Intermittent Explosive Disorder

Do you suffer from bouts of rage that lead to violence or the destruction of property? Although you feel your anger is mostly justified, do you realize that your reaction – your spell of rage – is out of proportion to the situation? Do you often feel remorseful or guilty after loosing control and succumbing to your rage?

If you answer yes to the questions above, you may be suffering from an impulse control disorder called intermittent explosive control disorder – a condition that makes it very difficult to resist impulses to react with violence or destruction when angry.

Those that suffer this condition are often perceived by those around them as being angry people, and they may have difficulty with relationships or at school or on the job. They are also, by the nature of the disease, at a greatly increased risk to get in trouble with the law or to get hurt in a violent confrontation.

Uncontrolled bouts of violent or destructive rage can greatly reduce a person’s quality of life – as well as affect the emotional well being of those around him or her. Because of this, it’s important that anyone who experiences this disorder seek an accurate diagnosis and begin treatments that can help a lot to control symptoms of rage.  

Do You Have Intermittent Explosive Disorder?

According to the America Psychiatric Association’s manual of mental disorders, the DSM-IVr, to meet a diagnosis of intermittent explosive disorder you must:¹

1. Have reoccurring bouts of rage that have resulted in a loss of control and to violent behavior or the destruction of property

2. Experience bouts of rage, aggression and violence or destruction that are clearly out of proportion as a response to a given situation

3. Not have another mental health disorder that better explains the rage behaviors, such as anti social personality disorder, psychosis, a manic disorder etc.

4. Not be using substances, such as illicit drugs or medications or have hallucinations that would better account for the rage behaviors. Not have experienced a medical condition, like  ahead trauma or a disease, like Alzheimer’s that  would better explain the violent outburst

People with this disorder generally feel tension preceding an attack and feel relief afterward. Feelings of relief often transform to feelings of remorse after the fact.

Still not sure? Ask yourself a few questions.

According to Daniel Ploskin MD, if you answer yes to 2 of the first 4 questions or to 5 questions in total, you may have a problem and should strongly consider getting an evaluation by a trained mental health professional²

1. Do you find it hard to control your temper?
2. Do you sometimes have rage attacks?
3. Do you ever find yourself overreacting to a situation or a provocation?
4. During a rage episode, have you ever physically assaulted another person or destroyed property?
5. Do you have a drug or alcohol problem?
6. Do rage problems run in your family?
7. Have you ever had a head trauma or brain injury?
8. Do you have epilepsy of a history of epilepsy?
9. Do you or does someone in your family have a mood or anxiety disorder?

In the DSM-IVr, Intermittent explosive disorder is currently considered an impulse control disorder not otherwise specified.

What Does an Intermittent Explosive Disorder Episode Look/Feel Like?

Episodes generally last for 10 or 20 minutes in duration and the rage exhibited during an episode often results in violent actions, injury to self or to others and/or to the destruction of properties. Symptoms, such as headache or feelings of irritability and tightness can emerge minutes or even hours before an outburst of rage.

Symptoms that may accompany or precede a violent outburst include:³

• Feelings of tension
• Headache
• Tightness in the chest
• Chest palpitations
• A surge in energy
• Irritability and rage
• Tingling sensations

Who Gets Intermittent Explosive Disorder?

The disorder affects men more than women and the typical age of onset ranges form childhood to a person’s early twenties - onset is typically quite sudden. People with intermittent explosive disorder frequently suffer from a co-occurring condition, like alcohol addiction, personality disorders or other brain disorders. They are also more likely to have a family history of addiction and/or mood disorders.

People with the disorder usually get better as they age, but factors like extreme stress, alcohol abuse or drug abuse, brain injury or head trauma can cause a sudden worsening in symptoms.⁴

What Causes Intermittent Explosive Disorder

Scientists aren’t yet sure exactly what causes the disorder, but strongly suspect that a combination of biological and environmental factors play a role.

Some factors thought to increase the risks of the disorder include:⁵

1. Growing up in a household where physical, emotional or verbal violence or assault are commonplace
2. Growing up in a very unstable household, or one lacking an appropriate role model to teach impulse control for aggressive behaviors
3. Having very low self esteem
4. Learned negativity – assuming the worst in those around you
5. Abnormalities in the brain’s serotonin system
6. Abnormal levels of testosterone
7. Dysfunction in areas of the brain related to planning or memory

Intermittent Explosive Disorder Treatments

Treatments for the disorder most typically combine one or more medications with psychotherapies, like cognitive behavioral therapy.

Medications sometimes used include:⁶

• Anti anxiety drugs, like valium or other benzodiazepines (although in some cases, some minor tranquilizers have been shown to exacerbate the severity of symptoms by lowering inhibition, similarly to alcohol)
• Anti depressant medications, such as the SSRI Prozac
• Anti convulsant medications
• Mood stabilizers, like lithium

Psychotherapy, such as psychodynamic therapy or cognitive behavioral therapy can help a person with the disorder learn better control over their actions, such as by learning to avoid situations that can prompt aggressive impulses and by learning to recognize early symptoms of an outburst and by countering these feelings with relaxation exercises.