Signs and Symptoms of Intermittent Explosive Disorder

Learn about IED

Intermittent explosive disorder (IED) is a mental health condition that involves multiple episodes of impulsivity, hostility, and recurrent aggressive outbursts that are grossly out of proportion to the situation. Individuals with IED may attack others and/or their belongings, causing bodily harm and property damage. Additionally, during an outburst a person with IED may injure him or herself. Aggressive episodes associated with IED are seen as a person suddenly losing control, breaking or smashing things, hitting or trying to hurt someone, or threatening to hurt someone. Some signs of IED may include road rage, throwing and breaking objects, and temper tantrums (as a teen or adult).

Those with intermittent explosive disorder describe their aggressive episodes as spells or attacks in which the explosive behavior is preceded by a sense of tension or arousal leading to an outburst that is followed by a sense of relief. However, after the sense of relief wears off, the person usually feels upset, remorseful, or embarrassed about their unacceptable behavior. While this disorder can be extremely disruptive, through medication and proper treatment, it is possible to learn to control anger and react more appropriately to specific situations.

IED statistics

According to the National Institute of Mental Health (NIMH), intermittent explosive disorder affects as many as 11.5 million to 16 million people in the United States throughout their lifetime. Of those in the United States diagnosed with IED, 67.8% reported having engaged in direct interpersonal aggression, 20.9% in threatened interpersonal aggression, and 11.4% in aggression against objects.

Causes and risk factors for IED

While the specific cause for the development of intermittent explosive disorder hasn’t been identified, IED is thought that to be the result of a combination of biological, physical, and environmental risk factors working together. Some of the most commonly cited causes for IED include:

Genetic: Research suggests that there may be a genetic component that causes this disorder to be passed down from parents to children.

Physical: Research has discovered that IED may be the result of abnormalities in areas of the brain that regulate behavioral arousal and inhibition. Impulsive aggression is related to abnormal brain mechanisms in a system that inhibits muscular movement activity and is regulated by the neurotransmitter serotonin, which regulates behavioral inhibition. Additionally, research indicates that those with IED have abnormalities on the frontal portion of the brain. These areas of the brain appear to be involved in information processing and controlling movement, both of which are unbalanced in individuals with IED.

Environmental: Some researchers believe that IED can be the result of growing up in an environment in which harsh punishments were carried out by parents. Children in this environment grow up believing that others have it in for them and that violence is the best way to restore damaged self-esteem. Additionally, as a child they may have witnessed their parents or others close to them act out in explosive or violent manners and have learned that violence is acceptable solution.

Risk factors:

• Being male
• Presence of a mood, anxiety, or personality disorder
• Certain medical conditions
• Traumatic brain injuries
• Being in teens or 20s
• History of physical abuse

Signs and symptoms of IED

The explosive eruptions of intermittent explosive disorder tend to last less than 30 minutes and often lead to verbal assaults, injuries, and destruction of property. Explosive episodes can occur in clusters or may be separated by weeks or even months of nonaggressive behaviors. Between outbursts, individuals with IED may become irritable, angry, and impulsive. Some common signs and symptoms experienced by individuals with IED may include:

Behavioral symptoms:

• Breaking objects and causing property damage
• Verbal and physical aggressive
• Road rage
• Constantly getting into fights
• Increased energy
• Acts of self-harm
• Suicide attempts

Physical symptoms:

• Tension in head or chest
• Fatigue after explosive episode
• Tingling
• Tremors
• Chest tightness
• Hearing an echo
• Palpitations

Cognitive symptoms:

• Racing thoughts
• Inability to concentrate
• Poor performance in school or work settings

Psychosocial symptoms:

• Low frustration tolerance
• Intense anger
• Irritability
• Rage
• Depressed mood
• Guilt
• Shame

Effects of IED

The long-term effects of untreated intermittent explosive disorder can affect virtually every part of life. People with intermittent explosive disorder experience significant impairment on a daily basis. The longer the disorder goes untreated, the harder it is to successfully recover from IED. Long-term effects of untreated intermittent explosive disorder include:

• Impairment in social areas
• Accidents
• Loss of job
• School suspension
• Divorce or problems with interpersonal relationships
• Hospitalization due to injuries from fights or accidents
• Financial problems
• Incarceration or other legal problems

IED and co-occurring disorders

It is common for those with intermittent explosive disorder to have another comorbid mental health disorder as well. Some of the most common comorbid, co-occurring disorders include:

• Anxiety disorders
• Depression disorders
• Substance abuse and addiction
• Alcoholism
• Bipolar disorder
• Personality disorders