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Intermittent explosive disorder (IED) is a behavioral disorder characterized by extreme expressions of anger, often to the point of uncontrollable rage, that are disproportionate to the situation at hand. It is currently categorized in the Diagnostic and Statistical Manual of Mental Disorders as an impulse control disorder. IED belongs to the larger family of Axis I impulse control disorders listed in the DSM-IV-TR, along with kleptomania, pyromania, pathological gambling, and others.Some individuals may also report that their aggressive episodes are often preceded or accompanied by symptoms such as tingling, tremors, palpitations, chest tightness, head pressure, or hearing an echo. Treatment is achieved through both cognitive behavioral therapy and psychotropic medication regimens. Therapy aids in helping the patient recognize the impulses in hopes of achieving a level of awareness and control of the outbursts, along with treating the emotional stress that accompanies these episodes. Multiple drug regimens are frequently indicated for IED patients. Patients often need psychological treatment along with medication treatment, and it is often very helpful to base their psychological treatment on addiction-based models.Causes of Intermittant Explosive DisorderAlthough the prevalence of intermittent explosive disorder is unknown and considered to be rare, the disorder is probably more common than realized and may be an important cause of violent behavior. As presently defined, intermittent explosive disorder is more common in men. However, women also have problematic impulsive aggression, and some women have reported an increase in intermittent explosive symptoms when they are premenstrual.Signs and Symptoms of Intermittant Explosive DisorderSymptomsIED is characterized by violent behaviors that are impulsive as well as assaultive. One example involved a man who felt insulted by another customer in a neighborhood bar during a conversation that had lasted for several minutes. Instead of finding out whether the other customer intended his remark to be insulting, or answering the "insult" verbally, the man impulsively punched the other customer in the mouth. Within a few minutes, however, he felt ashamed of his violent act. As this example indicates, the urge to commit the impulsive aggressive act may occur from minutes to hours before the "acting out" and is characterized by the buildup of tension. After the outburst, the IED patient experiences a sense of relief from the tension. While many patients with IED blame someone else for causing their violent outbursts, they also express remorse and guilt for their actions.Treatment of Intermittant Explosive DisorderPsychotherapySome persons with IED benefit from cognitive therapy in addition to medications, particularly if they are concerned about the impact of their disorder on their education, employment, or interpersonal relationships. Psychoanalytic approaches are not useful in treating IED.Group counseling sessions, focused on rage management, also have proved helpful. Some people have found relaxation techniques useful in neutralizing anger.PreventionSince the cause(s) of IED are not fully understood as of the early 2000s, preventive strategies should focus on treatment of young children (particularly boys) who may be at risk for IED before they enter adolescence.
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