7 Signs of Intermittent Explosive Disorder in Adults
Intermittent explosive disorder (IED) is a mental health condition that can lead to sudden outbursts of aggressive or impulsive behaviors. So, if you or a loved one struggles to control their anger in intense moments, IED could be the cause.
Up to 16 million Americans are affected by IED in their lifetime.1 But despite this, few people have heard of intermittent explosive disorder, and even fewer know the signs to look out for or the treatment options available.
Below, we explore:
- What intermittent explosive disorder is
- 7 signs of intermittent explosive disorder in adults
- The causes of IED in adults
- How to treat adult intermittent explosive disorder
- IED treatment options, including:
- Cognitive behavioral therapy
- Medication like SSRIs
What Is Intermittent Explosive Disorder in Adults?
Those with IED tend to struggle with frequent temper outbursts, during which they can become verbally or physically aggressive. This anger tends to be out of proportion to the event that triggered it, such as:
Extreme road rage after being cut up by someone on the road- Domestic violence due to anger aimed at their romantic partner
- Throwing or breaking objects during workplace conflict
IED typically begins in the early teenage years and may trigger or increase the person’s risk of developing depression or anxiety at a later date.1
7 Signs of Intermittent Explosive Disorder in Adults
If you, or someone you love, is becoming violent when they’re angry, they could be struggling with intermittent explosive disorder. In these situations, knowing the signs can help you or your loved one get the support needed.
1. Frequent Aggressive Outbursts2
Regular, recurring aggressive outbursts are a crucial sign of intermittent explosive disorder. To be classified as IED under the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) – the guide mental health practitioners use to diagnose psychological conditions – these aggressive outbursts need to occur:
- Twice a week (on average)
- For 3 months or more
This includes both verbally and physically aggressive behaviors.
2. Anger Episodes Are Sudden and Unpredictable2
A person with IED often experiences intense anger that feels out of control. As a result, they act in ways they later regret, including destroying other people’s property. For example, in a road rage incident, they may damage another person’s car, or during an argument with a romantic partner, they may throw objects.
3. Destroying Property While Angry2
A person with IED often experiences intense anger that feels out of control. As a result, they act in ways they later regret, including destroying other people’s property. For example, in a road rage incident, they may damage another person’s car, or during an argument with a romantic partner, they may throw objects.
4. Anger Is Out of Proportion to the Trigger Event2
All of us get angry, and we don’t always have the tools we need to manage our anger in the moment. This is also true in the case of IED, but the intensity of the feeling and the inability to cope with these feelings is magnified. When someone with IED experiences an aggressive outburst, their anger generally seems extremely exaggerated or out of proportion compared to the event that triggered it.
5. Verbal Abuse During Angry Outbursts2
As we touched on earlier, verbal abuse and aggression are common when someone with IED loses control. They may say hurtful things that they don’t mean to people they love, or get into heated arguments with strangers or colleagues that end in verbal abuse. In these instances, a person with IED may make threats, shout insults, or speak offensively.
6. Showing Physical Aggression Toward People or Animals2
Alongside verbal aggression and property destruction, those with IED may also show physical aggression when they lose control of their anger. This physical aggression may be directed toward people or could be aimed at a pet or other animal.
It’s important to note that physical violence is an indicator of more serious rages – this isn’t a sign for every single person with IED.
7. Anger Is Affecting Their Job or Relationships2
A person with IED may also find it incredibly difficult to have friendships and relationships, as their intense anger often results in relationship breakdowns. In fact, studies show that IED puts people at higher risk of being unemployed, divorced, or separated.3
Causes of Intermittent Explosive Disorder in Adults
It’s impossible to pinpoint the causes of intermittent explosive disorder in adults, as research only shows us a relationship between two factors, not if one caused the other. However, we can see from the research that certain factors influence IED in adults, either by increasing the risk or often occurring alongside. These include:
1. Co-Occurring Mental Health Conditions
2. Traumatic Past Experiences
Other traumatic past experiences that may increase a person’s risk of developing IED are3:
Traumatic war experience- Sexual abuse
- Traumatic car accident
- Natural disaster
- Life-threatening illness
- Unexpected death of a loved one
- Witnessing a traumatic injury to a loved one
3. Abnormalities in Neurotransmitters in the Brain4
Neurotransmitters are chemical messengers that send signals within areas of the brain, and sometimes from the brain to our muscles. Some studies suggest that there may be certain abnormalities in how specific neurotransmitters function within the brain, particularly serotonin.
Serotonin is thought to be a “happy” hormone – it plays a role in our happiness, as well as our learning, memory, body temperature, sleep, and hunger. However, that’s nor all. It has another important role – regulating our impulsivity and aggressive behavior. Therefore, abnormalities in the serotonin neurotransmitters in the brain may lead to the behaviors we associate with IED.
4. Differences in the Structure of Certain Brain Regions5
People diagnosed with IED tend to have several key differences in the structure of their brains, which could indicate that IED has a biological cause. Research suggests that the main brain difference is that those with IED typically have less gray matter. Some of the key brain regions that make up the gray matter are:
- Orbitofrontal Cortex: This brain region is vital for decision-making, especially when weighing up potential consequences of behavior. Because of this, it helps regulate our social behaviors and control our impulses.
- Ventral Medial Prefrontal Cortex: This area is important for how we perceive ourselves and regulate our emotions.
- Amygdala: This is the brain’s emotional center, particularly for processing fear and other difficult emotions.
Differences in these three brain regions could potentially explain the difficulties with impulsivity, emotion regulation, and intense anger that we see in adults with IED.
How to Treat Intermittent Explosive Disorder
While IED can be scary and overwhelming – not just for loved ones but also for those struggling with the condition – there are effective treatment options available. If you think you may have IED, consult with a qualified mental health professional for an accurate diagnosis and personalized treatment plan.
Therapy for IED in Adults6
Studies suggest that the most useful psychotherapy for adults with IED is cognitive behavioral therapy (CBT). CBT is a structured, often short-term, therapy approach. A person with IED would set goals with their CBT therapist in the first few sessions and work towards these in their later sessions.
CBT therapists support people to understand how their thoughts are affecting their actions, and help them change any unhealthy thinking patterns and behaviors, swapping them for healthier ones. This process is known as cognitive restructuring. CBT for IED in adults involves several other key techniques, too. These include5:
Relaxation Techniques: People with IED often experience a build-up of tension before an outburst. Relaxation techniques, such as deep breathing exercises, progressive muscle relaxation, or mindfulness meditation, can help them manage this tension and de-escalate before an outburst occurs.- Coping Skills Training: This involves teaching specific strategies to manage anger and impulsive behaviors in the moment. It could include assertiveness training, problem-solving skills, and communication skills.
- Relapse Prevention: This focuses on identifying potential triggers for future outbursts and developing plans to manage these situations effectively. It could involve role-playing challenging scenarios and practicing coping skills in real-life situations.
At Mission Connection, we offer flexible treatment plans to support each adult with intermittent explosive disorder. We’ll talk you through the treatment options we offer and help you find a treatment program that fits with your life. Contact us today at 866-721-7952 for more details.
Medication for Adult With Intermittent Explosive Disorder7
Medication isn’t the right choice for everyone, and it’s a completely personal decision whether or not to include medication within your treatment plan. However, evidence suggests that some medications can help people with IED. But how?
Well, medication can increase a person’s threshold at which events trigger an angry outburst. For example, before medication, an adult with IED may have lost control of their anger after someone accidentally stepped on their foot. But once they have begun taking medication, it may take something more extreme, such as someone insulting them, to tip their anger over the edge.
Studies show that selective serotonin reuptake inhibitors (SSRIs) such as Prozac can reduce irritability, and mood stabilizers may lessen the intensity of mood swings.
Seek Intermittent Explosive Disorder Treatment Today
Intermittent explosive disorder can practically wage war on an adult’s life. Fits of rage can make it difficult to keep hold of a job, build healthy relationships, and feel good about yourself. If this sounds familiar and you think you may be struggling with IED, know that help is available.
The team at Mission Connection is a great option if you want your treatment to fit your lifestyle. We offer one-a-week in person therapy or virtual telehealth services for you to access in your own home, so your treatment can fit seamlessly into your life.
Our treatment programs are delivered by licensed, experienced clinicians, and a fantastic team of therapists, who can help you learn to manage your explosive anger and develop coping strategies to live a happier, more fulfilled life.
So, if you’re struggling right now, don’t wait to reach out. Get started now.
References
- National Institute of Health. (2006, June 5). Intermittent Explosive Disorder Affects up to 16 Million Americans. https://www.nih.gov/news-events/news-releases/intermittent-explosive-disorder-affects-16-million-americans
- Luna, R. E. (2024). What are disruptive, impulse control and conduct disorders? American Psychiatric Association. https://www.psychiatry.org/patients-families/disruptive-impulse-control-and-conduct-disorders/what-are-disruptive-impulse-control-and-conduct
- Scott, K. M., Lim, C. C. W., Hwang, I., Adamowski, T., Al-Hamzawi, A., Bromet, E., Bunting, B., Ferrand, M. P., Florescu, S., & Gureje, O. (2016). The cross-national epidemiology of DSM-IV intermittent explosive disorder. Psychological Medicine, 46(15), 3161–3175. https://doi.org/10.1017/S003329171600208X
- Fanning, J. R., Lee, R., & Coccaro, E. F. (2020). Neurotransmitter function in impulsive aggression and intermittent explosive disorder. In A. R. Felthous & H. Saß (Eds.), The Wiley International Handbook on Psychopathic Disorders and the Law (2nd ed., Chapter 10). Wiley. https://doi.org/10.1002/9781119159322.ch10
- Coccaro, E. F., Fitzgerald, D. A., Lee, R., McCloskey, M., & Phan, K. L. (2016). Frontolimbic morphometric abnormalities in intermittent explosive disorder and aggression. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 1(1), 32–38. https://doi.org/10.1016/j.bpsc.2015.09.006
- Liu, F., Yin, X., & Jiang, W. (2025). Comprehensive review and meta-analysis of psychological and pharmacological treatment for intermittent explosive disorder: Insights from both case studies and randomized controlled trials. Clinical Psychology & Psychotherapy, 32(1), Article e70016. https://doi.org/10.1002/cpp.70016
