After working hard during the day, Aman was driving home. He had faced many challenges and stress while at work, then something happened that surprised him. A cyclist rode in front of his car suddenly. Aman couldn’t believe it! Aman became very angry, shouted and pounded the steering wheel. He began chasing the cyclist on his bike. Once Aman calmed down, he felt guilty for how he handled that situation. He was also embarrassed and realised he had overreacted to his frustration as he found out later that it was simply a cyclist who made a mistake.
Aman’s family has told him that he tends to get angry about trivial things. It’s a challenge for Aman to control his anger. Aman gets angry, then feels regret after overreacting to his anger, as he did this time, at the cyclist. He may be experiencing recurrent occurrences of intense anger, which may indicate that he may have Intermittent Explosive Disorder (IED).
Intermittent explosive disorder (IED) is a mental health concern that can cause people to have repeated episodes of anger that are far beyond what would actually be warranted given the circumstances of what happened (McCloskey et al., 2008). Those who have IED may yell, destroy things or act violently and typically will feel bad after acting that way, but have difficulty controlling future acts of aggression (Fanning et al., 2014).
Studies indicate that almost 5-7% of individuals may have at least some level of IED at some point during their lives; various causal factors for IED have been identified, such as early childhood experiences of trauma or abuse by family members, low levels of serotonin in the brain and difficulties in areas of the brain associated with managing emotions (Coccaro et al., 2004; Kessler et al., 2006).
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Causes of Intermittent Explosive Disorder
It’s still not clear what causes intermittent explosive disorder (IED), but most researchers suggest that it may occur as a result of biological, psychological, and environmental factors (McCloskey et al., 2008).
1. Biological Factors– The study found that some people suffering from Intermittent Explosive Disorder have brain functional impairments, particularly in an area of the brain called the amygdala. The amygdala regulates many of the emotion-based behaviours, including anger and fear (Coccaro, 2012).
2. Genetic Factors- Aggression can be hereditary, according to family studies. Studies show that impulsive aggression is likely to have genetic components for 44%-72% of all cases (Coccaro, 2012). Children who have aggressive parents tend to have aggressive behaviours themselves.
3. Environmental Factors- IED also results from long-term experiences from childhood. The types of experiences that contribute to an increased risk for developing ITE are listed as Physical Abuse, Emotional Neglect, Bullying, Being Witness to Domestic Violence, and Unstable Environment (McCloskey et al., 2008). Many individuals diagnosed with ITE have often been exposed to violence during childhood, and this learned aggressive behaviour may manifest itself in maladaptive ways of coping with anger.
Studies have also shown that IED occurs with stressors, alcohol (or other drugs), anxiety, depression and ADHD (Coccaro & Lee, 2010). If this is the case, these stress-related conditions may contribute to increased emotional instability and impulsive behaviour.
Symptoms and Characteristics of IED
The most significant characteristic of Intermittent Explosive Disorder (IED) is recurrent, abrupt outbursts of aggressiveness that are out of proportion to any particular stimulus (Kessler et al., 2006). The aggressive episode(s) will happen without prior thought or affection. Common symptoms include:
- Out-of-control anger that occurs suddenly,
- Making threats against others.
- Yawn gasps or harshly at someone in anger
- Fighting or being aggressive with someone else by hitting or using some other physical means
- Throwing or breaking something intentionally
- Demonstrating road rage or being out of control when angry
- Experiencing tension that is building before an outburst
- Believe their anger has been let out and feel guilty/embarrassed afterwards after trying to release their anger.
The most common length of an episode is under 30 minutes; however, effects from episodes can persist and negatively impact relationships as well as day-to-day functioning (Fanning et al., 2014). Those suffering from IED typically deal with difficulties finding or keeping enough work, drama in their families, legal issues (such as avoiding jail time), and being socially isolated from others.
According to the results of research, persons with IED have an increased risk for developing depression, anxiety, substance use problems, and self-harm behaviour (Feder et al., 2011).
Intervention and Treatment of IED
IED can be extremely detrimental to someone’s life; however, there are effective treatments available for this condition. Typically, IED treatment consists of a combination of psychotherapy, medications, and lifestyle changes to help individuals manage their symptoms of IED.
1. Rewiring Thoughts with Cognitive Behavioural Therapy (CBT)- The program assists individuals in recognising negative thought patterns and emotional triggers that create problems and anger. The conventional program also includes teaching how to use various coping strategies (e.g., relaxation techniques, anger management skills, and problem-solving) to help them manage their anger and aggression more effectively than they might otherwise have done (Feder et al., 2011).
2. Balancing Emotions through Medication- To treat some patients, doctors may prescribe medication for conditions such as a selective serotonin reuptake inhibitor (SSRI), mood stabiliser, or anti-anxiety medication. These medications act by regulating brain chemicals, which in turn reduces the amount of impulsive rage and aggressiveness that a person may experience (Fanning et al., 2014).
3. Managing Stress in a Healthy Way- Meditating, being mindful and exercising regularly, as well as communicating healthily, can all help reduce stress and emotional stress. Avoiding alcohol and drug use is also essential since they may make aggressive behaviour worse (McCloskey et al., 2008).
4. Healing through Family and Social Support- Having support from family, through counselling/therapy, and/or family therapy, provides people with an understanding of the situation, encouragement to stay in recovery, and help in repairing relationships affected by anger problems.
Conclusion
Intermittent Explosive Disorder (IED) is significantly different from just being an angry person. Rather, IED is classified as a severe mental health disorder and characterised by intense behavioural outbursts that are sudden, severe, unpredictable, and beyond the individual’s control. These outbursts can result in damaged relationships, job loss, etc., as well as cause significant difficulty functioning. Several variables may contribute to the development of IED, including biological factors (neurotransmitters) or genetic predisposition to IED, childhood trauma, and environmental stressors.
Although aggressive outbursts caused by IED may have serious consequences, receiving assistance from various types of therapy will aid individuals with this disorder in improving their quality of life. In addition, psychosocial support before a diagnosis is crucial in assisting individuals with IED to learn better methods of controlling their emotions and leading a socially functioning life (Coccaro & Lee, 2010). Supporting someone with the disorder through empathy is also critical for reducing stigma against them and giving them hope that they can receive assistance and be treated for their disorder.
References +
- American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.; DSM–5–TR). American Psychiatric Publishing.
- Ari Feder Feder, A., et al. (2011). Anger management treatments for intermittent explosive disorder and impulsive aggression. Harvard Review of Psychiatry, 19(3), 156–168.
- Emil F. Coccaro Coccaro, E. F., & Roy Lee Lee, R. (2010). Pathophysiology of intermittent explosive disorder and implications for treatment. CNS Drugs, 24(8), 653–669.
- Jennifer R. Fanning Fanning, J. R., et al. (2014). Serotonin and impulsive aggression in intermittent explosive disorder. Journal of Psychiatric Research, 58, 158–163.
- National Institute of Mental Health. (2023). Mental health information: Intermittent explosive disorder. National Institutes of Health.
- Roy Lee Lee, R. (2010). Pathophysiology of intermittent explosive disorder and implications for treatment. CNS Drugs, 24(8), 653–669.
- Ronald C. Kessler, R. C., et al. (2006). The prevalence and correlates of DSM-IV intermittent explosive disorder in the National Comorbidity Survey Replication. Archives of General Psychiatry, 63(6), 669–678.
