What is intermittent explosive disorder (IED)?

Intermittent explosive disorder (IED) is a mental health condition characterized by brief but intense bursts of anger or violence that are out of proportion to the situation at hand. These episodes can result in harm to other people, animals, property, or the person themselves. 

People with IED are often unable to regulate their thoughts and behaviors, and their outbursts can arise seemingly out of nowhere. The condition is typically diagnosed in adolescence, but it can also affect children as young as 6 and adults, and research shows that IED affects between 1% and 7% of the population.

What does intermittent explosive disorder look like?

To an observer, the angry outbursts core to IED can seem difficult to predict. Without warning, a person with IED may become erratic, angry, and violent. For example, they might get into physical altercations, break household items, or engage in road rage. 

While the person may experience some internal warning signs before the outburst occurs (i.e. feelings of rage or a rapid heart rate), for others, these symptoms can be difficult to detect. Then, almost as quickly as the episode takes hold, the IED outburst will begin to subside, typically in under 30 minutes. 

This experience can feel like a rollercoaster ride of emotions. But it’s important to remember there’s a major difference between the moments of anger most people experience occasionally and the violent outbursts occurring with IED. 

To be diagnosed with IED, a person must be at least six years old and exhibit the following symptoms: 

• An inability to control impulses, resulting in repeated violent or aggressive behavior
• Demonstrated physical or verbal violence toward people, objects, or animals at least twice per week for at least three months OR three incidents of violence involving the destruction of physical property or physical assault within 12 months
• Aggression that’s far out of proportion to the situation at hand
• Spontaneous outbursts that are distressing for the person and others, and impairs functioning

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What causes IED outbursts? 

Researchers are yet to identify the underlying causes of IED. But it appears that IED disproportionately affects people who are young, assigned male at birth, don’t have a romantic partner, are unemployed, have a lower level of education, and have been the victim of violence or abuse. 

In addition, there are some other factors that may contribute to the onset of IED:

• Genetics: IED has been shown to run in families. So if you have a close relative, like a sibling or parent, who also has IED, you are at greater risk.
• Biology: Studies have shown that people with IED have differences in the part of the brain that govern emotional functioning. 
• Environment: Experiencing childhood trauma — especially in the form of abuse or neglect — may make you more vulnerable to IED.

Conditions similar to IED

IED falls into the category of mental health conditions known as impulse control disorders. It’s similar to other conditions that cause anger or violent behavior such as:

• Oppositional defiant disorder 
• Conduct disorder
• Pyromania
• Kleptomania
• Other specified disruptive, impulse-control, and conduct disorder
• Unspecified disruptive, impulse-control, and conduct disorder

80% of the time IED occurs alongside other mental health concerns such as attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), or other impulse control disorders. However, note that IED can’t be diagnosed as co-occurring with disruptive mood dysregulation disorder (DMDD). 

It’s also important for clinicians to rule out other potential causes of angry outbursts when assessing for IED. For example, violent behavior can also stem from bipolar disorder, substance use disorders, or traumatic brain injuries. These concerns require distinct treatments.

IED in children and adults

IED is typically first diagnosed in childhood, and the average age of onset is about 11 years old. However, while symptoms can persist throughout a person’s life, some research has shown that half of those with IED in adolescence are no longer showing active symptoms in adulthood. This suggests some improvement occurring as young people age into adulthood. 

Treating intermittent explosive disorder

While there’s no cure for IED, it can be managed with the right support. Treating IED typically involves interventions such as:

• Cognitive behavioral therapy (CBT): CBT can help you identify, interrupt, and replace unhelpful thought and behavior patterns. It can also increase self-awareness, help you see the connections between your thoughts and your actions, and improve your ability to respond to stress in healthy ways. These skills can help prevent explosive episodes and improve emotional regulation.
• Relaxation techniques: Activities like breathing exercises, mindfulness meditation, and progressive muscle relaxation can keep your stress level in check and help calm your mind and body when you feel an outburst coming on. Pausing to attend to the anger you’re experiencing can help you respond to triggers in healthier ways.
• Medication: Currently, no medications are approved to treat stand-alone IED. But medications can be helpful if you’re living with a co-occurring condition like ADHD, depression, or anxiety. If you have questions about the pros and cons of medication, don’t hesitate to talk to your doctor.

Find care with Rula

If you’ve ever done or said something in a fit of anger only to regret it later, you’re far from alone. Everyone gets angry sometimes, and we don’t always stop to think about the consequences of our actions. But people with IED have a different experience with anger. Their anger can feel out of control and lead to aggressive or violent outbursts that harm people, property, and/or animals. Left untreated, IED can negatively affect a person’s quality of life in many ways. But fortunately, there are effective treatments that can help you manage your emotions, regulate your behavior, and improve your quality of life.

Whether you need support for an impulse control disorder like IED or another condition, we want to welcome you to Rula. With over 10,000 providers to choose from, you can use our extensive network to find the right therapist or psychiatrist for your needs. Start the process today using our therapist-matching program in which you can select a provider who takes your insurance and schedule your first live video session in just a few clicks.

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