The Hope Project (THP): Understanding Intermittent Explosive Disorder


Intermittent Explosive Disorder and its manifestations have been referred to as 'Rage Attacks', 'Episodic Dyscontrol', and 'Explosive Personality'.

Intermittent Explosive Disorder usually appears in late infancy or early adolescence, and it seldom appears after the age of 40. It is more frequent in persons between the ages of 35 and 40, as well as those with a high school education or even less. Intermittent Explosive Disorder is generally a long-term condition, with symptoms lasting for years. Each year, about 2.7 percent of persons in the United States are diagnosed with an Intermittent Explosive Disorder.

When somebody is diagnosed with Intermittent Explosive Disorder, they are approximately 82 percent more likely to identify with yet another mental health issue. Depression, Bipolar Disorder, Substance Use Disorders, Anxiety Disorders, Attention Deficit Hyperactivity Disorder, and Personality Disorders are the most prevalent co-occurring abnormalities. Intermittent Explosive Disorder usually appears before the co-occurring condition.

Since this major symptom of Intermittent Explosive Disorder, aggressiveness, can have a variety of reasons, it can be difficult to identify from other mental health problems and/or physical diseases, especially among those with intellectual/developmental disabilities. As a consequence, it's frequently a diagnosis established by exclusion, i.e., ruling out the possibility of alternative explanations.

Patterns of Outbursts


There are two patterns of aggressive outbursts typically seen in people with Intermittent Explosive Disorder:


• High frequency/low intensity (ex. non-destructive aggression averaging two times per week for a minimum of three months).

• Low frequency/high ferocity (ex. aggression causing injury or significant property damage at least three times in a 12-month period).

The majority of individuals with Intermittent Explosive Disorder suffer from both kinds, with low-intensity outbursts interspersed with high-intensity outbursts. At least 80% of patients with Intermittent Explosive Disorder will have an explosive episode at least once every year for the rest of their lives. Irritability, rage, impulsivity, and aggressiveness are all common symptoms of IED.

What to Look For?


Children and teens with IED have a poor frustration tolerance and are easily agitated by little irritations, frequently becoming verbally and physically violent and causing a disturbance or even bodily injury. People with the condition are prone to road rage, destroying furniture, and picking fights. They usually feel out of control and overtaken with rage. The explosions are usually short, lasting less than 30 minutes, and are neither premeditated nor directed at a specific target. Adolescents and young adults who have IED are more vulnerable. Adolescents and young adults who have an IED are more likely to purposefully hurt themselves or commit suicide.

Intermittent Explosive Disorder in People with Intellectual / Developmental Disability


Many of the illnesses (behavioral and mental) that affect persons with I/DD include impulsivity as a common characteristic. His or her capacity to gain self-control and problem-solving abilities via experiences (especially during the formative phase) may be hindered by cognitive impairment. Deficits in language skills may also have an influence, in this case on self-communication (also known as "self-talk"). Self-monitoring, self-consequence, and self-instruction are all abilities that can help you learn to regulate impulsivity, especially impulsive rage and violence.


By definition, impulsivity refers to a person's inability or unwillingness to deliberate before acting. Due to neurological impairment, this might be a permanent condition. Disinhibition induced by other mental disorders (e.g., Anxiety Disorders, Mania), discomfort, anger, and/or alcohol and narcotics are all temporary causes (including some prescription medications). A history of symptom onset/worsening can assist determine if symptoms are due to a skill deficiency (the individual lacks the essential abilities) or a performance deficit (the person performs poorly) (the person has the skills but is unable to use them at the moment).


Risk Factors


The intermittent explosive disorder is more common in children who have undergone physical and mental stress, as well as those who have first-degree relatives who have the disorder. Furthermore, the existence of Traumatic Brain Injury throughout the developmental period is linked to a higher chance of acquiring Intermittent Explosive Disorder. Military personnel and persons who are extremely obese have been reported to have a greater rate of Intermittent Explosive Disorder. Several studies have linked aberrant Serotonin activity — a chemical messenger essential in brain function — to regions of the brain that control and inhibit aggressiveness.

DSM-5 criteria


The DSM-5 classifies Intermittent Explosive Disorder (IED) under Disruptive, Impulse-Control, and Conduct Disorders. These are illnesses characterized by actions that infringe on others' rights and/or result in a substantial confrontation with authority figures and, in certain cases, society as a whole. Intermittent Explosive Disorder is characterized by impulsive verbal and/or physical aggressiveness that appears out of proportion to the stimulus that set it off. It can have social, school/workplace, financial, and legal implications if left untreated.

Diagnosis

To be diagnosed with Intermittent explosive disorder, you must have a tendency of being unable to control your emotions, which leads to outbursts of passion that are out of proportion to the situation and can be harmful or destructive. Because violent conduct can occur in the context of a variety of mental problems, a clinician must first rule out other possible causes, such as substance addiction, another psychiatric disorder, or a physical cause such as brain trauma.

Treatment available


Medication and Cognitive-Behavioral Therapy are the two most common ways to treating Intermittent Explosive Disorder (CBT). According to research, when used jointly, they are more effective than when used alone. The objective of treatment is to reduce symptoms to the point where the person only has one or two minor symptoms (if any).


SSRIs are commonly used as first-line treatments for Intermittent Explosive Disorder, with Fluoxetine (Prozac) being the most well-studied. It may take 6 to 12 weeks to determine if the person responds, and throughout that time, doses may be raised. In numerous trials, Dilantin, Trileptal, and Tegretolwere found to considerably reduce Intermittent Explosive Disorder symptoms. Mood stabilizers (Lamictal, Topamax, Depakote, Lithium) have a shorter half-life than antidepressants. Mood stabilizers (Lamictal, Topamax, Depakote, Lithium) have a smaller body of data supporting their effectiveness.


• After achieving remission, the patient may require maintenance treatment for up to two years.

Support Measures

• It's critical to address any skill deficiencies the person may have in terms of self-control. Teaching and practicing techniques like meditation, deep breathing, and problem-solving can help people not only acquire a repertoire of abilities to deal with stressful circumstances, but also lessen the frequency and intensity of outbursts by establishing a calmer baseline condition. Encourage exercise since it has been found to boost endorphins, which are neurochemicals linked to pleasure.

• If you've identified triggers, try to stay away from them as much as possible. To get people ready for changes ahead of time. When the situation becomes tense, be a role model for self-control by remaining cool. Keep in mind that this isn't your outburst. Concentrate your efforts on listening empathically and reflecting on what the other is saying in a more tranquil tone. It's not about agreeing with the person; it's about ensuring that he or she feels heard and understood.

• Often, behind the emotional reaction, there is a thinking habit that focuses on blaming others. Again, don't defend yourself or fight with the individual; simply mirror what he or she appears to be experiencing.

• Maintain a clear distinction between your emotions and your actions. While emotions are always acceptable, some acts (such as aggressiveness) are not. It's important to remember to validate the feeling rather than the behavior (unless it is a positive coping behavior). Make a point of praising any attempts at self-control the person makes.

Having an impulse control disorder, such as IED, implies that the person may be unable to stop themselves, and your only option may be to keep the individual, others, and yourself safe.


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The Hope Project (THP) is a neuro-disorder awareness initiative within the organizational framework of Unwired India. The initiative aims at creating and scaling awareness against the stigma, fear, and apprehensions associated with Neurological disorders.


Aims: to create awareness about the scientific and psychological aspects of neurological diseases. It creates awareness across the global masses. It promotes the importance of understanding neurological disorders that affect the lives of many people.


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A friendly reminder: We've done our research, but you should too! Check our sources against your own and always exercise sound judgment.


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Coccaro, E. F., Kavoussi, R. J., Berman, M. E., & Lish, J. D. (1998). Intermittent Explosive Disorder-Revised: Development, Reliability, and Validity of Research Criteria.
 
JENKINS, S. C., & MARUTA, T. (1987). Therapeutic Use of Propranolol for Intermittent Explosive Disorder. In Mayo Clinic Proceedings (Vol. 62, Issue 3, pp. 204214). https://doi.org/10.1016/S0025-6196(12)62444-6
 
Kessler, R. C., Coccaro, E. F., Fava, M., Jaeger, S., Jin, R., & Walters, E. (2006). The Prevalence and Correlates of DSM-IV Intermittent Explosive Disorder in the National Comorbidity Survey Replication. In Arch Gen Psychiatry (Vol. 63).
 
McCloskey, M. S., Phan, K. L., Angstadt, M., Fettich, K. C., Keedy, S., & Coccaro, E. F. (2016). Amygdala hyperactivation to angry faces in intermittent explosive disorder. Journal of Psychiatric Research, 79, 3441. https://doi.org/10.1016/j.jpsychires.2016.04.006
 
Olvera, R. L. (2000). Intermittent Explosive Disorder Epidemiology, Diagnosis and Management.
 

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About the Author


Divyanshi Singh


Guest Writer for The Hope Project


Divyanshi Singh is a student of psychology honors from Delhi University. She is an aspiring researcher in the discipline of mental health, social psychology, clinical pathology, and neuroscience. She has worked in the clinical and pediatrics department of major hospitals, Mental health projects, and outreach programs. She is fascinated by behavioral genetics and abnormal behavioral patterns.