Intermittent Explosive Disorder (IED) is part of a cluster of diagnoses called the disruptive, impulse-control, and conduct disorders. Disruptive, impulse control and conduct disorders are a group of psychiatric conditions that include:
These disorders are characterized by the presence of difficult, aggressive, or antisocial behavior. It is often associated with physical or verbal injury to the self, others, or objects or with violating the rights of others (e.g., destruction of property). These behaviors can appear in several forms and can be defensive, premeditated or impulsive. Individuals with disruptive, impulse control and conduct disorders may have an irritable temperament, be impulsive or inattentive, be defiant towards adults, be aggressive towards peers, and lack problem solving skills. They may also have a coercive interaction style and lack social skills.
Oppositional defiant disorder is defined as defiant, hostile, and disobedient behavior, usually directed at authority figures. Intermittent explosive disorder is explosive outbursts of anger, often to the point of rage, that are disproportionate to the situation at hand. Conduct disorder is repetitive and persistent aggression toward others in which the basic rights of others are violated. Disruptive, impulse control and conduct disorders appear to have addictive properties as they tend to have strong aspects of compulsion, craving, loss of control, and hedonistic release.
In a survey of 6,000 children and adolescents, more than 60% reported at least one angry outburst that resulted in violence, threat of violence, or destruction of property. In the same sample, approximately 8% of participants met the criteria for IED. Epidemiological data is limited because there is a broad overlap with many disorders that feature impulsive, aggressive behavior.
IED is characterized by recurrent behavioral outbursts representing a failure to control aggressive impulses. Children and adolescents with IED have low frustration tolerances and are disproportionately enraged by small annoyances. The behavioral outbursts manifest as:
Some children and adolescents with IED will engage in verbal aggression or physical aggression that results in damage or destruction of property or in physical injury to animals or other individuals. Others will have less severe episodes of verbal and physical aggression that don't result in injury or destruction.
The magnitude of aggression expressed during the recurrent outbursts is grossly out of proportion to the provocation or to any precipitating psychosocial stressors. The recurrent outbursts are not premeditated, nor are they committed to achieve a tangible objective such as money, power, or intimidation. The child or adolescent senses increasing tension prior to committing the act and experiences pleasure, gratification or relief during or following the act. The impulsive aggressive outbursts have a rapid onset and typically last for less than 30 minutes.
IED is more prevalent among younger individuals. The average age of onset is 14 years old. The aggression that characterizes IED can be harmful to the aggressor as well as the victim. Children and adolescents with IED tend to experience interpersonal difficulties such as damaged friendships and poor social skills.
Verbal and physical aggressive behavior creates a sense of distrust among family members and close friends. As a result of their physical and verbal aggression, children and adolescents encounter school suspensions and involvement in the juvenile justice system. Individuals with IED may also experience negative health consequences such as high blood pressure, heart disease, ulcers, and stroke.
Children and adolescents who have experienced physical or emotional trauma are at an increased risk for IED. IED may result from abnormalities in the serotonergic system that regulates behavioral arousal and inhibition. Research also indicates abnormal amygdala responses to anger stimuli in fMRI scanning. A comorbid diagnosis of attention-deficit/hyperactivity disorder (ADHD) is commonly found in this population.
IED is treatable. However, few controlled studies exist for the treatment of IED. Published treatment guidelines for disruptive disorders include those from the Society of Clinical Child and Adolescent Psychology, and the National Institute for Clinical Excellence. Treatment recommendations for IED can be found at PsychiatryOnline.
Clinical research suggests that the following treatments are indicated for the treatment of children and adolescents with IED:
Clinical research suggests that the following treatments are indicated for the treatment of children and adolescents with IED: