Intermittent Explosive Disorder

Intermittent Explosive Disorder (IED) is characterized by outbursts of rage and erratic behavior that can cause bodily harm and property damage. These behaviors are repeated, unexplained and out of proportion to the context in which they occur.

Diagnosing IED

In order to be correctly diagnosed, a person who suffers from IED must meet three criteria:
  • The behavior cannot be diagnosed as any other disorder, such as substance abuse, head injury, a medication side effect or any other medical situation such as epilepsy that may cause the brain to function abnormally. In other words, this diagnosis is made after everything else has been ruled out.
  • The degree of anger or rage is out of proportion to the situation that prompted the response.
  • Several episodes of unrestrained aggressive impulses have resulted in aggression towards people or damage to property. IED is not diagnosed after one episode.
The Diagnostic and Statistical Manual (DSM) is used to formally diagnose the disorder. It should be noted that the classification is not readily accepted by all clinicians, as some psychiatrists consider it a symptom of other psychiatric and mental disorders.
 
Intermittent explosive disorder is tricky to diagnose in children because similar symptoms can be the result of a conduct disorder. IED is characterized by very specific behaviors while a conduct disorder covers a number of symptoms.

Symptoms of Intermittent Explosive Disorder

People who have been diagnosed with IED experience strong impulses to act dangerously and are unable restrain themselves. Some IED sufferers report various physical symptoms at the time of an episode that include:
  • pressure in the head
  • tightness of the chest
  • tingling
  • tremors.
Other reported symptoms include heightened energy levels and intensity, and racing thoughts as the feeling of rage increases.
 
After engaging in an outburst or a dangerous act, the person usually feels great relief and satisfaction. The rage is gone and they are left with a sense of peace. However, once the body returns to normal, most people report revulsion, guilt and regret for their actions.
 
According to Dr. Aaron Beck, a pioneer in the application of cognitive therapy to violence prone individuals, most victims of IED misinterpret others’ words, actions and motivations. The IED sufferers may believe that everyone is untrustworthy and hostile toward them.
 
These symptoms are similar to paranoia, but differ because they are episodic reactions, not a permanent state of mind.

Causes of IED

The cause of impulse control disorders is difficult to determine. Most people who identify with impulse control disorders have a history of anger management problems.
 
Several theories on the cause of IED exist, including learned behavior, chemical imbalance or both. Some research has indicated a possible connection between seizures and intermittent explosive disorder, as well as other medical problems including migraines and attention deficit disorder.

Intermittent Explosive Disorder Treatment

In emergencies after an IED episode, the patient may be committed, against his will, to further observation and treatment. A neurosurgeon may be called in to rule out any organic causes for the outburst, and a tranquilizer may be given, if necessary.
 
For non-emergencies, medications such as lithium, Tegretor or Inderal, and anti-depressants such as Prozac and Zoloft can be given to an IED patient. Adolescents have been treated successfully with Clozaril, a drug normally used for schizophrenia.
 
Most patients diagnosed with IED are dual-diagnosed, which means that more than one disorder is present, and IED may or may not be a symptom of another disorder.
 
Resources
 
Healthatoz. (n.d.).Intermittent explosive disorder. Retrieved April 28, 2008, from the Health A to Z website: http://www.healthatoz.com/healthatoz/Atoz/common/standard/transform.jsp?request.
 
Mayo Clinic Staff. (2008). Mental health: Intermittent explosive disorder. Retrieved April 28, 2008, from the Mayo Clinic website: http://www.mayoclinic.com/health/intermittent-explosive-disorder/DS00730.
 
Psychcentral. (n.d.).Intermittent explosive disorder. Retrieved April 28, 2008, from the Psych Central website: http://www.psychcentral.com/disorders/sx51.htm.