Intermittent Explosive Disorder – Diagnosis and Treatment
Diagnosis
Healthcare professionals diagnose intermittent explosive disorder (IED) by reviewing symptoms such as repeated impulsive aggression, sudden verbal or physical outbursts, and disproportionate reactions to minor provocations.
They begin with a comprehensive medical and psychiatric history, along with a physical examination and laboratory tests, to rule out other possible causes of aggressive behavior. These may include neurological conditions, head injuries, substance use, or hormonal imbalances.
A mental health evaluation is a key part of the diagnostic process. This involves discussing recent aggressive impulses, behavioral patterns, triggers, and the impact of these outbursts on relationships, work, and daily life.
The clinician may use structured interviews or psychological questionnaires to assess anger control and impulse regulation.
Health care providers use the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria to confirm the diagnosis.
According to the DSM-5, a person must exhibit recurrent behavioral outbursts representing a failure to control aggressive impulses, which may include:
- Verbal aggression (e.g., temper tantrums, tirades, verbal arguments).
- Physical aggression toward property, animals, or other individuals.
These outbursts are grossly out of proportion to any provocation or stressor and are not premeditated or committed to achieve a tangible objective.
In addition, the diagnosis requires that the individual be at least six years old (or equivalent developmental level), and that the aggressive episodes are not better explained by another mental disorder, medical condition, or substance use.
Clinicians also assess for the presence of co-occurring mental health conditions such as depression, anxiety disorders, antisocial personality disorder, or attention-deficit/hyperactivity disorder (ADHD), as these may influence treatment planning.
Treatment
Counseling and Skill-Building
People can work with a therapist, either alone or in a group, to learn how to manage anger. Cognitive behavioral therapy (CBT) is a common method.
Cognitive behavioral therapy (CBT) includes:
- Spotting early signs and triggers that can cause anger
- Practicing ways to stay calm, like deep breathing or meditation
CBT also teaches people to view situations more realistically and use problem-solving instead of aggression.
Therapists help individuals improve communication during difficult moments. People practice these tools to gain better control over their reactions.
Medications That May Help
Doctors may recommend medications to lower the risk of outbursts.
The following medications are commonly used:
| Type of Medication | Purpose |
|---|---|
| Selective Serotonin Reuptake Inhibitors | May improve mood and reduce anger episodes |
| Mood Stabilizers, like anticonvulsants | Can help control mood swings and impulses |
| Other medicines as needed | Individualized for each patient |
Some people need to take these medicines for a long time to manage symptoms. Doctors choose medication plans based on what works best for each person.
A doctor often combines talk therapy and medication for effective results.
Strategies for Managing Emotions and Ensuring Safety
Ways to Handle Anger and Aggression
Learning to control anger takes practice. People with IED or similar disorders can benefit from working with a mental health specialist.
- Recognize Triggers: Tracking what triggers strong emotions helps people learn new responses.
- Prepare an Action Plan: This plan may include walking away, calling a friend, or using relaxation exercises when anger builds.
- Self-Care Habits: Good sleep and regular exercise support better emotional control. Managing stress with breathing exercises, stretching, or meditation can help reduce irritability.
- Avoiding Substances: Alcohol and illegal drugs lower self-control and increase aggression risk.
| Tip | Benefit |
|---|---|
| Sleep well | Increases patience |
| Exercise regularly | Boosts mood |
| Practice relaxation | Lowers stress |
| Avoid alcohol and drugs | Reduces aggression risk |
| Seek professional support | Teaches anger skills |
Supporting Yourself When a Loved One Refuses Help
Living with someone who has intense anger issues or related disorders is difficult. Sometimes the person will not agree to seek treatment.
In these cases, focus on protecting everyone in the home.
- Personal Safety: Abuse or violence is always the responsibility of the person acting that way. It is never your fault.
- Look Out for Children and Pets: Make their safety a priority. Watch for warning signs that things might escalate.
- Create Boundaries: Set limits on what behavior is acceptable in the home.
- Get Support: Talk to friends, family, or a support group for advice and comfort.
Note: Abuse can happen with any type of mood or personality disorder and can worsen with substance abuse or social stress.
Planning Ahead to Keep Safe from Domestic Abuse
If a family member may become violent, being ready can make leaving safer. Planning ahead is important if the person has a pattern of losing control.
Steps to consider:
- Speak to Domestic Violence Hotlines or Shelters: These places offer advice and help you make a plan.
- Hide Weapons or Dangerous Items: Lock away firearms or other weapons. Only trustworthy people should have access.
- Pack a Bag: Keep a bag with essentials ready to go. Leaving it with a neighbor or friend can be safer.
- Let Someone Know: Trusted friends or neighbors should know about the situation and how to call for help.
- Plan an Exit: Know where to go and how to get there quickly. Practice how to leave, even at odd hours.
- Set Up a Code Word: Pick a secret word or signal that tells others to call the police for help.
| What to Pack in a Go-Bag | Why You Need It |
|---|---|
| Extra clothes | Protection and comfort |
| Identification and papers | Needed for help and shelter |
| Keys | Fast exit |
| Medications | Ongoing health needs |
| Cash or bank cards | Pay for rides or necessities |
Resources to Protect Yourself from Abuse
No one should accept violence at home. Many resources are available for those affected by domestic abuse, whether or not the person is diagnosed with a mental health issue.
- Emergency Services: In urgent situations, call 911 or the local emergency number for help.
- Medical Support: Healthcare workers at clinics or emergency rooms provide treatment for injuries and can connect you with support options.
- National Hotlines: The National Domestic Violence Hotline at 1-800-799-7233 offers support and information about shelters and legal resources.
- Local Shelters and Crisis Centers: These centers provide emergency housing, advocacy, and practical help.
- Mental Health Programs: Counseling centers offer support groups and therapy for those dealing with abusive relationships.
- Legal Support: Local courts and advocates can help file restraining orders or assault charges.
Getting Ready for Your Visit
Steps to Take Before Your Appointment
Getting organized before meeting a health professional can make the visit more helpful. Start by listing any emotional or behavioral symptoms, even if they seem minor.
Include details like sudden anger, lying, trouble at school, or feeling out of control. These notes may help the doctor spot patterns in your behavior.
Write down personal events or stresses that may have triggered your symptoms. Include problems with family, trouble at work or school, or difficult emotions after a loss or major change.
List any health issues, such as high blood pressure or a history of rule violations. Bring a list of all medicines and supplements, including doses, or bring the bottles.
This helps the doctor see if any substance may be linked to mood or behavior.
Prepare questions for your appointment, such as:
- What could be causing these emotional outbursts?
- Could brain changes be a factor?
- Are there tests for mental health or social cognition problems?
- What treatment choices are available, and what are their side effects?
- How long does therapy take to work?
- Could another health problem or medicine make things worse?
- Are there non-medication options?
- Where can I learn more about my condition and treatment?
If you have concerns about theft, rule-breaking, or other behaviors, mention these issues during your visit.
What Your Health Provider May Ask
The doctor or mental health expert will likely ask several questions to understand your situation. Common topics include how often angry episodes happen and what sets them off.
They may ask if you have caused any physical or verbal harm to others. Other questions may include:
- Did you damage belongings during outbursts?
- Has anyone in your family had a psychotic disorder or other mental health issues?
- Do these emotional spells cause problems in school, work, or family life?
- Do substances like alcohol or drugs play a role?
- Have you ever tried to hurt yourself?
- Did you have a recent head injury?
- What helps you calm down?
Be ready to answer honestly. This helps your provider understand the main issues quickly.
Hereโs a simple checklist table to bring to your appointment:
| Checklist | Completed? |
|---|---|
| Symptom list | โฌ |
| Key personal events/triggers | โฌ |
| Medication & supplement list | โฌ |
| Questions for health provider | โฌ |
