What Is Intermittent Explosive Disorder?
“I didn’t mean to do it,” said Andrew after slapping his coworker across the face. Andrew had succumbed to the impulse to hit him in response to a small offense that consisted of his co-worker having previously told him “you should have worked harder on this task.” This is a good example of an episode of physical aggression from an imaginary patient with intermittent explosive disorder.
Although the comment in our example could be hurtful in certain circumstances, the response with which Andrew reacted was clearly excessive. Under normal circumstances, a comment like this wouldn’t be followed by these harmful consequences.
“The patient is aware of their aggression, but can’t control it.”
An approach to the concept of intermittent explosive disorder (IED)
For the World Health Organization (WHO, 2020), IED is characterized by the existence of brief but frequent incidents in which another person is verbally or physically assaulted. Behaviors that have to do with the destruction of objects or property would also be included here. This occurs because the individual is unable to inhibit their aggressive impulses.
In addition, the intensity that characterizes the outbursts is completely disproportionate to the stressor that causes them. For the American Psychiatric Association, these attacks must happen at least a couple of times each week for a minimum period of three months.
To differentiate IED from other more serious entities related to impulse control, such as behavior disorders, the consequences of IED don’t result in significant physical injury or harm.
The attacks are far from premeditated. Rather, they’re impulsive. They must produce a substantial deterioration in important areas for the person, such as work, interpersonal relationships, or school. At the same time, the ultimate goal of aggression is the release of the impulse. This differentiates it from instrumental aggression, in which an attack is made with the aim of achieving something tangible.
“Impulse is the medium of emotion; the seed of all impulse is a feeling bursting to express itself in action.”
The symptoms of the episode begin and end with extraordinary rapidity. In fact, they don’t last more than half an hour. They’re produced in the face of small provocations by people in the environment that, under normal circumstances, wouldn’t produce this reaction in other people.
In fact, patients describe IED as feeling “hijacked by their impulses.” Prior to the attack, the absolute need to respond aggressively arises and, immediately afterward, they obtain the feeling of “being liberated.” After the episodes, they often feel emotions such as dismay, guilt, shame, or regret.
“One’s greatest challenge is to control oneself.”
Prevalence refers to how many cases of this clinical entity exist (or existed) in the population, at a given time. In this regard, almost 3 out of 100 people suffer from IED in the world. However, there are differentiated prevalence profiles depending on the population.
If we take people who go to a basic mental health center as a reference, 13 out of 100 suffer from ISD. On the other hand, if we take people who are hospitalized as a reference, it has been found that up to 7 out of 100 people are diagnosed with this disorder.
In addition, it’s more common to find IED in young people between 30 and 40 years of age (APA, 2015), compared to older subjects. It’s also more common for the disorder to emerge in people with little education.
“Anger doesn’t demand action, when you act in anger you lose control.”
The development and course of intermittent explosive disorder
Intermittent explosive behaviors usually appear at the end of childhood, when the affected person enters adolescence. They can last a long time, even years. In addition, it’s common to observe a history of explosive behavior during childhood.
The way IED develops is referred to as the course. In this regard, IED adopts a course in episodes. It’s far from being something that occurs insidiously or progressively. However, the episodes have a tendency to become chronic over time.
Regarding the prognosis, the evolution of the disorder will be better the older the person is. However, paradoxically, being older is also associated with a more ineffective response to psychotherapy (APA, 2015).
“I count him braver who overcomes his desires than him who conquers his enemies, for the hardest victory is over self.”
Risk factors and prognosis
We can distinguish between two types of risk factors: Environmental and biological. Regarding environmental factors, it has been found that abusive situations that potentially trigger trauma are a perfect breeding ground that feeds the probability of developing ISD in the first twenty years of life. In addition, for Belloch (2020) both physical and psychological trauma during early childhood can increase the risk.
At a biological level, an increased risk of EID has been found in siblings, children, or parents of patients with this disorder. There could be dysfunctions in the way the serotonin molecule works in a specific brain region: The limbic system. This brain center is one of the great regulators of impulsivity and the emotional universe.
Specifically, a structure of this system would be altered. Namely, the anterior cingulate. At the same time, another region of the system, the amygdala, would be activated excessively. Furthermore, according to Belloch (2020), the size of the prefrontal cortex could be decreased.–
Discover more: Differences Between Hormones and Neurotransmitters
Logically, EID produces an enormous impact on the life of the person who suffers from it and on those around them. As a consequence of the attacks, problems can arise at a social, occupational, and legal level.
One of the consequences of the above is the beginning of disorders related to the abuse of drugs such as alcohol and a lack of emotional stability.
Cultural characteristics and gender
IED occurs throughout the world, however, its expression may vary by culture. For example, the American Psychiatric Association (2015) indicates that the prevalence decreases in certain countries in Asia, the Middle East, Romania, and Nigeria. On the other hand, men tend to be the most affected by this disorder.
“Violence is an uncontrollable animal that usually ends up attacking its own master.”
This term refers to the coexistence of two or more psychological disorders in the same person. In this regard, it’s common for IED to concur with depression in almost 40% of patients, while anxious symptoms occur in up to almost 60% of those affected. At the same time, drug addiction can occur after the symptoms of IED begin.
Despite the fact that an electroencephalogram produces normal results initially, non-specific alterations may appear, such as the transposition of letters, slowing of the EEG, and other minor neurological signs (APA, 2015). Biochemical alterations have also been found. Specifically, in the levels of serotonin and other monoamines whose function is to regulate the limbic system and the inhibition of impulses.
In addition, there are a number of psychological characteristics that could increase the risk of reacting violently. Such is the case of poor self-esteem or paranoid or antisocial personality traits. A psychopathic personality could also predispose one to ISD.
A complex disorder that must be detected and treated
Growing up in environments where violence is the norm rather than the exception and where the child is abused and parenting is negligent are powerful factors that predispose one to the development of this clinical entity. IED is a complex disorder. In this regard, it’s important to continue researching in this regard with the aim of being able to better define it and develop more effective, safe, and efficient lines of treatment.
Belloch, A. (2023). Manual De Psicopatologia. Vol. II (2.a ed.). MCGRAW HILL EDDUCATION.
CIE-11. (s. f.). https://icd.who.int/es.
First, M. B. (2015). DSM-5. Manual de Diagnóstico Diferencial. Editorial Médica Panamericana.
Mallén, V. (2017). Trastorno explosivo intermitente: una propuesta para su supervisión en el aula. https://repositori.uji.es/xmlui/handle/10234/169170.
Bustamante, G. (2013). Transtorno Explosivo Intermitente (TEI). Revista de Actualización Clínica Investiga, 35, 1824. http://www.revistasbolivianas.ciencia.bo/scielo.php?script=sci_arttext&pid=S2304-37682013000800008&lng=es&nrm=iso.