What is intermittent explosive disorder
and what do we do about it?
That's what I'm talking about today.
I'm Dr. Tracey Marks, a psychiatrist
and I make mental health education videos.
This video is based on several viewer questions
and some of the questions
were around distinguishing it from bipolar disorder.
Other people asked me about it
because they were diagnosed with it
and they wanted to understand it better.
So before I define it,
let's look at an example of what this can look like
and this is adapted from the DSM-5 case book.
Joe is a business executive,
his wife, Sally, insisted that he see a psychiatrist
for help with his anger.
His wife told the psychiatrist
he was impossible to live with.
Sally said Joe was always high strung,
but over the years his outbursts
were getting more frequent and intense,
so she feared he would start getting violent
with her or the kids.
(dog whining)
Their most recent argument began
when Joe came home after a hard day at work
to find that dinner wasn't ready.
Instead, he found Sally soaking in the tub
reading the newspaper.
He exploded and launched into a tirade
about how bad of a wife she was.
When she tried to explain how she had a long day
and needed to de-stress, Joe cursed at her, threw his shoe,
and broke a chair.
Terrified, Sally scooped up the kids and left.
She put on her clothes, though.
She then told Joe he would have to get some help
or she would leave him.
Joe said his blowups began in childhood,
but really didn't become a problem
until he was around 13 and then he had frequent fights
with classmates and had to go
to the principal's office a lot.
Currently, Joe was having four verbal outbursts a week
and about every other month he would break something.
The last time he threw a computer
and punched several holes in the wall.
He said that he never hit anyone
and these blowups only lasted a few minutes
and then he'd feel better.
As for alcohol, Joe drank occasionally but not really
on a regular basis.
He was never drunk or tipsy when he got angry.
In fact, alcohol tended to make him more mellow
and actually make him explode less.
So that's one way that this can look.
Let's look at how we
diagnosis intermittent explosive disorder
using the Diagnostic and Statistical Manual
of Mental Disorders, the Fifth Edition.
You have recurrent behavioral outbursts
that are a failure to control your aggressive impulses
as manifested by either of the following two scenarios.
One, you have high frequency, low intensity outbursts
and the low intensity would be defined
as verbal aggression like temper tantrums, tirades,
verbal arguments or fights
or physical aggression toward property,
animals, or other people,
but the physical aggression does not result
in property damage or injury to someone.
So, in this case, the physical aggression
could be pushing or grabbing your clothes.
As for frequency, they occur on an average
of twice a week for at least three months.
The second scenario is that you would have low frequency,
high intensity outbursts
and in this the high intensity would involve damage
or destruction of property,
physical assault that does involve physical injury against
the person and as for intensity,
it would occur around three times in a 12 month period,
so much less often.
Other criteria is that the magnitude
of the aggression is grossly out
of proposition to the provocation or any other triggers.
You have to be at least age six.
So this can be diagnosed in children, in fact,
it often is.
The outbursts are not premeditated or intentional.
Lastly, the aggressive outbursts either cause
a lot of distress for the person or a lot of problems
with your life, with your work,
the way you relate to people.
You may have financial or legal consequences.
So, this is not having an anger outburst
that ends up landing you in a couple of arguments
a few times a year or putting your fists
through a wall twice when you're drunk.
These are outbursts that are way over the top
because the action doesn't match the situation
and it causes serious problems for you.
A few commenters questioned
if their anger could really be bipolar disorder
and there's so much more to bipolar disorder
than impulsivity and anger.
In fact, not everyone who
becomes manic and impulsive is angry.
I did a video breaking down the details
of mania and hypomania so you can better understand
the complexities of the disorder
and I'll link to that video in the corner
and in the description,
but suffice it to say
that the anger outburst that you get with IED
are more extreme, much more extreme
than what someone experiences with mania or depression,
but you can have bipolar disorder and IED at the same time.
When does this usually happen?
It usually starts in late childhood or early adolescence.
It rarely starts after age 40.
Now, that doesn't mean that someone can't start
having a lot of explosive anger after 40.
In fact, there are medical illnesses like epilepsy
and other brain disorders like stroke
that can cause personality changes
that may lead to this kind of behavior,
but in that case it wouldn't be called
intermittent explosive disorder,
it would be a behavioral disturbance due
to whatever the medical condition is.
This disorder does run in families,
so if you have a first degree relative
like a parent or a sibling with it,
you are at a greater risk of having it.
What causes it?
We don't know exactly,
but people with IED do have abnormal functioning
of the brain chemical serotonin
and they have a hyperreactive amygdala.
The amygdala is a structure in your brain
that helps detect fear and threat level.
What do we do about it?
The two approaches are therapy and medication.
The therapy would focus on building skills
and improving coping mechanisms.
You'd also identify triggers as best you can
and then learn different techniques
to process your aggression in a less destructive way.
Medications can be serotonin-enhancing antidepressants
like Prozac or even mood stabilizers.
And some people have responded well to beta blockers
like Propranolol which is a blood pressure medication
that we use in psychiatry for anxiety
and impulse control problems.
If you're interested in anger in general
and the source of it,
watch this video that's showing up right here.
For more information on mental health education,
subscribe to my channel.
I post videos every Wednesday at nine.
See you next time.