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Intermittent explosive disorderBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/intermittent-explosive-disorder/DS00730
Intermittent explosive disorder involves repeated episodes of impulsive, aggressive, violent behavior or angry verbal outbursts in which you react grossly out of proportion to the situation. Road rage, domestic abuse, throwing or breaking objects, or other temper tantrums may be signs of intermittent explosive disorder.
People with intermittent explosive disorder may attack others and their possessions, causing bodily injury and property damage. They may also injure themselves during an outburst. Later, people with intermittent explosive disorder may feel remorse, regret or embarrassment.
If you have intermittent explosive disorder, treatment may involve medications and psychotherapy to help you control your aggressive impulses.
Explosive eruptions, usually lasting less than 30 minutes, often result in verbal assaults, injuries and the deliberate destruction of property. These episodes may occur in clusters or be separated by weeks or months of nonaggression. In between explosive outbursts, the person may be irritable, impulsive, aggressive or angry.
Aggressive episodes may be preceded or accompanied by:
- Increased energy
- Racing thoughts
- Chest tightness
- Feeling of pressure in the head
Depression, fatigue or relief may occur after the episode.
The exact cause of intermittent explosive disorder is unknown, but the disorder is probably caused by a number of environmental and biological factors.
- Environment. Most people with this disorder grew up in families where explosive behavior and verbal and physical abuse were common. Being exposed to this type of violence at an early age makes it more likely these children will exhibit these same traits as they mature.
- Genetics. There may be a genetic component, causing the disorder to be passed down from parents to children.
- Brain chemistry. There may be differences in the way serotonin, an important chemical messenger in the brain, works in people with intermittent explosive disorder.
People with other mental illnesses — such as mood, anxiety or personality disorders — or certain medical conditions — such as Parkinson's disease or traumatic brain injury — may display aggressive behaviors. However, they would not be diagnosed as having intermittent explosive disorder because the cause is from another condition.
A number of factors increase your risk of developing intermittent explosive disorder:
- History of substance abuse. People who abuse drugs or alcohol have an increased risk of intermittent explosive disorder.
- History of physical abuse. People who were abused as children or experienced multiple traumatic events have an increased risk of intermittent explosive disorder.
- Age. The start of intermittent explosive disorder most commonly occurs in people in their teens and 20s.
- Being male. Men are more likely to have intermittent explosive disorder than women are.
People with intermittent explosive disorder have an increased risk of:
- Self-harm. They don't always direct their anger at others. They're at significantly increased risk of harming themselves, either with intentional injuries or suicide attempts. Those who are also addicted to drugs or have another serious mental disorder, such as depression, are at greatest risk of harming themselves.
- Impaired interpersonal relationships. They're often perceived by others as always being angry. This can lead to relationship problems, divorce and family stress.
- Trouble at work, home or school. Other complications of intermittent explosive disorder may include job loss, school suspension, auto accidents, financial problems or trouble with the law.
Preparing for your appointment
If you're concerned because you're having repeated emotional outbursts, talk with your primary care doctor or make an appointment with someone who specializes in treating emotional disorders, such as a psychiatrist, psychologist or social worker.
What you can do
These steps can help you make the most of your appointment:
- Write down the symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, vitamins, supplements or herbal products that you're taking.
- Write down questions to ask your doctor.
Prepare a list of questions to make sure you cover everything that's important to you. For intermittent explosive disorder, some basic questions to ask your doctor include:
- Why am I having these angry outbursts?
- Do I need any tests? Do these tests require any special preparation?
- Is this condition temporary or long lasting?
- What treatments are available, and which do you recommend?
- Are there any side effects from treatment?
- Are there any alternatives to the primary approach that you're suggesting?
- I have other health conditions. How can I best manage these conditions together?
- Is there a generic alternative to the medicine you're prescribing?
- How long does therapy take to work?
- Do you have any printed material on this topic? What websites do you recommend?
Don't hesitate to ask questions anytime that you don't understand something.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Be ready to answer them so you can focus on points you want to spend more time on. Your doctor may ask:
- How often do you have explosive episodes?
- What triggers your outbursts?
- Have you injured or verbally abused others?
- Have you damaged property when angry?
- Have you ever tried to hurt yourself?
- Have your outbursts negatively affected your family or work life?
- Does anything seem to makes these episodes occur more often?
- Is there anything that you've found that can help calm you down?
- Has anyone else in your family ever been diagnosed with a mental illness?
- Have you suffered from a head trauma?
Tests and diagnosis
To determine a diagnosis of intermittent explosive disorder and eliminate other conditions that may be causing your symptoms, expect your doctor to do a:
- Physical exam. Your doctor will try to rule out physical problems that could cause your symptoms. Your exam may include lab tests.
- Psychological evaluation. A doctor or mental health provider will talk to you about your symptoms, thoughts, feelings and behavior patterns. You may be asked to fill out a questionnaire to help answer these questions.
To be diagnosed with intermittent explosive disorder, your doctor will ask about your behavior to see if you meet the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association. This manual is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.
DSM criteria include:
- Multiple incidents of failure to resist aggressive impulses that resulted in deliberate destruction of property or assault of another person
- A degree of aggressiveness during incidents that's completely out of proportion to the event that triggered the behavior
- Aggressive episodes that aren't accounted for by another mental disorder and aren't due to the effects of a drug or a medical condition
Other conditions that must be ruled out before making a diagnosis of intermittent explosive disorder include other mental disorders or substance use problems.
Treatments and drugs
There's no one treatment that's best for everyone with intermittent explosive disorder. Treatment generally includes psychotherapy and medication.
Individual or group therapy sessions can be helpful. A commonly used type of therapy, cognitive behavioral therapy, helps people with intermittent explosive disorder identify which situations or behaviors may trigger an aggressive response. And, more importantly, this type of therapy teaches people how to manage anger and control inappropriate responses using techniques such as relaxation training, thinking differently about situations (cognitive restructuring) and learning coping skills.
Different types of drugs may help in the treatment of intermittent explosive disorder. These medications include:
- Antidepressants, such as fluoxetine (Prozac) and others
- Anticonvulsants, such as carbamazepine (Tegretol), oxcarbazepine (Trileptal), phenytoin (Dilantin), topiramate (Topamax) and lamotrigine (Lamictal)
- Anti-anxiety agents in the benzodiazepine family, such as lorazepam (Ativan) and clonazepam (Klonopin)
- Mood stabilizers, such as lithium (Lithobid)
Coping and support
Controlling your anger
If you recognize your own behavior in the description of intermittent explosive disorder, talk with your doctor about treatment options or ask for a referral to a mental health professional. Some techniques that may be part of your treatment include:
- Unlearn bad behavior. Coping well with anger is a learned behavior. Cognitive behavioral therapy or anger management will help you recognize what pushes your buttons and how to respond in ways that work for you instead of against you.
- Develop a plan. Work with your doctor on developing a plan of action for when you feel yourself getting angry. For example, if think you might lose control, try to remove yourself from that situation. Go for a walk or call a trusted friend to try to calm down.
- Avoid alcohol and other substance use. These can increase aggressiveness and the risk of explosive outbursts.
If your loved one won't get help
Unfortunately, many people with intermittent explosive disorder don't seek treatment. If you're involved in a relationship with someone who has intermittent explosive disorder, take steps to protect yourself and your children. The abuse isn't your fault. No one deserves to be abused.
Create an escape plan to stay safe from domestic violence
If you see that a situation is getting worse, and suspect your loved one may be on the verge of an explosive episode, try to safely remove yourself and your children from the scene. However, leaving someone with an explosive temper can be dangerous. Consider taking these steps before an emergency arises:
- Call a domestic violence hot line or a women's shelter for advice, either when the abuser isn't home or from a friend's house.
- Keep all firearms locked away or hidden. Don't give the abuser the key or combination to the lock.
- Pack an emergency bag that includes items you'll need when you leave, such as extra clothes, keys, personal papers, medications and money. Hide it or leave the bag with a friend or neighbor.
- Know where you'll go and how you'll get there if you feel threatened, even if it means you have to leave in the middle of the night.
Get help to protect yourself from domestic violence
In an emergency, call 911 or your local emergency number or your local law enforcement agency. These resources also can help:
- Your doctor or the emergency room. If you're injured, doctors and nurses can treat and document your injuries and let you know what local resources are available to keep you safe.
- National Domestic Violence Hotline: 800-799-SAFE (800-799-7233). This hot line is available for crisis intervention and referrals to resources, such as women's shelters.
- A local women's shelter or crisis center. Shelters and crisis centers generally provide 24-hour emergency shelter, as well as advice on legal matters and advocacy and support services.
- A counseling or mental health center. Many communities offer counseling and support groups for people in abusive relationships. Be wary of advice to seek couples or marriage counseling. If violence has escalated to the point that you're afraid of your partner, this type of counseling won't be enough. Remember that your safety comes first.
- A local court. Your local court can help you get a restraining order that legally orders the abuser to stay away from you or face arrest. Local advocates may be available to help guide you through the process.
If you have intermittent explosive disorder, prevention is likely beyond your control unless you get treatment from a professional. Combined with, or as part of, treatment, these suggestions may help you prevent some incidents from getting out of control:
- Stick with your treatment. Attend your therapy sessions, practice your coping skills, and if your doctor has prescribed medication, be sure to take it.
- Practice relaxation techniques. Regular use of deep breathing, relaxing imagery or yoga may help you stay calm.
- Develop new ways of thinking (cognitive restructuring). Changing the way you think about a frustrating situation by using rational thoughts, reasonable expectations and logic may improve how you view and react to an event.
- Use problem-solving. Make a plan to find a way to solve a frustrating problem. Even if you can't fix it right away, it can refocus your energy.
- Learn ways to improve your communication. Listen to the message the other person is trying to share, and then think about your best response rather than saying the first thing that pops into your head.
- Change your environment. When possible, leave or avoid situations that upset you. Also, scheduling personal time may enable you to better handle an upcoming stressful or frustrating situation.
- Avoid mood-altering substances. Don't use alcohol or street drugs.
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