Intermittent Explosive Disorder: DSM-5, Treatment, and More - Verywell Health

Intermittent explosive disorder (IED) is a mental health disorder that causes a person to experience recurrent aggressive behavioral outbursts that are unwarranted in the given situation. These episodes can involve aggressive, impulsive, and violent behaviors or angry verbal outbursts.

Many people are unfamiliar with IED. However, one study found around 7% of the U.S. population may have the disorder.

Read on to learn more about IED and how the disorder affects those who have it.  

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What Are the Symptoms of IED?

IED is similar to a temper tantrum, and when a person has the disorder, they may experience the following symptoms:

• Rage
• Irritability
• Feeling high levels of tension
• High energy levels
• Tremors (involuntary rhythmic shaking)
• Heart palpitations (a pounding, fluttering, or irregular heartbeat that is highly noticeable for a short period of time)
• Tightness in the chest
• Argumentative behaviors and shouting
• Getting into verbal or physical altercations
• Threatening other people
• Physically assaulting animals or people
• Damaging their own or someone else's property

The attacks may seem to come out of nowhere and are deemed as out-of-proportion reactions to the situation.

Who Is Most Affected by IED?

Men are twice as likely to have IED than women. Young adults and adolescents are also more likely than other age groups to suffer from IED. Race prevalence research reports that people who identify themselves as "other" (not white, Black, or Hispanic) are also more affected.

What Causes IED?

Although the exact cause of IED is unknown, experts believe that a combination of factors can cause a person to develop the disorder at some point in their life. Research has found that one of the strongest contributors to the onset of IED is being exposed to trauma during childhood.

Childhood is an important time in a person's life when it comes to brain development. Children that go through traumatic experiences often have delayed or altered brain development. This means they may not adequately learn the skills needed to manage emotions such as anger or rage.

Although childhood trauma is thought to be the main driver in the development of IED, other research has found that genetics and abnormalities in the brain can also contribute.

For example, one study found an association of inflammatory responses in the brain with aggressive behavior in IED by analyzing different areas of DNA. The study found that people with IED had differences in those areas than those who did not. These differences in genes may affect IED risk.

Research has also found that people with IED have abnormalities in serotonin levels in the brain. Serotonin is a neurotransmitter (chemical messenger in the brain) that's associated with feelings of well-being. It also plays a role in stabilizing mood.

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 includes recurrent behavioral outbursts of:

• Verbal aggression or physical aggression that occurs twice per week for a period of three months
• Aggressive behavioral outbursts that involve physical damage or injury to property, another person, or an animal and occurs three times in a 12-month period
• Anger that is grossly out of proportion to the stressor
• Outbursts that are impulsive and unplanned
• There is no goal associated with the behavior such as financial gain or emotional intimidation

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 doctor will determine whether to make an official diagnosis of IED.

IED Co-Occurring Conditions

A person with IED may be more susceptible to other mental health disorders, such as depression, anxiety, and substance use disorders. One study has correlated IED with bipolar disorder, a mental health condition characterized by extreme mood swings, including emotional highs (mania or hypomania) and lows (depression). The study revealed that  as many as 60% of people with IED may also have bipolar disorder .

How Is IED Treated?

According to the American Psychiatric Association, treating IED typically involves cognitive-behavioral therapy (CBT). 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.

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, mood stabilizers to help quell overreactions, antipsychotics, and antianxiety medications.

What Are the Complications of IED?

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. They may also be at risk for developing physical health problems such as high blood pressure, diabetes, heart disease, stroke, and chronic pain.

How Can You Cope With IED?

Coping with IED can be difficult because a person with the disorder doesn't have control over their angry outbursts. What's worse is that 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:

• Meditation
• Yoga
• Breathing exercises
• Avoiding triggers, people, or situations that may cause you to get angry
• Not using drugs or alcohol

Suicidal Behaviors in IED

According to research, as many as 38.1% of people with IED experience suicidal ideation (suicidal thoughts or ideas), and as many as 17.4% with the disorder will attempt suicide at some point in their lifetimes. If you or someone you know is coping with IED and is displaying suicidal behaviors, call the National Suicide Prevention Lifeline or seek help from your nearest emergency department.

Summary

IED is a mental health illness that is characterized by repeated outbursts of anger, rage, and aggression for seemingly no reason. The disorder may affect around 7% of adolescents and adults. 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.

A Word From Verywell

Having IED is difficult to cope with and many people may not even realize that they have the disorder until long after it develops. 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.

That is why you should always seek treatment if you happen to have over-the-top and aggressive reactions in situations that do not warrant it. It can't be easy dealing with IED, but with the right treatment, you can manage your disorder and improve your overall quality of life.

Frequently Asked Questions

• Although IED and bipolar disorder may manifest in similar ways, the two are not the same condition. That being said, the co-occurrence rate of both disorders is roughly 60%, which means that over half of people with IED may have both.

• To help calm someone having an IED episode, you can practice active listening and detach yourself emotionally. Taking their behavior personally will only make matters worse. To help another person through an episode, be empathetic, and validate their feelings until they have calmed down. If you are in physical danger, remove yourself from the situation immediately.

• 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. They include:

  • Following your angry outburst, you feel tired, guilty, or embarrassed of your behavior.
  • You are often triggered by the same types of situations such as being corrected in public or being told what to do.
  • You physically harm others, yourself, or property during your anger episodes.
  • You can't think clearly or about any consequences during the episode.
  • You feel as though you have no control over your behavior once you begin having an episode.
  • Your anger affects personal and professional relationships often.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

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By Angelica Bottaro
Angelica Bottaro is a professional freelance writer with over 5 years of experience. She has been educated in both psychology and journalism, and her dual education has given her the research and writing skills needed to deliver sound and engaging content in the health space.

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