In Syndromes & Disorders

Exploring Intermittent Explosive Disorder

Intermittent Explosive Disorder

Intermittent explosive disorder, or IED, brings about violent outbursts occurring on impulse that result in aggressive and violent behavior, obviously wholly out of balance with the situation at hand. The outbursts can involve domestic violence, rage behind the wheel, even throwing or breaking things.

In addition, the aggressor may hurt others or damage their possessions, causing injury and property damage, all with a high probability of hurting themselves in the process. Once the episode is over, oftentimes the aggressor feels embarrassed and remorseful.

According to Psych Central, the symptoms of intermittent explosive disorder in a person are defined as several separate occurrences of a failure to fight back impulses to act aggressively resulting in serious acts or property damage. In concert with this behavior is the requirement the act must be, as mentioned earlier, obviously wholly out of balance with the situation at hand. In other words, the person must experience sudden, total loss of control and become physically aggressive by breaking things or threatening to hurt another person. In addition, among those who experienced these episodes three times in one year, a subgroup was discovered that suffered a more persistent problem, especially when both people and property are involved. The number of those affected in any given year totaled approximately 8 million U.S. citizens.

Further, it’s said that aggressive behavior has been known to occur within the context of various mental disorders and a proper diagnosis can be made only after the presence of all other types of related disorders are determined as non-existent.

IED is a relatively unknown mental disorder that distinguishes itself by presenting uncalled for anger, and is more common than many people think. According to a study by the National Institute of Mental Health, as many as 7.3 percent of adults or about 16 million people will be affected at some point in their lives. The data, from the National Comorbidity Survey Replication, was based on household surveys in face-to-face conversations of 9,282 adults in the U.S. during the period from 2001-2003.

Many episodes begin in the early teens of individuals and can lead to depression, anxiety and substance abuse in later years. Approximately 82 percent of people with IED suffered with these disorders, but only about one-third sought treatment, according to a report by Ronald Kessler, Ph.D., Harvard Medical School, and colleagues. It’s also been suggested that if these conditions can be detected early, some of the episodes might be prevented. Additional evidence proposes IED sufferers may also be more likely to experience depression, anxiety, alcohol or drug abuse issues which in turn amplify stressful experiences leading to financial problems and divorce.

Diagnosis

The diagnosis of IED is tricky because doctors sometimes confuse the symptoms of IED with other disorders. An example is the symptoms of Alzheimer’s disease and drug or alcohol abuse are similar and are confused, leading to a misdiagnosis. This is why it’s so important to definitively eliminate all other associated disorders before finalizing a diagnosis of IED. When people are interviewed and questioned about their particular behavior, if the behavior has all the earmarks of IED, then the diagnosis is likely correct.

Treatment

Because many factors are associated with IED, intermittent explosive disorder treatment varies. IED has causes related to low brain serotonin turnover rates and in some cases symptoms are relieved by the use of selective serotonin reuptake inhibitors. However, behavioral therapy and medicine are the most effective treatments. A cure for IED is still in the future so medications and therapy are the only avenues to explore. It’s known that therapy on a regular basis helps the individual become more aware of their frightening impulses and lack of control thereof. The key is the individual must understand what’s happening and that he or she needs to be willing to try to change before progress can begin to show.

While it’s true many people sometimes have trouble dialing back their anger when a trigger situation arises, the individuals may avoid these embarrassing and often dangerous events by getting themselves into anger management therapy. People diagnosed with IED don’t exhibit tendencies to plan or anticipate episodes, rather they are impulsive and occur without warning, but the symptoms can begin within minutes or even hours before the actual event.

The usual treatment for IED involves medicine and therapy, or both if deemed necessary for proper treatment.Therapy and counseling for IED focuses more on anger management while those with other types of disorders usually add medication to the treatment mix, especially when the level of violence impacts important areas of their lives such as relationships, school and employment.

The purpose of therapy is to help the person with IED understand more about their thoughts to better control their behavior. The anger management therapy also helps facilitate stronger focus on learning techniques to help control their impulsive behavior. In addition, therapy teaches the person more understanding about the reasons for their behavior in order to learn how to recognize what causes their disorder and the reasons for the outbursts. This is turn leads to a development of techniques the person can use to help prevent their violent behavior altogether.

Causes

According to the Mayo Clinic, it’s assumed the cause of IED is due to a number of biological and environmental factors, but an actual cause is still unknown. If the person affected grew up in a family environment fraught with angry and explosive behavior where verbal and physical abuse were commonplace, the likelihood of developing symptoms of IED later in life are increased. It’s also likely genetics played a part in the person being predisposed to the disorder by way of having it passed down from his or her parents. In the brain, the chemistry makeup may make a difference in how serotonin, a chemical in the brain, works with IED.

Risk Factors

It’s likely a person with IED will live in penal institutions or psychiatric facilities more so than in the general population where IED is rare, and is more common in men than in women. The disorder begins to show in people during adolescence or within 10 years later. The acting out may start suddenly or could be a carryover from childhood. Fortunately, IED usually improves over time, but trauma to the head or brain, or substance abuse can play a role in worsening the condition.

Childhood risk factors

Childhood risk factors involve a physical and emotional history of early exposure to drugs or alcohol, head trauma, seizures, brain infections and inflammations. Additional psychological factors that could influence a person to be more susceptible to IED include an unhappy and violent upbringing with physical and/or emotional abuse and the absence of a positive role model in their lives.

Adulthood risk factors

In adulthood the main risk factor associated with IED becomes abuse of addictive substances like alcohol and/or drugs. By early adulthood people have already developed basic character traits and depending on circumstances, these could be impulsive behavior, being addiction prone or antisocial.

Situations in social settings or at work, people with IED are at risk due to the possibility of a confrontation where they’re reminded of childhood situations that make them lose control and become aggressive or violent, demonstrating classic IED symptoms. As people with IED age, they stand a heightened chance of IED symptoms due to medical or neurological issues such as brain tumors and degenerative diseases, for example.

Complications

Those who are diagnosed with IED stand an increased risk of harming themselves by way of suicide or other intentional attempts at self-harm. At highest risk are drug addicted individuals who also suffer from other forms of mental disorders such as depression. In social situations, IED sufferers are many times thought of as always being or appearing angry, which can lead to strained relationships with loved ones, criminal behavior or financial problems.

Symptoms

Intermittent explosive disorder symptoms are described by affected individuals as hard to overcome impulses of aggressiveness just before the actual act. They’re typically associated with symptoms such as uncontrollable rage with a rush of energy occurring during their acting out. Once the episode is over, the individuals report a rapid onslaught of remorse, depression and fatigue. In addition, those with narcissistic, obsessive or paranoid traits are more prone to suffer from IED, especially when they’re under abnormal stress. Other disorders such as anxiety, eating, or other impulse driven disorders are known to be associated with IED. When a study is made of the childhoods of those affected, oftentimes a history of severe temper tantrums, attention problems, hyperactivity and the like are present.

Intermittent explosive disorder test for adults

It’s imperative to see a doctor for a complete physical before any other treatment begins. This is because, as mentioned earlier, all other disorders must be excluded first before an accurate diagnosis of IED is given. It’s also expected that a psychological evaluation will be made to help determine a proper diagnosis in order to provide the doctor with important information regarding symptoms, thoughts and feelings before an episode occurs, and a detailed diagnosis of behavioral patterns. Most of this information will be provided via a detailed questionnaire.

Symptoms of intermittent explosive disorder in children

So far, the discussion about symptoms of IED have been isolated mainly to adults. Using the same criteria for adults to diagnose children is more difficult because of the stage of development in a particular child. Children, depending on their age sometimes cannot fully articulate actual symptoms and may not provide enough information to warrant an accurate diagnosis. However, a common trait in children affected with IED is they are quick to anger and lash out with behavior similar to adults with IED, but some may not remember what made them so angry. IED in children must be understood to be more, much more than a simple temper tantrum like that of a spoiled child who purposely acts out to gain attention in an attempt to get what they want. On the other hand, a child with IED acts out uncontrollably regardless if anyone is watching.

Treatment for children with IED

Therapy has proven to be the most effective treatment for children with IED. Conversely, while adults are normally treated with medication and therapy, medication for children is kept to a strict minimum and is used only when absolutely necessary, as in the most extreme cases. Therapy for children helps them realize what situations trigger their outrage and are taught to control their anger through relaxation exercises. This also helps manage their “over-the-top” reactions to minor incidents. Another interesting therapy technique is that of “play therapy”. This is effective because younger children with developmental issues are more successful at expressing thoughts and expressions through playing, instead of talking in a somewhat regimented format. The therapist monitors the child during play and studies how the child expresses themselves during play, and uses this vital information to help the child understand what their playing means. If needed, the therapist could also suggest anger management classes to help the child learn to minimize their angry behavior. In addition, family classes may also be planned so the family unit as a whole learns to cope with issues that arise when a child with IED is a part.

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