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Intermittent Explosive Disorder

Intermittent Explosive Disorder – More Than Just Anger

Intermittent Explosive Disorder (also called IED, that is appropriate as it can go off unexpectedly and cause significant damage)

Intermittent Hulk Explosive DisorderProbably everyone knows that teenage boy (or girl) who punched a hole through the wall.  Perhaps for some, this became a regular pattern of behavior during adolescence but most of those teenagers outgrew it.  In fact, at least one-quarter of teenage boys has done something dumb like punching a wall.

One boy I knew in high school even broke his hand by punching the roof of his car, and some boys were routinely doing stupid stuff.  Despite that, all of it was teenage angst and changes that can be attributed to the massive amounts of testosterone flowing through the male adolescent body – none of them had intermittent explosive disorder.

Intermittent Explosive Disorder is worse than punching a hole through a wall.

It typically is first identified in the early teens – but can be seen much earlier in some cases.    In order to be actually characterized as intermittent explosive disorder, an individual must have had three episodes of explosive behavior that is severely out of proportion to the stressor.

Intermittent Explosive Disorder HulkinsectThey must have broken or smashed something that is monetarily valuable (more than a few dollars), physically attacked or made explicit threats to attack someone with the intent of causing harm.  If these three episodes occur within the space of 12 months, the disorder is considered to be more severe.

Here is the catch.

How do you distinguish between IED, average – though extreme teenage behavior and other psychiatric conditions?  It turns out that IED is probably a diagnosis of “if nothing else fits” as other psychiatric disorders certainly overlap with similar symptoms – and you have to rule out the adolescent hormone issue.

Bipolar disorder may cause outbursts of extreme anger and agitation, Borderline personality disorder may cause outbreaks, ADHD patients can exhibit a severe lack of self-control, and drug abuse is always a potential cause.  Even though those diseases may cause IED-like events, a sustained behavior pattern is something to address.

Intermittent Explosive Disorder WarningA recent study reported by the National Institutes of Health shows that IED can actually affect up to 4 percent of adults and lead to an estimated 43 attacks over a lifespan.  The disorder may also increase that chance of depression, anxiety and substance abuse disorders.  People with IED have an obvious increased risk of legal trouble, financial difficulties, and divorce – that’s a no-brainer.

So the biggest problem for mental health professionals, like many other disorders, is to untangle all of the information leading in and out with a mix of behaviors and a mix of causes.  What came first – the chicken or the egg?  What came first – the drug abuse or the anger?  Which illness is more important – bipolar disorder or the IED?

One of the biggest clues may be in examining (or better, paying attention to) behavior that occurs before puberty.  In other words: What came first – the behavior or puberty?  Clearly if the behavior started before puberty, there was and is an issue.  If the behavior begins during adolescence – you have to wait (and hope) to see if the behavior goes away once the hormones are settled.

IED is not a simple diagnosis.

It requires a careful examination of an entire psychiatric and behavioral history – and the “ruling out” of a lot of other disorders that may be to blame.  Unfortunately, in the end – unless an underlying cause can be found, there is no medicationAnger management and cognitive behavioral therapy are likely the only answer – minimization of harm, not very satisfactory if it was your car window that got smashed in a fit of rage.

Melissa Lind

Depression – When to Seek Help

Some level of depression is perfectly normal and does not require treatment

Sad and Depressed GirlWe all feel a little down or a little “blue” from time to time. We all have life events that will make us feel very sad as well, such as the loss of a loved one, the breakup of a relationship, financial difficulties, etc.

In most cases, however, these down periods are temporary. At what point, however, should you seek help for your depression? While people feel depression in different ways, and to different extents, there are specific warning signs that one should look for when determining whether or not they actually need treatment or not.

First, if your depression has lasted for more than a period of two weeks, you most likely need to seek treatment. Make an appointment with your medical doctor for a checkup, and discuss your feelings with him. He will most likely perform a physical exam to determine if there is a physical cause for those feelings, and he will also ask about your life events and current stressors.

Other than seeking help if the sadness lasts for more than two weeks, another sign that help is needed — immediately — is if you are having suicidal thoughts, or if you have already attempted suicide.
Do not wait to seek treatment. Contact your doctor, or call a suicide hotline for immediate help!

Feeling HopelessEven if depression is temporary, all of the other symptoms of depression are normal — except for the two discussed above. You may have a change in sleeping and eating patterns, you may feel like everything is hopeless. You may have the fatigue and the aches and the pains.

But again, if those symptoms do not go away within two weeks, or you feel suicidal, treatment is needed.

In many cases, a medical doctor can treat you for the depression, depending on the cause and the severity of your mental state. The important thing is to seek the help and to be as honest with your doctor as possible — whether your doctor is a therapist or not, he (or she) must still keep all conversations with you in confidence.

When should one seek help in cases of depression?