Intermittent Explosive Disorder

Intermittent Explosive Disorder


Intermittent explosive disorder (IED) is an impulse-control disorder characterized by sudden episodes of unwarranted anger. The disorder is typified by hostility, impulsivity, and recurrent aggressive outbursts. People with IED essentially “explode” into a rage despite a lack of apparent provocation or reason. Individuals suffering from intermittent explosive disorder have described feeling as though they lose control of their emotions and become overcome with anger. People with IED may threaten to or actually attack objects, animals, and/or other humans. IED is said to typically begin during the early teen years and evidence has suggested that it has the potential of predisposing individuals to depression, anxiety, and substance abuse disorders. Intermittent explosive disorder is not diagnosed unless a person has displayed at least three episodes of impulsive aggressiveness.

Individuals with IED have reported that once they have released the tension that built up as a result of their rage, they feel a sense of relief. Once the relief wears off, however, some people report experiencing feelings of remorse or embarrassment.

Adolescents who have intermittent explosive disorder often have a very low tolerance for frustration and become unreasonably furious by small irritations. This frustration is often expressed by becoming verbally or physically aggressive – sometimes causing physical injury or property damage. Teens with IED have expressed that they experience a sensation of building tension in the head or chest that is finally released after the aggressive behavior. The explosions of rage generally last less than thirty minutes, are not premeditated, or aimed at a tangible objective, such as retribution or financial gains.

According to the National Institute of Mental Health (NIMH), intermittent explosive disorder affects 11.5-16 million Americans throughout their lifetime. Of those diagnosed with IED, 67.8% engaged in direct interpersonal aggression, 20.9% had threatened interpersonal aggression, and 11.4% engaged in aggression against property and objects. Intermittent explosive disorder is said to affect approximately 1 in 12 teenagers. It is also believed that nearly 82% of people who have IED are also suffering from another mental health disorder, with the most common being depression, bipolar disorder, and/or substance abuse disorders.


Episodes of anger tend to last less than 30 minutes and often lead to verbal abuse, physical injuries, and willful property damage. These episodes may occur in clusters or can be separated by weeks or months of non-aggressive behaviors. Between episodes, the person may be moody, irritable, impulsive, angry, or aggressive.

The signs and symptoms of IED will vary from child to child based upon individual makeup, severity of IED, presence of co-occurring mental health disorders, and use of alcohol or drugs. The most common signs and symptoms of IED may include the following:

Behavioral symptoms:

  • Breaking things and causing property damage
  • Verbal and physical aggression
  • Road rage
  • Frequent fighting
  • Increased energy during an aggressive outburst
  • Acts of self-harm
  • Suicide attempts

Physical symptoms:

  • Tension or pressure in head or chest that builds before an episode
  • Fatigue after episode
  • Tingling
  • Tremors
  • Hearing an echo
  • Palpitations

Cognitive symptoms:

  • Racing thoughts
  • Inability to concentrate
  • Poor scholastic or occupational functioning

Psychosocial symptoms:

  • Low tolerance for frustration
  • Mood changes before an outburst
  • Intense anger
  • Irritability during and between outbursts
  • Blinding rage
  • Feeling “out of control” before and during an episode
  • Depressed mood
  • Guilt following episode
  • Shame following an episode

Causes and Risk Factors

The development of intermittent explosive disorder is believed to be the result of a combination of genetic, physical, and environmental factors, as described in the following:

Genetic: Researchers and other professionals in the field have hypothesized that there is some genetic component to the presence of IED because the traits have been known to be passed down from parents to children. However, there has not yet been any specific gene identified as having the most prominent impact.

Physical: Research findings have suggested that IED may occur as the result of abnormalities in the parts of the brain that are responsible for regulating behaviors, arousal, and inhibition. Impulsive aggression is also thought to be related to abnormalities in the areas of the brain that inhibit or prohibit muscular activity through the neurotransmitter serotonin.

Environmental: Many people believe that the environment in which a person grows up can have a significant impact on whether or not he or she will develop the symptoms of intermittent explosive disorder. For example, it is believed by some that children who grew up in a home where they were given harsh punishments will develop the symptoms of IED because they are following the examples of the violent behaviors that were set by their parents.

Risk Factors:

  • Being male (IED is said to be more prevalent in men than it is in women)
  • Family history of mental illness, especially mood disorders
  • Family history of substance abuse
  • Personal history of substance abuse
  • Exposure to violence
  • Having been physically, sexually, or emotionally abused
  • Growing up in a chaotic environment
  • Traumatic brain injuries
  • Certain medical conditions


he biggest challenge for the field is that people who have trouble resisting their violent impulses, no matter what the cause, are not very likely to seek treatment. There is a lack of controlled trials of agents for the treatment of patients with IED, but there is evidence that mood stabilisers, antipsychotics, β-blockers, α2-agonists, phenytoin, SSRI, SNRI, and antidepressants may be useful. Behavioural interventions may be valuable as part of the overall treatment of IED, Cognitive behavioral therapy (CBT) that combines cognitive restructuring, coping skills training, and relaxation training looks promising.

Without treatment, the long-term effects of IED can be detrimental on children or adolescents, and the ramifications of their behaviors have the possibility of following them into adulthood. Some examples of the negative effects of untreated intermittent explosive disorder can include:

  • Academic failure
  • Being suspended from school
  • Low self-worth
  • Inability to develop and maintain healthy interpersonal relationships
  • Social isolation or impairment
  • Legal problems / incarceration
  • Self-harm
  • Legal Problems
  • Homicidal


It is common for people who are suffering from IED to suffer from symptoms of other mental disorders as well. Sometimes the symptoms of the disorders will overlap or will directly mirror the symptoms of another illness. Some of the most common co-occurring disorders include:

  • Anxiety disorders
  • Attention-deficit hyperactivity disorder (ADHD)
  • Bipolar disorder
  • Conduct disorder (CD)
  • Depressive disorders
  • Oppositional defiant disorder (ODD)
  • Personality disorders
  • Post-traumatic stress disorder (PTSD)

If your loved ones are exhibiting signs and symptoms of IED then consult an expert psychiatrist earliest as you can.

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Alabama Clinics: 334-712-1170