Intermittent Explosive Disorder: Symptoms and Mental Health Support

Anger is a natural human emotion that may occur in response to irritating or enraging events. For some, anger responses may be unpredictable or cause problems in relationships, work, and home life. When these interruptions to life occur because of anger, it can be valuable to reach out for support. 

Intermittent explosive disorder (IED) causes explosive outbursts of anger, frequently accompanied by violence and disproportionate responses to the issue or situation at hand. During an intermittent explosive disorder episode, punching, kicking, screaming, or throwing objects may occur, and these actions might escalate into physical aggression and violent behavior.

Being at the receiving end of this type of explosive rage can be scary, and the risk factors can feel frightening for those who live with this condition.

An individual diagnosed with intermittent explosive disorder can seek the support of a mental health professional to treat their condition, especially if the symptoms escalate to violent behavior and aggression, like physical fights. In psychiatric research, it is frequently reported that individuals who do not seek treatment may experience a lifetime prevalence of uncontrolled anger, leading to physical or emotional danger, and an increased risk of certain chronic health problems.

As with many mental health conditions, learning about your symptoms and the treatments approved for your condition can be beneficial.

Intermittent explosive disorder (IED) causes and risk factors

If you haven't heard of intermittent explosive disorder or know little about it, you may be curious about its causes. Understanding the motives behind the rage outbursts that often occur with this mental health condition can be challenging. Often, symptoms of intermittent explosive disorder result from a build-up of stress throughout an extended period of persistent stressors, anxiety, or fear.

Below are some of the most common causes of intermittent explosive disorder (IED), including both genetic factors and environmental factors.

Biological and neurological factors

Environmental, genetic, and other mental health disorders or conditions may contribute to intermittent explosive disorder. Sometimes, differences in brain structure may play a role in the development of mental health disorders. Below are a few of the mental illnesses that may be associated with intermittent explosive disorder and may accompany an intermittent explosive disorder diagnosis: 

• Mood disorders (like depression or bipolar disorder)
• Personality disorders (like borderline personality disorder, antisocial personality disorder, and narcissistic personality disorder)
• Conduct disorder
• Substance use disorders
• Attention-deficit/hyperactivity disorder (ADHD)

It can be beneficial to moderate or avoid mood-altering substances, including recreational drugs, when you have a diagnosis of intermittent explosive disorder (IED).

Environmental and childhood risk factors

While a direct cause has not been correlated with intermittent explosive disorder, the rate of those diagnosed with the condition has been discovered to be high in military personnel. It is often believed that while the military is trained to focus and sustain life in highly stressful situations, it leaves participants ill-equipped for civilian life afterward.

When living in a heightened state of awareness, one's stress level increases and may cause significant reactions to minor occurrences when returning from service. As rage and outbursts can also be symptoms of post-traumatic stress disorder (PTSD) in veterans, it may be possible that intermittent explosive disorder is a co-occurring diagnosis with PTSD for these people. However, rage is not only a symptom of intermittent explosive disorder. Conditions like depression and PTSD can also cause the same traits of extreme irritability, anger, and rage. It can be important to get the proper treatment for these other disorders as well.

Traumatic childhood experiences

As intermittent explosive disorder (IED) can be connected to PTSD and traumatic experiences, it may also be common in those who grow up in a household with high tension, traumatic events, or stress.

Children exposed to war, domestic violence, and child abuse may be at risk of developing intermittent disruptive disorder. They may also have difficulty identifying and understanding their anger, which can manifest in many ways and with little or no warning.

Personality traits and emotional regulation challenges

Studies show that intermittent explosive disorder may also be more prevalent in individuals with certain personality traits. For example, children who demonstrate low empathy, constrained effect, and lack of performance-related concern are more at risk for developing IED and other externalizing disorders. 

Intermittent explosive disorder in children

In infants and toddlers, early signs of developing intermittent explosive disorder include temper tantrums, biting, kicking, or other aggressive impulses. Pre-teens and teenagers may exhibit violence towards siblings or parents, illegal behaviors, or school fights. They may be observed getting into verbal arguments or breaking objects during an explosive episode as well. Children often do not understand that they feel anger and may not know how to label it or control their feelings. However, intermittent explosive disorder often stems from something in the individual's past or upbringing. 

The symptoms of intermittent explosive disorder affect family and friends in the lives of diagnosed individuals from an early age and warrant rapid treatment for the verbal and physical symptoms as early as possible.

Professionals can identify what is causing these children to act out such anger and how to help them to choose more appropriate ways to exhibit their feelings. If a therapist specializing in intermittent explosive disorder diagnoses and treats the disorder early in a person's life, there may be more hope for recovery. 

Intermittent explosive disorder is similar to another disorder called disruptive mood dysregulation disorder, or DMDD. The difference between the two is that for those with intermittent explosive disorder diagnosed, the bouts of impulsive aggression come and go, but with DMDD, the underlying rage is always present.

While the nature of intermittent explosive disorder makes the cause challenging to identify, it can be essential to recognize the signs and symptoms and take proper measures to receive treatment from a professional. Symptoms of intermittent explosive disorder affect not just the person living with the disorder, but also everyone around them, so it can be crucial to seek treatment, whether through talk therapy or clinical psychiatry.

Symptoms of intermittent explosive disorder

As approved by the American Psychiatric Association, the Diagnostic and Statistical Manual of Mental Disorders includes intermittent explosive disorder as a mental disorder in its fifth edition. According to the DSM-5, there are several intermittent explosive disorder symptoms and diagnostic criteria. 

Some of the behavioral symptoms demonstrated by people with intermittent explosive disorder include but are not limited to the following: 

These angry and aggressive outbursts can result in abusive behaviors, physical fights, destruction of property, physical assault, road rage, car accidents, dangerous behavior, health risks, impaired personal relationships, or lashing out toward strangers, potentially causing them physical harm.

Emotional and cognitive symptoms

In addition to behavioral symptoms, a person with intermittent explosive disorder may also experience the following emotional or cognitive symptoms: 

• Irritability
• Impulsive anger 
• Regret after angry outbursts
• Racing thoughts
• Tension

Frequency and intensity of anger episodes

During times of anger, the ability to reason about actions and the ability to control behaviors may be reduced in people with intermittent explosive disorder. This impulsive anger, paired with the increased energy that can come with angry outbursts, can mean that there are higher chances of someone getting hurt because of an outburst and the explosive behavior that can come with it.

People with intermittent explosive disorder can experience symptoms that are potentially mild, like chest tightness but are also at increased risk for sudden, frequent episodes of anger, leading to more complex situations like physical abuse and physical injury. Some people are also at an increased risk for intermittent explosive disorder subtypes requiring specialized treatment. It can be crucial to receive a proper diagnosis and begin treatment as soon as possible if you believe you may be living with intermittent explosive disorder or want to better control aggressive behavior. 

Triggers and patterns of IED episodes

Let’s take a closer look at how intermittent explosive disorder episodes may look, and the patterns to look for in IED behaviors. 

Common emotional and situational triggers

Frequently reported triggers of anger episodes associated with IED include both internal emotional disturbances, and external stressors. Some of the most common include:

• Stressful situations
• Interpersonal conflict
• Sensory stimuli
• Substance use
• Perceived disrespect or injustice

Why reactions are grossly inappropriate

The disproportionate reactions of individuals with IED occur when the higher tension and energy levels overtake the body’s impulse control systems. The brain’s structural anomalies in the amygdala and prefrontal cortex, as well as irregular neurotransmitter response can contribute to the override of the body’s impulse control. What might be a minor irritation to someone without IED may seem like an unforgivable offense to someone with IED, especially if they are also dealing with unprocessed trauma. 

Patterns seen across the lifespan

When IED is left untreated, research shows that symptoms can become worse, leading to more intense and frequent outbursts of anger. They may also develop comorbid conditions like depression or anxiety. These symptoms can also affect daily life and relationships, leading to loss of loved ones, isolation, job loss, property damage, development of other psychiatric disorders, and even incarceration, serious injury, or death. However, IED is treatable, and while it can’t be cured, following treatment protocol can help individuals manage symptoms and live a fulfilling life. 

Conditions commonly associated with IED

Intermittent explosive disorder can be complex, with complex origins and comorbidities, especially if symptoms are left untreated. Some common co-occurring psychiatric disorders include: 

• PTSD: This trauma-based condition can be mistaken for IED, or occur alongside it. It’s important that those with symptoms seek help from an expert in psychological medicine to get a proper diagnosis.
• Mood disorders: including bipolar disorder: Research shows that individuals with BPD and other mood disorders are at greater risk for developing IED and vice-versa.
• Anxiety and depression: Untreated IED can lead to loss of relationships, isolation, and regret, and chronic tension. Often those with untreated IED develop symptoms of anxiety and/or depression.
• Substance use disorders: Self-medication and unhealthy coping mechanisms can lead to the development of substance use disorder in individuals with IED.

Because of the complexity of symptoms, the similarity of overlapping symptoms, and the co-occurrence of disorders, diagnosis is essential for the proper treatment of IED and any comorbid conditions. 

How intermittent explosive disorder is diagnosed

Early diagnosis and treatment can be key to managing symptoms of intermittent explosive disorder. IED diagnosis can be a process, but here are the steps you can take. 

Diagnostic criteria and clinical assessment

First, talk to your primary care doctor about referral to a psychiatrist or other mental health professional. Psychiatry can be a good place to start, because you may require prescription medication. Your provider will take a medical and psychological history, and ask about your symptoms, and then evaluate according to the criteria laid out in the DSM-5. 

Differentiating IED from other psychiatric conditions

Psychiatric research shows that IED can be closely linked to a number of other mental health conditions. Symptoms can be similar, or overlap, and you may be experiencing more than one mental health condition. It may take some time for your mental health provider to gather all of the information, evaluate, and make the right diagnoses. However, once you have this information, treatment can begin. 

When to seek professional evaluation

If you notice that your anger or other symptoms impact your daily life and relationships, it’s time to talk to a professional. Anger is a normal emotion, but outbursts should not be frequent, disproportionate to the situation, or put you in danger. 

Intermittent explosive disorder treatment 

There are several ways to get intermittent explosive disorder treated, including the following options. 

Medications to manage violent behavior and other symptoms

Placebo controlled trial research shows that there are several types of medication that may improve symptoms of IED. If someone is feeling happier and less impulsive, they may be less likely to respond to inciting events with anger and rage. Medical treatments like mood regulators may help someone feel in control of their body and mind and more able to cope around family, friends, coworkers, and the general population. Common medications for treatment of IED include:

• Mood stabilizers
• Selective serotonin reuptake inhibitors
• Beta blockers

Before starting, changing, or stopping a medication, consult a medical professional like a psychiatrist or primary care physician. 

Therapy and behavioral interventions

Medication may sometimes mask the root cause of intermittent explosive disorder. For that reason, therapy is often recommended as a component of intermittent explosive disorder treatment. While there might be a genetic component to intermittent explosive disorder, behavioral changes like using relaxation techniques can alleviate significant distress and anger outbursts. A licensed therapist can teach an individual to practice relaxation techniques that lower blood pressure, and regular relaxation training can be highly beneficial.

Therapy sessions can also account for biological factors by training the brain. By speaking with their therapist, one can understand the root causes of anger, along with coping skills for moments of rage. In doing this, a client may recognize that rage can be unhealthy. Afterward, other treatments like anger management or cognitive-behavioral therapy (CBT) can be utilized. 

Studies have led to various tools for therapists to teach someone with intermittent explosive disorder to alleviate the aggressive episodes accompanying the chronic disorder.  Coping skills training can help teach healthy coping strategies to manage outbursts and reduce stress, and group therapy can offer support and camaraderie with others who understand, in a controlled, therapist-led environment. 

Relapse prevention and long-term outlook

With the right treatment, living with IED doesn’t have to be a barrier to a fulfilling life. Ongoing therapy, life skills training, and medication management can help. 

Managing stress and early warning signs

Many people can benefit from anger management techniques, not just those diagnosed with intermittent explosive disorder. Techniques like emotional regulation skills and cognitive restructuring can also be taught to children and adolescents so that they can better accept challenges that may occur in their lifetime. 

Role of ongoing therapy and support

By accepting an intermittent explosive disorder diagnosis and seeking professional treatment, an individual can begin a treatment plan and get on the path to living a happy, healthy, and productive life. Family and friends can also help by being supportive and involved with treatment. With a social support system involved, the person diagnosed with intermittent explosive disorder may begin work on impulse control, communication skills, and relaxation techniques like progressive muscle relaxation or deep breathing to work through their explosive episodes.

Professional support for intermittent explosive disorder

An increasing body of evidence points to online therapy as a beneficial form of treatment for those experiencing emotional control issues arising from intermittent explosive disorder and other mental health conditions.  

Cognitive behavioral therapy

Cognitive-behavioral therapy works by helping individuals reframe the negative thought patterns that can often lead to unwanted feelings and behaviors, such as severe, problematic anger so that inciting situations and interactions are more manageable. In one meta-analysis of CBT-based anger management, researchers looked at the interventions' effectiveness in reducing recidivism among adult men, concluding that anger management therapy is effective in reducing recidivism risk, especially regarding violent crime. 

Getting support through BetterHelp

Online therapy proves equally effective in supporting people living with anger management challenges. In a recent study published by the Center for Psychiatry Research at Karolinska Institute in Sweden, researchers demonstrated how a four-week internet-administered CBT course achieved positive results for people struggling with anger and aggression. The 234 participants were assigned to mindful emotion awareness, cognitive reappraisal, and a combination of the two modes. All treatments were associated with decreased rates of self-reported anger and aggression.

Online therapy can be a flexible and effective option if you or someone you know exhibits signs and symptoms of intermittent explosive disorder. The ability to schedule appointments from the comfort of your own space may be particularly beneficial if you're concerned about anger in an uncontrolled environment. Through a platform like BetterHelp, you can connect with one of over 30,000 licensed mental health professionals specializing in unique areas of mental health based on your needs, preferences, and location. With more options than those in your area, you may be more likely to find someone specializing in your condition. A BetterHelp therapist can support relapse reduction with coping strategies that help to control aggressive impulses.