Intermittent explosive disorder, or IED, is a mental health condition that causes sudden and intense outbursts of anger that are disproportionate to the situation. These outbursts can involve physical violence or verbal threats.

People with IED usually cannot control their anger, and the episodes can happen at any time, without warning. As a result, IED can interfere with daily life and cause significant distress to individuals and their friends and family.

Although there is no one-size-fits-all treatment for IED, doctors can recommend effective therapies and medications to manage the symptoms and improve quality of life.

This article looks at intermittent explosive disorder in more detail, including its causes, diagnosis, and treatment.

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IED is a mental health condition, the hallmarks of which include short periods of unexpected, intense aggression, rage, or violence. These strong feelings often appear spontaneously and are typically more intense than the situation warrants.

IED often appears in late childhood or the early teenage years, with affected individuals often feeling as though they have no control over their anger.

Children with IED may have tantrums, fights, or outbursts that are less serious. However, they may also have severe rages that lead to physical violence toward people, animals, or objects.

Due to these reactions, IED frequently affects a child’s performance at school and causes problems in their relationships with their family and friends.

Those with IED may present with differing forms of aggressive episodes, which may include:

  • an inability to control sudden bursts of anger
  • frequent outbursts in the form of arguments, tantrums, and fights
  • occasionally having more intense instances of anger and violence
  • explosive bursts of anger lasting less than 30 minutes
  • aggressive outbursts when frustrated

Doctors remain unsure about the exact causes of IED but speculate that numerous factors play a role.

Environmental factors encompass the behaviors that someone experienced as a child. These include trauma and growing up in a physical, sexually, or verbally abusive household.

Other experts note that the repeated aggressive and impulsive behavior characteristic of IED correlates with low serotonin levels in the brain. Therefore, brain chemistry might also contribute to the development of IED.

Some research shows that people at a higher risk of developing IED are those who:

  • are male
  • are aged 13–23 years
  • are unemployed
  • are divorced or separated
  • underwent multiple traumatic events as a child
  • grew up in a physically, verbally, or sexually abusive household

Additionally, people with other mental health conditions have an increased chance of developing IED. These conditions include those with symptoms of problematic or impulsive behaviors, such as attention deficit hyperactivity disorder (ADHD), conduct disorder, and oppositional defiant disorder (ODD).

Having IED does not necessarily mean that a person is more likely to receive another mental health diagnosis and vice versa. However, the rate of comorbidity is high. Causation can work both ways, and the correlation between IED and other mental health conditions is still a topic of debate.

Individuals with IED also have a higher chance of developing a substance use disorder or considering self-harm or suicide.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours per day at 800-273-8255. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 800-273-8255.

Click here for more links and local resources.

Doctors often begin the diagnostic process for IED by ruling out other potential causes of the individual’s behavior.

Other conditions that could cause similar behaviors include:

  • other mental health disorders
  • drug or alcohol use disorder
  • physical causes, such as a head injury

Once a doctor has ruled out the above, they may diagnose someone with IED if they:

  • cannot control their anger
  • often get into fights or have tantrums
  • occasionally have destructive outbursts of violence and rage that do not accurately reflect the severity of the situation

The first-line treatment for IED is usually a combination of medication and therapy.

Medication

Although no specific medications exist for IED, there are still many effective options, such as:

  • anti-anxiety medications, including beta-blockers such as propranolol (Inderal) and nadolol (Corgard)
  • antidepressants, including fluoxetine (Prozac), fluvoxamine (Luvox), and citalopram (Celexa), which are selective serotonin reuptake inhibitors
  • anticonvulsant mood stabilizers, including valproic acid (Depakote) and topiramate (Topamax)

It is important to note that medications for mental health may take as long as 2 months to have their full effect. Furthermore, people may need a long-term prescription.

Inappropriately discarded drugs can harm people, animals, and the environment. It is essential to dispose of any unwanted medication safely. Read our guide on medication disposal here.

Therapy

Doctors may recommend cognitive behavioral therapy (CBT) for individuals with IED. CBT allows people to understand and recognize the situations that cause their severe outbursts of anger.

CBT offers a way for those with IED to manage their anger in a healthy way rather than with violent and verbal outbursts. This practice not only ensures that no one else gets hurt during an outburst, but it also helps people feel better about their situation by providing them with a level of control that they did not have previously.

With CBT, the individual’s caregivers may also work with the therapist. CBT can help them understand the triggers for angry outbursts and how they can navigate the situation.

Learn more about types of therapy.

Some other mental health conditions may have similar symptoms to IED, but there are also key differences.

Bipolar disorder

Bipolar disorder is a mental health condition that leads to unusual changes in mood, activity levels, energy, concentration, and the ability to complete regular, daily tasks.

These mood changes often result in a person switching from high energy states, such as being motivated, elated, or irritable, to low energy states of sadness, indifference, and hopelessness.

These low moods do not characterize IED. In addition, the manic periods of bipolar disorder typically last for at least 7 days, whereas an IED episode typically lasts less than 30 minutes.

Oppositional defiant disorder (ODD)

Doctors may diagnose ODD in children who have tantrums, are unusually angry, do not follow the rules, or harm others on purpose. Children with ODD exhibit this extreme behavior for at least 6 months.

Usually, ODD affects children before the age of 8 years and no later than 12 years, which is younger than the typical age for IED.

Children may outgrow ODD, but early treatment helps family life and can improve the child’s future.

Intermittent explosive disorder is a mental health condition that often manifests as sudden anger and violent outbursts. It usually appears in the early teenage years and can cause problems with relationships and performance at school.

Doctors are unsure about the specific causes, but brain chemistry and exposure to childhood trauma likely play a role.

To diagnose IED, doctors first eliminate other possible causes of anger and irritability. These include other mental health conditions, substance misuse, and head injuries.

The treatment options for IED include CBT and medications such as mood stabilizers, anti-anxiety medications, and antidepressants.