. Don’t add to the hysteria.
  • When the person regains control, use positive reinforcement.
  • If you feel intimidated, you should be more assertive. You may need to switch from a supportive to a controlling posture and/or retreat to a safe location.

An intimate partner of somebody with an IED  may be aware of the person’s emotional reactions and identify the warning indications of an impending outburst. Individuals with IED, for instance, may shiver, feel heaviness in their chest, or even become irritated. This does not, however, imply that a companion has the option of escaping the episode. They could even be the initial defense.

A loved one may see intense IED outbursts as emotional oppression. It’s possible that the person will become physically or verbally violent, which is never acceptable in a romantic relationship. Remove access to a weapon or dangerous items that the individual could use to harm oneself or others to keep yourself safe. Make a plan for how you’ll get out if you feel threatened.

Sadly, only a small percentage of IED patients receive treatment. They may never realize the damaging implications of out-of-control explosive events. If the person you love refuses to accept they have a problem and attempt to control their uncontrollable anger, you may have to protect yourselves by ending the relationship permanently.

A variety of methods have been in practice for IED treatment. The majority of the time, a combination of these treatment methods are used. The various strategies for treating IED disorder are as under:

Therapy

Individual or group counseling with a counselor, therapist, or psychologist may be beneficial in managing IED symptoms.

To deal with violent urges, cognitive behavioral therapy (CBT) helps identify damaging patterns and applies coping techniques, relaxation exercises, and relapse prevention education.

Group or individual CBT for 12 weeks improved IED symptoms such as aggression, anger management, and hostility, according to a 2008 study. This was true during therapy as well as three months later.

Medication

Although there are no particular drugs for IED, some medications may assist to lessen impulsive or aggressive behavior. These are some of them:

  • Medications, most notably serotonin reuptake inhibitors (SSRIs)
  • Lithium, Carbamazepine, and Valproic acid are examples of mood stabilizers.
  • Antipsychotic medications
  • Anti-anxiety drugs

There is a scarcity of research on IED medications. One of the key questions in choosing medications is whether antidepressants help with anger in IED? The SSRI fluoxetine, a well-known depression medication, more popularly known by its trademark Prozac, was proven to lessen impulsive-aggressive behavior in persons with IED in 2009 research.

The full benefits of SSRIs can take up to 3 months to feel, and complaints tend to recur once the medicine is stopped. Furthermore, not everyone is helped by medicine.

Alternative Methods Of Treating IED

Alternative treatments and lifestyle changes for IED have been studied in a limited number of studies. Nonetheless, there are a number of therapies that are unlikely to be harmful. Here are a few examples:

  • Consuming a well-balanced diet
  • Obtaining adequate sleep
  • Keeping yourself physically active
  • Abstaining from drugs, alcohol, and smoking
  • Minimizing and coping with stressors
  • Allowing time for calming activities like music listening
  • Meditating or using other mindfulness techniques
  • Experimenting with alternative therapies including acupressure, acupuncture, and massage

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