Intermittent Explosive Disorder Basics

Children with intermittent explosive disorder (IED) exhibit short episodes of intense, uncontrollable anger or aggression with very little or no apparent cause. Our guide outlines how to recognize the symptoms of IED, and how it is diagnosed and treated.

IED: What Is It?

Intermittent explosive disorder (IED) is a behavior disorder characterized by brief episodes of disproportionate anger and aggression. Onset is in late childhood or adolescence. A child or adolescent with IED can’t control his anger and will impulsively explode into rage with little or no apparent provocation. The pattern is often one of frequent, less severe outbursts  (tantrums, tirades, arguments or fights) that don’t do physical damage, punctuated by less frequent, more severe episodes that do cause injury to people or animals or damage to property. IED greatly interferes with a child’s family life as well as his social relationships and academic achievement.

IED: What to Look For

Adolescents with IED have low frustration tolerance and are disproportionately enraged by small annoyances, often becoming verbally and physically aggressive, sometimes causing property damage or even physical injury.  Road rage, breaking furniture and getting into fights are all common behaviors for people with the disorder.  They describe feeling overcome with anger and “out of control.”  Some experience a sensation of building tension in the head or chest that is finally released when they react aggressively.  The explosions are typically brief, less than 30 minutes, and are not premeditated, or aimed at some tangible objective.  Adolescents and young adults with IED are at a higher risk of intentionally harming themselves or committing suicide.

IED: Risk Factors

Children who have experienced physical and emotional trauma are more likely to develop intermittent explosive disorder, as are those with first-degree relatives who have the disorder.

IED: Diagnosis

To be diagnosed with intermittent explosive disorder, one must exhibit a pattern of being unable to resist angry impulses, resulting in explosions of rage that are disproportionate to the situation and sometimes quite dangerous or destructive.  Since aggressive behavior can occur in the context of many mental disorders, a doctor must first rule out other reasons for these symptoms, such as substance abuse, another psychiatric disorder, or a physical explanation like head trauma.

IED: Treatment

Treatment for intermittent explosive disorder generally involves a psychotherapeutic and a psychopharmacological component.

Psychotherapeutic: Cognitive behavioral therapy (CBT) is commonly used to help people with IED learn which situations trigger their rage episodes. Through CBT they can learn to recognize and manage their anger in a healthy, non-disruptive way. A therapist will work with the patient and family (and, when appropriate, teachers) to manage and prevent explosive episodes.

Pharmacological: There are no medications specifically for IED, but a variety of medications have been used to help people with IED, including antidepressants and anti-anxiety medications, nas well as anticonvulsants and other mood regulators. After a careful evaluation, a psychiatrist will prescribe the appropriate type of medication for an individual case.

IED: Risk For Other Disorders

Someone diagnosed with intermittent explosive disorder is more likely to also develop an anxiety,  depressive, or substance use disorder.