What is intermittent explosive disorder?

Intermittent explosive disorder or IED. We may have never heard of this term, but at some point in our lives most of us have experienced this disorder, even if to a much small extent. It is a mental disorder that involves sudden episodes of unwarranted, impulsive, aggressive, violent and angry verbal outbursts. This anger is often out of proportion with respect to the situation at hand. These outbursts commonly lead to feelings of guilt, despair and distress and have negative impact on the individual's social life as well as causing financial and legal troubles in the severe cases. People with IED are found to be very volatile as they may attack people and their possessions and can cause bodily harm, property damage and serious injuries. This disorder is chronic and may last for years in some cases, however the outbursts are more controlled as the individual grows old. Some people even feel pleased and relieved after an outburst, but are later struck by remorse.

What are the signs and symptoms of intermittent explosive disorder?

There are some warning signs, which when well perceived can alert you of IED so you can seek IED treatment as soon as possible. These signs are:

• Prior to an outburst, some people may perceive affective changes. These changes can be feelings of tension, swift change in moods and abrupt surge of energy.
• Some bodily symptoms of these outbursts are sweating, stuttering, feeling a tightness in chest, palpitations, and twitching.
• If you feel tempted to rage, throwing and breaking objects and temper tantrums, then it is highly likely you have intermittent explosive disorder.
• Sudden loss of control, smashing expensive property and threatening or attempting to cause someone bodily harm are the signs that indicate one may have IED.

 

How is Intermittent explosive disorder diagnosed?

IED is usually found to co-occur with other mood disorders, highly likely with Bipolar disorder. For a person to be treated with IED, they must meet the following criteria:

• The individual must have had at least three episodes of impulsive outburst that involve injury and property damage within the time of an year.
• Three months of physical or verbal aggression that occurs at least twice a week.
• The aggressive behavior must be grossly disproportionate to any precipitating psychosocial stressors.
• Distress, impairment of functioning and negative financial and legal consequences must be present for the diagnosis of IED.
• Other mental disorders such as head injury, Alzheimer's disease or the ones induced by substance abuse or medication should be ruled out before diagnosing for IED.
• Outbursts of high intensity and low frequency that leads to destruction of property without any regards to its value and assault to an animal or an individual in a gushing surge of aggression along with temper tantrums, tirades, verbal arguments and fights are also necessary factors for the diagnosis of IED.

How to differentiate between intermittent explosive diagnosis and other mental disorders?

Increased aggression is an existing factor in many psychiatric and substances misuse induced disorders which are comorbid with IED. This makes diagnosis of IED difficult. Let us learn how to differentiate between them.

IED predisposes toward depression, anxiety and substance abuse disorders by increasing stressful life experience i.e. people with intermittent explosive disorder have more tendency to develop anxiety and depressive disorders as well as bipolar disorder. However, in bipolar disorder the aggression and agitation is limited to the manic and depressive episodes only, meanwhile in IED the aggression prevails even during the period of neutral or positive mood. Similarly in alcohol and drug abuse disorders, the aggression limits to periods of acute intoxication and withdrawal. Unless the aggression blows out of these limits, diagnosis of IED is not given. Other than that, in Antisocial personality disorder the nature of aggression is instrumental which is rather unpremeditated in case of IED as it is an impulsive disorder. It is essential to establish whether the level of aggression met the criteria of IED before the development of another disorder in case of PTSD.

What are the possible treatments to cure intermittent explosive disorder?

Psychotropic medication regimes as well as cognitive behavioral therapy, both have been proven effective in treatment of IED, however the effectiveness of pharmaceutical methods is not at par with the CBT. What therapy does for the IED patients is helping them to recognize the impulses, therefore enabling them to achieve a level of awareness and contain the outburst. Multiple drug regimes are too prescribed for patients of IED. Preliminary success of the CRCST or Cognitive Relaxation and Coping Skills Therapy has been shown to be effective in group as well as individual settings. This therapy is an aggregate of twelve sessions out of which the first three concentrate on relaxation training, followed by three sessions of cognitive restructuring and exposure therapy individually. The main focus of the remaining sessions is to resist the aggressive impulses and other preventive measures.

For the alleviation of some psychopathological symptoms, tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, fluvoxamine, and sertraline are used meanwhile GABAergic mood stabilizers and anticonvulsive drugs such as gabapentin,

Lithium, carbamazepine, and divalproex seem to aid in controlling the incidence of outbursts.

To help alleviate tension and reduce the intensity of explosive outbursts, Anxiolytics are used which achieve this feat by increasing the provocative stimulus tolerance threshold. This is indicated especially for patients with comorbid anxiety and obsessive-compulsive disorders.