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Intermittent Explosive Disorder

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

Childhood Sexual Abuse and Mental Health

Mental Health and Childhood Sexual Abuse – Don’t Carry the Secret

Recently I saw something on Facebook that was very sad.  It was a video of a 50 plus year old man named Scott – also called “Spider,” who told the story of his life through written cards, in a fashion similar to Ben Breedlove’s “This is my story” about his heart condition. In the video, this tough looking man, confessed the trauma of his own sexual abuse and the damage it had done to him over the years – drug abuse, divorce, culminating in an arrest for beating his child’s sexual predator with a bat.

The story was naturally sad but is all too common.  In fact, statistics shows that 1 in 6 boys will be sexually molested by the age of 18 and worse for girls with 1 in 3.  The other sad fact is that many, many children who are sexually abused don’t tell anyone.  Either they are threatened or ashamed – or both.  They carry the secret for much of their lives.

Trauma, abuse, neglect – biology didn’t account for its infliction on children.  As children, our brains develop best in a loving,
supportive environment with plenty of nutritional food and quality exercise so that our bodies become the best they can be.  Childhood Trauma - Mental HhealthAround the world we see the damage that poor nutrition, neglect and physical abuse can do to children.  What is not so obvious is the damage wreaked by sexual abuse – it is a hidden traumaSexual abuse is hidden by the child, hidden from the adults, hidden from other children, and sometimes even hidden by the child’s memory.

Secrets are always dark.  Carrying secrets can ruin a relationship or ruin a career.  Carrying secrets imposes a burden of stress on your body – your heart doesn’t work as well, your adrenal system gets burned out, your sleep is affected.  Carrying a secret like that can change a child’s brain.

Studies have shown that abuse or childhood trauma actually causes physical changes to the developing brain.  It can make the child unable to grow to what they would have been.

So what does this have to do with mental health?

The effects of childhood trauma are hard to predict.  Mental health is hard to identify – particularly the cause.  In some cases, we can easily point to the parents and say “Mom and Grandma have clinical depression; it is no surprise that the daughter has depression.”  Schizophrenia has been shown to be driven by over 100 genes and a child with one schizophrenic person has a 13 percent chance of developing the disorder.  Some people are “born” alcoholics in that they are missing an enzyme that allows them to process alcohol properly and will nearly always become addicted if they drink.

In other cases – we can’t identify the cause.  You have some cases of mental disorders that develop in people with perfect childhoods.  You have people with horrible experiences who are remarkably healthy – rare, but true.  In many cases though, someone with a history of child abuse will develop some mental disorder – but the type is very hard to predict.

In “Spider’s” case, he became a drug addict, had an anger problem and felt that he had to prove he could “conquer” women (his own words), leading to the destruction of his family.  Likely he suffered from depression, anxiety disorder, and possibly Mental Health - Child AbusePost-Traumatic Stress Disorder.  Telling the “secret”, not carrying the weight may, just may have kept him from his self-destructive behavior.  Unfortunately, it may not have stopped his daughter from being a victim, but it might have allowed him better tools than a bat to deal with her problem.

In severe cases, extreme trauma can actually cause the personality to “split,” in “Dissociative Identity Disorder” (DID), which was previously called “Multiple Personality Disorder” (MPD).

(Photo-source: http://blogs.ocweekly.com/navelgazing/2014/08/scott_spider_spideralamode_facebook_molest.php)

Sexual abuse has another problem – that children are often disbelieved which worsens the trauma.  Unlike physical abuse, unlike neglect, unlike starvation – there are no “obvious” signs.  There are signs, but you have to know what they are.  Children who have been sexually abused do exhibit signs:

•    changes in behavior or personality type – a normally outgoing child becomes withdrawn, a normally gregarious child becomes angry and sullen
•    bed wetting and nightmares (oddly the bed-wetting may be punished)
•    refusal to go to school, church, sports or club activities or to a certain friend’s house
•    sudden clinginess or a sudden desire to be left alone

Too often, adults don’t ask.  Too often, children don’t tell.  Sadly, sometimes adults won’t listen.  If you know of a child that has
sudden behavioral changes – ask.  If you are an adult, believe.  If you are a victim, tell.  Even at a late date, telling can change your life and resolve some of your “issues.” I think in the end, “Spider’s” main message was “tell your kids to tell.”

What does this have to do with mental health?

Sexual abuse can contribute to:

PTSD, Depression, Bipolar Disorder, Anxiety Disorder, Intermittent Explosive Disorder, Obsessive Compulsive Disorder, Bulimia, Anorexia, Drug Addiction, Alcoholism, Attachment Disorder… and many more.

History of Child Abuse – Free PDF

Melissa Lind