Intermittent explosive disorder is a psychological disorder which is characterized by repeated and sudden episodes of aggressive and violent behavior or verbal outbursts which are grossly disproportionate to the inciting situation.
A key component of intermittent explosive disorder is that the explosive behavior and outbursts are associated with significant emotional distress on the individual, impacting negatively on social activities including work and schooling, as well as their interpersonal relationships. Typical signs of intermittent explosive disorder include domestic abuse, temper tantrums, road rage, and domestic abuse.
Several population surveys have revealed a lifetime prevalence of intermittent explosive disorder of approximately 1 to 5 percent. The disorder has a mean age of onset of 14 to 18 years and it is most commonly seen in the young male adult population. It is said to affect 1 in 12 teenagers. Additionally, studies reveal that more than 80% of people who have intermittent explosive disorder also suffer from another psychological disorder most commonly substance abuse disorders and bipolar disorder.
Although the exact cause of intermittent explosive disorder is unclear, an interplay of factors may be responsible for its development.
Genetics – There may be a genetic predilection to this disorder. Studies have revealed that people with a family history of intermittent explosive disorder are more likely to develop the disorder than other people.
Brain biological factors – Certain chemical imbalances in the regions of the brain responsible for emotions may contribute to the development of intermittent aggressive disorder.
Environmental factors – Growing up in an environment where parents or siblings constantly display aggressive behavior or verbal abuse may increase one’s risk of having the disorder. In addition, a childhood history of child abuse may contribute to the risk of the disorder.
Symptoms of this disorder manifest abruptly without any warning and usually last for about 30 minutes or less. Intermittent explosive disorder varies in severity between individuals. In some individuals, the episodes may occur in frequent intervals or may be separated by longer intervals of normal behavior.
Symptoms of aggressive episodes include:
The behavioral outbursts may include the following and are often out of proportion to the inciting situation.
According to the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition (DSM-5), the criteria for the diagnosis of intermittent explosive disorder include:
It is noteworthy that DSM-5 now includes two separate criteria for the types of aggressive outbursts
The symptoms of intermittent explosive disorders often overlap with several others and it is essential to differentiate them clinically.
While both disorders have many similarities, conduct disorder is characterized by a repetitive, persistent, and often premeditated behavioral pattern which is characterized by the violation of the basic rights of others or societal values appropriate for the patient’s age. This is not the case in intermittent explosive disorder in which symptoms are largely impulsive and not premeditated. Behavioral characteristics in conduct disorder include aggression to people and animals in form of bullying, threats, and physical assault, and destruction of others’ property with the intention of causing harm. In addition, patients who suffer from conduct disorder also display a violation of age-appropriate norms.
Both disorders have some similarities, however, oppositional defiant disorder has an earlier onset – usually by the age of 8 years and are usually not characterized by violence or grossly aggressive physical behavior. Oppositional defiant disorder has different diagnostic criteria which includes a recurrent pattern of irritable or angry mood, rebellious behavior, or vindictiveness which lasts at least 6 months. Patients with oppositional defiant disorder are generally irritable and touchy and often annoy others and contravene laid down laws deliberately. In addition, in contrast to intermittent explosive disorder, the behavioral pattern and outbursts are usually premeditated in oppositional defiant disorder.
Other psychological disorders which may be characterized by aggressive behavior and physical abuse include substance intoxication such as with amphetamine and cocaine, schizoaffective disorder characterized by aggressive behavioral pattern triggered by delusions and hallucinations, and antisocial personality disorder which is characterized by rebellious behavior, lack of remorse, and recalcitrant social irresponsibility.
The disorder typically begins in late childhood or adolescent years, progressing to young adulthood. It is very common in adults below the age of 40.
A 23-year-old man is brought to the clinic by a group of police officers. He was said to have beat up his wife over an altercation about how he spends his money. His wife noted that he frequently gets angry most times and usually over slight mistakes or disagreements since they got married over a year ago. On that occasion, she had asked him to save some money for the children’s tuition fees since he usually spends a lot of money on luxury and unnecessary fancy possessions. He got so angry after hearing this and he began to beat her and destroy things in the house.
She further noted that every little disagreement pushes him to a violent outburst and he tends to become physical even when she tries to calm him down. She also mentioned that after such episodes, he cries and apologizes only to behave similarly after a couple of days.
Intermittent explosive disorder is associated with significant emotional distress which impairs social relationships and function. One must look out for the following risk factors to prevent this disorder:
Common complications of intermittent explosive disorder which suggest severity of the condition include:
Treatment for intermittent explosive disorder involves both drug therapy and psychotherapy. However, supportive therapy and lifestyle modifications are useful adjuncts to treatment.
Drug therapy involves the use of drugs such as antidepressants such as selective serotonin reuptake inhibitors including Prozac. Other medications used in the treatment of this disorder include mood stabilizers, antianxiety medications, anticonvulsants, and drugs to treat specific symptoms.
Helpful tips for improving the symptoms of this disorder, in addition to medical treatment and psychotherapy, include:
Check your insurance plan benefits for coverage of mental or behavioral health services. You may inquire through your human resources unit for employer-sponsored health coverage for treatment of this condition or contact your health insurance company directly. Also, find out about out-of-pocket costs and deductibles you will pay to access the mental health services under your insurance plan.
Your primary care physician will refer you to a psychiatrist or clinical psychologist for therapy. You may also ask friends and family for good therapists, or check through online resources and directory to find the right therapist for you.
Qualities you should look for in an LMHP include:
You should ask a potential therapist the following questions to help you gain more insight into your symptoms and the scope of your treatment options.
Intermittent explosive disorder is a chronic psychological disorder characterized by recurrent episodes of aggressive behaviors or angry outbursts which are often grossly out of proportion to the inciting situation. Intermittent explosive disorder can be managed with medications, psychotherapy, and supportive therapy consisting of home remedies, self-control, and avoidance of mood-altering substances.
Persons living with patients suffering from intermittent explosive disorder should protect themselves from possible violence and harm by involving the police, a mental health care center, or by calling the National Domestic Violence Hotline 1-800-799-SAFE (1-800-799-7233).
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