Signs and Symptoms of Intermittent Explosive Disorder

Learn about IED and mental illness

Intermittent explosive disorder (IED) is a behavioral health disorder characterized by impulsive, violent, or angry acts of aggression that are disproportionate to the situation. Aggressive acts, often called “spells” or “attacks,” may include attacks upon others and their personal property, and may lead to property damage or accidental self-injury; most often, the perpetrator feels as though his or her aggressive acts are justifiable. However, often, after the attacks, people who have this impulse control disorder feel regret, remorse, guilt, or embarrassment about their behaviors. As impulsive violent acts of aggression or anger are not limited to intermittent explosive disorder, the diagnosis of IED is often considered a diagnosis of exclusion – given only after other disorders have been ruled out. Patients who are diagnosed with IED often feel a sense of heighted arousal or tension before an outburst of aggressive behaviors and feel a sense of welcome relief following the act of aggression.

While many people have IED as a secondary diagnosis, as depression, anxiety, or substance abuse disorders are the primary diagnosis, only a few are treated for their anger. While there is no cure for this disorder, successful treatment of IED includes a combination of antidepressants (SSRIs) and behavioral therapy.

IED addiction statistics

Each year in the United States, nearly 3% of the population meets the criteria for intermittent explosive disorder. IED is more prevalent among those younger than age 40 and those with a high school education or less.

Causes and risk factors for IED

The precise cause for the development of IED is currently unknown, although research in the field has generated some probable reasons why certain individuals may be predisposed to develop this disorder. Generally, the consensus among professionals is that IED is probably triggered by a number of environmental, physical, and genetic risk factors working simultaneously. The most commonly cited reasons for IED include:

Genetic: It appears that intermittent explosive disorder likely has a genetic component, meaning that people who have this disorder may pass it down through the generations. It’s worth noting that not all people who have a family history of the disorder go on to develop it and many who do have a genetic predisposition of the disorder do not go on to develop it.

Physical: It appears that abnormalities in the structures of the brain responsible for arousal and inhibition may lead to the characteristic impulsive, aggressive acts of IED. Impulse aggression may be related structural changes in the serotoninergic system of the brain that inhibits motor activity, controlled by the neurotransmitter serotonin.

Environmental: A great deal of people who are diagnosed with intermittent explosive disorder were raised in a family in which explosive behaviors such as, verbal and physical violence, were the norm. This can increase the chance a child exposed to this behavior will exhibit the same traits as he or she ages.

Risk factors:

• History of substance abuse
• Undiagnosed or untreated mental health disorders
• Prior history of physical abuse
• History of traumatic events, notably during childhood
• Onset between the ages of teens and early 20s
• Being male

Signs and symptoms of intermittent explosive disorder

These explosive episodes often last less than thirty minutes and often lead to verbal assaults, injuries, and deliberate, willful destruction of property. These outbursts may occur in clusters or may be separated by weeks or even months of non-aggressive behaviors. Between these explosive outbursts, the person who has IED may be irritable, impulsive, aggressive, or angry.

Aggressive episodes may include the following:

Behavioral Symptoms:

• Road rage
• Breaking furniture
• Willful destruction of property of self or others
• Getting into fights with others, including friends, family, colleagues, and other loved ones
• Irritability

Physical Symptoms:

• Physical sensation of building tension before an attack occurs
• Increased amounts of energy directly before and during the attack
• Increased anxiety precipitating the attack

Cognitive Symptoms:

• Low frustration tolerance
• Tingling (prior to attack)
• Palpitations (prior to attack)
• Chest tightness (prior to attack)
• Pressure in the head (prior to attack)
• Hearing an echo (prior to attack)
• Racing thoughts during aggressive impulses
• Relief (following the attack)
• Fatigue (following attack)

Psychosocial Symptoms:

• Disproportionate outrage for small annoyances
• Feeling out of control
• Aggressive outbursts are not premeditated and are not used to achieve a tangible outcome
• Intense anger and rage
• Intentional self-harming behaviors
• Suicidal thoughts and behaviors
• Depressed mood (following an attack)
• Shame (following an attack)

Effects of IED

If left untreated, the effects of IED can lead to tremendous turbulence for the individual and his or her family and loved ones. Long-term complications of IED will vary based upon genetic makeup, co-occurring disorders, substance abuse, and length of symptoms. The most common effects of intermittent explosive disorder may include:

• Decreased functioning in interpersonal relationships leading to loss of friendships, domestic violence, child abuse, and divorce
• Troubles at home, work, or school that may include loss of gainful employment, suspension and expulsion from school, car accidents, and/or financial challenges
• Legal problems related to violent attacks and/or damage of personal property of others
• Self-harming behaviors as a result of self-directed anger as those who have IED may not always direct anger at other people or their possessions, but may turn it inward
• Suicidal thoughts and behaviors often related to violent attacks on oneself that may be intentionally designed to lead to suicide or accidently result in grave injury

IED and co-occurring disorders

Intermittent explosive disorder rarely occurs alone; often people who have IED experience other types of mental health disorders. The most common co-occurring, comorbid disorders include:

• Depressive disorders
• Anxiety disorders
• Substance abuse
• Antisocial personality disorder
• Borderline personality disorder
• History of disruptive behavior disorders