Symptoms
Core symptoms of IED include:
Recurrent, sudden episodes of verbal aggression (e.g., temper tantrums, tirades, heated arguments or fights) or physical aggression directed toward property, animals, or other individuals.
The aggressive outbursts are grossly out of proportion to the provocation or precipitating stressors.
The outbursts are not premeditated and are not committed to achieve some tangible objective (e.g., money, power, intimidation).
Outbursts cause marked distress, impairment in occupational or interpersonal functioning, or are associated with financial or legal consequences. Other common signs and symptoms:
Irritability
Impulsivity
Anger
Rage
Frequent arguments
Temper tantrums
Heated debates
Feeling out of control
Racing thoughts
Tingling
Tremors
Palpitations
Chest tightness
Causes
The exact cause of IED is not fully understood, but it is likely a combination of genetic, environmental, and neurobiological factors. Potential contributing factors include:
Genetics: There may be a genetic predisposition to developing IED.
Brain chemistry: Differences in brain structure, function, and chemistry (particularly serotonin levels) may play a role.
Environment: A history of abuse, trauma, or other adverse childhood experiences may increase the risk of developing IED.
Learned behavior: Exposure to explosive behavior in the family or community.
Medicine Used
Medications commonly used to treat IED include:
Antidepressants: Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and citalopram (Celexa), are often prescribed to help regulate serotonin levels and reduce impulsivity and aggression.
Mood Stabilizers: Lithium, carbamazepine (Tegretol), and valproic acid (Depakote) can help stabilize mood swings and reduce the frequency and intensity of outbursts.
Anti-anxiety Medications: Benzodiazepines, such as clonazepam (Klonopin) or lorazepam (Ativan), may be prescribed for short-term relief of anxiety or agitation during acute episodes.
Beta Blockers: Propranolol may be used to manage physical symptoms of anxiety, such as rapid heart rate or tremors, and can help reduce overall arousal.
Antipsychotics: In some cases, antipsychotic medications, such as risperidone (Risperdal) or quetiapine (Seroquel), may be used to manage severe aggression or impulsivity, particularly if there are co-occurring mental health conditions.
Precautions
Precautions to take if you or someone you know has IED:
Identify Triggers: Recognize situations, people, or events that provoke outbursts.
Develop Coping Mechanisms: Learn and practice relaxation techniques (deep breathing, meditation), problem-solving skills, and cognitive restructuring.
Seek Professional Help: Consult a mental health professional for diagnosis, therapy, and medication management.
Create a Safety Plan: Develop a plan with family and friends on how to respond during an outburst.
Remove Yourself from the Situation: If possible, step away from a triggering situation to avoid an outburst.
Communicate Assertively: Learn to express your feelings and needs in a calm, respectful manner.
Avoid Alcohol and Drugs: These substances can impair judgment and increase impulsivity.
Ensure Safety: Remove any objects that could be used to harm yourself or others during an outburst.
How long does an outbreak last?
Episodes of IED typically last for less than 30 minutes. However, the aftermath of an outburst, including feelings of regret, remorse, or shame, can last much longer.
How is it diagnosed?
IED is diagnosed through a comprehensive psychological evaluation. This usually includes:
Clinical Interview: The mental health professional will ask detailed questions about the individual's symptoms, history, and functioning.
Diagnostic Criteria: The criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM) are used to determine if the individual meets the diagnostic criteria for IED.
Medical History: A review of medical history to rule out any underlying medical conditions that may be contributing to the symptoms.
Psychological Testing: Questionnaires or standardized assessments may be used to gather additional information about symptoms and functioning.
Timeline of Symptoms
The onset of IED often occurs in late childhood or adolescence, typically between the ages of 6 and 18. The course of the disorder can vary. For some, the frequency and intensity of outbursts may decrease over time, while for others, the disorder may be chronic and require ongoing management. The symptoms tend to come and go in episodes, with periods of relative calm in between.
Important Considerations
Co-occurring Conditions: IED often occurs with other mental health conditions, such as anxiety disorders, depression, substance use disorders, and attention-deficit/hyperactivity disorder (ADHD).
Risk of Harm: IED can pose a significant risk of harm to oneself and others, including physical injury, legal consequences, and relationship problems.
Impact on Functioning: The disorder can significantly impair social, occupational, and academic functioning.
Importance of Treatment: Early diagnosis and treatment are crucial to managing symptoms and improving quality of life.
Family Involvement: Family members can play an important role in supporting the individual with IED and participating in therapy.
Long-Term Management: IED often requires long-term management through a combination of therapy, medication, and lifestyle changes.