Intermittent Explosive Disorder: Symptoms and Treatment 

Do you lose control of your anger on a regular basis in a destructive way? Do you tend to get enraged disproportionately to a given situation, levying verbal abuse on those around you? Do you have a tendency to throw or break things in sudden fits of anger? Do you become physically abusive to people or animals during sudden bouts of anger?

These are clear signs of an anger problem, and they may indicate a potential impulse-control disorder called Intermittent Explosive Disorder (IED), which affects both adolescents and adults. Roughly 4% of Americans will have IED across their lifespan according to recent research estimates.

While these angry outbursts rarely last more than a half-hour, they are highly destructive to personal and professional relationships, sometimes causing serious financial and legal issues. Unfortunately, the stigma around having “anger issues” makes it difficult for individuals who may have intermittent explosive disorder to seek help.

Here’s how to identify IED, what causes it, and better yet, what you can do to treat it.

WHAT IS INTERMITTENT EXPLOSIVE DISORDER?

Experiencing angry feelings is a normal and necessary part of being human. However, with intermittent explosive disorder, anger recurrently erupts as sudden and intense episodes of verbal or physical aggression, out of proportion to the trigger.

An angry episode often creates a mess, either with the physical destruction of things/property or with physical or emotional harm to people. Following an outburst, a person with IED may feel exhausted, relieved, and sometimes remorseful or embarrassed about their behavior and its consequences.

IED is most prevalent in adolescent children with the average age of onset being 11. That said, it can be diagnosed in children as early as age 6.

Can you grow out of intermittent explosive disorder? IED is generally considered a long-term disorder, but the intensity of the angry outburst may decline with age. Adults with IED usually show signs before the age of 40.

Although an outburst of anger comes on suddenly, there are some signals just before it happens. Here are the most common signs before an individual with IED experiences an angry episode:

• Tingling
• Shaking
• Quickened or pounding heartbeat
• Tightness in the chest
• Greater tension and energy
• Increasing irritability
• Rage
• Racing thoughts

The most common intermittent explosive disorder symptoms include the following:

• Irritability
• Rageful episodes
• Temper tantrums, verbal tirades
• Getting in physical altercations and/or verbal assaults with others
• Pushing, slapping, scratching, punching, or causing bodily harm to another person
• Engaging in physical aggression that leads to the damage of property, people, or animals

WHAT CAUSES INTERMITTENT EXPLOSIVE DISORDER?

People with IED may have destructive behavior, but they are not bad people. They deserve understanding and empathy as they are suffering from a mental health condition.

While researchers are still trying to determine what exactly causes IED and other anger issues, the evidence to date suggests a mix of biological, genetic, and environmental factors.

Biological Influences

Like most mental health disorders, the brains of people with intermittent explosive disorder work differently. Brain-imaging research using SPECT scans at Amen Clinics show that more than 70% of individuals who had damaged property or assaulted another person had abnormalities in their brain’s left temporal lobe region.

This suggests that dysfunction of or damage to the left temporal lobe is associated with pronounced irritable, angry, or violent thoughts.

Also associated with impulse control behaviors is suboptimal functioning of the prefrontal cortex (PFC). The PFC plays a major role in impulse control and judgment.

When it is not working properly or there’s poor blood flow to this area of the brain, it’s harder for your brain to put the “brakes” on behavior. Imaging studies have found that damage to the prefrontal cortex (PFC) can contribute to anger problems.

Other studies have found a predisposition of anger is associated with an elevated amygdala response, as well as larger amygdala volume. The amygdala is where fear/anxiety live in the brain, and anger can mask fearful and anxious feelings.

Interestingly, individuals with IED tend to have lower levels of the feel-good neurotransmitter serotonin, according to research published in the journal Neuropschopharmacology.

Additional research from the University of Cambridge indicates that lower serotonin levels are associated with poor impulse control and aggressive behavior.

Other potential biological factors include certain infections. One study from the University of Chicago shows a link between toxoplasmosis and intermittent explosive disorder in humans.

Toxoplasmosis is an infection with a tiny parasite known as toxoplasma gondii. People often become infected through contact with cat feces. In this study, researchers found that people with rage disorder are more than twice as likely to be infected with toxoplasmosis.

Genetics

Intermittent explosive disorder tends to run in families. In fact, medical experts believe that 44 to 72% of the likelihood of developing IED may be due to genetics.

Psychological Factors

What are the underlying psychological causes for intermittent explosive disorder? Many psychological factors may be contributors.

For example, adverse childhood experiences and trauma are highly associated with IED. So, does post-traumatic stress disorder (PTSD) cause intermittent explosive disorder?

A study published in Psychiatric Research involving more than 5,000 individuals found that IED is associated with increased exposure to trauma and, in particular, trauma experienced in childhood.

That includes physical or sexual abuse, as well as physical or emotional neglect or living with an individual who has addiction issues or a mental health condition.

Having one of these co-occurring mental health conditions may increase the likelihood of developing explosive episodes of anger:

• ADD/ADHD
• Anxiety disorders
• Depression
• Substance abuse
• Post-traumatic stress disorder (PTSD)
• Personality disorders, including antisocial personality disorder, narcissistic personality disorder, and borderline personality disorder

TREATMENT OF INTERMITTENT EXPLOSIVE DISORDER

Intermittent explosive disorder cannot be cured, but it is treatable, and can get vastly better if properly managed through several methods. Here are several steps you can take:

1. Treat other mental health conditions.

When being evaluated for IED, it’s critically important to also be evaluated for any co-occurring mental health conditions. Treating common mental health conditions such as clinical depression, anxiety, or substance abuse can greatly improve IED.

2. Try psychotherapy.

Therapy can help address many of the issues that fuel explosive episodes. The following methods can be helpful:

• Cognitive behavioral therapy: CBT focuses on changing the way you think about the frustrating and stressful situations that tend to stir your aggression.
• Relaxation strategies: By practicing deep breathing exercises, self-hypnosis, or guided imagery, you can learn to calm angry impulses.
• EMDR therapy: Eye movement desensitization and reprocessing therapy can help you process traumatic experiences and reduce related anger responses.
• Group therapy: A therapy group focused on cognitive coping and anger management can be helpful for the treatment of IED, research has found.

3. Address biological factors.

Anger management strategies can be helpful, but they do not address underlying brain dysfunction or damage related to the development of IED. Functional brain scans with SPECT can be very helpful in revealing where the brain is underactive or overactive, which can help in determining a protocol for optimizing brain function.

4. Make a healthy lifestyle a priority.

Restful sleep, a brain-healthy diet, regular exercise, and avoiding brain-damaging habits such as alcohol consumption or smoking can be incredibly helpful in supporting brain health and a steady mood.

5. Seek help.

Of course, without an accurate diagnosis, there can be no treatment. If you or someone you love is showing signs of IED, see a qualified mental health professional for psychiatric evaluation.

Destructive episodes of verbal abuse or physical aggression and other mental health issues can’t wait. At Amen Clinics, we’re here for you. We offer in-clinic brain scanning and appointments, as well as mental telehealth, clinical evaluations, and therapy for adults, teens, children, and couples. Find out more by speaking to a specialist today at 888-288-9834 or visit our contact page here.