Intermittent Explosive Disorder (IED) is becoming a more widely used term for psychologists who are trying to classify an emerging phenomena in schoolyard behavior. Experts are trying to understand the reasons for the increase in teenage rampage not only in the US
IED is defined as a psychological disorder manifested through impulsive acts of aggression in which those diagnosed may attack others and their possession, causing bodily injury and property damage. This disorder was originally described by the French Psychiatrist, Jean-Etienne Esquirol. He described this disorder as one of “partial insanity” related to impulsive acts considered to be senseless (Thackery & Harris, 2003, p. 534-536). He believed these impulsive acts to be involuntary.
Patients diagnosed with this disorder often feel a great sense of tension before the outburst. This tension can be accompanied by tingling, tremors, palpitations, and head pressure. There is a great sense of relief after the outburst. Although they feel that their outburst is justified, there is also a great sense of remorse, embarrassment, and regret in respect to their impulsive behavior.
According to the National Institute of Mental Health, through a study done in June 2006, IED is more common than previously thought. They found that it most commonly affects young men, and as many as 7.3 percent of adults in the United States
In order for a person to be diagnosed with IED, they have to meet three criteria. The first of these is they have to display several episodes of failing to resist aggressive impulses. This failure must result in destruction of property or serious assaultive acts against others or oneself (Diagnostic and Statistical Manual of Mental Disorders, 2000, p. 667). These impulses are usually anger driven. People with this disorder have a problem controlling their anger. This anger is usually manifested in temper tantrums that can involve throwing or breaking things. Other examples of serious assaultive acts include hitting, punching, striking, or physically hurting another person. Verbally threatening to physically hurt another person is also considered an assaultive act. Destruction of property is considered purposely breaking an object of value. If a person unintentionally damages something of value during an episode, it is not sufficient to meet this criteria.
The second criteria for being diagnosed with IED is the degree of aggressiveness displayed during an episode is grossly out of proportion to any precipitating stressor (Diagnostic and Statistical Manual of Mental Disorders, 2000, p. 664). In other words, their violent behavior is usually not in proportion to the incident that triggered the episode. For example, a child in a classroom with IED may consider a timed activity to be a source of stress. They would overreact to this by displaying some type of aggressive act, such as throwing a chair or threatening a teacher.
The final criteria for diagnosing an individual with IED, and perhaps the most difficult criteria to meet, is the aggressive episodes must not be associated with, or the result of another mental disorder. These episodes also cannot be due to the influence of a controlled substance, such as alcohol, drugs or medication. In addition, if a medical condition such as epilepsy or Alzheimer’s is causing the aggressive impulses, IED cannot be diagnosed (Diagnostic and Statistical Manual of Mental Disorders, 2000, p. 667). It is because of these criteria that IED is considered a diagnosis of elimination, meaning that it is given only after all other disorders have been ruled out as causes of aggressive impulses.
Aggressive impulses are characteristics of many other mental disorders. For example people with Attention Deficit/Hyperactivity Disorder, Conduct Disorder, and Antisocial Personality Disorder may all fail to resist aggressive impulses and end up assaulting people or destroying property. It is important for clinicians to recognize when these impulses are the result of these disorders. A diagnosis of IED is only made when symptoms are not caused by any other disorder.
People who use controlled substances, such as PCP or alcohol may overreact violently to unwarranted situations. Even though they meet the first criteria of IED, they cannot be diagnosed with this disorder because their viole3nt behavior is a result of a substance and not a mental disorder.
There is some discrepancy among professionals about the causes of IED. Although scientists do not know the exact causes of this disorder, most believe that both physical and emotional factors play a part in its onset. According to Daniel Ploskin, MD, IED may result from abnormalities in areas of the brain that regulate impulses and inhibition. Studies show that impulsive aggression is related to abnormal levels of the neurotransmitter Serotonin. Serotonin helps a person control their behavior (Ploskin, 2007). When these neurotransmitters are dysfunctional, a person’s ability to control their impulses is hindered.
Some studies have correlated IED with abnormalities on both sides of the front portion of the brain. This part of the brain appears to be involved in processing information and movement control. In a person with IED both of these are unbalanced (“Intermittent explosive disorder“, n.d.). This causes the individual to perceive a threat where none may exist. They are also unable to control their reactions to this unwarranted precipitator.
In a study of 326 children in adolescence, researchers found that 46% of the subjects who manifested explosive behavior had unusual high amplitude brainwaves (“Intermittent explosive disorder“, n.d.). As a result, researchers concluded that people with IED might be predisposed to explosive behavior because of this abnormality in their nervous system. This abnormality in brainwaves causes the nervous system to fire inappropriately which leads a person to overreact to stimuli.
In addition to biological influences, some scientists believe that there may also be emotional and psychological causes of this disorder. Studies have shown that people with impulse control disorders are more likely to have a family history of mood disorders and addiction. People with IED often grow up in an unstable environment. This type of environment may include severe frustration, physical and emotional abuse, alcoholism, violence, and other life-altering situations (Ploskin, 2007). These people are exposed to all these negative environmental stressors and often lack proper role models to teach them how to control their emotions and impulses. People with IED were not only exposed to damaging negative environments, but also they were never the correct way to cope with these events.
Cognitive therapists may attribute IED to cognitive distortions. Some clinicians believe that people with IED have a set of strongly negative beliefs about other people. These beliefs are the result of harsh punishments inflicted by their parents (“Intermittent explosive disorder“, n.d.).
He or she might have witnessed their parents, older siblings, or other adults displaying explosively violent outbursts. The child grows up believing that others are “out to get him” and that violence is the best way to protect their damaged self-esteem. In other words, people with IED have learned, usually from a young age that certain behaviors and attitudes in other people warrant an aggressive act on them.
IED can often have lasting and damaging effects on a person’s life. Children with IED often have difficulties interacting effectively with their peers, causing them additional stress at school. Their violent physical acts often result in being removed from the class environment. Students with IED are frequently disciplined, further increasing their frustration.
Adults with IED may find it difficult to interact in social and professional environments. This disorder often results in conflicts with their spouses, which may lead to divorce. Their lack of impulse control may result in job loss, which can lead to financial and legal problems. Because of the violent acts associated with IED, hospitalization may be necessary due to injuries sustained from fighting (Diagnostic and Statistical Manual of Mental Disorders, 2000, p. 664). Overreactions or “road rage” in people with IED may lead to car accidents.
According to drivers.com, two thirds of all driving fatalities in the United States
References
Diagnostic and Statistical Manual of Mental Disorders (4th ed.). (2000). Washington , DC
Thanks
ReplyDelete