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Intermittent explosive disorder involves repeated episodes of impulsive, aggressive, violent behaviour or angry verbal outbursts in which you react grossly out of proportion to the situation.
Road rage, domestic abuse, throwing or breaking objects, or other temper tantrums may be signs of intermittent explosive disorder.
People with intermittent explosive disorder may attack others and their possessions, causing bodily injury and property damage.
They may also injure themselves during an outburst. Later, people with intermittent explosive disorder may feel remorse, regret or embarrassment.
If you have intermittent explosive disorder, treatment may involve medications and psychotherapy to help you control your aggressive impulses.
Symptoms
Explosive eruptions, usually lasting less than 30 minutes, often result in verbal assaults, injuries and the deliberate destruction of property.
These episodes may occur in clusters or be separated by weeks or months of nonaggression.
In between explosive outbursts, the person may be irritable, impulsive, aggressive or angry.
Aggressive episodes may be preceded or accompanied by:
Irritability, Increased energy, Rage, Racing thoughts, Tingling, Tremors, Palpitations, Chest tightness, Feeling of pressure in the head, Depression, fatigue or relief may occur after the episode.
Causes
The exact cause of intermittent explosive disorder is unknown, but the disorder is probably caused by a number of environmental and biological factors.
Environment
Most people with this disorder grew up in families where explosive behaviour and verbal and physical abuse were common.
Being exposed to this type of violence at an early age makes it more likely these children will exhibit these same traits as they mature.
Genetics
There may be a genetic component, causing the disorder to be passed down from parents to children.
Brain chemistry
There may be differences in the way serotonin, an important chemical messenger in the brain, works in people with intermittent explosive disorder.
People with other mental illnesses such as mood, anxiety or personality disorders or certain medical conditions such as Parkinson’s disease or traumatic brain injury may display aggressive behaviours.
However, they would not be diagnosed as having intermittent explosive disorder because the cause is from another condition.
Risk factors
A number of factors increase your risk of developing intermittent explosive disorder:
History of substance abuse
People who abuse drugs or alcohol have an increased risk of intermittent explosive disorder. History of physical abuse.
People who were abused as children or experienced multiple traumatic events have an increased risk of intermittent explosive disorder.
Age
The start of intermittent explosive disorder most commonly occurs in people in their teens and 20s.
Being male
Men are more likely to have intermittent explosive disorder than women are.
Complications
People with intermittent explosive disorder have an increased risk of:
Self-harm
They don’t always direct their anger at others. They’re at significantly increased risk of harming themselves, either with intentional injuries or suicide attempts. Those who are also addicted to drugs or have another serious mental disorder, such as depression, are at greatest risk of harming themselves.
Impaired interpersonal relationships
They are often perceived by others as always being angry. This can lead to relationship problems, divorce and family stress.
Trouble at work, home or school
Other complications of intermittent explosive disorder may include job loss, school suspension, auto accidents, financial problems or trouble with the law.
Tests and diagnosis
To determine a diagnosis of intermittent explosive disorder and eliminate other conditions that may be causing your symptoms, expect your doctor to do a:
Physical exam
Your doctor will try to rule out physical problems that could cause your symptoms. Your exam may include lab tests.
Psychological evaluation
A doctor or mental health provider will talk to you about your symptoms, thoughts, feelings and behaviour patterns. You may be asked to fill out a questionnaire to help answer these questions.
To be diagnosed with intermittent explosive disorder, your doctor will ask about your behaviour to see if you meet the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM).
This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.
DSM criteria include:
Multiple incidents of failure to resist aggressive impulses that resulted in deliberate destruction of property or assault of another person.
A degree of aggressiveness during incidents that’s completely out of proportion to the event that triggered the behaviour.
Aggressive episodes that aren’t accounted for by another mental disorder and aren’t due to the effects of a drug or a medical condition
Other conditions that must be ruled out before making a diagnosis of intermittent explosive disorder include other mental disorders or substance use problems.
Treatments and drugs
There is no one treatment that’s best for everyone with intermittent explosive disorder. Treatment generally includes psychotherapy and medication.
Psychotherapy
Individual or group therapy sessions can be helpful.
A commonly used type of therapy, cognitive behavioural therapy, helps people with intermittent explosive disorder identify which situations or behaviours may trigger an aggressive response.
And, more importantly, this type of therapy teaches people how to manage anger and control inappropriate responses using techniques such as relaxation training, thinking differently about situations (cognitive restructuring) and learning coping skills.
Medication
Different types of drugs may help in the treatment of intermittent explosive disorder. These medications include:
Antidepressants, such as fluoxetine (Prozac) and others
Anticonvulsants, such as carbamazepine (Tegretol), oxcarbazepine (Trileptal), phenytoin
(Dilantin), topiramate (Topamax) and lamotrigine (Lamictal)
Anti-anxiety agents in the benzodiazepine family, such as lorazepam (Ativan) and clonazepam (Klonopin)
Mood stabilizers, such as lithium (Lithobid)
Lifestyle and home remedies
If you have intermittent explosive disorder, prevention is likely beyond your control unless you get treatment from a professional.
Combined with, or as part of, treatment, these suggestions may help you prevent some incidents from getting out of control:
Stick with your treatment. Attend your therapy sessions, practice your coping skills, and if your doctor has prescribed medication, be sure to take it.
Practice relaxation techniques. Regular use of deep breathing, relaxing imagery or yoga may help you stay calm.
Develop new ways of thinking (cognitive restructuring). Changing the way you think about a frustrating situation by using rational thoughts, reasonable expectations and logic may improve how you view and react to an event.
Use problem-solving
Make a plan to find a way to solve a frustrating problem. Even if you can’t fix it right away, it can refocus your energy.
Learn ways to improve your communication. Listen to the message the other person is trying to share, and then think about your best response rather than saying the first thing that pops into your head.
Change your environment
When possible, leave or avoid situations that upset you. Also, scheduling personal time may enable you to better handle an upcoming stressful or frustrating situation.
Avoid mood-altering substances
Don’t use alcohol or street drugs.
Coping and support
Controlling your anger
If you recognise your own behaviour in the description of intermittent explosive disorder, talk with your doctor about treatment options or ask for a referral to a mental health professional. Some techniques that may be part of your treatment include:
Unlearn bad behaviour
Coping well with anger is a learned behaviour. Cognitive behavioural therapy or anger management will help you recognise what pushes your buttons and how to respond in ways that work for you instead of against you.
Develop a plan
Work with your doctor on developing a plan of action for when you feel yourself getting angry.
For example, if think you might lose control, try to remove yourself from that situation. Go for a walk or call a trusted friend to try to calm down.
Avoid alcohol and other substance use. These can increase aggressiveness and the risk of explosive outbursts.
If your loved one won’t get help
Unfortunately, many people with intermittent explosive disorder don’t seek treatment.
If you’re involved in a relationship with someone who has intermittent explosive disorder, take steps to protect yourself and your children.
The abuse isn’t your fault. No one deserves to be abused.
A counselling or mental health centre.
Many communities offer counselling and support groups for people in abusive relationships.
Be wary of advice to seek couples or marriage counseling.
If violence has escalated to the point that you’re afraid of your partner, this type of counseling won’t be enough. Remember that your safety comes first.
A local court. Your local court can help you get a restraining order that legally orders the abuser to stay away from you or face arrest.
Local advocates may be available to help guide you through the process.
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