Overview

Intermittent explosive disorder involves repeated, sudden 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.

These intermittent, explosive outbursts cause you significant distress, negatively impact your relationships, work and school, and they can have legal and financial consequences.

Intermittent explosive disorder is a chronic disorder that can continue for years, although the severity of outbursts may decrease with age. Treatment involves medications and psychotherapy to help you control your aggressive impulses.

Symptoms

Explosive eruptions occur suddenly, with little or no warning, and usually last less than 30 minutes. These episodes may occur frequently or be separated by weeks or months of nonaggression. Less severe verbal outbursts may occur in between episodes of physical aggression. You may be irritable, impulsive, aggressive or chronically angry most of the time.

Aggressive episodes may be preceded or accompanied by:

• Rage
• Irritability
• Increased energy
• Racing thoughts
• Tingling
• Tremors
• Palpitations
• Chest tightness

The explosive verbal and behavioral outbursts are out of proportion to the situation, with no thought to consequences, and can include:

• Temper tantrums
• Tirades
• Heated arguments
• Shouting
• Slapping, shoving or pushing
• Physical fights
• Property damage
• Threatening or assaulting people or animals

You may feel a sense of relief and tiredness after the episode. Later, you may feel remorse, regret or embarrassment.

When to see a doctor

If you recognize your own behavior in the description of intermittent explosive disorder, talk with your doctor about treatment options or ask for a referral to a mental health professional.

Causes

Intermittent explosive disorder can begin in childhood — after the age of 6 years — or during the teenage years. It's more common in younger adults than in older adults. The exact cause of the disorder is unknown, but it's 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.
• Differences in how the brain works. There may be differences in the structure, function and chemistry of the brain in people with intermittent explosive disorder compared to people who don't have the disorder.

Risk factors

These factors increase your risk of developing 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.
• History of other mental health disorders. People who have antisocial personality disorder, borderline personality disorder or other disorders that include disruptive behaviors, such as attention-deficit/hyperactivity disorder (ADHD), have an increased risk of also having intermittent explosive disorder.

Complications

People with intermittent explosive disorder have an increased risk of:

• Impaired interpersonal relationships. They're often perceived by others as always being angry. They may have frequent verbal fights or there can be physical abuse. These actions 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, car accidents, financial problems or trouble with the law.
• Problems with mood. Mood disorders such as depression and anxiety often occur with intermittent explosive disorder.
• Problems with alcohol and other substance use. Problems with drugs or alcohol often occur along with intermittent explosive disorder.
• Physical health problems. Medical conditions are more common and can include, for example, high blood pressure, diabetes, heart disease and stroke, ulcers, and chronic pain.
• Self-harm. Intentional injuries or suicide attempts sometimes occur.

Prevention

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. Your doctor may suggest maintenance medication to avoid recurrence of explosive episodes.
• 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 the problem right away, having a plan 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 recreational or illegal drugs.

Diagnosis

To determine a diagnosis of intermittent explosive disorder and eliminate other physical conditions or mental health disorders that may be causing your symptoms, your doctor will likely:

• Do a physical exam. Your doctor will try to rule out physical problems or substance use that could be contributing to your symptoms. Your exam may include lab tests.
• Do a psychological evaluation. Your doctor or mental health professional will talk to you about your symptoms, thoughts, feelings and behavior patterns.
• Use the criteria in the DSM-5. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, is often used by mental health professionals to diagnose mental conditions.

Treatment

There's no single treatment that's best for everyone with intermittent explosive disorder. Treatment generally includes talk therapy (psychotherapy) and medication.

Psychotherapy

Individual or group therapy sessions that focus on building skills can be helpful. A commonly used type of therapy, cognitive behavioral therapy, helps people with intermittent explosive disorder:

• Identify which situations or behaviors may trigger an aggressive response
• Learn how to manage anger and control inappropriate responses using techniques such as relaxation training, thinking differently about situations (cognitive restructuring), and applying communication and problem-solving skills

Medication

Different types of medications may help in the treatment of intermittent explosive disorder. These may include certain antidepressants ? specifically selective serotonin reuptake inhibitors (SSRIs) ? anticonvulsant mood stabilizers or other drugs if needed.

Coping and support

Controlling your anger

Part of your treatment may include:

• Unlearning problem behavior. Coping well with anger is a learned behavior. Practice the techniques you learn in therapy to help you recognize what triggers your outbursts and how to respond in ways that work for you instead of against you.
• Developing a plan. Work with your doctor or mental health professional to develop a plan of action for when you feel yourself getting angry. For example, if you think you might lose control, try to remove yourself from that situation. Go for a walk or call a trusted friend to try to calm down.
• Improving self-care. Getting a good night's sleep, exercising and practicing general stress management each day can help improve your frustration tolerance.
• Avoiding alcohol or recreational or illegal drugs. These substances can increase aggressiveness and the risk of explosive outbursts.

If your loved one won't get help

Unfortunately, many people with intermittent explosive disorder don't seek treatment. If you're involved in a relationship with someone who has intermittent explosive disorder, take steps to protect yourself and your children. The abuse isn't your fault. No one deserves to be abused.

Create an escape plan to stay safe from domestic violence

If you see that a situation is getting worse, and suspect your loved one may be on the verge of an explosive episode, try to safely remove yourself and your children from the scene. However, leaving someone with an explosive temper can be dangerous.

Consider taking these steps before an emergency arises:

• Call a domestic violence hotline or a women's shelter for advice, either when the abuser isn't home or from a friend's house.
• Keep all firearms locked away or hidden. Don't give the abuser the key or combination to the lock.
• Pack an emergency bag that includes items you'll need when you leave, such as extra clothes, keys, personal papers, medications and money. Hide it or leave the bag with a trusted friend or neighbor.
• Tell a trusted neighbor or friend about the violence so that he or she can call for help if concerned.
• Know where you'll go and how you'll get there if you feel threatened, even if it means you have to leave in the middle of the night. You may want to practice getting out of your home safely.
• Come up with a code word or visual signal that means you need the police and share it with friends, family and your children.

Get help to protect yourself from domestic violence

These resources can help:

• Police. In an emergency, call 911 or your local emergency number or your local law enforcement agency.
• Your doctor or the emergency room. If you're injured, doctors and nurses can treat and document your injuries and let you know what local resources can help keep you safe.
• The National Domestic Violence Hotline: 1-800-799-SAFE (1-800-799-7233). This hotline is available for crisis intervention and referrals to resources, such as women's shelters, counseling and support groups.
• A local women's shelter or crisis center. Shelters and crisis centers generally provide 24-hour emergency shelter, as well as advice on legal matters and advocacy and support services.
• A counseling or mental health center. Many communities offer counseling and support groups for people in abusive relationships.
• A local court. Your local court can help you get a restraining order that legally orders the abuser to stay away from you or face arrest. Local advocates may be available to help guide you through the process. You can also file assault or other charges when appropriate.

Preparing for an appointment

If you're concerned because you're having repeated emotional outbursts, talk with your doctor or make an appointment with a mental health professional who specializes in treating emotional disorders, such as a psychiatrist, psychologist or social worker. Here's some information to help make the most of your appointment.

What you can do

Before your appointment, make a list of:

• Symptoms you're experiencing, including any that may seem unrelated to the reason for the appointment
• Key personal information, including any major stresses, recent life changes and triggers for your outbursts
• All medications, vitamins, herbs and other supplements that you're taking, including the dosages
• Questions to ask your doctor

Some basic questions to ask your doctor include:

• Why am I having these angry outbursts?
• Do I need any tests? Do these tests require any special preparation?
• Is this condition temporary or long lasting?
• What treatments are available, and which do you recommend?
• Are there any side effects from treatment?
• Are there any alternatives to the primary approach that you're suggesting?
• I have other health conditions. How can I best manage these conditions together?
• Is there a generic alternative to the medicine you're prescribing?
• How long does therapy take to work?
• Do you have any printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

• How often do you have explosive episodes?
• What triggers your outbursts?
• Have you injured or verbally abused others?
• Have you damaged property when angry?
• Have you ever tried to hurt yourself?
• Have your outbursts negatively affected your family or work life?
• Does anything seem to make these episodes occur more often or less often?
• Is there anything that helps calm you down?
• Has anyone else in your family ever been diagnosed with a mental illness?
• Have you ever had a head injury?
• Are you currently using alcohol, drugs or other substances?

Be ready to answer these questions so you can focus on points you want to spend more time on. Preparing and anticipating questions will help you make the most of your time with the doctor.