You’ve been waiting in line at the coffee shop longer than you wanted to. You’re already late for an appointment, and with every passing minute, you can feel your anger building. When the barista hands you the wrong order, it all boils over.
Before you know it, you let out a string of expletives, throw the drink on the floor, and storm out. Not long after, a wave of remorse and embarrassment comes over you. And it might not the first time you’ve lost control like that.
If you’ve experienced recurring problems with your temper and outbursts, it could be a sign of intermittent explosive disorder.
What is intermittent explosive disorder?
Intermittent explosive disorder (IED) is a psychological disorder that causes frequent outbursts of anger and recurrent aggressive behavior.
Though it might feel hopeless, there are ways to manage. But first, we’ve got to understand what we’re dealing with. Here’s what you need to know about IED and how to get help.
Some form of a disorder characterized by impulsive aggression has appeared in the Diagnostic and Statistical Manual (DSM) since 1956, but the term “intermittent explosive disorder” wasn’t used until the DSM-III in 1980.
Back then, IED was thought to be rare, but evidence now shows many people experience it in their lifetime.
“It is much more common than people think,” said Emil Coccaro, MD and professor at Ohio State University. Coccaro, who has led much of the research on IED, estimates that 4 percent of people meet the criteria for diagnosis in their lifetime.
People with IED are estimated to commit 65 to 70 acts of assault and/or property damage in their lifetime.
Older studies indicated that men were more likely to have IED than women, but the gender difference is small according to more recent research. Coccaro notes, however, that women engage in more verbal aggression than physical aggression.
How do you know if your angry outbursts could be IED? Watch for these signs.
| Mental signs | Physical signs | Outward expressions |
|---|---|---|
| anger irritation rage confusion racing thoughts losing control remorse | adrenaline rush headache or pressure trembling tense muscles racing heart tight chest | argumentative making threats throwing or breaking things pushing, hitting, or injuring someone yelling damaging property road rage fist fights name-calling domestic violence |
According to the DSM-5, these criteria indicate IED:
- Lower intensity aggressive outbursts that happen at least twice a week for 3 months or longer.
and/or
- Higher intensity outbursts (resulting in physical injury and/or damage/destruction of property) that happen at least 3 times in 1 year.
Along with the following criteria:
- The aggressive outbursts are out of proportion to the stressor.
- Outbursts are unplanned, angry, and not productive.
- Episodes are associated with distress and/or impairment.
- The aggressive person is at least 6 years old.
- The aggression is not better explained by another disorder.
Is IED the same as having a short temper?
According to Cocarro, IED is different from being “hot-headed” or having a short temper — it’s outside the range of normal behavior.
“It is not simply at the extreme end of the distribution of aggression,” Cocarro said. “It is its own entity. It’s also not just a case of behaving badly or needing an attitude adjustment. IED is a brain-based disorder just like depression, anxiety, and the like.”
Risk factors correlated with having IED include being
- male
- young (median age of onset is 17)
- unemployed
- divorced or separated
- less educated
- a victim of trauma from physical or sexual violence
However, correlations are not necessarily direct causes. While the cause of IED is not completely understood, it seems to be part genetic, part environmental, and part neurochemical.
“It’s complicated, of course. Impulsive aggression is under genetic control depending on the type of aggression,” Coccaro said.
“Verbal aggression is about 25 percent under genetic influence, whereas physical aggression on people is under about 50 percent genetic influence. This is also seen in family studies, where about 25 percent of first-degree relatives (parents, siblings, offspring) of those with IED also have IED.
“Then there is exposure to aggression, such as being emotionally or physically abused in childhood, which leads to the effects of trauma and also, learning that aggression is a way to deal with frustration and threat. There are biochemical issues such as low brain serotonin and disturbances in other neurotransmitters.”
As you can imagine, having unpredictable aggressive or violent outbursts can cause many social problems, including:
- difficulty maintaining relationships
- losing jobs
- arrest and legal consequences
- domestic violence
- substance abuse
There are also several health risks associated with IED including:
- high blood pressure
- heart disease
- stroke
- ulcers
- headaches
- arthritis
- chronic pain
- traumatic brain injury
IED can be treated with a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs) and cognitive behavior therapy (CBT). Other medications like anticonvulsants and mood stabilizers may be used also. The goal of CBT is to learn coping skills for dealing with anger in a healthy way.
In addition to therapy and medication, there are things you can do on your own to help your manage moods:
- Get enough sleep.
- Avoid alcohol and drugs.
- Exercise regularly.
- Meditate or practice mindfulness.
To be clear, these activities will not cure your IED, but simply support your professional treatment by helping you manage stress.
If you recognize signs of IED in yourself or someone you care about, guidance from a doctor or therapist. IED can cause a lot of fear, guilt, and shame, but it’s a brain disorder that can improve with treatment.
If your job, relationships, or quality of life have been impacted by recurring angry outbursts, contact a professional for evaluation. If you have been violent or fear becoming violent during an outburst, it’s especially important to seek additional support.
IED is characterized by repeated episodes of aggression and affects about 4 percent of the population.
The exact causes are unknown, but outbursts can be more frequent and less intense or less frequent and more intense, depending on the individual. Signs of IED to look out for include sudden anger that leads to violence and a propensity to damage or destroy property.
Treatment is usually found through antidepressant medication and cognitive behavioral therapy. The key is to acknowledge the signs as they arise and seek guidance from a professional.
