Intermittent Explosive Disorder

A little-known mental disorder marked by episodes of unwarranted anger is more common than previously thought, a study funded by the National Institutes of Health's (NIH) National Institute of Mental Health (NIMH) has found. 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.

People with IED may attack others and their possessions, causing bodily injury and property damage. Typically beginning in the early teens, the disorder often precedes — and may predispose for — later depression, anxiety and substance abuse disorders. Nearly 82 percent of those with IED also had one of these other disorders, yet only 28.8 percent ever received treatment for their anger.

To be diagnosed with IED, an individual must have had three episodes of impulsive aggressiveness "grossly out of proportion to any precipitating psychosocial stressor," at any time in their life, according to the standard psychiatric diagnostic manual. The person must have "all of a sudden lost control and broke or smashed something worth more than a few dollars…hit or tried to hurt someone…or threatened to hit or hurt someone."

Given its earlier age-of-onset, identifying IED early — perhaps in school-based violence prevention programs — and providing early treatment might prevent some of the associated psychopathology.

Although the new prevalence estimates for IED are somewhat higher than previous studies have found, the researchers consider them conservative. For example, anger outbursts in people with bipolar disorder, which often overlaps with IED, were excluded. Previous studies have found little overlap between IED and other mental illnesses associated with impulsive violence, such as antisocial and borderline personality disorders.

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