Intermittent Explosive Disorder

From public acts of teenage violence to adult episodes of road rage, anger seems to have escalated in our society. A psychiatric condition known as intermittent explosive disorder (IED) could be responsible for many of these outbursts. While most of us feel overwhelmed by anger at times, people with IED have frequent explosions of rage that result in the destruction of property or violence against others. Unlike the majority of the population, people with IED can’t resist the impulse to lash out physically and verbally when they experience anger. These episodes are often triggered by minor incidents that would seem unimportant to anyone else.

If you or someone close to you is known to have an “anger problem,” there may be more involved than meets the eye. You might have a substance use disorder, a chemical imbalance or a family history that predisposes you to acts of intense aggression. A complete assessment of your psychological history and your patterns of substance abuse could reveal that you have IED — a condition that can be treated by qualified addictions specialists with a background in impulse-control disorders.

How Common Is Intermittent Explosive Disorder?

If haven’t heard of IED yet, you may be hearing more about this mental health condition in the future. The National Institute of Mental Healthestimates that this disorder is much more common than psychiatrists once believed:

  • As many as 16 million people (7.3 percent) in the US have had IED during their lifetime.
  • An individual must have at least three episodes of explosive anger during their lifetime to meet the criteria for IED.
  • People with a more intense form of IED may have three or more episodes of anger in a 12-month period.
  • Close to 82 percent have depression, anxiety or a substance use disorder.
  • Less than 29 percent actually receive treatment for these conditions.

Like drug addiction, alcoholism or compulsive gambling, IED is characterized by a failure to control your impulses. While people who are addicted to drugs may find it impossible to control their drug-seeking behavior, people with IED can’t control their impulse to commit acts of violence or aggression when they’re angry. For someone with IED, the need to smash objects, attack other people physically or explode verbally could be just as overpowering as an addict’s need for a euphoric high.

Warning Signs of IED
What Causes IED?

How do you know if you have IED, as opposed to a run-of-the-mill “hot temper”? IED often appears in behavioral patterns that start in adolescence and continue through the adult years:

  • Regular outbursts of destructive anger that are out of proportion to the cause of the episode
  • A tendency to erupt into anger when you lose a competition or can’t get something you want
  • Conflict in personal relationships because of your temper
  • A history of losing jobs or being denied promotions because of your volatile temper
  • A history of legal problems or incarceration because of threats, physical assaults or property damage
  • Physical symptoms such as a burst of energy, tingling, palpitations, headaches or chest pain before an outburst
  • A feeling of exhaustion, relief or depression after an outburst

The frequency and intensity of these explosive episodes varies from one person to another. The Journal of Family Practice notes that 69 percent of people with IED have less intense outbursts approximately twice a week, with more intense episodes involving destructive activity and violence at least three times a year. Eleven percent of those with IED have only the less intense, more frequent outbursts, the journal adds.

The exact cause of intermittent explosive disorder remains a mystery. According to the Mayo Clinic, substance abuse is one of the primary risk factors for intermittent explosive disorder. People who drink heavily or abuse drugs are more likely to suffer from emotional instability, including episodes of extreme anger and aggression. They are also more likely to act on those impulses when they’re drunk or high. Additional risk factors for IED include:

  • Gender. Males are more likely to exhibit the signs of IED than females.
  • Age. Teenagers and young adults are more likely to suffer from IED, which usually begins when the individual is 15 to 20 years old.
  • Abuse history. People who have been physically or sexually abused as children have a higher risk of developing IED.
  • Brain chemistry. An imbalance in certain brain chemicals may predispose you to IED.

The National Institute on Alcohol Abuse and Alcoholism states that both anger control problems and alcoholism may be linked to a deficiency of serotonin, a neurotransmitter that helps you control your emotional responses and remain calm in stressful situations. People with low serotonin levels may have difficulty resisting the impulse to respond violently when they’re frustrated, even by minor problems. They may also be more prone to drink or use drugs compulsively.

Anger Disorders and Substance Abuse

The combination of IED with drug or alcohol abuse is an especially volatile mix. It’s no secret that intoxication can alter your moods and emotions, making it hard to control your anger. Alcohol and drugs are frequently involved in episodes of domestic violence, child abuse and criminal activity. Psychology Today reports that people with IED may be more sensitive than others to the effects of alcohol, which means that you may get drunk more quickly and respond more dramatically to drinking. Below are a few of the warning signs that you may be struggling with IED as well as a drug or alcohol problem:

  • You’ve been called an “angry drunk” or a “surly drunk.”
  • You drink or use drugs to mask your feelings of anger, yet you feel even angrier once you’re under the influence.
  • When you’re intoxicated, you have overpowering feelings of rage that seem to take control of your mind and body.
  • You’ve lost relationships, gotten into fights or spent time in jail because of angry drunken episodes.
  • You feel deeply depressed or remorseful about your anger when you’re sober.
  • Your friends no longer want to drink or use drugs with you because of your aggression.

If you have an anger disorder and a substance use disorder, your chances of recovering from both disorders are much greater if you are treated for these conditions at the same time. Integrated treatment for co-occurring disorders is the best way to ensure that you’ll achieve long-lasting results in recovery. As part of drug or alcohol rehabilitation, you’ll also receive treatment for IED, depression, anxiety or other psychological conditions that underlie your substance abuse.

How Is IED Treated?

When you’re battling both a mental health disorder and a substance abuse problem, life can seem hopeless at times. But hope is available if you reach out to addiction specialists for help. Unfortunately, many of those who meet the criteria for IED don’t seek treatment until it’s too late. The Harvard School of Medicine estimates that less than 20 percent of individuals who have IED receive specific treatment for the condition, and that out of this group, the majority don’t get help until at least 10 years after the symptoms first appeared.


IED and substance abuse should be treated by qualified mental health professionals who have been cross-trained in addiction treatment and impulse-control disorders. Some of the most effective approaches to treating these co-occurring disorders include:


  • Medication therapy. SSRIs (selective serotonin reputake inhibitors), a class of antidepressants that increase serotonin levels in the brain, have been used successfully to reduce the symptoms of IED.
  • Cognitive behavioral therapy. Research published in the Journal of Psychoactive Drugs indicates that cognitive behavioral therapy, which involves identifying and modifying destructive thought patterns, can be effective in the treatment of anger disorders and substance abuse.
  • Addiction counseling. As part of a comprehensive, integrated treatment program, you should participate in therapy with an addiction treatment. specialist, both on an individual level and with your spouse, partner or children
  • Group therapy. Peer group counseling sessions are especially helpful for substance abuse and anger management therapy. Participants exchange hope, support and coping strategies with others like themselves.
  • Anger management classes. Participants who struggle with emotional self-control learn how to identify their triggers and respond in a healthy, productive way to the situations that frustrate them.
  • Holistic therapies. Complementary modalities like yoga, massage and acupuncture can be extremely useful at promoting stress reduction and relaxation.

At Axis, we provide a full range of rehabilitation services, from drug and alcohol detox to integrated psychotherapy for co-occurring disorders. To achieve a true recovery, you need treatment for both your anger disorder and your addiction. Unless both conditions are addressed in rehab, the chances of maintaining long-term abstinence are very slim. We encourage you to call us for information about our comprehensive, personally tailored treatment plans.

If your life is being controlled by anger, addiction, or both, we have the resources you need to regain a sense of stability and health. Call us today.