Table of ContentsView AllTable of ContentsSymptomsCausesComplicationsDiagnosisTreatmentCoping
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Complications
Diagnosis
Treatment
Coping
Intermittent explosive disorder (IED) is amental health disorderin which a person has aggressive outbursts out of proportion for a situation. These episodes can involve aggressive, impulsive, and violent behaviors or angry verbal outbursts.
Many people are unfamiliar with IED. However, one study found that 5% of the U.S. population showed signs of the disorder, which is defined as three or more anger attacks in the same year.Treatment typically involves talk therapy, with some people using medications andmindfulnesspractices to manage the condition.
This article discusses IED and how the disorder affects those who have it. It explains how IED is diagnosed and treated, and presents examples of healthy coping behaviors your healthcare provider may suggest.
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Symptoms of Intermittent Explosive Disorder
IED is similar to a temper tantrum. It can be hard to tell if you have IED, but there are some signs that may indicate you should see a professional about your angry outbursts.
Behavioral Symptoms
People who demonstrate IED traits find they can impact quality of life and can interfere with their careers and relationships.These behaviors can include:
Physical Symptoms
Physical symptoms of IED can manifest themselves when someone has episodes of angry outburst. These symptoms can include:
Cognitive Symptoms
Cognitive symptoms of IED manifest themselves in how you think and how that drives behavior and mood. These symptoms include:
Psychosocial Symptoms
People diagnosed with IED can be limited in their ability to recognize and read emotion in others, especially when misreading anger in others rather than their actual emotion.They tend to demonstrate their own:
Common Symptoms of a PhobiaWhilephobias(irrational fear of objects or situations) are a separate disorder, they are often a co-occurring disorder in people diagnosed with IED.Symptoms of phobia typically involve anxiety-related symptoms like a rapid heart rate or sweating. People also seek to avoid the source of their phobia.
Common Symptoms of a Phobia
Whilephobias(irrational fear of objects or situations) are a separate disorder, they are often a co-occurring disorder in people diagnosed with IED.Symptoms of phobia typically involve anxiety-related symptoms like a rapid heart rate or sweating. People also seek to avoid the source of their phobia.
Causes of Intermittent Explosive Disorder
The exact cause of IED is unknown. Although childhood trauma is thought to be the main driver in the development of IED, including socioeconomic stressors, other research has found that genetics and abnormalities in the brain can contribute.
During childhood, chronic stress-related activity of neurotransmitters (chemical messengers in the brain) that connect thehypothalamus,pituitary, andadrenal glandsmay be at work. So can other changes in the brain.
Research has found that people with IED have abnormalities inserotoninlevels in the brain. Serotonin is a neurotransmitter that’s associated with feelings of well-being. It also plays a role in stabilizing mood.A history of traumatic brain injury occurs more often in people diagnosed with IED than in neurotypical people, too.
Studies suggest that the risk of developing IED is higher in:Males (though females may seek professional help more often)Younger people (the average age of onset is 17)Unemployed peoplePeople with less educationThose who are divorced or separatedIED also is more likely in those who have a history of physical or sexual violence. In 80% of cases, there’s another mental health diagnosis.
Studies suggest that the risk of developing IED is higher in:
IED also is more likely in those who have a history of physical or sexual violence. In 80% of cases, there’s another mental health diagnosis.
How Does Intergenerational Trauma Work?
Along with an increased risk for mood disorders and substance abuse issues, people with IED often experience a lower quality of life and issues with all aspects of their personal and professional relationships.
A person with IED may be more susceptible to other mental health disorders. Attention deficit hyperactivity disorder (ADHD) is among them, with some research among young offenders suggesting that childhood trauma can lead to co-occurring ADHD and IED, but not always IED itself.
Apart from phobia disorder, a comprehensive study also found these conditions most often co-occurring with IED:
They may also be at risk for developing physical health problems such ashigh blood pressure,heart disease, andstroke.
IED and Suicide RiskPeople diagnosed with IED are at higher risk of suicide. One study found 38% of those with IED had specific thoughts of suicide (ideation) and 17% had attempted suicide.The risk increased in people known for more violent attacks and those with more than one mental health disorder.
IED and Suicide Risk
People diagnosed with IED are at higher risk of suicide. One study found 38% of those with IED had specific thoughts of suicide (ideation) and 17% had attempted suicide.The risk increased in people known for more violent attacks and those with more than one mental health disorder.
How to Manage Suicidal Ideation
How Is IED Diagnosed?
IED is diagnosed using the fifth edition of the “Diagnostic and Statistical Manual of Mental Disorders (DSM-5).” The DSM-5 outlines certain criteria that need to be met for a person to be diagnosed with any given mental disorder. The criteria in the DSM-5 for IED include recurrent behavioral outbursts of:
The DSM-5 also indicates that a person must be over the age of 6, without any other mental health disorders, to be diagnosed with IED. The episodes also cause marked distress in the individual or are associated with the person suffering financial or legal consequences because of the outbursts.
If a person meets these criteria, their healthcare provider will determine whether to make an official diagnosis of IED.
Substance Use Disorders: Types, Symptoms, and Treatments
Treatment for Intermittent Explosive Disorder
According to the American Psychiatric Association, treating IED typically involvescognitive-behavioral therapy (CBT).
Cognitive Behavioral Therapy
CBT is a type of psychotherapy, or talk therapy, that focuses on changing thoughts related to anger and aggression. It is based on the notion that all thoughts, feelings, actions, and physical sensations are connected and can be addressed as a whole.
CBT can be done in groups or solo, however, research has shown that people with IED who participate in group CBT therapy can better manage their anger and learn new coping skills to deal with the symptoms of their disorder in a group setting.
Medications
There are no specific medications to treat IED, but some people with the disorder have benefited from the use of antidepressants that impact levels of serotonin in the brain. These drugs include:
Mood stabilizers, antipsychotic drugs, and antianxiety medications also have been used in treating IED.
Overview of Common Psychotropic Medications
Coping With Intermittent Explosive Disorder
Coping with IED can be difficult because a person with the disorder doesn’t have control over their angry outbursts. To compound the condition, in many cases, a person is also dealing with unresolved trauma from childhood.
To help cope with the symptoms of IED, people with the disorder need to seek out professional treatment from a mental health professional and stick to their treatment plan.
Practicing relaxation techniques or other activities that can help a person gain control of their emotions could also be beneficial for someone with IED. Some good examples of activities you can do to cope with your disorder include:
Seek Help for Suicide RiskIf you or someone you know is coping with IED and is displaying suicidal behaviors, call theNational Suicide Prevention Lifelineor seek help from your nearest emergency department.
Seek Help for Suicide Risk
If you or someone you know is coping with IED and is displaying suicidal behaviors, call theNational Suicide Prevention Lifelineor seek help from your nearest emergency department.
Validating Someone’s Anger May Help Them Be More Positive, Study Finds
Summary
Because of the way you may act with IED, people in your life may avoid you or feel as though you are just an angry person because of the disorder. While IED can negatively impact a person’s life and overall health, there are treatment options that can help a person cope and manage their disorder.
CBT and, in some cases, medication have shown to be effective at managing symptoms and decreasing violent or aggressive outbursts. Relaxation and stress management techniques can help.
16 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Scott KM, de Vries YA, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Bromet EJ,et al.Intermittent explosive disorder subtypes in the general population: association with comorbidity, impairment and suicidality.Epidemiol Psychiatr Sci.2020 Jun 23;29:e138. doi:10.1017/S2045796020000517Rynar L, Coccaro EF.Psychosocial impairment in DSM-5 intermittent explosive disorder.Psychiatry Res. 2018 Jun;264:91-95. doi:10.1016/j.psychres.2018.03.077.Valley Behavioral Health System.Signs & Symptoms of Intermittent Explosive Disorder.Patoilo MS, Berman ME, Coccaro EF.Emotion attribution in intermittent explosive disorder.Compr Psychiatry. 2021 Apr;106:152229. doi:10.1016/j.comppsych.2021.152229.Coccaro EF.Psychiatric comorbidity in Intermittent Explosive Disorder.J Psychiatr Res. 2019 Nov;118:38-43. doi: 10.1016/j.jpsychires.2019.08.012.Shevidi S, Timmins MA, Coccaro EF.Childhood and parental characteristics of adults with DSM-5 intermittent explosive disorder compared with healthy and psychiatric controls.Compr Psychiatry. 2023 Apr;122:152367. doi:10.1016/j.comppsych.2023.152367.Cremers H, Lee R, Keedy S, Phan KL, Coccaro E.Effects of Escitalopram Administration on Face Processing in Intermittent Explosive Disorder: An fMRI Study.Neuropsychopharmacology.2016 Jan;41(2):590-597. doi:10.1038/npp.2015.187Mosti C, Coccaro EF.Mild Traumatic Brain Injury and Aggression, Impulsivity, and History of Other- and Self-Directed Aggression.J Neuropsychiatry Clin Neurosci. 2018 Summer;30(3):220-227. doi:10.1176/appi.neuropsych.17070141.Montalvo-Ortiz JL, Zhang H, Chen C, Liu C, Coccaro EF.Genome-Wide DNA Methylation Changes Associated with Intermittent Explosive Disorder: A Gene-Based Functional Enrichment Analysis.Int J Neuropsychopharmacol.2018 Jan 1;21(1):12-20. doi:10.1093/ijnp/pyx087Scott KM, de Vries YA, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Bromet EJ,et al.Intermittent explosive disorder subtypes in the general population: association with comorbidity, impairment and suicidality.Epidemiol Psychiatr Sci. 2020 Jun 23;29:e138. doi:10.1017/S2045796020000517.Barra S, Turner D, Müller M, Hertz PG, Retz-Junginger P, Tüscher O,et al.ADHD symptom profiles, intermittent explosive disorder, adverse childhood experiences, and internalizing/externalizing problems in young offenders.Eur Arch Psychiatry Clin Neurosci. 2022 Mar;272(2):257-269. doi: 10.1007/s00406-020-01181-4.Substance Abuse and Mental Health Services Administration.Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health: DSM-IV to DSM-5 Intermittent Explosive Disorder ComparisonAmerican Psychiatric Association.What are Disruptive, Impulse-Control and Conduct Disorders?Costa AM, Medeiros GC, Redden S, Grant JE, Tavares H, Seger L.Cognitive-behavioral group therapy for intermittent explosive disorder: description and preliminary analysis.Braz J Psychiatry.2018 Jul-Sep;40(3):316-319. doi:10.1590/1516-4446-2017-2262U.S. Food and Drug Administration.Selective serotonin reuptake inhibitors (SSRIs) information.Coskun F, Akca OF.Treatment of Intermittent Explosive Disorder With Carbamazepine.Clin Neuropharmacol.2018 Mar/Apr;41(2):82-83. doi:10.1097/WNF.0000000000000276
16 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Scott KM, de Vries YA, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Bromet EJ,et al.Intermittent explosive disorder subtypes in the general population: association with comorbidity, impairment and suicidality.Epidemiol Psychiatr Sci.2020 Jun 23;29:e138. doi:10.1017/S2045796020000517Rynar L, Coccaro EF.Psychosocial impairment in DSM-5 intermittent explosive disorder.Psychiatry Res. 2018 Jun;264:91-95. doi:10.1016/j.psychres.2018.03.077.Valley Behavioral Health System.Signs & Symptoms of Intermittent Explosive Disorder.Patoilo MS, Berman ME, Coccaro EF.Emotion attribution in intermittent explosive disorder.Compr Psychiatry. 2021 Apr;106:152229. doi:10.1016/j.comppsych.2021.152229.Coccaro EF.Psychiatric comorbidity in Intermittent Explosive Disorder.J Psychiatr Res. 2019 Nov;118:38-43. doi: 10.1016/j.jpsychires.2019.08.012.Shevidi S, Timmins MA, Coccaro EF.Childhood and parental characteristics of adults with DSM-5 intermittent explosive disorder compared with healthy and psychiatric controls.Compr Psychiatry. 2023 Apr;122:152367. doi:10.1016/j.comppsych.2023.152367.Cremers H, Lee R, Keedy S, Phan KL, Coccaro E.Effects of Escitalopram Administration on Face Processing in Intermittent Explosive Disorder: An fMRI Study.Neuropsychopharmacology.2016 Jan;41(2):590-597. doi:10.1038/npp.2015.187Mosti C, Coccaro EF.Mild Traumatic Brain Injury and Aggression, Impulsivity, and History of Other- and Self-Directed Aggression.J Neuropsychiatry Clin Neurosci. 2018 Summer;30(3):220-227. doi:10.1176/appi.neuropsych.17070141.Montalvo-Ortiz JL, Zhang H, Chen C, Liu C, Coccaro EF.Genome-Wide DNA Methylation Changes Associated with Intermittent Explosive Disorder: A Gene-Based Functional Enrichment Analysis.Int J Neuropsychopharmacol.2018 Jan 1;21(1):12-20. doi:10.1093/ijnp/pyx087Scott KM, de Vries YA, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Bromet EJ,et al.Intermittent explosive disorder subtypes in the general population: association with comorbidity, impairment and suicidality.Epidemiol Psychiatr Sci. 2020 Jun 23;29:e138. doi:10.1017/S2045796020000517.Barra S, Turner D, Müller M, Hertz PG, Retz-Junginger P, Tüscher O,et al.ADHD symptom profiles, intermittent explosive disorder, adverse childhood experiences, and internalizing/externalizing problems in young offenders.Eur Arch Psychiatry Clin Neurosci. 2022 Mar;272(2):257-269. doi: 10.1007/s00406-020-01181-4.Substance Abuse and Mental Health Services Administration.Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health: DSM-IV to DSM-5 Intermittent Explosive Disorder ComparisonAmerican Psychiatric Association.What are Disruptive, Impulse-Control and Conduct Disorders?Costa AM, Medeiros GC, Redden S, Grant JE, Tavares H, Seger L.Cognitive-behavioral group therapy for intermittent explosive disorder: description and preliminary analysis.Braz J Psychiatry.2018 Jul-Sep;40(3):316-319. doi:10.1590/1516-4446-2017-2262U.S. Food and Drug Administration.Selective serotonin reuptake inhibitors (SSRIs) information.Coskun F, Akca OF.Treatment of Intermittent Explosive Disorder With Carbamazepine.Clin Neuropharmacol.2018 Mar/Apr;41(2):82-83. doi:10.1097/WNF.0000000000000276
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Scott KM, de Vries YA, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Bromet EJ,et al.Intermittent explosive disorder subtypes in the general population: association with comorbidity, impairment and suicidality.Epidemiol Psychiatr Sci.2020 Jun 23;29:e138. doi:10.1017/S2045796020000517Rynar L, Coccaro EF.Psychosocial impairment in DSM-5 intermittent explosive disorder.Psychiatry Res. 2018 Jun;264:91-95. doi:10.1016/j.psychres.2018.03.077.Valley Behavioral Health System.Signs & Symptoms of Intermittent Explosive Disorder.Patoilo MS, Berman ME, Coccaro EF.Emotion attribution in intermittent explosive disorder.Compr Psychiatry. 2021 Apr;106:152229. doi:10.1016/j.comppsych.2021.152229.Coccaro EF.Psychiatric comorbidity in Intermittent Explosive Disorder.J Psychiatr Res. 2019 Nov;118:38-43. doi: 10.1016/j.jpsychires.2019.08.012.Shevidi S, Timmins MA, Coccaro EF.Childhood and parental characteristics of adults with DSM-5 intermittent explosive disorder compared with healthy and psychiatric controls.Compr Psychiatry. 2023 Apr;122:152367. doi:10.1016/j.comppsych.2023.152367.Cremers H, Lee R, Keedy S, Phan KL, Coccaro E.Effects of Escitalopram Administration on Face Processing in Intermittent Explosive Disorder: An fMRI Study.Neuropsychopharmacology.2016 Jan;41(2):590-597. doi:10.1038/npp.2015.187Mosti C, Coccaro EF.Mild Traumatic Brain Injury and Aggression, Impulsivity, and History of Other- and Self-Directed Aggression.J Neuropsychiatry Clin Neurosci. 2018 Summer;30(3):220-227. doi:10.1176/appi.neuropsych.17070141.Montalvo-Ortiz JL, Zhang H, Chen C, Liu C, Coccaro EF.Genome-Wide DNA Methylation Changes Associated with Intermittent Explosive Disorder: A Gene-Based Functional Enrichment Analysis.Int J Neuropsychopharmacol.2018 Jan 1;21(1):12-20. doi:10.1093/ijnp/pyx087Scott KM, de Vries YA, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Bromet EJ,et al.Intermittent explosive disorder subtypes in the general population: association with comorbidity, impairment and suicidality.Epidemiol Psychiatr Sci. 2020 Jun 23;29:e138. doi:10.1017/S2045796020000517.Barra S, Turner D, Müller M, Hertz PG, Retz-Junginger P, Tüscher O,et al.ADHD symptom profiles, intermittent explosive disorder, adverse childhood experiences, and internalizing/externalizing problems in young offenders.Eur Arch Psychiatry Clin Neurosci. 2022 Mar;272(2):257-269. doi: 10.1007/s00406-020-01181-4.Substance Abuse and Mental Health Services Administration.Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health: DSM-IV to DSM-5 Intermittent Explosive Disorder ComparisonAmerican Psychiatric Association.What are Disruptive, Impulse-Control and Conduct Disorders?Costa AM, Medeiros GC, Redden S, Grant JE, Tavares H, Seger L.Cognitive-behavioral group therapy for intermittent explosive disorder: description and preliminary analysis.Braz J Psychiatry.2018 Jul-Sep;40(3):316-319. doi:10.1590/1516-4446-2017-2262U.S. Food and Drug Administration.Selective serotonin reuptake inhibitors (SSRIs) information.Coskun F, Akca OF.Treatment of Intermittent Explosive Disorder With Carbamazepine.Clin Neuropharmacol.2018 Mar/Apr;41(2):82-83. doi:10.1097/WNF.0000000000000276
Scott KM, de Vries YA, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Bromet EJ,et al.Intermittent explosive disorder subtypes in the general population: association with comorbidity, impairment and suicidality.Epidemiol Psychiatr Sci.2020 Jun 23;29:e138. doi:10.1017/S2045796020000517
Rynar L, Coccaro EF.Psychosocial impairment in DSM-5 intermittent explosive disorder.Psychiatry Res. 2018 Jun;264:91-95. doi:10.1016/j.psychres.2018.03.077.
Valley Behavioral Health System.Signs & Symptoms of Intermittent Explosive Disorder.
Patoilo MS, Berman ME, Coccaro EF.Emotion attribution in intermittent explosive disorder.Compr Psychiatry. 2021 Apr;106:152229. doi:10.1016/j.comppsych.2021.152229.
Coccaro EF.Psychiatric comorbidity in Intermittent Explosive Disorder.J Psychiatr Res. 2019 Nov;118:38-43. doi: 10.1016/j.jpsychires.2019.08.012.
Shevidi S, Timmins MA, Coccaro EF.Childhood and parental characteristics of adults with DSM-5 intermittent explosive disorder compared with healthy and psychiatric controls.Compr Psychiatry. 2023 Apr;122:152367. doi:10.1016/j.comppsych.2023.152367.
Cremers H, Lee R, Keedy S, Phan KL, Coccaro E.Effects of Escitalopram Administration on Face Processing in Intermittent Explosive Disorder: An fMRI Study.Neuropsychopharmacology.2016 Jan;41(2):590-597. doi:10.1038/npp.2015.187
Mosti C, Coccaro EF.Mild Traumatic Brain Injury and Aggression, Impulsivity, and History of Other- and Self-Directed Aggression.J Neuropsychiatry Clin Neurosci. 2018 Summer;30(3):220-227. doi:10.1176/appi.neuropsych.17070141.
Montalvo-Ortiz JL, Zhang H, Chen C, Liu C, Coccaro EF.Genome-Wide DNA Methylation Changes Associated with Intermittent Explosive Disorder: A Gene-Based Functional Enrichment Analysis.Int J Neuropsychopharmacol.2018 Jan 1;21(1):12-20. doi:10.1093/ijnp/pyx087
Scott KM, de Vries YA, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Bromet EJ,et al.Intermittent explosive disorder subtypes in the general population: association with comorbidity, impairment and suicidality.Epidemiol Psychiatr Sci. 2020 Jun 23;29:e138. doi:10.1017/S2045796020000517.
Barra S, Turner D, Müller M, Hertz PG, Retz-Junginger P, Tüscher O,et al.ADHD symptom profiles, intermittent explosive disorder, adverse childhood experiences, and internalizing/externalizing problems in young offenders.Eur Arch Psychiatry Clin Neurosci. 2022 Mar;272(2):257-269. doi: 10.1007/s00406-020-01181-4.
Substance Abuse and Mental Health Services Administration.Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health: DSM-IV to DSM-5 Intermittent Explosive Disorder Comparison
American Psychiatric Association.What are Disruptive, Impulse-Control and Conduct Disorders?
Costa AM, Medeiros GC, Redden S, Grant JE, Tavares H, Seger L.Cognitive-behavioral group therapy for intermittent explosive disorder: description and preliminary analysis.Braz J Psychiatry.2018 Jul-Sep;40(3):316-319. doi:10.1590/1516-4446-2017-2262
U.S. Food and Drug Administration.Selective serotonin reuptake inhibitors (SSRIs) information.
Coskun F, Akca OF.Treatment of Intermittent Explosive Disorder With Carbamazepine.Clin Neuropharmacol.2018 Mar/Apr;41(2):82-83. doi:10.1097/WNF.0000000000000276
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