Intermittent Explosive Disorder

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KEY POINTS

• Intermittent explosive disorder (IED) is when you have sudden, violent reactions that are out of proportion to things that happen.
• Treatment usually involves both therapy and medicine.
• It may help to leave the situation, try to calm yourself with deep breathing and self-talk, or do something physical such as walking, jogging, or bicycling.

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What is intermittent explosive disorder?

Intermittent explosive disorder (IED) is when you have sudden, violent reactions that are out of proportion to things that happen. You are not violent or aggressive most of the time.

What is the cause?

The exact cause of this disorder is not known. Possible causes include:

• The brain makes chemicals that affect thoughts, emotions, and actions. Without the right balance of these chemicals, there may be problems with the way you think, feel, or act. People with this disorder may have too little or too much of some of these chemicals.
• Stress plays a part. You may be at higher risk due to problems such as abuse, financial stresses, or the death of loved ones.
• It seems to run in families. Some studies show that it may be caused by genes passed from parent to child.
• Problems in your family when you were growing up may increase your risk, such as parents or others who:
  • Abused and neglected you
  • Abused drugs or alcohol
  • Were impulsive, destructive, reckless, or violent
  • Were not consistent in their discipline

Violent, destructive behaviors often start in childhood. IED occurs more often in men. Women may have it as part of premenstrual syndrome (PMS).

What are the symptoms?

Symptoms may include:

• Verbal outbursts in the form of tantrums, threats, arguments, or fights
• Being repeatedly and suddenly violent
• Being unable to stop or control impulsive, aggressive actions
• Destroying property
• Reacting way out of proportion to things that happen. You may hurt people you love or those you don’t even know, such as road rage. You may attack or even kill another person. People with IED may hurt themselves or commit suicide when they are in a rage.

How is it diagnosed?

Your healthcare provider or a mental health specialist will ask about your symptoms and any drug or alcohol use. He will make sure you do not have a medical illness or drug or alcohol problem that could cause the symptoms.

How is it treated?

The most important first step is to recognize there is a problem and get help. Treatment for IED usually involves both therapy and medicine.

Medicine

Several kinds of medicines may be helpful. Your healthcare provider will work with you to select the best medicine.

Therapy

• Cognitive behavior therapy (CBT) is a way to help you identify and change views you have of yourself, the world, and the future. CBT can make you aware of unhealthy ways of thinking. It can also help you learn new ways to think and act.
• Behavior therapy helps you recognize that the way you act affects others. This can help you change problem behaviors.
• Group therapy and anger management programs can be helpful.

How can I take care of myself?

Time-outs can be useful.

• Set a specific amount of time (15 minutes to 1 hour).
• Leave the situation (for instance, take a walk or go into another room).
• Calm yourself mentally with deep breathing and self-talk.
• Do something physical such as walking, jogging, or bicycling.
• Return to the situation if the anger does not return. If the anger returns, take another time-out. Do not drink or use drugs during the time-out.

Maintaining a healthy lifestyle is important. To help control intermittent explosive disorder:

• Get support. Talk with family and friends. Consider joining a support group in your area.
• Learn to manage stress. Ask for help at home and work when the load is too great to handle. Find ways to relax. For example take up a hobby, listen to music, watch movies, or take walks. Try yoga, meditation, or deep breathing exercises when you feel stressed.
• Take care of your physical health. Try to get at least 7 to 9 hours of sleep each night. Eat a healthy diet. Limit caffeine. If you smoke, quit. Exercise according to your healthcare provider's instructions. Regular exercise can help calm you and make it easier for you to deal with stress.
• Avoid alcohol and drugs, because they can make your symptoms worse.
• Check your medicines. To help prevent problems, tell your healthcare provider and pharmacist about all of the medicines, natural remedies, vitamins, and other supplements that you take. Take all medicines as directed by your provider or therapist. It is very important to take your medicine even when you are feeling and thinking well. Without the medicine, your symptoms may not improve or may get worse. Talk to your provider if you have problems taking your medicine or if the medicines don't seem to be working.
• Contact your healthcare provider or therapist if you have any questions or your symptoms seem to be getting worse.

If you’re involved with someone who has sudden, violent reactions, take steps to protect yourself and your children. Talk with a healthcare provider, counselor, trusted friend, or family member about what is happening. Find someone you can call if you need to leave a dangerous situation.

Get emergency care if you or a loved one has serious thoughts of suicide, self-harm, or harming others.

For more information, contact:

• National Alliance on Mental Illness (NAMI)
  800-950-NAMI
  http://www.nami.org
• Mental Health America
  800-969-6642
  http://www.mentalhealthamerica.net/