Intermittent Explosive Disorder – More Than Just Anger
Probably 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.
They 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.
A 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 medication. Anger 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.