Intermittent explosive disorder (IED) is a condition in which an individual displays repetitive and unpredictable outbursts of impulsive and aggressive behavior. This can be either physical or verbal, with the anger prominent and the aggression out of proportion to the cause, even if one is present.
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The results of IED may be breakdown of relationships, failure at work and school, legal trouble, and financial distress, along with personal stress and personality disturbances. The disorder may continue to erupt for years though the person sometimes mellows with age. Both medical and psychological treatment may be required to help control the condition.
IED is characterized by the following symptoms:
- Sudden occurrence of explosive outbursts of temper or aggression, which typically cools within 30 minutes or less, and which is quite excessive when compared to the inciting factor, if any.
- The aggressor does not feel a sense of responsibility for the loss of control, but rather blames the circumstances, the victim, or other factors, for ‘making’ them angry. This typical lack of assumption of responsibility helps to lessen any feeling of guilt that might otherwise have assailed him, and prevents any movement in the direction of desire to change or seek help to change such behaviors. The sense of gratification associated with the aggression, coupled with the lack of self-blame, leads to further episodes of the same kind.
- Frequent occurrence of such episodes, at intervals of days, weeks or months.
- Aggressive or angry episodes of lower intensity may occur between typically explosive episodes.
- Chronic anger, with an irritable, impulsive, and pugnacious personality, is often observed.
- Certain personality types, notably the borderline, histrionic, antisocial or narcissistic types, have a predisposition towards IED.
The explosive episodes themselves may be heralded by any of the following features:
- Sudden intense anger
- Irritable mood
- Excessive energy
- Racing thoughts
- A sense of tingling
- Tremors or palpitations
- A feeling of constriction in the chest
The explosion itself is quite impulsive and carries no thought of consequences. The nature of the aggression may be:
- Shouting and yelling
- Fierce arguments
- Violent speech
- Temper tantrums
- Slapping or pushing
- Breaking or throwing objects, and damaging property
- Attacking or threatening people or animals
People with IED have an increased risk of having another psychiatric disorder, such as:
- Borderline or antisocial personality disorder
- Fear disorder
- Alcohol abuse
- Post-traumatic stress disorder
- Mood disorder
Medical conditions such as hypertension, diabetes, heart disease, gastric ulcers, chronic pain conditions, and stroke are also more common in people with IED.
There is a small increase in the risk of suicide or intentional self-harm.