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Intermittent explosive disorder

Intermittent explosive disorder involves repeated episodes of impulsive, aggressive, violent behavior or angry verbal outbursts in which you react grossly out of proportion to the situation. Road rage, domestic abuse, throwing or breaking objects, or other temper tantrums may be signs of intermittent explosive disorder.

People with intermittent explosive disorder may attack others and their possessions, causing bodily injury and property damage. They may also injure themselves during an outburst. Later, people with intermittent explosive disorder may feel remorse, regret or embarrassment.

If you have intermittent explosive disorder, treatment may involve medications and psychotherapy to help you control your aggressive impulses.

Symptoms Causes Risk factors Complications Prevention

Explosive eruptions, usually lasting less than 30 minutes, often result in verbal assaults, injuries and the deliberate destruction of property. These episodes may occur in clusters or be separated by weeks or months of nonaggression. In between explosive outbursts, the person may be irritable, impulsive, aggressive or angry.

Aggressive episodes may be preceded or accompanied by:

  • Irritability
  • Increased energy
  • Rage
  • Racing thoughts
  • Tingling
  • Tremors
  • Palpitations
  • Chest tightness
  • Feeling of pressure in the head

Depression, fatigue or relief may occur after the episode.

The exact cause of intermittent explosive disorder is unknown, but the disorder is probably caused by a number of environmental and biological factors.

  • Environment. Most people with this disorder grew up in families where explosive behavior and verbal and physical abuse were common. Being exposed to this type of violence at an early age makes it more likely these children will exhibit these same traits as they mature.
  • Genetics. There may be a genetic component, causing the disorder to be passed down from parents to children.
  • Brain chemistry. There may be differences in the way serotonin, an important chemical messenger in the brain, works in people with intermittent explosive disorder.

People with other mental illnesses — such as mood, anxiety or personality disorders — or certain medical conditions — such as Parkinson's disease or traumatic brain injury — may display aggressive behaviors. However, they would not be diagnosed as having intermittent explosive disorder because the cause is from another condition.

A numberof factors increase your risk of developing intermittent explosive disorder:

  • History of substance abuse. People who abuse drugs or alcohol have an increased risk of intermittent explosive disorder.
  • History of physical abuse. People who were abused as children or experienced multiple traumatic events have an increased risk of intermittent explosive disorder.
  • Age. The start of intermittent explosive disorder most commonly occurs in people in their teens and 20s.
  • Being male. Men are more likely to have intermittent explosive disorder than women are.

People with intermittent explosive disorder have an increased risk of:

  • Self-harm. They don't always direct their anger at others. They're at significantly increased risk of harming themselves, either with intentional injuries or suicide attempts. Those who are also addicted to drugs or have another serious mental disorder, such as depression, are at greatest risk of harming themselves.
  • Impaired interpersonal relationships. They're often perceived by others as always being angry. This can lead to relationship problems, divorce and family stress.
  • Trouble at work, home or school. Other complications of intermittent explosive disorder may include job loss, school suspension, auto accidents, financial problems or trouble with the law.

If you have intermittent explosive disorder, prevention is likely beyond your control unless you get treatment from a professional. Combined with, or as part of, treatment, these suggestions may help you prevent some incidents from getting out of control:

  • Stick with your treatment. Attend your therapy sessions, practice your coping skills, and if your doctor has prescribed medication, be sure to take it.
  • Practice relaxation techniques. Regular use of deep breathing, relaxing imagery or yoga may help you stay calm.
  • Develop new ways of thinking (cognitive restructuring). Changing the way you think about a frustrating situation by using rational thoughts, reasonable expectations and logic may improve how you view and react to an event.
  • Use problem-solving. Make a plan to find a way to solve a frustrating problem. Even if you can't fix it right away, it can refocus your energy.
  • Learn ways to improve your communication. Listen to the message the other person is trying to share, and then think about your best response rather than saying the first thing that pops into your head.
  • Change your environment. When possible, leave or avoid situations that upset you. Also, scheduling personal time may enable you to better handle an upcoming stressful or frustrating situation.
  • Avoid mood-altering substances. Don't use alcohol or street drugs.
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