Intermittent Explosive Disorder: Symptoms & Treatment

Classified as a disruptive, impulse control, and conduct disorder, intermittent explosive disorder is often linked with childhood trauma and bipolar disorder and affects as many as 16 million Americans.

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Everyone gets angry and overreacts sometimes, but regularly responding to minor issues with aggressive outbursts could be a sign of a bigger mental health issue. Intermittent explosive disorder (IED) is a mental health condition marked by recurrent episodes of impulsive, aggressive, or violent behavior. People with IED often have difficulty controlling their anger or aggression, leading to outbursts that are disproportionate to the provocation or trigger. Although it is not as well known as other mental health conditions, one study suggests the disorder affects as many as 16 million Americans.

IED can be distressing for people experiencing it and for those around them, but there are treatment options that can help. Learn more here about the signs and symptoms of IED, its causes, and treatment options offered at Charlie Health.

Signs and symptoms of intermittent explosive disorder

The signs and symptoms of IED can vary from person to person, but they typically involve the following cycle: a triggering event, escalating tension, an explosive outburst, and subsequent feelings of relief followed by guilt or remorse. These symptoms need to be recurrent and cause significant distress or impairment in daily life for a diagnosis of IED, which can only be accurately diagnosed by a mental health professional. The signs and symptoms of IED typically play out in the following cycle:

Intense anger and irritability

People with IED may have frequent feelings of intense anger, irritability, or rage. They may have a short fuse and find it challenging to control their anger in various situations. It’s also common for people with IED to have persistent thoughts about aggression, revenge, or past instances of aggression. They may dwell on perceived injustices or grudges, leading to a heightened state of anger or irritability.

Explosive outbursts

People with IED experience recurrent episodes of extreme anger, aggression, and verbal or physical aggression. These outbursts are often triggered by minor provocation or frustration and result in behaviors beyond what is considered socially acceptable.

Verbal or physical aggression

During an outburst, people with IED may engage in verbal aggression, such as yelling, shouting, or using profanity. In some cases, physical aggression may occur, resulting in acts of physical violence, property damage, or harm to others.

Tremendous guilt or remorse

Following an explosive outburst, people with IED often experience feelings of guilt, remorse, or embarrassment about their behavior. They may regret the consequences of their actions and struggle to understand why they acted in such an extreme manner.

What causes intermittent explosive disorder?

The exact causes of IED are not fully understood. However, there are several risk factors that may contribute to the development of the condition. These factors are not definitive causes but rather potential influences that may interact and contribute to the development of IED:

• Biological factors: Some research suggests that certain biological factors, such as abnormalities in the brain’s neurotransmitter systems or genetic predisposition, may play a role in IED. Variations in serotonin and dopamine levels, which are involved in regulating mood and impulse control, have been implicated in the development of aggressive behavior, which is one of the hallmarks of IED.
• Environmental factors: Environmental influences can contribute to the development of IED. People who have been exposed to a chaotic or violent upbringing, inconsistent parenting, or a history of physical or emotional abuse may be more susceptible to developing aggressive and explosive behaviors. Stressful life events, such as trauma, loss, or significant life changes, can also contribute to the onset or exacerbation of symptoms.
• Psychological factors: Some psychological factors may contribute to the development of IED. Individuals with difficulties in emotional regulation, such as a limited ability to cope with stress or manage anger, may be more prone to explosive outbursts. Other underlying mental health conditions, such as mood disorders, substance abuse, or personality disorders, can also coexist with IED and contribute to its symptoms.

Intermittent explosive disorder and childhood trauma 

There is evidence to suggest a link between IED and childhood trauma. Childhood trauma, which can include physical, emotional, or sexual abuse, neglect, or witnessing violence, has been identified as a risk factor for the development of IED in some people, according to one study.

Experiencing trauma during childhood can significantly impact one’s emotional regulation and coping mechanisms. It can lead to difficulties in managing and expressing emotions, including anger. Traumatic experiences may contribute to the development of intense anger responses, heightened irritability, and a decreased threshold for explosive outbursts—all key features of IED.

Furthermore, childhood trauma can also contribute to the development of other mental health conditions, such as post-traumatic stress disorder (PTSD), depression, or anxiety disorders, which can coexist with or exacerbate symptoms of IED.

However, not everyone who experiences childhood trauma will develop IED, and not all individuals with IED have a history of childhood trauma. The relationship between childhood trauma and IED is complex, and—as mentioned—other risk factors, such as genetic predisposition, biological factors, and environmental influences, can also contribute to the development of the disorder.

Intermittent explosive disorder and bipolar disorder 

Many people experience more than one mental health condition or substance use disorder at the same time, otherwise known as co-occurring disorders. IED can co-occur with various mental health conditions, including different mood, anxiety, and substance use disorders. 

Some research suggests a potentially high rate of co-occurrence between IED and bipolar disorder, but the two conditions are separate. Bipolar disorder, which is a mood disorder, involves a broader range of mood symptoms compared to IED, which is classified by the American Psychiatric Association as a disruptive, impulse control, and conduct disorder. However, both disorders may involve brain regions responsible for regulating the top-down control of aggression and violent behavior.

Bipolar disorder is characterized by significant mood swings that alternate between episodes of mania (elevated mood, increased energy) and depression (low mood, decreased energy). These mood episodes typically last for days, weeks, or even months. While anger and irritability can be part of the manic or depressive episodes in bipolar disorder, the intensity and duration of these mood swings distinguish them from the impulsive and explosive outbursts seen in IED. However, some individuals with bipolar disorder may also exhibit symptoms of impulsive aggression and explosive outbursts, which may meet the criteria for a coexisting diagnosis of IED. 

The co-occurrence of IED and bipolar disorder can present challenges in terms of diagnosis and management, as the treatment approaches for each condition may differ. A comprehensive assessment by a qualified mental health professional is essential to differentiate between the two conditions and provide an appropriate treatment plan for both or either.

How is intermittent explosive disorder diagnosed?

The diagnosis of IED involves a comprehensive assessment conducted by a qualified mental health professional. During the evaluation, the clinician will gather detailed information about the individual’s symptoms, medical history, and psychosocial background. 

They will assess whether the individual meets the diagnostic criteria outlined in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which include recurrent episodes of impulsive aggression that are out of proportion to the triggering event and are not premeditated. The clinician will also rule out other mental health disorders or medical conditions that may better explain the symptoms. The duration of symptoms, their impact on daily functioning, and any associated distress or impairment are also considered. 

Additional information can be gathered by collaborating with people close to the individual and through direct observation. A thorough and accurate diagnosis is essential for developing an appropriate IED treatment plan tailored to the individual’s specific needs.

How is intermittent explosive disorder treated?

The treatment of IED typically involves a multimodal approach that combines various therapeutic strategies. The specific IED treatment plan, which should be determined in consultation with a qualified mental health professional, may vary depending on the severity of symptoms, individual needs, and preferences. IED treatment is typically long-term and requires ongoing support and monitoring to manage symptoms and promote overall well-being effectively. Some common IED treatment approaches include:

Psychotherapy

Cognitive-behavioral therapy (CBT) is often used to help people identify and modify distorted thinking patterns and learn effective coping skills to manage anger and impulse control. Other forms of therapy, such as dialectical behavior therapy (DBT) or anger management therapy, may also be beneficial.

Medication

In some cases, medication may be prescribed to help control impulsive aggression and manage underlying symptoms. Antidepressants, mood stabilizers, or anticonvulsant medications may be prescribed by a psychiatrist, depending on the individual’s specific needs.

Skills training

Teaching people specific skills for anger management, communication, and conflict resolution can be helpful in reducing explosive outbursts. These skills focus on improving emotional regulation, impulse control, and problem-solving abilities.

Stress and anger management techniques

Learning relaxation techniques, stress reduction strategies, and healthy coping mechanisms can help people better manage anger triggers and reduce the likelihood of explosive episodes.

Supportive interventions

Family therapy or support groups can provide a supportive environment where people can share experiences, receive guidance, and learn from others facing similar challenges. Family involvement is important for understanding and supporting the individual’s treatment.

Addressing co-occurring conditions

If there are any co-occurring mental health or substance use disorders, they should be identified and treated concurrently to achieve the best outcomes.

Intermittent explosive disorder at Charlie Health 

Living with IED can be overwhelming, but you don’t have to suffer alone. IED is manageable, especially when you have the resources and support to cope.

Charlie Health’s virtual intensive outpatient program (IOP) connects each client with a licensed therapist based on their individual needs, preferences, background, and experiences to promote healing in a safe, supportive space. Get started today.