Explosive Disorder

Explosive disorder, also called Intermittent explosive disorder (IED) or Militant episode disorder (MED), is an disorder of the brain characterized by explosive outbursts of behavior that are disproportional to the provocation.

Explosive disorder is characterized by failure to resist aggressive impulses, resulting in serious assaults or property destruction. Examples of this behavior include threatening to or actually hurting another person and purposefully breaking or damaging an object of value. It is an impulse control disorder and it has been suggested as the underlying cause of road rage (Wikipedia).

The individual may describe the episodes of explosiveness as "spells" or "attacks" in which the explosive behavior is preceded by a sense of tension or arousal and followed immediately by a sense of relief. Often genuine regret is expressed after the outburst. Later the individual may also feel upset, remorseful or embarrassed about the behavior. 

Individuals with Explosive Disorder sometimes describe intense impulses to be aggressive prior to their aggressive acts. Explosive episodes may be associated with affective symptoms such as irritability or rage, increased energy, and racing thoughts during the aggressive impulses and acts, and rapid onset of depressed mood and fatigue after the acts.

A study (National Institutes of Health) funded by the National Institutes of Health’s National Institute of Mental Health (NIMH) has found intermittent explosive disorder (IED) is more common than previously thought, . Depending upon how broadly it’s defined, intermittent explosive disorder (IED) affects as many as 7.3 percent of adults — 11.5-16 million Americans — in their lifetimes.  Typically beginning in the early teens, the disorder often precedes, and may predispose for, later depression, anxiety and drug abuse or alcohol abuse. As presently defined, intermittent explosive disorder is more common in men.

Intermittent explosive disorder (IED) belongs to the greater family of impulse-control disorders as categorized in the DSM-IV along with kleptomania, pyromania, pathological gambling, and other impulsive personality disorders.  To be Intermittent explosive disorder (IED), these behaviors are not caused by another mental disorder (e.g. antisocial personality disorder, bipolar disorder, borderline personality disorder, or attention-deficit/hyperactivity disorder).  Impulse-control disorders are primarily characterized by the experience of impulses that are difficult or even impossible to resist, even if the impulses may be harmful to self or others.  Impulse aggression is non-premeditated, and is characterized as a disproportionate reaction to any provocation felt by the patient.

The diagnostic characteristics of Intermittent explosive disorder (IED include:
1) On several occasions the patient has lost control of aggressive impulses, leading to serious assault or property destruction.
2)The aggression is markedly out of proportion to the seriousness of any social or psychological stressors.
3) No other mental disorder or personality disorder better explains the symptoms.
4) These symptoms are not directly caused by a general medical condition or substance use, including medications and drugs of abuse.

As with other impulse-control disorders, the cause of IED has not been determined.  Treatment approaches include Psychotherapy, biofeedback, and medication..

Traditional psychotherapy, reality therapy and cognitive behavioral therapy have shown positive results with Intermittent explosive disorder. Therapy aids in helping the patient recognize the impulses in hopes of achieving a level of awareness and control of the outbursts, along with treating the emotional stress that accompanies these episodes.

Multiple drug regimens are frequently indicated for intermittent explosive disorder patients. Tricyclic antidepressants and serotonin reuptake inhibitors (SRIs) such as fluoxetine, fluvoxamine, and sertraline appear to alleviate some pathopsychological symptoms.  Mood stabilizers and anticonvulsive drugs sometimes aid in controlling the incidence of outbursts. 

For more information about intermittent explosive disorder or other mental health problems, please click on the linked websites listed below.

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