What Is Intermittent Explosive Disorder? Is It Just Being Angry?
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What Is Intermittent Explosive Disorder? Is It Just Being Angry?

September 2, 2019

– What is intermittent explosive disorder and what do we do about it? That’s what I’m talking about today. I’m Dr. Tracey Marks, a psychiatrist and I make mental health education videos. This video is based on
several viewer questions and some of the questions were around distinguishing
it from bipolar disorder. Other people asked me about it because they were diagnosed with it and they wanted to understand it better. So before I define it, let’s look at an example
of what this can look like and this is adapted from
the DSM-5 case book. Joe is a business executive, his wife, Sally, insisted
that he see a psychiatrist for help with his anger. His wife told the psychiatrist he was impossible to live with. Sally said Joe was always high strung, but over the years his outbursts were getting more frequent and intense, so she feared he would
start getting violent with her or the kids. (dog whining) Their most recent argument began when Joe came home
after a hard day at work to find that dinner wasn’t ready. Instead, he found Sally soaking in the tub reading the newspaper. He exploded and launched into a tirade about how bad of a wife she was. When she tried to explain
how she had a long day and needed to de-stress, Joe
cursed at her, threw his shoe, and broke a chair. Terrified, Sally scooped
up the kids and left. She put on her clothes, though. She then told Joe he would
have to get some help or she would leave him. Joe said his blowups began in childhood, but really didn’t become a problem until he was around 13 and
then he had frequent fights with classmates and had to go to the principal’s office a lot. Currently, Joe was having
four verbal outbursts a week and about every other month
he would break something. The last time he threw a computer and punched several holes in the wall. He said that he never hit anyone and these blowups only
lasted a few minutes and then he’d feel better. As for alcohol, Joe drank
occasionally but not really on a regular basis. He was never drunk or
tipsy when he got angry. In fact, alcohol tended
to make him more mellow and actually make him explode less. So that’s one way that this can look. Let’s look at how we diagnosis intermittent explosive disorder using the Diagnostic
and Statistical Manual of Mental Disorders, the Fifth Edition. You have recurrent behavioral outbursts that are a failure to control
your aggressive impulses as manifested by either of
the following two scenarios. One, you have high frequency,
low intensity outbursts and the low intensity would be defined as verbal aggression like
temper tantrums, tirades, verbal arguments or fights or physical aggression toward property, animals, or other people, but the physical
aggression does not result in property damage or injury to someone. So, in this case, the physical aggression could be pushing or grabbing your clothes. As for frequency, they occur on an average of twice a week for at least three months. The second scenario is that
you would have low frequency, high intensity outbursts and in this the high
intensity would involve damage or destruction of property, physical assault that does
involve physical injury against the person and as for intensity, it would occur around three
times in a 12 month period, so much less often. Other criteria is that the magnitude of the aggression is grossly out of proposition to the provocation
or any other triggers. You have to be at least age six. So this can be diagnosed
in children, in fact, it often is. The outbursts are not
premeditated or intentional. Lastly, the aggressive
outbursts either cause a lot of distress for the
person or a lot of problems with your life, with your work, the way you relate to people. You may have financial
or legal consequences. So, this is not having an anger outburst that ends up landing you
in a couple of arguments a few times a year or putting your fists through a wall twice when you’re drunk. These are outbursts that
are way over the top because the action doesn’t
match the situation and it causes serious problems for you. A few commenters questioned if their anger could
really be bipolar disorder and there’s so much
more to bipolar disorder than impulsivity and anger. In fact, not everyone who becomes manic and impulsive is angry. I did a video breaking down the details of mania and hypomania so
you can better understand the complexities of the disorder and I’ll link to that video in the corner and in the description, but suffice it to say that the anger outburst
that you get with IED are more extreme, much more extreme than what someone experiences
with mania or depression, but you can have bipolar disorder
and IED at the same time. When does this usually happen? It usually starts in late
childhood or early adolescence. It rarely starts after age 40. Now, that doesn’t mean
that someone can’t start having a lot of explosive anger after 40. In fact, there are medical
illnesses like epilepsy and other brain disorders like stroke that can cause personality changes that may lead to this kind of behavior, but in that case it wouldn’t be called intermittent explosive disorder, it would be a behavioral disturbance due to whatever the medical condition is. This disorder does run in families, so if you have a first degree relative like a parent or a sibling with it, you are at a greater risk of having it. What causes it? We don’t know exactly, but people with IED do
have abnormal functioning of the brain chemical serotonin and they have a hyperreactive amygdala. The amygdala is a structure in your brain that helps detect fear and threat level. What do we do about it? The two approaches are
therapy and medication. The therapy would focus on building skills and improving coping mechanisms. You’d also identify
triggers as best you can and then learn different techniques to process your aggression
in a less destructive way. Medications can be
serotonin-enhancing antidepressants like Prozac or even mood stabilizers. And some people have responded
well to beta blockers like Propranolol which is
a blood pressure medication that we use in psychiatry for anxiety and impulse control problems. If you’re interested in anger in general and the source of it, watch this video that’s
showing up right here. For more information on
mental health education, subscribe to my channel. I post videos every Wednesday at nine. See you next time.

Only registered users can comment.

  1. Thats was really interesting, it was just a chance that I saw the notification and I stopped what I was doing and came to watch the video. I am seeing my psychiatrrist for a mental health assesment next week and have just had an explosive outburst that left me facing down on the road thimping the tarmac with my fists whenthere was a queue of traffic behine me. I thought if I carry on like this I am going to have a stroke or a heart attack. My poor wife in the car was terrified. Thanks again for doing this.

  2. Great informative video Dr. Marks. Thank you. How much I always like the animations. They are so funny 😁…. hahaha. Laughing is one of the best medicines. Have a great day doc 😃🇳🇱

  3. Great video Doctor Marks! Could you maybe do a video on long term effects a
    person exposed to trauma may experience, and what professional help and treatment
    options are mostly recommended?

  4. Very informative video Thanks Dr Tracey Marks. Having an illness doesn't make you a bad person. Sometimes being ill makes you do irrational behavior and major decisions in life that result in serious problems. Seeking for help of a professional is a one good decision. Whatever your struggle, it can be mood, behavior or an illness there is always a cure and always believe in yourself and have faith that this too shall pass and everything will be okay.

  5. Dr Tracey Marks 🤔Wow i Had know idea of this!! This is literally just Like my wife thanks and just like her Dad and 🤔 and therapy has Not been able too help or Identity Anything so i will bring this up next time thanks so much💜🙏🏼

  6. Where does someone stand if they have daily outbursts which I initially thought they would mean they fall into the ‘low intensity/high frequency’ however the rest of the criteria is not totally applicable. They had zero problems with work or anyone other than immediate family. A typical day would mean being shouted out (in a most aggressive way) for simply saying good morning and them not hearing you correctly (so them having to ask what you just said would irritate them and they wouldn’t simply say pardon, it would warrant a very short curt ‘what??!?’ along with a face that is just filled with anger. They’d go off to work only to return in the same mood. Anytime anyone speaks to him if he isn’t in the mood to talk means they will be dealt with in exactly the same manner. It’s kind of sad to think we should have pushed for him to get treatment because even though he would not have gone, it may have opened doors to a different life for others in this persons life. The person in question is 82 now so no way in hell they will change. Does someone with that level of anger fall into this diagnosis or is there a separate condition for someone who lost literally angry all the time, but they can control it so it is only ever directed at their partner and his children? Hope to hear back 🙏🏼

  7. Hi Dr Marks. I'm still manic. It started after benzos withdrawal. I've written to you many times. I'm now making inappropriate comments. And I'm so manic I'm speaking whatever on a high level of anxiety. It's been almost 2 years off benzos. I take meds for anxiety and mood stabilizers. I also have chronic pain everyday, all day. Ive also started menopause late. I have many disorders. I'm not sure what to do for myself. I'd sincerely value any encouragement that you might have not just for me, but for anyone who has. issues like me. Thanks alot for sharing your knowledge with me. Have a good day, Dr Marks.

  8. Doctor how I cherish the sense of belonging you help me to feel, how you shoulder me with your strength in this low land of oppressive floodwaters, I come to you and I come back with all the psychic presence I can muster, to give you fellowship and thanks, and return I would, merely because I know as good a system as you are, any day I could come to seek you, and find just a footprint, for you’d be gone…

  9. Excellent video with great descriptions. Dr. Marks, have you heard any data about lithium orotate as a treatment for IED? Thank you!

  10. You're really good at translating vague symptom descriptions into specific, practical examples of their manifestation. Thanks again Tracey !

  11. Hi Dr. Marks,

    Could you make a video on why it is very common for psychiatrists to misdiagnose patients? I got diagnosed with bipolar from one psychiatrist and internalised it and accepted it, until I went to a very thorough psychological evaluation where I was reassured I was "absolutely not bipolar."

    Diagnoses cause a lot of distress to many of us, so receiving false diagnoses traumatises us to a certain extent.

    Thanks for your informative excellent work!

  12. Doctor you should do a discussion about the occasional concurrence of mental illness and high I.Q., I'd be curious to understand in what way a creative emotional maturity serves as a buffer against paranoia, disorganized thought, and can therapy foster an intelligent seed in a psych recovery person?

  13. I have the utmost respect for you and thanks for the video. I was talking to someone about what is genetic and not when discussing what we ate because he was the first person I ever met who eats what I eat for good heart health.

    I mentioned that sometimes, things appear to run in families but the environment is the same for those people and that at least partially led to the condition. An example would be food. People can have heart disease in a family and appear genetic but it goes away when someone eats well I feel that seeing a disease in a family shows the possibility of genetics being involved, but not guaranteed to be so.

    Maybe the way family raises people, as learned behavior, over generations can be the same and in a way harmful to mental health.

  14. Very interesting as usual. I’m a psych student and I work with mentally ill patients on a daily basis in a nursing and rehab center, so I try to soak up all your videos. I was wondering if you could ever make a video on trichotillomania or dermotillomania, as I’ve struggled personally with trichotillomania. Thank you!

  15. My sister has some weird symptoms and she gets mad or harms the ones she loves, and has the need to hit someone especially me, some time ago my father was almost kidnapped and she revealed this weird things about her and I'm wondering if there is any mental disorder that she could have
    I'm very worried

  16. Dr Tracy marks do you know anything about dissociative identity disorder my and it's something my Dr suggested to me and if you do can you do a video on in most times I never really was a very anger outbursts person ussualy that's because I've always been very good at hiding my emotions does anyone with intermittent explosive disorder bottle it up

  17. Dr Marks,
    I’m sure you read some of the comments . You’re making some people realize they could have this IED .I’m glad you did this video for me .sorry for pestering you about it but it turned out awesome 👏. Unfortunately this sounds like my father 100% and also unfortunately a bit like me I put plenty of holes through doors hollow doors of course . Life is so difficult with mental illness I have a suggestion for your next video or to come how about(. Living with psychosis ) this would be also very educational for people who don’t understand people like me with bipolar disorder and potentially IED .
    Thank you 🙏
    General repair

  18. I am interested to know how often intermittent explosive disorder is mistaken for bpd rage and vice versa. I don't see how one can distinguish them.

  19. I thought the dsmV was reaching for a long time. But we know so much about the stars than our own mind. We are still learning about humanity. Or maybe these are concepts we knew for a long time but didn't have the words.

  20. Have you delivered any discourse here about mental health survivors' lives and the chance event of Ego-death, Doctor ?  the question arises from my own past memories

  21. I’ve been noteworthy as a Dizzy-Ding, and I have found that I Need my status as a SpaceCadet, this out-of-focus mind I keep sustains me where so many material matters would erode my will, as so much unwanted sobriety, although I’ve never used drugs, feels like blunt force against my posture, and I am gifted with a natural fluency with relaxation exercise and my own formulas for altered state that serve as my vice

  22. I love your outfit ! You're so pretty today. And great video! This sounds like it would be very challenging for someone to live with. Question, is this more common in men? I'm not trying to be sexist its just that I heard of some disorder where pregnant women have to much of a certain hormone and can cause a male fetus to become immune to serotonin.

  23. Well, if I came home and found my Wife reading the National Busybody, I’d be angry too. 😉 It’s interesting how many disorders are due to serotonin imbalances. I had no idea a BP medication could be used as a mood stabilizer. Very interesting Dr. Marks, and well done as usual. 👍

  24. You are so thorough on the descriptions and explanations. I believe our society’s overlook of mental health for so very long has taken a detrimental effect on us all to the point of no return. People are angry, some ALL THE TIME!!!!! A lot of erratic behaviors are so commonplace they are the “norm”. Growing up I was taught co dependence and did not understand the damage it does to all parties until I found myself in a cycle of trauma-domestic violence- drug addiction relationships,. As I am trying to repair my life I have had to purposefully change and unclutter my life of unnecessary people and habits. You DO ATTRACT HOW YOU FEEL INTO YOUR LIFE. Most if not all my relationships were unhealthy and toxic, and I don’t mean just the romantic relationships, I MEAN ALL.!!!! It’s been a hard year, but challenge brings about changes which usually produces growth. I’m much more me centered, and trying to heal me in so many ways. I appreciate your channel as an venue in helping me, THANKS

  25. Hi Tracey, thank you for always putting up such great videos! I wanted to see if you might be able to cover this topic – or maybe already have. I’d like to know some tips for how to help friends when you notice things changing with them in a worrying way. Recently a friend of mine started losing weight quickly and has become kind of obsessed – for lack of a better word – with tummy teas and workout plans and cutting out and only eating certain foods in a way that I can see affecting her life. I want to help but don’t know how/what would actually be useful for her for me to say/do. I brought it up to her sister, who I'm also friends with, but she blew it off and said that she's fine.

    Is there a time when it’s appropriate and helpful for the person going through something for a friend to bring it up? And how should one go about that? Or is there something else that’s better? Especially in circumstances where you don't see anyone else in their life taking it seriously. I really appreciate any insight you have into this! Thank you!

  26. Hi! Thank you so much for the videos, they're great. Could you make some videos on Dissociative Identity Disorder please? It would be much appreciated 😊

  27. Hi Dr. Marks. Thank you for sharing. I'm glad I discovered your channel. I very much appreciate your informative videos. I find myself calming down or better yet my anxiety decreases whenever I hear your voice. I think perhaps it's because you remind me of my therapist who I've been seeing for the last 9 years. Anyway, I get better understanding of my mental health illness from watching your videos. My Psychiatrist is wonderful as well but I'm uptight most of the time even in his office. I watch your videos alone and it's like you're speaking to me personally even though I know you are speaking to everyone who watches your videos. I'm a disabled veteran who needs all the mental health support and information for not only duty related mental health issues, but also for another area of trauma I experienced in childhood that was supressed for many years. Anyway, I think I've posted more info than I intended. Sorry for the length of this post. I just should've stopped at Thank You…..

  28. My parents are also angry but not so explosive , they have a lower degree of outbursts, but we both my partner and myself are really bad, he is mostly type 1 – lower outbursts but more frequent ( he broke two of my mobile p hones in the last months) , while I have more rare outbursts but more intense, they were more often in the past , I broke my own phones and more personal objects , then it took a brake for a while ( afew years)but now as it seems the condition is coming back with a vengeance, I remembered why I no more can wear any necklace or bracelet or similar accessories, because I am very prone to break them apart when I get distressed; I will consider propranolol because I had heart about it in the past and I already have it and use it occasionally for tachycardia or palpitations that not respond to lighter stuffs like magnesium, BUT I can tell you for my humble experience THAT once the anger outburst is triggered, NO medication or substance that you swallow can stop it so sudden, until further damage is done or you or someone else is hurt 😑; when I was a kid my parents had to throw water on me a few times, when I was getting too hard to controll ; but they took that kind of behaviour as a sign of bad education, they thought they might had loved me too much and allowed me too much, and they hadn't punished me when it should ; other parents think they hadn't loved enough their children and neglected them so they do so to draw their attention or to revenge, to punish their parents, every body has his opinion but nobody actually do what they should, to ask professional help for the kids especially if for themselves is too late 😠

  29. Hey, Dr. Marks! I loved this video. Can you make a follow-up with some techniques to calm down or channel the aggression in a less destructive way?

  30. Dr. Tracey,
    Can you please clarify how tardive dyskinesia and akithesia should be managed. I still don't understand how dopiminergic blocking agents can cause both rigidity and akithesia.

  31. I also see clients with neurodevelopmental disorders diagnosed with IED. Is this an accurate stand alone diagnosis or related to an inability to communicate effectively and the outbursts are out of frustration? I see clients who have developmental disabilities, diagnosed with psychiatric disorders such as schizophrenia. However, when interacting with them, it seems impossible that anyone could have been able to distinguish between psychotic (or other symtomatologies) and characteristics that we may observe in this population (some stereotypical). Also I am learning a great deal from you. Do you have a separate forum that medical professionals, especially newbies can go to for advice and or videos such as this? Thanks Dr. Marks.

  32. Hello Tracey, quick question. If Prozac and Venlafaxine both exhibit the CYP 2D6 metabolite enzyme, would Prozac slow down Venlafaxine significantly in leaving my body?

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