Intermittent Explosive Disorder attacks are out of proportion to the social stressors triggering them and are not due to another mental disorder or the effects of drugs or alcohol, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). People with this disorder overreact to situations with uncontrollable rage, feel a sense of relief during the angry outburst, and then feel remorseful about their actions.
'Intermittent Explosive Disorder is not a clinical term well-known in society, but the weight of these numbers should help patients and physicians come to recognize the pervasiveness of this disorder and develop appropriate treatment strategies,' says Kessler, senior author of the study.
'In the general population, aggressiveness or 'blowing up' is considered bad behavior; people think, 'This person just needs an attitude adjustment.' But Intermittent Explosive Disorder goes beyond that, having strong genetic and biomedical underpinnings,' says coauthor Emil Coccaro, MD, the Ellen C. Manning professor and chair of the Department of Psychiatry at the University of Chicago Pritzker School of Medicine.
Among people with this disorder, 81.8 percent also were diagnosed with depression, anxiety, and alcohol or drug abuse disorders, although the age of onset of Intermittent Explosive Disorder was usually much earlier than that of these other disorders. 'This suggests that people with this disorder may be more susceptible to other disorders because of increased stressful life experiences as a result of their disorder, such as financial difficulties or divorce,' says Kessler. This raises the possibility that Intermittent Explosive Disorder may be a risk factor for other mental disorders.
A narrow definition of Intermittent Explosive Disorder includes three or more of these attacks in one year. In the study, people with narrow Intermittent Explosive Disorder had a more persistent and severe illness, particularly if they attacked both people and property, causing 3.5 times more property damage than other violent Intermittent Explosive Disorder subgroups.
The study shows that for both broad and narrowly-defined Intermittent Explosive Disorder, the first episode of rage occurred in early adolescence, around age 13 for males and age 19 for females. 'Given its age of onset, identifying Intermittent Explosive Disorder early, determining its causes, and providing treatment might prevent some of the associated secondary disorders, such as anxiety or alcohol abuse,' says Kessler.
Although most study respondents with the disorder had seen a professional for emotional problems at some time in their lives, only 11.7 percent had been treated for their anger in the 12 months prior to the study interview.
Shame or embarrassment about these violent reactions may prevent people from discussing this disorder with their doctors, says coauthor Maurizio Fava, MD, professor of psychiatry at HMS and Massachusetts General Hospital (MGH). 'Clinicians may also be at fault for concentrating on secondary symptoms, such as anxiety or depression, and not asking about outbursts of anger,' he says.
Effective treatment for Intermittent Explosive Disorder includes both behavioral and pharmacological interventions (selective serotonin reuptake inhibitors [SSRIs] and mood stabilizers), says Coccaro.
A form of cognitive-behavioral therapy involving cognitive restructuring, coping skills training, and relaxation training—a combination known as CRCST—has proven to be effective in treating Intermittent Explosive Disorder, says Coccaro.