Intermittent Explosive Disorder (IED)

What intermittent explosive disorder looks like

Outbursts are usually sudden, with little warning, and last less than 30 minutes. They may include:

• yelling, screaming, tirades and heated arguments
• threatening others
• slamming doors, throwing or breaking objects
• pushing, hitting or fighting
• road rage

Before an outburst, people may feel tension, racing thoughts, tightness in the chest, a pounding heart or tremor. Afterward, many feel relief, then regret, guilt or embarrassment.

Between outbursts, people with IED may be chronically irritable or impulsive, or may seem calm.

DSM-5-TR criteria in brief

1. Recurrent outbursts showing failure to control aggressive impulses, either: - verbal aggression or physical aggression without damage or injury, occurring on average twice a week for 3 months, or - 3 outbursts involving damage to property or physical injury within 12 months
2. Aggression grossly out of proportion to the provocation
3. Outbursts are not premeditated or aimed at a goal such as money or power
4. Outbursts cause distress or problems at work, at home, financially or legally
5. Age at least 6 years
6. Not better explained by another condition, a medical cause or a substance

Causes and risk factors

The exact cause is unknown. Contributing factors include:

• brain function: differences in brain areas that regulate emotion and impulses, and in serotonin signaling
• genetics: IED tends to run in families
• childhood environment: exposure to violence, abuse or harsh discipline
• trauma
• male sex and younger age

Conditions that often occur with IED

• depression and anxiety disorders
• ADHD
• post-traumatic stress disorder
• substance use disorders
• other impulse-control and conduct disorders

Conditions to rule out

Diagnosis

A mental health professional diagnoses IED through a detailed interview, sometimes with input from family. A physical examination and blood tests may be done to rule out medical or substance-related causes.

Treatment

Psychological therapy

Cognitive behavioral therapy (CBT) is the best-supported treatment. It helps people:

• recognize early warning signs and triggers
• challenge thoughts that fuel anger
• use relaxation techniques such as slow breathing
• practice problem-solving and assertive communication
• use time-outs to leave situations before escalating

Group, individual and family formats can all help. Anger management programs build similar skills.

Medicines

There is no medicine specifically approved for IED, but some reduce impulsive aggression:

• SSRIs such as fluoxetine have the strongest evidence
• mood stabilizers and some anticonvulsants in selected cases
• treating coexisting ADHD, depression or substance use

Self-help

• notice physical signs of rising anger and step away
• slow breathing: in for 4 counts, out for 6
• regular exercise and sleep
• avoid or cut down alcohol and drugs
• plan responses to known triggers in advance

Outlook

IED is often long-lasting, but outbursts may lessen with age. Treatment can significantly reduce the frequency and severity of outbursts, protecting relationships, work and safety.

Frequently asked questions

What is intermittent explosive disorder?

It is a mental health condition with repeated, sudden outbursts of anger or aggression that are far out of proportion to what triggered them. Outbursts are impulsive, not planned, and cause distress or problems in daily life.

What triggers intermittent explosive disorder outbursts?

Outbursts are often triggered by minor frustrations, perceived insults or disagreements. Stress, alcohol, lack of sleep and feeling disrespected can make them more likely. The reaction is much stronger than the situation warrants.

Is intermittent explosive disorder treatable?

Yes. Cognitive behavioral therapy that teaches recognition of triggers, relaxation and coping skills is effective. Medicines such as SSRIs can reduce impulsive aggression. Treating related conditions like depression or substance use also helps.

What is the difference between IED and normal anger?

Everyone gets angry, but in IED the outbursts are repeated, sudden, and grossly out of proportion to the trigger, and they cause harm or significant problems in relationships, work or with the law.

At what age does intermittent explosive disorder start?

It usually begins in late childhood or adolescence. It can be diagnosed from age 6, but it is most often recognized in teenagers and young adults.