Intermittent explosive disorder: Causes, symptoms, and treatment

Intermittent explosive disorder, or IED, is a mental health condition that causes sudden, intense outbursts of anger that are out of proportion to the situation. These outbursts may involve physical violence or verbal threats.

People with IEDs are usually unable to control their anger, and episodes can occur at any time, without warning. As a result, IEDs can interfere with daily life and cause significant distress to individuals and their friends and family.

Although there is no single treatment for all IEDs, doctors can recommend effective therapies and medications to control symptoms and improve quality of life.

This article discusses intermittent explosive disorder in more detail, including its causes, diagnosis, and treatment.

IED is a mental health condition, whose characteristics include brief periods of unexpected and intense aggression, anger, or violence. These strong feelings often appear spontaneously and are usually more intense than the situation warrants.

IED often appears in late childhood or early adolescence, and affected individuals often feel that they have no control over their anger.

Children with IEDs may have tantrums, fights, or outbursts that are less serious. However, they can also have severe outbursts of anger that lead to physical violence toward people, animals, or objects.

Because of these reactions, IED often affects a child’s performance in school and causes problems in his relationships with family and friends.

Those with IEDs may present with different forms of aggressive episodes, which may include:

  • an inability to control sudden outbursts of anger
  • frequent outbursts in the form of arguments, tantrums, and fights
  • occasionally having more intense instances of anger and violence
  • explosive outbursts of anger that last less than 30 minutes
  • aggressive outbursts when frustrated
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Doctors remain unsure of the exact causes of IED, but speculate that numerous factors play a role.

Environmental factors encompass behaviors that someone experienced as a child. These include trauma and growing up in a physically, sexually, or verbally abusive home.

Other expert note that the repeated aggressive and impulsive behavior characteristic of IED correlates with low levels of serotonin in the brain. Therefore, brain chemistry could also contribute to the development of IEDs.

Some investigate shows that people most at risk of developing IED are those who:

  • they are men
  • are between 13 and 23 years old
  • they are unemployed
  • are divorced or separated
  • suffered multiple traumatic events as a child
  • grew up in a physically, verbally, or sexually abusive home

Also, people with other mental health conditions have a increased probability of developing FDI. These conditions include those with symptoms of impulsive or problem behaviors, such as attention deficit hyperactivity disorder (ADHD), conduct disorder, and oppositional defiant disorder (ODD).

Having IED does not necessarily mean that a person is more likely to receive another mental health diagnosis and vice versa. However, the comorbidity rate is high. Causality can work both ways, and the correlation between IED and other mental health conditions remains a matter of debate.

People with IED are also more likely to develop a substance use disorder or consider self-harm or suicide.

doctors often begin the process of diagnosing IED by ruling out other possible causes of the individual’s behavior.

Other conditions that could cause similar behaviors include:

  • other mental health disorders
  • drug or alcohol use disorder
  • physical causes, such as a head injury
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Once a doctor has ruled out the above, someone may be diagnosed with IED if:

  • can’t control his anger
  • often get into fights or have tantrums
  • occasionally have destructive outbursts of violence and rage that do not accurately reflect the seriousness of the situation

First-line treatment for IED is as usual a combination of medication and therapy.


Although there are no specific drugs for IEDs, there are still many effective options, such as:

  • anti-anxiety medications, including beta blockers such as propranolol (Inderal) and nadolol (Corgard)
  • antidepressants, including fluoxetine (Prozac), fluvoxamine (Luvox), and citalopram (Celexa), which are selective serotonin reuptake inhibitors
  • anticonvulsant mood stabilizers, including valproic acid (Depakote) and topiramate (Topamax)

It is important to note that mental health medications can take as long as 2 months to have its full effect. Also, people may need a long-term prescription.


Doctors may recommend cognitive behavioral therapy (CBT) for people with IED. CBT allows people to understand and recognize the situations that trigger their severe outbursts of anger.

CBT offers a way for people with IED to manage their anger in a healthy way instead of violent and verbal outbursts. Not only does this practice ensure that no one else gets hurt during an outburst, it also helps people feel better about their situation by giving them a level of control they didn’t have before.

With CBT, the person’s caregivers can also work with the therapist. CBT can help them understand the triggers for angry outbursts and how they can handle the situation.

Learn more about types of therapy.

Some other mental health conditions may have similar symptoms to IEDs, but there are also key differences.

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Bipolar disorder

Bipolar disorder is a mental health condition carries unusual changes in mood, activity levels, energy, concentration, and ability to complete regular daily tasks.

These mood swings often result in a person switching from high-energy states, such as being motivated, elated, or irritable, to low-energy states of sadness, indifference, and hopelessness.

These low moods do not characterize IED. In addition, manic periods of bipolar disorder typically last at least 7 days, whereas an IED episode typically lasts less than 30 minutes.

Oppositional Defiant Disorder (ODD)

Doctors can diagnose ODD in children who have tantrums, are unusually angry, do not follow rules, or hurt others on purpose. Children with ODD exhibit this extreme behavior for at least 6 months.

As usual, ODD affects children before the age of 8 and no more than 12 years, which is less than the typical age for FDI.

Children can outgrow ODD, but early treatment helps family life and can improve a child’s future.

Intermittent explosive disorder is a mental health condition that often manifests as sudden anger and violent outbursts. It usually appears in the early teen years and can cause problems with relationships and school performance.

Doctors aren’t sure of the specific causes, but it’s likely that brain chemistry and exposure to childhood trauma play a role.

To diagnose IEDs, doctors first rule out other possible causes of anger and irritability. These include other mental health conditions, substance abuse, and head injuries.

Treatment options for IEDs include CBT and medications such as mood stabilizers, anxiolytics, and antidepressants.


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