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by EBSCO Medical Review Board
(IED; Recurrent Aggressive Behavior; Disordered Aggression)

Definition

Intermittent explosive disorder (IED) is a problem controlling impulses. A person has frequent verbal or physical outbursts that do not match what is happening. It can make it hard to be in a social setting or relationships.

Causes

The cause is not known. It may be a mix of genetics and the environment.

Risk Factors

This problem is more common in men and in people who are 40 years of age and younger.

Other things that may raise the risk are:

  • Having other family members with these problems
  • Behavior problems in children, such as attention deficit hyperactivity disorder (ADHD)
  • Toxoplasmosis—an infection caused by a parasite
  • Substance use disorder
  • Problems managing emotions
  • Abuse or family violence in children

Symptoms

Problems may be:

  • Repeated verbal or physical outbursts that start quickly and last less than 30 minutes
  • Getting very upset by small problems
  • Breaking objects, such as furniture or cars
  • Hurting people or animals
  • Feeling relieved after an outburst and then feeling concerned
  • Having less severe outbursts in between severe ones

Diagnosis

The doctor will ask about symptoms, and physical and mental health. Physical and mental health exams will be done.

Treatment

The goal of treatment is to stop outbursts.

Therapy may be used to help a person learn how to control outbursts. Choices are:

  • Cognitive behavioral therapy (CBT) to learn how to control emotions, manage anger, and solve problems.
  • Group therapy to learn with others who are struggling to control outbursts
  • Training to help parents manage their child’s outbursts
  • Relaxation methods

Medicines may be given to ease outbursts. These may be:

  • Antidepressants
  • Mood stabilizers
  • Antiseizure medicine

Prevention

There are no known guidelines to prevent this problem.

RESOURCES

American Psychiatric Association  https://www.psychiatry.org 

Mental Health America  https://www.mentalhealthamerica.net 

CANADIAN RESOURCES

Canadian Mental Health Association  https://www.cmha.ca 

Canadian Psychiatric Association  https://www.cpa-apc.org 

References

Coccaro EF. Intermittent explosive disorder as a disorder of impulsive aggression for DSM-5. Am J Psychiatry. 2012 Jun;169(6):577-588.

Felthous AR, Stanford MS. A Proposed Algorithm for the Pharmacotherapy of Impulsive Aggression. J Am Acad Psychiatry Law. 2015 Dec;43(4):456-467.

Intermittent explosive disorder. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/intermittent-explosive-disorder. Accessed January 20, 2021.

Sukhodolsky DG, Smith SD, et al. Behavioral Interventions for Anger, Irritability, and Aggression in Children and Adolescents. J Child Adolesc Psychopharmacol. 2016 Feb;26(1):58-64.

Treating intermittent explosive disorder. Harvard Health Publishing—Harvard Medical School website. Available at: https://www.health.harvard.edu/mind-and-mood/treating-intermittent-explosive-disorder. Accessed October 13, 2020.

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