Intermittant Explosive Disorder

What is Intermittent Explosive Disorder?

Intermittent Explosive Disorder is classified in the DSM-5 in the category of Disruptive, Impulse-Control, and Conduct Disorders. All of the disorders in this category involve problems controlling behavior and emotions.

The major symptom of this disorder can be either one of the following:

• Recurring behavioral outbursts or aggressive impulses that the person is not able to control. This can be verbal aggression (temper tantrums, verbal arguments, name-calling, etc.) or physical aggression toward people, animals, or property. The physical aggression does not result in damage to the property or physical injury to other people or animals. These outbursts must occur at least twice a week, on average, for at least 3 months in order for a diagnosis to be made.
• Three behavioral outbursts in a 12-month period that involve damage to property and/or causes physical injury to other people or animals.

The outbursts typically last for less than 30-minutes and are not simply a situation of someone getting frustrated or upset. It is anger or aggression that goes way beyond what could be typically expected and is completely out of proportion to what others would do in the same situation.

These outbursts are not planned or thought about ahead of time and are not designed to intimidate or get something from others. In the heat of the moment, the person is completely unable to control their angry or aggressive impulses and react toward others because of these feelings.

The outbursts also cause either distress in the individual or impairment in their relationships with others, problems at school or work, and are typically associated with financial or legal consequences.

The person must be at least 6 years old (or at an equivalent developmental level) in order to receive a diagnosis of Intermittent Explosive Disorder.

The outbursts also cannot be better explained by another mental disorder (depression, bipolar disorder, personality disorders, etc.), another medical condition (head trauma, traumatic brain injury, etc.) or as a result of a substance (drug of abuse, medication, etc.).

How common is Intermittent Explosive Disorder?

According to research, approximately 2.7% of the United States population meets the criteria for this disorder. It is typically more common in younger individuals and in those with a high school education or less.

Onset for the disorder is generally in late childhood or adolescence and is rarely seen for the first time in those over 40 years of age.

The disorder often follows a pattern of chronic episodes that persist over many years.

What are the risk factors for Intermittent Explosive Disorder?

There are two types of risk factors for this disorder - environmental and genetic/physiological.

People that have a history of physical and emotional trauma during their first 20 years of life have an increased risk of developing the disorder.

Those that have a first-degree relative (parent or sibling) with the disorder are more likely to develop the disorder. Research with twins has shown a strong genetic component and studies of the brain have found issues that may contribute as well.

What other disorders or conditions often occur with Intermittent Explosive Disorder?

Disorders that are most commonly seen with Intermittent Explosive Disorder include depressive disorders, anxiety disorders, substance use disorders, antisocial personality disorder, borderline personality disorder, and other disruptive behavior disorders (ADHD, conduct disorder, oppositional defiant disorder).

How is Intermittent Explosive Disorder treated?

There are two main treatments for this disorder, which are psychotherapy and medication.

In individual or group counseling, the therapist helps the person identify triggers that cause their outbursts and then works with the person to teach skills to manage the anger or aggression in more health ways. This typically includes cognitive behavior therapy that works on cognitive restructuring (identifying and changing the thoughts that drive the behavior), relaxation training (to reduce anger impulses), and coping skills training (different ways to behave when feeling upset).

Medications that may be used include antidepressants, mood stabilizers, and antipsychotics.