| Intermittent explosive disorder (IED) is a behavioral | | | | another risk factor. This disorder may result in job |
| disorder characterized by extreme expressions of | | | | loss, school suspension, divorce, auto accidents or |
| anger, often to the point of uncontrollable rage, that | | | | incarceration. |
| are disproportionate to the situation at hand. IED is | | | | IED, an imbalance in brain chemicals, affects up to |
| marked by several discrete episodes of failure to | | | | one in 20 people -- more men than women. |
| resist aggressive impulses that result in serious | | | | IED-related injuries occur 180 times per 100 lifetime |
| assaultive acts or destruction of property. It occurs | | | | cases and is significantly comorbid with most DSM-IV |
| most often in young men. | | | | mood, anxiety, and substance disorders. |
| IED should be distinguished from Personality Change | | | | Individuals with narcissistic, obsessive, paranoid or |
| Due to a General Medical Condition, Aggressive Type, | | | | schizoid traits may be especially prone to intermittent |
| which is diagnosed when the pattern of aggressive | | | | explosive disorder. As children, they may have |
| episodes is judged to be due to the direct | | | | exhibited severe temper tantrums and other |
| physiological effects of a diagnosable general medical | | | | behavioral problems, such as stealing and fire setting. |
| condition. | | | | IED can fuel road rage, spousal abuse, etc., and may |
| IED attacks are out of proportion to the social | | | | also predispose people to other mental illnesses, such |
| stressors triggering them and are not due to another | | | | as depression and anxiety, and substance abuse |
| mental disorder or the effects of drugs or alcohol, | | | | problems. IED could very well be an overlooked |
| according to the Diagnostic and Statistical Manual of | | | | explanation for the frequency of violent crimes |
| Mental Disorders, Fourth Edition (DSM-IV). | | | | committed by violent offenders. |
| This is more common than once thought, according | | | | Individuals with intermittent explosive disorder may |
| to study funded by the National Institute of Mental | | | | attack others and their possessions, causing bodily |
| Health in a June 2006, but is relatively rare in people | | | | injury and property damage. Later, they may feel |
| aged 60 and older. Intermittent explosive disorder "is | | | | remorse, regret or embarrassment about the |
| very widely distributed in the population rather than | | | | aggression. |
| being concentrated in any one segment of society," | | | | Screening and diagnosis-- |
| one researcher writes. | | | | The diagnosis is based on these criteria: |
| People with intermittent explosive disorder may have | | | | · Multiple incidents in which the person failed to |
| an imbalance in the amount of serotonin and | | | | resist aggressive impulses that resulted in deliberate |
| testosterone in their brains. Individuals with | | | | destruction of property or assault of another person. |
| Intermittent Explosive Disorder sometimes describe | | | | · The aggressive episodes aren't accounted for |
| intense impulses to be aggressive prior to their | | | | by another mental disorder, and are not due to the |
| aggressive acts. | | | | effects of a drug or a general medical condition. |
| Signs and symptoms-- | | | | · The degree of aggressiveness expressed |
| Explosive eruptions, usually lasting 10 to 20 minutes, | | | | during the incidents is completely out of proportion |
| often result in injuries and the deliberate destruction | | | | with the precipitating event. |
| of property. These episodes may occur in clusters or | | | | Other conditions that must be ruled out before |
| be separated by weeks or months of nonaggression. | | | | making a diagnosis of intermittent explosive disorder |
| Aggressive episodes may be preceded or | | | | include delirium, dementia, oppositional defiant |
| accompanied by: | | | | disorder, antisocial personality disorder, schizophrenia, |
| · Chest tightness | | | | panic attacks, and substance withdrawal or |
| · Head pressure | | | | intoxication. |
| · Hearing an echo | | | | People with intermittent explosive disorder may have |
| · Palpitations | | | | an imbalance in the amount of serotonin and |
| · Tingling | | | | testosterone in their brains. They may also show |
| · Tremor | | | | some minor irregularities in neurological signs and |
| Causes-- | | | | electroencephalograms (EEGs). |
| Most people with this disorder grew up in families | | | | Treatment-- |
| where explosive behavior and verbal and physical | | | | Many different types of drugs are used to help |
| abuse were common. Being exposed to this type of | | | | control intermittent explosive disorder, including: |
| violence at an early age makes it more likely for | | | | · Anti-anxiety agents in the benzodiazepine |
| these children to exhibit these same traits as they | | | | family, such as diazepam (Valium), lorazepam (Ativan) |
| mature. | | | | and alprazolam (Xanax). |
| There may also be a genetic component, causing the | | | | · Anticonvulsants, such as carbamazepine |
| disorder to be passed down from parents to children. | | | | (Tegretol), phenytoin (Dilantin), gabapentin (Neurontin) |
| Other conditions that must be ruled out before | | | | and lamotrigine (Lamictal). |
| making a diagnosis of intermittent explosive disorder | | | | · Antidepressants, such as fluoxetine (Prozac) |
| include delirium, dementia, oppositional defiant | | | | and paroxetine (Paxil). |
| disorder, antisocial personality disorder, schizophrenia, | | | | · Mood regulators like lithium and propranolol |
| panic attacks, and substance withdrawal or | | | | (Inderal). |
| intoxication. Lives have been torn apart by this | | | | Group counseling sessions, focused on rage |
| disorder, but medications can help control you or your | | | | management, also have proved helpful. Some people |
| loved one's aggressive impulses. | | | | have found relaxation techniques useful in neutralizing |
| Many psychiatrists do not place intermittent explosive | | | | anger. |
| disorder into a separate clinical category, but consider | | | | Treatment could involve medication or therapy |
| it a symptom of other psychiatric and mental | | | | including behavioral modification, with the best |
| disorders. Many psychiatric disorders are associated | | | | prognosis utilizing a combination of the two. |
| with impulsive aggression, but some individuals | | | | Treatment with antidepressants, including those that |
| demonstrate violent outbursts of rage, which are | | | | target serotonin receptors in the brain, is often |
| variously referred to as rage attacks, anger attacks, | | | | helpful, along with behavior therapy akin to anger |
| episodic dyscontrol, or intermittent explosive disorder. | | | | management. |
| Explosive episodes may be associated with affective | | | | If the patient appears to be a danger to himself or |
| symptoms such as irritability or rage, increased | | | | others, he may be committed against his will for |
| energy, and racing thoughts during the aggressive | | | | further treatment. Researchers found that although |
| impulses and acts, and rapid onset of depressed | | | | 88% of individuals with IED studied were upset by |
| mood and fatigue after the acts. Some individuals | | | | the results of their explosive outbursts, but only 13% |
| may also report that their aggressive episodes are | | | | had ever asked for treatment in dealing with it. |
| often preceded or accompanied by symptoms such | | | | Since the cause(s) of IED are not fully understood as |
| as tingling, tremors, palpitations, chest tightness, head | | | | of the early 2000s, preventive strategies should |
| pressure, or hearing an echo. | | | | focus on treatment of young children (particularly |
| Some disorders have similar or even the same | | | | boys) who may be at risk for IED before they enter |
| symptoms. However, women also have problematic | | | | adolescence. These patients often need psychological |
| impulsive aggression, and some women have | | | | treatment along with medication treatment, and it is |
| reported an increase in intermittent explosive | | | | often very helpful to base their psychological |
| symptoms when they are premenstrual. The | | | | treatment on addiction-based models. |
| aggressive episodes may take the form of "spells" or | | | | Some patients with IED, often adult males who have |
| "attacks," with symptoms beginning minutes to hours | | | | assaulted their wives and are trying to save their |
| before the actual acting-out. If a patient appears to | | | | marriages, are aware that their outbursts are not |
| be intoxicated by a drug of abuse or suffering | | | | normal and seek treatment to control them. Younger |
| symptoms of withdrawal, a doctor may order a | | | | males with IED are more likely to be referred for |
| toxicology screen of the patient's blood or urine to | | | | diagnosis and treatment by school authorities or the |
| determine the possible source of the acting -out. | | | | juvenile justice system, or brought to the doctor by |
| Age, race and socioeconomic status don't seem to | | | | concerned parents. |
| be factors in predicting who suffers from IED-but | | | | The success of treatment with lithium and other |
| gender does: Studies find nearly twice as many men | | | | mood-stabilizing medications is consistent with findings |
| display symptoms than women. Clinicians may be at | | | | that patients with IED have a high lifetime rate of |
| fault for concentrating on secondary symptoms, such | | | | bipolar disorder. Given its earlier age-of-onset, |
| as anxiety or depression, and not asking about | | | | identifying IED early - perhaps in school-based |
| outbursts of anger. Sometimes what appears as | | | | violence prevention programs - and providing early |
| discipline problems are symptoms of a pathology. | | | | treatment might prevent some of the associated |
| Risk factors-- | | | | psychopathology. |
| People with other mental health problems - such as | | | | While 60 percent of people with IED seek |
| mood disorders, anxiety disorders and eating | | | | professional treatment for a mood or substance |
| disorders - may be more likely to also have | | | | problem, only about 29 percent receive treatment |
| intermittent explosive disorder. Substance abuse is | | | | for their anger. |