Introduction
The American Psychiatric Association (2013) defines intermittent explosive disorder (IED) as behavioral outbursts caused by failure to control impulses of aggression. The disorder differs from other kinds of aggression individuals may show, as it is a reoccurring issue. Due to the fact that patients with the disorder struggle to control the outbursts, their quality of life, including their relationships with other people, may be compromised. Many researchers have studied it to determine the causes and possible ways of treatment. Scott et al. (2016) stated that although the IED has been in the Diagnostic and Statistical Manual of Mental Disorders (DSM) for years, the criteria for diagnostics has been discussed constantly. The issue is prevalent in our society and therefore needs to be examined in detail. The intermittent explosive disorder can be a severe threat to a person’s life. Therefore, it is an essential condition that has to be treated.
Background Information about Intermittent Explosive Disorders
The history of IED can be traced back to 1980 when it was mentioned in the DSM-3 for the first time (Donovan, 2015). The name is a basic description of the symptoms of the condition. According to Donovan (2015), the name implies the “low-threshold, high-aptitude events” with “periods of calm between the events” and “bursts of violence” (p. 1507). Medical specialists and scientists have been aware of the IED for more than thirty years.
According to DSM-5, to be diagnosed with the intermittent explosive disorder one must show signs of aggressive outbursts that do not correspond with the provocation (American Psychiatric Association, 2013). Therefore, the primary indicator is the response of a person to a trigger that is much more aggressive than it would typically be. Additionally, this response should not be a result of a different mental disorder (American Psychiatric Association, 2013). DSM-5 specifically identified the number of episodes where a person demonstrated the outbursts during a period of time, which helps to diagnose the IED more easily. At least three of the events of destructive eruptions in a year have to happen (meaning that property, another person, or an animal are destroyed or injured as a result) for the IED diagnosis (as cited in Scott et al., 2016). The factor implies that a person, suffering from the condition can be dangerous to others. However, DSM-5 does include a characteristic of IED that provides a description of less aggressive outbursts (that did not result in injuries or destruction). Those need to happen more than three times a year (Scott et al., 2016).
The disorder is destructive and can be dangerous to people. Lee et al. (2016) stated that the condition is a “pathological impulsive aggression” (p. 128). The definition implies that the state is reoccurring and, therefore, needs an intervention from a specialist. Donovan (2015) stated, “The diagnosis of intermittent explosive disorder constitutes an attempt to characterize episodic violent behavior not better explained by another psychiatric diagnosis” (p. 1507). Therefore, a person who displays unexplained aggression without other psychiatric diseases can be diagnosed with IED.
Causes, Symptoms, and Treatment for the Intermittent Explosive Disorders
Some studies suggest that IED is related to the brain function of mediating the behavior (social and emotional). “Evidence to date implicates dysfunction in neural circuits mediating emotional behavior and executive function that relies on brain networks with hubs in both the cortical and subcortical structures” (Lee et al., 2016, p. 129). As identified by the DSM-5, the symptoms and signals of the IED are the reoccurring aggression outbursts, both violent and nonviolent.
DSM-5 identifies two patterns that the outbursts of aggression may follow (American Psychiatric Association, 2013). The first one is “high frequency/low intensity” or A1. It is characterized by non-destructive aggression that happens twice a week for three months. The second one is “low frequency/high intensity” or A2, which involves destructive outbursts that happen at least three times throughout a year (Scott et al., 2016). Therefore, both violent and nonviolent aggression that repeat over specified periods of time may be a signal of the IED.
To prevent the disorder Guerra and Duryea (2017) suggest developing aggression prevention programs. The focus of these developments would be on children, to help them learn how to cooperate with pressures and their emotions. The treatment for the condition implies the state of remission. As a result, it can be argued that such programs can be helpful in both preventing and further helping with recovery from the IED. Additionally, a study by Nickerson, Aderka, Bryant, and Hofmann (2012) found a correlation between the childhood trauma and IED. Therefore, it can be suggested that the environment a person grows up in is a contributing factor to the condition. In this case, a preventative measure would be not to disclose a child to violent behavior of any nature.
The IET is a severe condition, which can result in harmful behavior, injuries, and damage of a different kind. Therefore, it is crucial that people who suffer from it get help from specialists in order to control the anger outbursts. The condition can be treated by pharmacotherapy, prescribed by a qualified specialist. In addition, a cognitive-behavioral therapy (CBT) can be utilized in addition to the medicaments. (Coccaro, 2018). It can be argued that a combination of the two methods would be the most effective way of achieving the state of remission. Both short-term and long-term goals include achieving a remission state in which most of the symptoms are not in place. There are cases in which the remission state may be impossible. Therefore, the purpose of the treatment is to stabilize the condition to ensure that the patient cannot harm others. Coccaro (2018) presents evidence for this treatment plan of IED in the studies.
The prognosis for the treatment is that patients can manage their impulses and control the stimuli (Coccaro, 2018). Additionally, patients should be monitored after the treatment to determine the effectiveness and the reoccurrence of the symptoms. Due to the nature of the procedure, it is possible that the symptoms will reoccur in the future and additional treatment will be required.
Overcoming the Disorder
To overcome the disorder a person should monitor the behavior and aggression outbursts. In case they happen often, and without a particular reason, the person should seek medical help to receive therapy and medication. As was mentioned, studying and practicing self-regulation can help prevent the condition and possibly will help control it better in the state of remission. As was mentioned earlier, IED is linked to the childhood trauma; therefore, parenting skills are an essential factor here. Parents should avoid aggressive conflicts and pay attention to the aggression outbursts that a child might have.
Overall, the intermittent explosive disorder is a condition, characterized by uncontrolled and reoccurring anger outbursts. Due to the fact that these events can be violent and can cause injuries or damage it is crucial that people with IED get help from medical professionals. The treatments can include medication and therapy. The goal is to achieve the state of remissions. However, the patients will have to be monitored afterward to identify future symptoms of IED.
References
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (5th ed.). Arlington, VA: Author
Coccaro, E. (2018). Intermittent explosive disorder in adults: Treatment and prognosis. Web.
Donovan, S. (2015). Intermittent explosive disorder. The Encyclopedia of Clinical Psychology, 5 Volume Set, 1507-1517. Web.
Guerra, N., & Duryea, S. (2017). Prevention of aggression, violence, and mental health problems in childhood and adolescence: Innovative and sustainable approaches from around the world: Introduction and overview. Prevention Science, 18(7), 749-753. Web.
Lee, R., Arfanakis, K., Evia, A. M., Fanning, J., Keedy, S., & Coccaro, E. F. (2016).
White matter integrity reductions in intermittent explosive disorder. Neuropsychopharmacology, 41(11), 2697–2703. Web.
Nickerson, A, Aderka, I. M., Bryant, R. A., & Hofmann, S. G. (2012). The relationship between childhood exposure to trauma and intermittent explosive disorder. Psychiatry Research, 197, 128–134. Web.
Scott, K.M., Lim, C.C.W., Hwang, I., Adamowski, T., Al-Hamzawi, A., Bromet, … Gureje, O. (2016). The crossnational epidemiology of DSM-IV intermittent explosive disorder. Psychol.Med. 46, 3161–3172. Web.