Intermittent Explosive Disorder

Kajal, a 26-year-old, works as a teacher in a school. She was asked to resign as the school had received several complaints about Kajal's violent behavior with the children.  
At home, Kajal would complain of feeling down, guilty and low. She also had frequent thoughts of self-harm, some of which she would sometimes act on, cutting her wrists or banging her head against the wall. These episodes occurred at least once in a week. Sometimes, she would get so angry that she would break things or even hit others around her. She would get more enraged if someone pointed out to her that she needed to manage her anger better.
Kajal was taken to a general physician, who immediately referred her to a psychiatrist. She was diagnosed with Intermittent Explosive Disorder. After a few months of treatment, Kajal was able to manage her anger better and the frequency of her outbursts came down.

What is Intermittent Explosive Disorder (IED)?

IED is an impulse  control disorder, in which a person explodes into rage abruptly, without any reason or provocation. They lose control of their emotions, and the anger is not in proportion with the gravity of the situation.

While general anger issues and IED may seem similar, they differ in a number of ways. Anger builds gradually, while in the case of IED, the rage builds up quickly to a point where the person becomes extremely violent. People with IED are rarely able to understand and explain the reason behind their outburst. 

IED usually begins during adolescence and makes the person vulnerable to many other psychological disorders such as anxiety and depression. Individuals with IED feel calm post the episode, but feel regret, sad, remorse and embarrassment about their behavior.

The symptoms of IED are not only physical, but are also seen in cognitive and behavioral forms. Although the disorder is chronic in nature, therapy and medication can help people manage the symptoms. The outbursts are generally seen to decrease with age. Estimates show that these have been found in about 3.9 per cent of the population. 

What are the symptoms of intermittent explosive disorder?

Persons suffering from IED may exhibit symptoms in both verbal and non-verbal ways. An individual is not given a diagnosis of IED unless there have been at least three episodes of unwarranted outbursts. These episodes generally last for about half an hour or less and occur suddenly. 

What causes intermittent explosive disorder?

While the exact cause of IED is unknown, experts say it can be caused by a combination of biological and environmental factors. Evidence suggests that most people with this disorder grew up in families where verbal and physical abuse was common. This exposure to violence by adults can cause children to learn the same behavior and normalize it. Genes may also play a role. Some evidence also suggests the role of neurotransmitters - mainly serotonin - which may play a role.

How is intermittent explosive disorder treated?

The treatment for IED differs from person to person, and involves a combination of both psychotherapy and medication.

• Medication: Medication like antidepressants, anti-anxiolytics, and mood stabilizers are generally prescribed to people with IED.
• Therapy: Behavioural modification techniques, group counselling and anger management sessions have yielded good results. Relaxation techniques are also used to neutralize the anger.

References:

Kessler, R. C., Coccaro, E. F., Fava, M., Jaeger, S., Jin, R., & Walters, E. (2006). The prevalence and correlates of DSM-IV intermittent explosive disorder in the National Comorbidity Survey Replication. Archives of general psychiatry, 63(6), 669-678.