Intermittent Explosive Disorder
Anger is a natural human emotion, but people with intermittent explosive disorder (IED) struggle to control their anger, even in minor situations. Those with IED can learn how to manage their anger with therapy and medication, leading normal, happy lives.
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What Is Intermittent Explosive Disorder (IED)?
Intermittent explosive disorder (IED) is one of the several formally recognized impulse control disorders described in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, fifth edition).
Other impulse control disorders include:
- Pyromania
- Kleptomania
- Oppositional defiant disorder (ODD)
- Conduct disorder
Intermittent explosive disorder causes impulsive and uncontrollable episodes of intense anger and aggressive behavior.
While angry outbursts can be a standard part of the human experience, the explosive outbursts displayed by people with IED are far more severe and potentially violent.
These intense, aggressive outbursts can lead to emotional and physical harm to the individual and those around them. Additionally, the outbursts caused by IED are typically triggered by events or situations that do not warrant an extreme reaction.
IED is an impulse control disorder and can improve with appropriate treatment. Without treatment, IED can lead to violent behavior, physical abuse, destruction of property, and problems with the law.
Common Comorbidities with IED
Comorbid mental health conditions are typical with IED. According to Harvard Medical School, around 63.9% of people with IED also have other mental health conditions, such as anxiety disorders or other impulse control disorders.
The most common mental health disorders that are comorbid with IED include:
- Mood disorders like depression or bipolar disorder
- Anxiety disorders
- Personality disorders
- Intellectual differences
- Autism
- Attention deficit/hyperactivity disorder (ADHD)
- Substance use disorder
Prevalence of Intermittent Explosive Disorder
Intermittent explosive disorder tends to develop in childhood around age 11. Ohio State University reports that IED occurs in around 8% of adolescents, twice that of adults.
Still, around 7.3% of adults (11.5–16 million Americans) will experience IED in their lifetimes.
Symptoms of Intermittent Explosive Disorder
The symptoms of IED are not difficult to spot, as the individual’s behavior often leads to verbal and physical aggression when triggered.
Common symptoms of intermittent explosive disorder include:
- Uncontrollable temper tantrums and explosions of rage
- Sudden, impulsive aggression that does not match the situation
- Medical conditions like high blood pressure, diabetes, ulcers, and increased risk of heart disease and stroke
- Heart palpitations
- Racing thoughts
- Chest tightness
- Road rage
- Physical aggression (including physical assault)
- Domestic violence
- Self-harm
Intermittent Explosive Disorder and Addiction
Sadly, substance abuse is widespread among individuals with intermittent explosive disorder. In a study conducted by the University of Chicago, 80% of participants who had IED also had substance use disorder.
Individuals with IED may seek out drugs and alcohol to cope with their aggressive impulses, as well as symptoms associated with other mental health conditions. In many cases, substance use may only worsen the symptoms of IED.
Intermittent Explosive Disorder Causes and Risk Factors
Like with other impulse control disorders, intermittent explosive disorder is closely tied to genetics and the person’s environment.
Additionally, current research on IED has linked the condition to several risk factors and co-occurring disorders.
Causes of IED
A mixture of genetic, physical, and environmental factors is believed to be the cause of IED.
- Genetic: Current research suggests that 72% of IED diagnoses are due to genetics. Individuals with family members who have impulsive anger issues or certain mental health conditions are more likely to have IED themselves.
- Physical: The development of IED may also be connected with the neurotransmitter serotonin, which is associated with mood regulation. Individuals with IED tend to have lower levels of serotonin, in addition to structural differences in their brains.
- Environmental: Meanwhile, the environment a child grows up in can play a role in developing IED. Experiencing abuse (verbal or physical) or experiencing one or more traumatic events seems to increase the chance of IED.
Risk Factors for IED
Several factors put certain people at higher risk of developing intermittent explosive disorder. One of the biggest risks is having parents or family members with impulsive anger issues, as those traits can be genetically passed through families.
Common risk factors for developing intermittent explosive disorder include:
- Being male
- Family history of IED, substance abuse, and other mental illnesses
- Social isolation or impairment
- Brain trauma
- Having antisocial personality disorder or borderline personality disorder
- Growing up emotionally or physically abused and/or neglected
Treatment Options for Intermittent Explosive Disorder
If you meet the diagnostic criteria for IED, your mental health professional will recommend a treatment plan.
Treatment for IED may depend on several factors, such as the severity of symptoms or any co-occurring conditions. In general, IED is typically treated through psychotherapy and medications.
Psychotherapy
The most common type of psychotherapy used in the treatment of IED is cognitive behavioral therapy (CBT). CBT works by helping individuals analyze their thoughts and emotions, helping them identify the ones that contribute to their aggressive impulses.
CBT used for intermittent explosive disorder can help patients develop the following:
- Anger management techniques
- Relaxation techniques
- Improved coping skills
Medications
Certain medications can be very effective in the treatment of IED. Many mood stabilizers work by increasing the emotional threshold for handling situations that would typically trigger an IED patient’s explosive anger.
The most common medications used in the treatment of IED include:
- Lithium
- Mood stabilizers like phenytoin (Dilantin®), oxcarbazepine (Trileptal®), and carbamazepine (Tegretol®, Curatil®)
- Antipsychotics
- Antidepressants or Selective Serotonin Reuptake Inhibitors (SSRIs), especially fluoxetine (Prozac®)
- Antianxiety medications
Find Support and Treatment for Intermittent Explosive Disorder
Intermittent explosive disorder can be an incredibly challenging condition to address. In some cases, IED can even lead to dangerous behavior and physical harm to others. However, treatment can help people with IED manage their symptoms and help loved ones better support their recovery journey.
If you’re ready to seek treatment for yourself or a loved one with IED, talk to your doctor or mental health specialist to receive a formal diagnosis.
Don’t have an established mental health provider? Try SAMHSA’s online treatment locator or call 1-800-662-4357 to find care near you.
FAQs About Intermittent Explosive Disorder
What is the root cause of intermittent explosive disorder?
Intermittent explosive disorder is caused by a combination of genetics and the environment in which the individual was raised. Parents or family members can pass down aggressive and impulsive traits, so individuals with a family history of IED or similar conditions are at higher risk.
In addition, people raised in abusive households, those who have brain trauma, or have personality disorders may also be more likely to develop IED.
Is intermittent explosive disorder a form of bipolar disorder?
No. Bipolar disorder is a mood disorder that is characterized by cycles of mania (highs) and depression (lows). Intermittent explosive disorder, on the other hand, is an impulse control disorder. However, bipolar individuals may exhibit explosive anger similar to IED while in full-blown mania.
While the two conditions are different, bipolar disorder is a common co-occurring condition among people with IED.
What are the common triggers for someone with IED?
Common triggers for IED are typically quite minor. For example, being cut off by someone while driving, feeling criticized by a friend, or being corrected by a co-worker at work. While these events may be irritating or upsetting to most people, those with IED cannot control their explosive reactions.
Can intermittent explosive disorder be managed with medication?
Yes. The most common types of medications used to treat IED are antidepressants, antipsychotics, mood stabilizers, and antianxiety medications. Mood stabilizers can especially help by improving the person’s ability to emotionally handle situations that often trigger their angry outbursts.
Can children be diagnosed with intermittent explosive disorder?
Yes. IED typically develops in childhood between the ages of six and eleven. Once a diagnosis is made, the child will typically enter therapy and be prescribed medications if needed. However, many people may not receive a formal diagnosis until adulthood.
