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Intermittent Explosive Disorder (IED)

Intermittent Explosive Disorder (IED) is one of a cluster of five impulse control disorders. IED is characterized by episodes of violent or aggressive behavior that includes harm to others or destruction of property. These episodes typically result from minor incidents and the patient’s reaction is out of proportion to significance of the triggering event. The episodes begin with little provocation but they can last for hours, and usually end abruptly. The patient may break or destroy objects or property, become combative and hurt others, and often feels confused or suffers amnesia about the event. Following the event, patients will often exhibit guilt and accept responsibility for their actions. Between episodes, there is no evidence of violence or increased physicality.

Intermittent Explosive Disorder is somewhat controversial among psychiatrists. Some doctors believe that this disorder is not a specific disorder, but rather is symptomatic of other mental disorders. There is no specific cause of impulse control disorders, and the prevalence of this disorder has not been well studied. It typically occurs in late adolescence or early adulthood.

Most patients are men with a history of frequent traffic accidents, fighting and possibly sexually impulsive behavior. These patients often exhibit sensitivity to alcohol. While women are twice as likely to have panic attacks, men are twice as likely to suffer from IED, and male IED patients often have a maternal history of depression in their family.

What are the symptoms?

It is important to differentiate these symptoms from any other medical or mental disorder.

• Aggressive reaction or violence that is totally disproportionate to the triggering event
• Violent behavior, assault, fighting, homicide
• Destruction of property, breaking or smashing objects that belong to the patient or to others

How is it diagnosed and treated?

Some psychiatrists do not consider Intermittent Explosive Disorder to be a separate clinical category but rather a symptom of other psychiatric or mental disorders. Doctors will perform a complete physical and mental evaluation to rule out other medical conditions or mental disorders.

Aggressive episodes may be attributable to other mental disorders like Antisocial Personality Disorder, Borderline Personality Disorder, or any one of several other mental illnesses. These episodes may also be caused by drug abuse, or medication or a medical condition from head trauma, Alzheimer's or other illness. Diagnosis is made by a psychiatrist or psychologist after thorough interview and a complete battery of psychological testing. To diagnose IED, doctors will look for the following signs:

• Several reported instances of aggressive or violent behavior or destruction of property with no attempt to control behavior
• Triggering incidents are typically minor and response is out of proportion to the event
• Guilt or remorse following violent event

Treatment(s) can include:

• Cognitive Behavioral Therapy
• Medication if appropriate: mood stabilizers, antidepressants,
• Psychotherapy as appropriate
• Biofeedback

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