In Intermittent Explosive Disorder (IED), a person shows repeated outbursts of aggressive behavior that are disproportionate to the situation.1Leahy, L. G. (2014). Intermittent explosive disorder: a study in personalized psychopharmacotherapy. The Nurse Practitioner, 39(2), 10-13. While normal people show aggressive behaviors once in a while, those with IED show a frequent pattern of verbal and physical aggression. The outbursts are either high-intensity, occurring several times per year, or low-intensity, occurring several times monthly.2Coccaro, E. F. (2012). Intermittent explosive disorder as a disorder of impulsive aggression for DSM-5. American Journal of Psychiatry, 169(6), 577-588.
IED is an impulse control disorder. It’s a failure to control aggressive impulses.3Desilva, N., & Hollander, E. (2024). Impulse Control Disorders: Intermittent Explosive Disorder, Kleptomania, Pyromania. In Tasman’s Psychiatry (pp. 1-49). Cham: Springer International Publishing. Lack of impulse control in IED occurs at the cognitive, emotional, and behavioral levels. At the cognitive level, the person with IED is unable to control their thoughts when triggered by a situation.
Specifically, they’re prone to hostile attribution bias, where they attribute hostile intent to ambiguous behaviors.4Rad, H. S., Abolghasemi, A., Shakerinia, I., & Mousavi, S. V. (2024). Self-control problems in Intermittent Explosive Disorder: Presentation of an explanatory approach. Journal of behavior therapy and experimental psychiatry, 85, 101973. Normal people who make such hostile attributions can often override their strong cognitive inhibition.
Those with IED, in contrast, have weak cognitive inhibition. They can’t use their thoughts to control their aggressive thoughts. As a result, these aggressive thoughts take over their minds, and they experience intense emotions that seek release via aggressive behaviors.
Signs of IED
1. Emotions
A person with IED experiences an increased sense of tension before the outburst. They may feel frustrated, agitated, irritated, and full of rage. After this tension finds release in an outburst, they can feel guilt, shame, or embarrassment.
2. Behaviors
Verbal abuse can involve threatening, insulting, yelling, unnecessary arguing, temper tantrums, and tirades. Physical abuse involves physically attacking people, animals, or property.
3. Cognitive signs
Cognitive symptoms include racing thoughts, inability to tolerate frustration, making quick decisions without thinking, and feeling a loss of control over one’s thoughts.
4. Physical signs
Increased heart rate, sweating, tightness in the chest, shaking, muscle tension, headache, and adrenaline rush before and during the outburst. Feeling tired and relieved after the outburst.
5. Impact
Aggressive behaviors can be damaging to all the key areas of life. A person with IED is likely to find themselves in constant conflict with friends, partners, family, and coworkers. They can also get into legal problems due to their violent tendencies.
6. Episode characteristics
Outbursts are unplanned and occur without warning. They are reactions to perceived provocations, usually lasting less than 30 minutes.
7. Self-harm
Physical aggression in IED may not only be directed towards other people and things but also to self. During an outburst, the person with an IED may hit themselves, pull out their hair, cut themselves, and throw themselves on the floor, writhing like fish out of water.
