“Intermittent Explosive Disorder”

It’s that time of the year again!  Happy Holidays, lots of cheer and tension and stress.  And in such conditions, the possibility that someone will explode goes up.  And with it the chances of misery and even injury, perhaps a permanent break in a family group.

This blog has been very concerned about domestic abuse, and the fact that women are so often the target.  So I was  interested to see today in a list of recent papers that crossed my desk a reference to intermittent explosive disorder.   (I  didn’t know it had such an official name!)

According to the Mayo Clinic, this is a disorder characterized by:

Intermittent explosive disorder is characterized by repeated episodes of aggressive, violent behavior in which you react grossly out of proportion to the situation …  Later, people with intermittent explosive disorder may feel remorse, regret or embarrassment.

Explosive eruptions, usually lasting 10 to 20 minutes, often result in injuries and the deliberate destruction of property. These episodes may occur in clusters or be separated by weeks or months of nonaggression.

Road rage. Domestic abuse. Angry outbursts or temper tantrums that involve throwing or breaking objects.

Like many other clinical diagnoses, the behavior described may be exhibited without the full disorder, so there can be a number of different conditions that produce the frightening 10 to 20 minutes of rage that may be accompanied by behavior designed to hurt, either physically or emotionally.   

These anger fits can be dangerous; they should less bad that the systematic bullying and brutalizing that can go on.   But as always, anyone feeling in danger needs to try to get out of the situation. 

If it seems not that bad – maybe all that will happen is that a day is ruined for the rest of the family – then simply heading the tantrum off might be possible.  It completely sucks  to be stuck with such a problem, and the last thing you should think is that  you are responsible; think of taking action as instead like a way to protect oneself against the elements.

The Mayo Clinic suggests part  of the solution lies with anger management.  If you know someone you are concerned may throw one of these frightening tantrums, you might consider whether you can use any of the information on self-management.  Some of these translate into ways to head off the behavior in others.  For example, you can arrange some time out by suggesting a walk or another sort of break.  Other  things you might talk over with people who seem likely to explode. 

  1. Take a ‘timeout.’ Although it may seem cliche, counting to 10 before reacting really can defuse your temper.
  2. Get some space. Take a break from the person you’re angry with until your frustrations subside a bit.
  3. Once you’re calm, express your anger. It’s healthy to express your frustration in a nonconfrontational way. Stewing about it can make the situation worse.
  4. Get some exercise. Physical activity can provide an outlet for your emotions, especially if you’re about to erupt. Go for a brisk walk or a run, swim, lift weights or shoot baskets.
  5. Think carefully before you say anything. Otherwise, you’re likely to say something you’ll regret. It can be helpful to write down what you want to say so that you can stick to the issues. When you’re angry, it’s easy to get sidetracked.
  6. Identify solutions to the situation. Instead of focusing on what made you mad, work with the person who angered you to resolve the issue at hand.
  7. Use ‘I’ statements when describing the problem. This will help you to avoid criticizing or placing blame, which can make the other person angry or resentful — and increase tension. For instance, say, “I’m upset you didn’t help with the housework this evening,” instead of, “You should have helped with the housework.”
  8. Don’t hold a grudge. If you can forgive the other person, it will help you both. It’s unrealistic to expect everyone to behave exactly as you want.
  9. Use humor to release tensions. Lightening up can help diffuse tension. Don’t use sarcasm, though — it’s can hurt feelings and make things worse.
  10. Practice relaxation skills. Learning skills to relax and de-stress can also help control your temper when it may flare up. Practice deep-breathing exercises, visualize a relaxing scene, or repeat a calming word or phrase to yourself, such as “Take it easy.” Other proven ways to ease anger include listening to music, writing in a journal and doing yoga.

Any other suggestions?  Comments?  Thoughts?

26 thoughts on ““Intermittent Explosive Disorder”

  1. Cripes–I have this syndrome. However I never yell AT anybody since I’m mad at the Universe rather than at any individual and I never say anything I would regret because I just bellow inarticulately.

  2. I lived with several people, beginning with my father, with said disorder (although I never knew that it was an official disorder before reading the post): the slightest remark, one that normally would go unnoticed, can trigger verbal or physical violence. The best tactic is to play dumb and to tell them that they are right, to apologize for whatever inoffensive remark set off the screaming blitz and then get as far as one can from the enfuriated household member: take a walk, a drive, go to the movies. In my experience, the people involved never express remorse or regret, and there is no point reasoning with them about the incident, during or after it. Forgive, of course. Yes, they would profit from anger management, but they enjoy being angry too much to give up its pleasures. Anger provides the primary pleasure of the adrenaline rush, of the feeling of power, of being absolutely right, and provides the secondary gain of scaring other household members into letting that person get his or her way. Keep cool; arguing back does no good at all.

  3. Christine, I was listening to a local activist saying yesterday that she was through with activist groups unless they’d all done a lot of emotional work on themselves. She said they tear each other apart with relentless viciousness. I’ve since been wondering what philosophers share with activists. Though real fits of anger, adult tantrums, do seem special.

    HEB: You have a very large vision! I find it hard to get angry at anything larger than, say, a group of male philosophers at an APA. Tantrums, I have to say, are not my style, though fairly rude remarks made with utter earnestness can get me into enough trouble.

    Steve, that does sound so difficult. I am really sorry to hear about your experience. I have wondered whether such people have any idea of the effects of what they’re doing. I have suspected they enjoy it, and it actually seems to me extremely self-indulgent, but I always feel sort of british and repressive when I say that. I mean, the US is the place when bottling up is frowned upon.

  4. Steve, thanks also for your suggestions of what to do – and you too, Christine. I’m a bit taken aback to think that there are temper tantrums at many departments, though I know for a fact there are some at some. Still, on general principle about one’s sanity, staying away is good.

  5. i wonder how useful it is to call this sort of behaviour a ‘disorder’.
    (jj, i think your list of suggestions are good ones for anyone. we all get angry now and again, and many of us could do a better job of expressing our anger constructively!)

  6. elp, I think that’s a great question. I think there really are two aspects that are important.

    1. I had tried to suggest that the disorder would be more than the behavior (the behavior could have different causes), but I didn’t know what constituted the disorder. Nor does there seem to be any consensus on this in the literature, as far as I could see. In fact, as one psychotherapist says:

    So for some individuals, all the screaming,
    honking, throwing, and verbal violence
    may be attributed to IED, and they
    need to be taking anti-depressants and going
    for cognitive behavioral therapy that
    will help them deal with anger. But what
    about those who don’t have IED and who
    really believe that it is acceptable to aggress
    in order to get whatever they want whenever
    they want it?

    I.e., It this an illness or just selfish as**ole behavior? One author suggests that IED should be seen as a cluster of symptoms that accompany mental illnesses of various sorts.

    2. Can we just regard people with IED as unmitigated as**oles? How should we think about psychological disabilities that involve causing pain and grief to others? It’s been suggested that some corporate malfeasance is due to psychological disorders that result in some agents having no ability to imagine the pain they will cause. I just don’t know how to think about this, but I do think that people who have no emotional urge to refrain from the wrong thing are at a great disadvantage.

    The quote above was from:
    Rosenberg-Javors, Irene. Annals of the American Psychotherapy Association, Winter2006, Vol. 9 Issue 4, p36-36,

  7. Leaving aside the question of a correct diagnosis, in my experience it’s much easier to deal with, on a day to day basis, someone with a disorder than someone who is selfish, even if that disorder could be seen as selfish, just as it’s easier to deal with some who is depressed than with someone
    who refuses to pull him or herself together and put his or her shoulder to the wheel. That is, since human motivation is very complex, so complex that even introspection does not always explain why one does what one does, the best hypothesis for living together with others is to see so-called mental health problems as disorders or sicknesses rather than as personal defects.

  8. yes steve, i suppose that’s part of my worry: it’s easier to live with. so, if i’m in a relantionship with a person who has these explosive violent episodes, i could say ‘he/she’s an as**ole, i ought to get out of this relationship’ or i could say ‘she/he has a disorder; i ought to stick it out and be supportive’. and this latter might include things like not holding the person to account for the abuse. so, seeing it as a ‘disorder’ could actually stop one getting out of an abusive relationship, it seems like…

  9. I think I feel a bout of annoyed-with-therapists-peddling-pharmaceuticals-and-encouraging-victimization-syndrome coming on.

    Chant with me in my “happy place”…Matt Damon…ooom…Goodwill Hunting…ooom…shirtless…ooom…

  10. elp and Steve, the comparison with depression is interesting. It does seem that some cases of depression are very serious; they possibly have to do with causes way outside the present situation and could lead to pretty bad things, such as suicide. Maybe there are other cases of a kind of self-indulgent, narcissistic malaise.

    The problem with IED is that in either case one has a harmful and destructive syndrome. It isn’t clear one has any obligation when the case is mere self-indulgence. But I’m wondering what to think about the case where the disorder seems real and grounded in, perhaps, somewhat pervasive problems about understanding other people, for example.

    Are there any conditions where one is obliged to stay and try to be supportive if the behavior is very destructive?

    It may be that we should look at other complicating factors. A 10 year old who has tantrums might seem to bring different obligations from those of a 50 year old.

  11. Just because a particular chemical flux responds well to a particular medication in a preliminary study with 150 people does not mean it’s time to call it a “new” disorder and start selling “brain candy” to everybody that gets angry.

    You’re right, JJ. The symptoms of this “disorder” could be part of half a dozen other psychiatric afflictions requiring other remedies, an ear infection, PMS, or plain old frustration at “not being allowed to choke the s**t out of some **h*le (like one’s boss) who desperately deserves it”.

    At the very least, the people who named this “disorder” should conduct further research. I mean, 150 subjects with such an atomistic range of test parameters? Come on…

  12. Destructive disorders evoke our compassion a lot less than suffering ones do, so we (or at least I) tend to feel more solidarity and compassion with depression than with explosive disorders. However, if both depression and IED are true sicknesses, I suppose that our response, in ethical terms, should be more or less the same. If one is obliged to stay in a relationship and help someone who is destructive depends a lot on the relationship, doesn’t it? By the way, helping a person isn’t always the same as maintaining a relationship: you can help a person by keeping a certain distance, insisting that the person seeks therapy, being supportive without being intimate, etc. It’s not an either/or, Hollywood divorce type of thing: that is, I leave you, never see you again, sue you in court, sell your story to the media. It’s possible to deal with the situation in more adult terms.

  13. Xena, the article about medication wasn’t introducing the name. There’s been a lot of experimental work trying to correlate differences in brain functioning and IED. And I think we should try to distinguish between the uncontroversial claim that there’s a pattern of behavior and the claim that some of it is due to a disorder.

    Steve, I think you are right about what helping needn’t involve. I’m not sure I agree about the compassion, though that’s difficult. I think it’s also the case that one should be pessimistic about changing people, which might be the only help that could help, as it were. Another thing I suspect is that people who go in for socially destructive behavior often have trouble understanding the consequences of acting as they do. Not because they can’t predict, but rather because they are missing some of the initial cues from other people that lead many of us to feel that some actions could be very harmful to a relationship.

  14. I agree that people with socially destructive behaviors miss some clues: I’m not sure why. However, I don’t agree that the only way to help someone with socially destructive behaviors is to change him or her. People with socially destructive behaviors tend to go downhill in life: they lose jobs, don’t finish school, blow relationships, fight with family. One way to help such a person, if he or she cannot be changed, is to provide sufficient support that he or she feels that there is a base or support-net to his or her real or potential fall in life. I’m thinking not only of the person I know with IED, but also of a friend whose daughter has several drug problems. No one knows you when you’re down and out, as the song goes, and if you are capable of maintaining a friendship, even with conditions (respect for your space, distance, etc.) with someone who is down and hill or going there, you’ll help.

  15. Sometimes things are just wrong. Sure, I agree that maturity and anger management are key. But anger is not the enemy. There’s being angry, sure, and then there’s being a dick. Good girls – women and men do get angry and it can be the fuel to better circumstances.

    I think we are too quick to medicate and shush anger when it could be the change-making energy we need. There are all sorts of social injustices happening and the need for big change, yet with all the medicated and dulled people, there is no outrage. Some else will say something, confront, and so on. Why take the trouble and besides, anger is so unattractive. Go along to get along.

    And the worst – the “The Secret” new age blaming of angry people as if…if they weren’t angry, things would be kittens and giggles for them. In fact, blaming them: their very anger is creating their bad circumstance! If they weren’t “so” angry, they would not experience injustice, sexism, racism, bad luck, layoffs, unemployment, bad health and cancer.

  16. Sally, I’d hate to think this post would be read as against getting angry, so I’m glad you’ve brought the point up. IED should be understood as about bursts of anger that are WAY out of proportion to what has happened and that too often lead to real destruction. And the angry person is pretty much out of control. So think of road rage that ends up with someone shooting at your car because they think you cut them off, or the colleague who goes into orbit and writes colleagues with false accusations about you. Really harmful stuff based on an exceptionally disordered take on the actual situation.

    I like your thought, Sally, that too many people are drugged into complacency, but I’m not sure that’s quite true. A draft would probably take us back to some of the anger of the 60’s, for example. And we have little real social or political leadership.

    Steve, I have the feeling we’re talking almost at cross purposes, which may be in part because we’re thinking of very different sorts of cases. The cases I am thinking of are really ones where someone is on the unbalanced side and targets people, hurting them and maybe trying to hurt them. That’s very different from drug abuse, but if the abuser there starts to put you and people you love in danger – as can happen – we might be closer to talking about the same sort of case.

  17. I’m in a relationship with a person who has IED and used to consume cocaine… The trigger for him is alcohol and stressful moments. He’s always being fired, can’t finish studies, he’s always mad about something, had several relationships and so on… He’s always remembering child memories (violent episodes with is sister and father) and after the death of his grandfather, the only paternal figure he had, it’s been worse. The emotional explosion it self is basically 10 to 20 min, but after he talks for hours, almost 24h with non-stop talking. He usually sleeps with exaustian. This is the bad part… The good part is that he’s a wonderful person, caring and have lot of love to give. He’s intelligent and he only needs comprehension and support. If I listen and try to comprehend him when is frustrated with something and give him some space and respect he feels less frustrated. But I’d realized that if I’m too supportive, I do pressure on him because he felt I’m too good form him, that I’m perfect and I don’t need him for nothing because is nothing to offer me. So you had to be careful and just be there, listen and you have to love the person to be on there side. Once or twice days a week (sometimes more) I go away, leave him with his thoughts, give him some time and space. It seems to work so far…

  18. I tend to be a little skeptical whenever non-professionals diagnose mental disorders in themselves or people they know. This is not to say that they’re always wrong, but it always seems as though whenever you describe the symptoms of ADD, OCD, SAD, or some similar disorder, inevitably half the people in the room exclaim “Oh–I have that!” (Indeed, I think it’s somewhat interesting to ask just what might motivate people to do this.)

  19. It sounds familiar: in my case, she’s also always being fired, she’s also always angry, she also can’t finish her studies, she also talks for hours and hours about her problems without letting me get a word in. However, no drugs or alcohol here. In any case, you sound like an extraordinarily well-intentioned and caring person and I hope that things work out for you.

  20. I found this forum by googling some symptoms. I especially found post 18 interesting b/c my husband and those who know me the best or even hardly know me at all would says the same thing about me. I am intellegent and loving and compassionate and fun outspoken hard working ambitious I love people I love to help people I feel that I have a good heart and I certainly would never ever wish to hurt anyone or anything, I suffer to think of the pain of others in any form. but here I am knowing I have something wrong with me,b/c I am the cause of so much pain to my loved ones. I am 25 and female mother of 4, a full time student, mother, wife, so on and so on… I have had ” anger issues” since I was a child. Indeed I have so many “traumatic events” and environmental factors that play into what some may say is the “source” of my problem. Most of the time I feel very logical and “together” yes i am a little “high strung” they say in any situation that imposes the slightest amout of stress on me..(school mates say) But I feel thatI am in control of myself. since I was about 16-17 I knew I had a problem, I was told i had depression (i tried meds for that but no results so i would stop them) at that age after having kids it just got worse. I tried anger management techniques and calming techniques, and journals. I could always feel the tension building ahead of time, like the walls are closing in slowly or like you know people are whispering about you behind your back when you logically know they arent. and i could feel the burning come on in an instant it hit me.. example:…. had a great day in ADN clinicals everything was great…..I come home and if the phone rings the house is dirty i know i have homework the kids are telling me about their day, the baby needs a diaper changed, and then someone asks me whats for dinner (BAM!!!!!!) look out. all these things were noticed within a minute of walking in the house no reason for me to go off on a rampage and do the things i do or say the things i say that are so horrible mean and unlike who I know that I should be…. things i dont mean, things that they didnt mean but some how my brain twisted it..but in that moment it was a “truth”- how it really was- idk how to explain it. but after the attack… i feel so horrible guilty and exhausted, just drained to the point that i cant function. but i feel that initial overwhelming tension/ anxiety/ panick… whatever you call it ( feeling like i will die if i dont have the outburst i guess)..is gone… i could go a couple of weeks then or even a month or sometimes it will only take a few days… before it happens again….in the end things are so distorted and far from the original trigger I cant even remember how I got there…..REading this post was like it was like reading a post about me. as well as the initial topic itself.Like post 18 i too can “talk it out” for 24 hours without stop and my “want” from it is only to be “understood” and forgivness for what i did… the need for that is so strong that if he stays mad at me..like he has every right in the world to… it could likely send me into another bout of rage. which starts the love-hate cyle i have so much of in my life. i love him so much i feel i would rather let him leave me so he doesnt suffer by me.. does that make sense? its horrible the guilt the shame … my kids are suffering from my problem my marriage is hanging on by a thread, and I dont know what to do… I tell my husband i need meds.. he say you are an adult you should be able to control yourself without them… and I know.. I SHOULD be able to but i never can.. i dont plan it..i feel it but its so hard to control. I have to make the completely conscious mental effort and use all of my attention and all my strength in that very moment i feel it for like twenty minutes at least focused on nothing more than not losing control….and if i can do that then it will pass and i make it through with no more than a few dirty looks..but trying not to do it is just as exhausting as having it happen but the goal is that nobody/nothing gets hurt emotionally or otherwise. And with all that i have going on in my for years i have had the coming and going of this…i dont want to be this way i need help

  21. Arod: It sounds that you are simply stressed past the breaking point: diapers to change, dinner to cook, homework, the phone ringing, etc. All that would cause the Dalai Lama to lose his cool and mystic inner peace, although I’m sure that he has an army of servants to tend to him. Do your children and your husband help with your incredible load of multitasks? Are household chores shared fairly? In my case, just a ringing phone is enough to set off a series of unprintable words. At times, it’s wise to take the phone off the hook.

  22. Arod, it looks to me as though there are at least two different dimensions to your problem. One is practical; amos is right, you seem to have a highly stressful situation. If you are like most women, you are not getting the help you need from your husband; can you get members from your more extended family to help? Perhaps you could hire a local school kid to come in in the evenings and help with the more simple mechanics? I am reluctant to suggest anything about your education, but you might consider taking some time off.

    The thing is, you are right; what’s happening is probably not good for your marriage, and it is not good for the children.

    There’s another dimension you raise, which is a clinical dimension. I’m not a clinician, so I don’t know what to say, except that of course you may need clinical help. We do know a lot more about anti-depressants each year, and you may find a good specialist can help you find a drug that works.

    Do know that feminists have pointed out for decades that women get put in impossible situations and end up ill, even mentally ill, for a variety of reasons. Being ill may protect someone from further harm, for example. Or sometimes a family needs to locate all their problems in one individual who is pretty much instructed to be ill.

    In any case, please try simple routes to getting help with the children. Just having a helper for two hours each evening might make a huge difference, if you can afford it. At baby sitter wages, it might not be too expensive.

  23. One tip that tends to be underestimated is changing your physiology. When you change things like your posture and facial expressions from someone angry to someone relaxed it helps you relax easier on the inside. Also most of our communication is non verbal so it benefits you there also.

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