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 do symptoms of IED 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

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.

Even small stressors can lead to explosive anger for someone with IED. Triggers can include:

• Feeling disrespected or criticized

• Arguments with a partner, friend, coworker, or family member

• Traffic frustrations or road rage

• Waiting in long lines or feeling ignored

• Stress at work or school

• Memories of past trauma or feeling threatened

• Unhealthy substance use

• Sudden changes in routine or unexpected disappointments

Not everyone with IED has the same triggers. For some people, outbursts seem to come “out of nowhere.” For others, the anger builds slowly until it reaches a breaking point. Understanding personal triggers can be an important part of treatment and can help reduce the frequency and intensity of episodes over time.

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 can be diagnosed in both children and adults. It often shows up first in childhood or adolescence. One study found that the average age of onset is about 11 years old.

While many young people improve over time, symptoms can continue into adulthood. Some research suggests that about half of adolescents with IED no longer show active symptoms when they become adults.

If IED continues into adulthood, treatment can still make a big difference. Learning coping skills, getting support, and changing patterns can help reduce the severity of outbursts and improve quality of life.

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.

Clinician’s take

My recommendation to those experiencing intermittent explosive disorder is to get proactive versus reactive — not waiting for the next episode, but instead working in the now. Really dig into these episodes to explore triggers and patterns, as well as their general emotional state. Focus on mindfulness and slowing down thoughts and reactions in the day to day.

Elise Miller, MA, LPC

Clinical reviewer