Intermittent Explosive Disorder: Signs, Symptoms, & Treatments

Intermittent Explosive Disorder is a condition where an individual’s ability to resist aggressive impulses is impaired, resulting in outward fits of physical and verbal aggression. In many instances, adults who experience Intermittent Explosive Disorder have a related legal or criminal history. Recommended treatment for this disorder is often a combination of medication and psychotherapy focused on behavior modification.¹

Signs of Intermittent Explosive Disorder

Intermittent Explosive Disorder is characterized by fits of rage or temper tantrums that last 30 minutes or more. During these fits, the person may become physically and verbally aggressive, making direct threats, throwing objects, having road rage, or striking others around them. Afterward, there is typically a sense of relief which many times is followed by a sense of regret or embarrassment for their actions.²

Common signs of Intermittent Explosive Disorder include:

• Fits of rage
• Increasing sense of tension
• Racing thoughts
• Frequent shouting
• Combativeness
• Domestic violence
• Making threats
• Assaulting others
• Damaging property

Symptoms of Intermittent Explosive Disorder

Intermittent Explosive Disorder is present when there are “recurrent behavioral outburst representing a failure to control aggressive impulses” consisting of verbal or physical aggression toward property, people, or animals. These outbursts are not premeditated and cause distress in the individual’s life.³

Common symptoms of Intermittent Explosive Disorder include:

• Verbal aggression
• Physical aggression
• Temper tantrums
• Tirades
• Fights
• Property damage
• Assault to others
• Assault to animals
• Impulsiveness

Causes of Intermittent Explosive Disorder

The exact causes of Intermittent Explosive Disorder are unknown. Causal factors could include a mixture of environment, genetic factors, and dysfunction in brain structure or chemistry. Men have a higher tendency to be diagnosed with this disorder. Also, a history of being physically abused, and a history of related mental health disorders, such as antisocial personality disorder or borderline personality disorder, may increase risk of developing Intermittent Explosive Disorder.⁴

Common factors that increase risk of Intermittent Explosive Disorder include:

• Previous physical abuse
• Exposure to violence in the home from a young age
• History of a personality disorder
• History of violence toward animals or others when young
• Being male

Common Co-Occurring Disorders

Intermittent Explosive Disorder shares many symptoms with other mental health disorders. It is important to know that Intermittent Explosive Disorder usually occurs in combination with other disorders.

Here are some common conditions that often co-occur with Intermittent Explosive Disorder:⁵

• Attention deficit hyperactivity disorder (ADHD)
• Conduct disorder
• Oppositional defiant disorder (ODD)
• Bipolar disorder
• Anxiety disorders
• Depressive disorders
• Post-traumatic stress disorder (PTSD)
• Personality disorders including antisocial and borderline⁶

Treatment of Intermittent Explosive Disorder

The most effective treatment for Intermittent Explosive Disorder, in most circumstances, is a combination of medication and psychotherapy focused on behavior modification. Because this disorder is an impulse control disorder, addressing emotional and thinking patterns that lead to the detrimental behavior can be highly effective in combating symptoms and changing overall behavior. Medication can be used to slow impulsive decision-making.

Therapy

Effective therapeutic treatment of Intermittent Explosive Disorder typically focuses on reducing the amount someone acts on the impulses they have. To this end, behavioral approaches seem to be the most effective treatment modality. Therapy combined with medication can be an effective treatment to both change undesirable thoughts and behaviors, as well as slowing impulse reactions.

Common Type of Therapies

The preferred treatment for Intermittent Explosive Disorder is Cognitive Behavioral Therapy. This approach targets thinking patterns and emotions that fuel behavior, and targeted intervention can lead to overall changes and decreases in disruptive behaviors associated with Intermittent Explosive Disorder. Long term, this therapy can help address internal thought patterns to decrease and deter impulses before they become a problem.⁷

Other therapies that may be effective include behavioral approaches such as Rational Emotive Therapy or Acceptance and Commitment Therapy. Many times, family and group therapy may be called for, especially when there has been instances of domestic violence or child abuse.

Intended Treatment Outcome & Timeline

Treatment for Intermittent Explosive Disorder focuses on changing the reactions to impulses, and controlling behavior. Techniques will typically include relaxation training, cognitive restructuring, and coping skills. In family therapy, focus may be on healing from past behaviors, creating safety plans, and mending relationships. Effective treatment for Intermittent Explosive Disorder can last from 12 weeks to a year or more, depending on the severity of the disorder.

Medication

Typically, a psychiatrist will be the professional prescribing medication for a disorder such as Intermittent Explosive Disorder. Most family physicians will refer to a psychiatrist in cases of impulse control disorders, as medication fit and dosage can be challenging to pinpoint. The most common medication studied for treatment of Intermittent Explosive Disorder is fluoxetine. According to the Cleveland Clinic, “In general, the classes of medications that can be tried include antidepressants, anticonvulsants, antianxiety and mood regulators.”⁸

Lifestyle Changes

While lifestyle changes can help to some degree, their effectiveness is limited because Intermittent Explosive Disorder is an impulse-control issue having to do with thinking patterns, brain structure, and chemical imbalances in most situations.

Here are a few things that may be effective in reducing outbursts:

• Get adequate sleep
• Practice Meditation
• Exercise regularly
• Avoid overly stressful situations
• Stop illegal drug use
• Avoid alcohol

How to Get Help for Someone With Intermittent Explosive Disorder

Unfortunately, many people with Intermittent Explosive Disorder avoid treatment on their own. If you are in a relationship with someone who has Intermittent Explosive Disorder, first be sure you are safe. Take steps to protect yourself and your children, and know that abuse is not your fault and not something you deserve.

Many people who get help with Intermittent Explosive Disorder do so only after there have been repercussions, such as legal issues, assault, or property damage. Legally mandated therapy is possible when charges for behavior are pressed.

Three Practical Ways to Cope With Intermittent Explosive Disorder

The best thing you can do to cope with Intermittent Explosive Disorder is to seek treatment. Contact your physician for a referral to a psychiatrist, or contact your insurance company to be connected with an in-network provider.

Outside professional treatment, the following may be effective:

1. General Stress Reduction

You may be able to decrease negative impulses by managing stress levels and avoiding stressful situations when possible. Try to ensure regular exercise, adequate sleep, healthy eating, and meditation.

2. Avoid Drugs & Alcohol

Drugs of misuse and alcohol can lower inhibitions, making impulses all the stronger. If you have any type of impulse-control disorder, including Intermittent Explosive Disorder, you should completely avoid drug misuse.

3. Consider Harm Reduction

If you are not going to seek treatment for Intermittent Explosive Disorder, or try to reduce symptoms in any way, you may consider a harm-reduction approach, which entails avoiding those situations where you put yourself or others in danger because of your behavior. Harm reduction may require living alone, as this can decrease risk for domestic violence, and choosing work that does not directly require interaction with others, or stressful situations involving other people.

Intermittent Explosive Disorder Statistics

Here are some notable statistics on Intermittent Explosive Disorder:

• Fewer than 20% of people who get treatment do so specifically for Intermittent Explosive Disorder⁷
• 5-7% of the population can be diagnosed with Intermittent Explosive Disorder⁷
• It is more common in younger adults than the elderly⁴
• Males are at higher risk⁵

Additional Resources for Intermittent Explosive Disorders

The following are helpful additional resources for anyone impacted by Intermittent Explosive Disorder:

• American Psychiatric Association
• National Institute for Mental Health
• The Albert Ellis Institute