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Overview
Intermittent explosive disorder often referred to as IED is a form of impulsive control disorder that causes a person to have sudden and extreme outbursts of anger that they are unable to control. These outbursts can be violent and even aggressive and seem completely out of proportion to the situation or for no obvious reason. During these outbursts they can shout, scream or destroy things, be abusive to others or have road rage. People who have the condition have a low tolerance for coping with feelings of frustration or stress.
IED is a long term disorder that can last for several years, however as a person gets older it’s possible for the severity of the symptoms to decrease. Children as young as six can develop the condition, but it rarely affects people over the age of forty. It is more common in men than in women, and it’s believed that around eighty percent of people who have the condition also suffer from another mental health condition. Most commonly this could be either an anxiety disorder, intellectual disabilities, autism, externalising disorder or bipolar disorder. It’s believed that the condition affects between one and seven percent of the population.
Causes
Whilst IED can present in children or teenagers it most commonly presents in younger adults than older and its exact cause remains unknown. Researchers are still trying to find out its exact cause but they do believe that factors such as genetics, environment and biology could lead to its development. These can include:
Biological and genetic factors
The condition runs in biological families so it’s possible that there is a gene that could make you more likely to develop it. Studies have shown that between forty four and seventy two percent of cases have a family history.
A persons brain structure, chemistry and function can be different in someone who has IED as research has shown that they have lower levels of serotonin a neurotransmitter hormone.
Suffering from another mental health condition such as ADHD (attention deficit hyperactivity disorder), antisocial personality disorder, borderline personality disorder, depression or having substance abuse disorder. If you are male and under forty you are also at greater risk.
Environmental factors
If you suffered or witnessed abuse during childhood whether this was verbal or physical, or if you experienced one or more traumatic event this could also increase your risks of developing it. Learned behaviours, so if you were brought up in a home where violent verbal or physical outbursts were a regular occurrence you’re more likely to develop similar behaviours.
Symptoms of IED
Whilst an episode of IED can happen at any time and will typically last around thirty minutes they can vary in length and severity depending on the individual. Some individuals might have episodes daily but other people may not have an episode for weeks or months at a time. Symptoms can include:
· Tingling feelings, tremors or shaking
· Palpitations or tightness in the chest or your heart racing
· Scattered, confused or racing thoughts
· High levels of energy
· Feelings of frustration or irritability especially with contact with others
· Sudden anger, rage or aggression
· Picking fights or starting intense arguments
· Threatening people verbally, shouting or using abusive language
· Threatening to harm people or animals
· Becoming physically violent, slapping, shoving or committing assault
· Damaging other people’s belongings or property
· Road rage
· Temper tantrums
Whilst a person is having an outburst they are unable to control their behaviour even though they are aware of their actions. Afterwards they can often have a sense of relief and tiredness but then have feelings of remorse and guilt over their behaviour.
Associated Conditions or Risks
If the condition is left undiagnosed or remains untreated it can lead to conditions such as:
· Anxiety
· Alcohol abuse
· Depression
· Other impulsive behaviours such as gambling or having unsafe sex
· Self-Harming
· Substance Abuse
· Suicide
People with IED are also more at risk of having problems at school or work, which can lead to them falling behind with their studies or failing their exams. It could also cause them to lose their job, which can lead to financial problems. Within family and personal relationships it can cause relationships to break down especially if their IED results in domestic abuse. Problems with alcohol or substance abuse can have a detrimental effect on their health, work and homelife.
There are also several health conditions that have been related to IED which include:
· Arthritis
· Back and neck pain
· Chronic pain
· Coronary heart disease
· Diabetes
· Headaches
· High blood pressure
· Stroke
· Ulcers
Diagnosis
If you think you, your partner or child might have IED you should initially talk to your doctor or healthcare provider. Whilst there is no test for IED they can do a physical and mental health evaluation to rule out any other causes for your symptoms. Once they have done this they can refer you to a mental health professional such as a psychologist or psychiatrist who can diagnose IED.
To be diagnosed with IED you must meet one of the following criteria:
High frequency/low intensity episodes
Verbal or physical aggression towards people, animals or property that does not result in any physical harm at least twice a week for an average of three months.
Low frequency/high intensity
Aggression resulting in damage or destruction of property, or physical assault resulting in physical injury to other people or animals taking place at least three times over a twelve month period.
The degree of aggression displayed, must be out of proportion to the situation and be impulse or anger based and not pre-planned, and can’t be explained by any other mental health condition or substance use disorder.
Treatment
There is no single treatment for IED and it often consists of a mixture of medication and therapy depending on the individuals symptoms.
Medication
Some medications will work better than others for different people so your doctor could prescribe any of the following:
· Antianxiety medication
· Anticonvulsants
· Antidepressants
· Antipsychotics
· Mood regulators or SSRI’s (selective serotonin re-uptake inhibitors)
Therapy
Psychotherapy also known as talking therapy, in particular CBT (cognitive behavioural therapy) is the main type of therapy used to treat people with IED. It’s a structed goal orientated therapy; your therapist will help you to see how your thoughts affect your actions. Then they show you how to replace negative thinking and behaviours with positive healthier ones.
Other techniques in CBT include teaching you coping skills, so that you can develop more positive responses to situations that trigger your outbursts, like walking away from situations. Relaxation training can involve deep breathing and muscle relaxation techniques to help reduce your response when triggered.
Living with IED
Whilst therapy and medication can help to manage IED it is important to remember that depending on when the condition developed, studies show that it can last on average between twelve to twenty years. People who suffer from the condition can often live unfulfilling lives as they symptoms can have a negative effect on their health and relationships.
Making lifestyle changes can help to manage or reduce the effects of your symptoms, you can do this in a variety of different ways. Try and avoid the use of caffeine, alcohol or non-prescriptive drugs as they can exacerbate symptoms. Self-care should be a priority so try and ensure you eat healthily and maintain a regular sleep pattern. Take regular exercise especially in the outdoors, and try techniques like yoga, mindfulness or relaxation and breathing exercises. Written by Jan, Jeana and Wendy at Barnsley Hypnosis and Counselling (UK). For more free Information click above link.
