Do you sometimes get so angry that you can't even control it, even over a small incident? You scream, slam doors, throw things on the ground, and sometimes even hit someone. After it's all over, do you feel a lot of sadness and shame, thinking, "Oh, why did I do that?" If you've had this experience, you're not alone. Today we're talking about a mental health condition that can cause this kind of uncontrollable anger. That's Intermittent Explosive Disorder, or IED for short.
Simply put, what is Intermittent Explosive Disorder (IED)?
Simply put, Intermittent Explosive Disorder (IED) is a mental health condition characterized by frequent, unplanned, and sudden outbursts of uncontrollable anger or aggressive behavior. Most importantly, the anger is completely out of proportion to the event that triggered it. This means that even a very minor issue can cause a great deal of distress.
Imagine someone jumps in front of you in line. A normal person would be a little upset, and probably wouldn't say anything. But someone with IED might get so angry that they can't control themselves, they might yell at that person, and start a big fight.
When these outbursts are not occurring, these people behave normally and well. But when they do, they cannot control their anger. This is not just anger, it is a mental illness. About 80% of people with this condition may also have one or more other mental illnesses, such as anxiety or bipolar disorder.
Who is affected the most by this situation?
IED can affect children over the age of 6 and adults. However, adults who are diagnosed with the condition are usually younger than 40 years old. Also, the condition is more common in men than in women.
Research estimates that between 1.4% and 7% of the world's population may have IED, meaning it's not a rare condition.
What are the symptoms of IED? How do we recognize it?
The main symptom is sudden outbursts of anger that are inappropriate for the situation. People with this disorder know that their anger is wrong, but at the time they feel like they can't control it.
There are several common characteristics of these angry outbursts:
- Not intentional: These are not things that are planned in advance, like, "I'm going to fight with Aruth today." They are things that happen suddenly.
- Occurs quickly: When someone is hurt or angry, this outburst occurs within seconds.
- Short duration: The peak of this anger usually does not last more than 30 minutes.
- Post-traumatic stress: After the anger subsides, there is a great deal of stress, shame, and sadness.
- Impact on relationships: This behavior causes problems at school, at work, and at home.
The important thing is that someone with IED is not a bad person. They are struggling with these uncontrollable emotions. Therefore, it is important to understand this as a medical condition that requires treatment, rather than a behavioral problem.
The table below shows how this anger comes out and the feelings that precede it.
| Characteristic type | Examples and descriptions |
|---|---|
| Outbursts |
|
| Things you feel before getting angry |
These outbursts of anger can sometimes be minor, but can also be so severe that they can cause serious injury or even death. After the anger subsides, there is an initial feeling of relief, but then there is great regret and shame for what was done.
Why does this happen? What are the causes of IEDs?
Researchers are still trying to figure out the exact cause, but based on what they've found so far, they believe three main factors are at play.
1. Genetic factors: This condition can run in families. This means that if a parent or close relative has this type of impulsive behavior, there is a chance that their children will also have it. Studies suggest that between 44% and 72% of the time, genes play a role in the development of this type of behavior.
2. Biological factors: Changes in brain structure and function may be a factor. For example, MRI scans of the brain have shown that people with IED have changes in the amygdala, a part of the brain involved in emotion regulation. They have also found that people with IED have lower levels of the neurotransmitter serotonin, which controls our mood.
3. Environmental factors: Harsh experiences experienced during childhood have a major impact on this.
- Being physically or mentally abused as a child.
- Seeing others in the household being abused.
- Experiencing one or more traumatic events as a child.
Experiences like these can affect brain development and the way emotions are controlled, which can later lead to IED.
How do you know for sure if this is IED? (Diagnosis)
If you have even the slightest suspicion that you or your child has this condition, the best thing to do is to talk to your doctor . He or she will likely refer you to a mental health counselor (psychiatrist, psychologist) who is experienced in this area.
A mental health counselor diagnoses this condition by talking to you carefully and taking a detailed look at your symptoms. They will ask you questions like:
- Your and your family's medical history (especially mental illness).
- About your personal relationships.
- School or work history.
- The ability to control your impulses.
To be diagnosed with IED, at least one of the following criteria must be met:
| Episode Type | Description (Criteria) |
|---|---|
| Frequent, but low intensity eruptions (High Frequency/Low Intensity) | Verbal assaults (yelling, arguing) or assaults that do not result in physical harm to property, animals, or people, occurring at least twice a week over a three-month period. This does not result in serious injury or property damage. |
| Infrequent, but high intensity eruptions (Low Frequency/High Intensity) | Within a 12-month period, at least three major explosions resulting in property destruction or physical injury to animals/people. |
The most important thing is that the level of anger is completely out of proportion to the incident. It is also not intentional. The doctor will also make sure that these symptoms are not caused by another mental illness, physical illness, or substance abuse.
Is there a treatment for this condition?
Yes, absolutely. IED is a condition that can be successfully managed. The main goal of treatment is to completely eliminate the symptoms (outbursts of anger) or reduce their intensity and frequency to a level where the person and others can live safely.
Treatment methods are mainly divided into two parts:
1. Psychotherapy
This is the main treatment method. Cognitive Behavioral Therapy (CBT) in particular is very successful.
In CBT, a therapist helps you look deeply into your thoughts and feelings. You can understand how your thoughts affect your actions. Through this, you learn to change the wrong thought patterns that trigger anger and think and behave in healthier ways.
Some specific techniques used in CBT:
- Cognitive Restructuring: Changing the way you think about situations that trigger anger.
- Relaxation Training: Practice responding calmly to situations that provoke anger through techniques such as deep breathing and muscle relaxation.
- Coping Skills Training: Role-play situations that could lead to anger and practice how to deal with it in a healthy way (e.g., leaving the situation).
- Relapse Prevention: If this type of behavior occurs again after treatment, it is not considered a defeat, but rather a lesson learned and taught how to move forward.
2. Medication
Sometimes, doctors recommend using medication along with psychotherapy. These medications work by raising your threshold for anger. This means that you no longer get angry over small things that used to make you angry.
Fluoxetine is the most widely studied drug for this purpose. In addition, antidepressants, antipsychotics, and mood regulators may also be prescribed by the doctor depending on age and symptoms.
Will this situation continue? What other risks might arise?
People with IED may experience a decrease in life satisfaction and a lower quality of life. This can have a very negative impact on your health and personal relationships.
Although it can be successfully managed with treatment, studies show that IED is usually a long-term condition, lasting perhaps 12-20 years, or even a lifetime.
Additionally, people with IED are at increased risk of developing the following conditions:
- Depression
- Anxiety
- Alcohol and Substance Use Disorder
The biggest risk with this condition is self-harm and suicidal thoughts . Therefore, if you or someone in your family has these symptoms, it is extremely important to seek medical advice as soon as possible.
If you or someone you know is having thoughts of harming themselves, please call Sri Lanka's national mental health helpline number 1926 immediately.
Things you can do to take care of yourself
If you have IED, it's essential to seek professional medical treatment. In addition, it's important to incorporate the things you learn from treatment into your life.
- Practice calming techniques: Practice things like deep breathing every day.
- Change your thought patterns: When anger arises, ask yourself, "Why is this happening to me?" and try to change that thought.
- Develop communication skills: Practice expressing your feelings calmly through words, without anger.
- Remove yourself from stressful situations: If you feel yourself getting angry, remove yourself from the situation for a while if possible.
Avoid alcohol and drugs completely. These can make your impulsive behavior worse.
If someone in your family or close to you has IED, it can be mentally distressing for you too. So, take care of your mental health as well. Seek counseling if necessary. It is also very important to take steps to protect yourself and your children.
Take-Home Message
- Intermittent Explosive Disorder (IED) is not just a feeling of anger, it is a mental illness that requires treatment.
- The anger here is completely out of proportion to the incident that caused it.
- This condition can be influenced by genetic, biological (brain changes), and environmental factors (childhood experiences).
- This condition can be successfully managed with psychotherapy like CBT and, if necessary, medication.
- If you or someone you know has these symptoms, don't be ashamed or afraid to see a doctor and ask for help. It's the biggest help you can do for yourself.
- If you are having suicidal thoughts, please call the helpline number 1926. You are not alone.
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