Intermittent Explosive Causes & Effects

Learn about IED

Intermittent explosive disorder (IED) is a mental health disorder that is characterized by repeated episodes of failure to resist aggressive, impulsive, violent behaviors or angry verbal outbursts that are entirely out of proportion to the situation and often involve serious assaults or destruction of property. The onset for IED often occurs in late childhood or early adolescence and is usually first seen as an inability to control his or her anger alongside impulsive, uncontrollable rage without (or with very little) provocation. Onset may be noted when a child has frequent, less severe outbursts such as tirades, temper tantrums, and fights that do not do any physical damage. These less severe episodes are interspersed by less frequent and more severe outbursts that do cause physical damage to other people, property, or animals. Intermittent explosive disorder causes major disruption in the lives of a child, his or her family, relationships with peers, and poor academic achievement.

Adolescents who have intermittent explosive disorder often have a very low tolerance for frustration and become unreasonably furious by small irritations. This frustration is often expressed by becoming verbally or physically aggressive – sometimes causing physical injury or property damage. Teens with IED have expressed that they experience a sensation of building tension in the head or chest that is finally released after the aggressive behavior. The explosions of rage generally last less than thirty minutes, are not premeditated, or aimed at a tangible objective, such as retribution or financial gains.

Intermittent explosive disorder cannot be cured, however there are a number of treatment options available to help the child or teen control his or her outbursts and reduce the amount of attacks. As IED can impact virtually every aspect of a child or teen’s life, it’s absolutely imperative that proper diagnosis and treatment are sought as soon as the disorder is suspected. Generally, treatment involves a combination of medication and therapeutic interventions.

IED statistics

According to the National Institute of Mental Health (NIMH), intermittent explosive disorder affects 11.5-16 million Americans throughout their lifetime. Of those diagnosed with IED, 67.8% engaged in direct interpersonal aggression, 20.9% had threatened interpersonal aggression, and 11.4% engaged in aggression against property and objects.

Causes and risk factors for IED

Researchers believe that IED is not the result of a single risk factor, rather it is thought to be the result of a number of environmental, genetic, and physical risk factors working together. The most commonly cited causes and risk factors for IED include:

Genetic: Children and teens who have a family history of intermittent explosive disorder appear to be at greater risk for developing the disorder themselves than those without a similar family history.

Physical: There appear to be abnormalities in the limbic system  (which controls emotions) and the frontal lobes of the brain which are responsible for impulse control – of those with IED. It appears that there are differences in the way serotonin – a chemical messenger in the brain – works in the brain of those who have IED. Additionally, PET scans of some people who have IED show lower levels of brain glucose metabolism than those without the disorder.

Environmental: Many of the children and teens who have intermittent explosive disorder have been raised in families and living situations in which explosive behaviors, physical, and verbal abuse are common.

Risk factors:

• Being male
• History of head and brain trauma
• Seizures
• Being between the teen years and the 20s
• History of childhood physical abuse
• History of childhood trauma
• History of alcohol or drug abuse

Signs and symptoms of IED

Episodes of anger tend to last less than 30 minutes and often lead to verbal abuse, physical injuries, and willful property damage. These episodes may occur in clusters or can be separated by weeks or months of non-aggressive behaviors. Between episodes, the person may be moody, irritable, impulsive, angry, or aggressive.

The signs and symptoms of IED will vary from child to child based upon individual makeup, severity of IED, presence of co-occurring mental health disorders, and use of alcohol or drugs. The most common signs and symptoms of IED may include the following:

Behavioral symptoms:

• Breaking things and causing property damage
• Verbal and physical aggression
• Road rage
• Frequent fighting
• Increased energy during an aggressive outburst
• Acts of self-harm
• Suicide attempts

Physical symptoms:

• Tension or pressure in head or chest that builds before an episode
• Fatigue after episode
• Tingling
• Tremors
• Hearing an echo
• Palpitations

Cognitive symptoms:

• Racing thoughts
• Inability to concentrate
• Poor scholastic or occupational functioning

Psychosocial symptoms:

• Low tolerance for frustration
• Mood changes before an outburst
• Intense anger
• Irritability during and between outbursts
• Blinding rage
• Feeling “out of control” before and during an episode
• Depressed mood
• Guilt following episode
• Shame following an episode

Effects of IED

Left untreated, intermittent explosive disorder can affect virtually every area of a child or teen’s life. The effects and consequences of untreated IED will vary based upon substance use, genetic makeup, severity of symptoms, and presence of co-occurring disorders. Long-term effects of untreated intermittent explosive disorder include:

• Academic impairment
• School suspension
• Dropping out of school
• Poor social skills
• Injuries
• Incarceration
• Substance abuse and addiction
• Alcohol abuse
• Domestic violence
• Child abuse
• Self-harm
• Suicidal ideations

IED and co-occurring disorders

Children and teens who have intermittent explosive disorder often struggle with additional mental health disorders. These comorbid, co-occurring disorders include:

• Anxiety disorders
• Oppositional defiant disorder (ODD)
• Attention-deficit/hyperactivity disorder (ADHD)
• Tourette’s
• Obsessive-compulsive disorders (OCD)
• Depression disorders
• Substance abuse and addiction
• Alcoholism
• Bipolar disorder
• Personality disorders