Intermittent Explosive Disorder


The fundamental feature of this disorder is the appearance of isolated episodes of aggressive impulses, which often result in violent behaviors toward others or destruction of objects.

When somebody looses their temper, frequently, or has a tendency to "fly off the handle" there may be a deep lying problem.

The disorder, known as intermittent explosive disorder (abbreviated IED) is a behavioral disorder characterized by extreme expressions of anger, often to the point of uncontrollable anger that are disproportionate to the circumstances in which they occur. Currently, within the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is categorized within impulse control disorders, along with kleptomania (theft of eye-catching objects for the affected person), pyromania, and pathological play such as gambling, among others.

The person overreacts to certain situations with uncontrolled anger, experiences a sense of relief during the outburst of rage and then feels remorse and feelings of guilt for his actions.

A small incident can trigger this episode of excessive aggression, then moving on to a depressed and guilty mood. This "attack," as many of the patients describe it, usually remits quickly and spontaneously. Sometimes they can blame others. E.g. "it's that my wife made me very nervous because she didn't listen to me and that made me jump…" This defense mechanism is used so as not to have to acknowledge its responsibility for the violent act, although the feeling of subsequent guilt is usually characteristic of this disorder.

A 2005 study in the state of Rhode Island found a prevalence of 6.3% ( /- 0.7%) for the experimentation of a lifelong episode of IED among 1,300 patients under psychiatric evaluation. Prevalence is higher among men than among women. It is characteristic of Asian countries and its most common onset age was in the end of late adolescence (18 years approximately) until the third decade of life, this has changed in DSM-5 where it is established in childhood over . The disorder is not easily characterizable, and there is often comorbidity with other mood disorders, mainly with bipolar disorder. Patients diagnosed with IED often report that their episodes of anger were brief (lasting less than an hour), with a variety of bodily symptoms (sweat, chest tightness, contractions, palpitations) experienced by a third of the sample. Violent acts were often accompanied by a sense of liberation, and in some cases, pleasure, but followed by remorse after the episode was over.

Basic assessment for impulse control disorders such as IED should include at least tools for:

  1. Diagnosing and delimiting problem behaviors.
  2. The conceptualization and planning of the intervention.
  3. The evaluation, monitoring and results of the intervention.

Therapeutic treatment planning requires prior conceptualization of the case. The multi-causal nature of these disorders confers enormous complexity in the intervention and treatment.

Treatment may involve a mixture of cognitive behavioral therapy and drug treatment. Therapy can help the patient recognize impulses to facilitate the acquisition of a higher level of awareness and control of anger access, as well as treat the emotional stress that accompanies these episodes. There are several pharmacological treatments indicated for this type of patient seem to help control the onset of anger access. Anxiolytics help relieve tension and may help reduce anger attacks by increasing tolerance to the stimuli that cause them, and are especially indicated in patients who also suffer from an obsessive-compulsive disorder, or other anxiety disorders.

IED may also be associated with prefrontal cortex injuries, including the amygdala, increasing the incidence of impulsive and aggressive behaviors, as well as the inability to predict one's behavior. Injuries in these areas have also been associated with inappropriate blood glucose control, leading to a decrease in brain function in these areas, which are related to planning and decision-making.

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