Intermittent explosive disorder: a storm inside the mind that erupts suddenly Intermittent Explosive Disorder is a type of behavior problem in which a person suddenly has violent outbursts of anger and aggression, to the point of losing control. These reactions are usually disproportionate to the situation and can cause serious problems in a person's relationships and daily life. In this article from Pirouz Psychology Clinic website, we examine the symptoms of Intermittent Explosive Disorder and introduce effective treatment strategies for its management.

What is Intermittent Explosive Disorder or Impulse Control Disorder? We all get angry sometimes, but people with Intermittent Explosive Disorder feel unable to resist aggressive and destructive behavior. While most people can vent their anger without harming others, people with this disorder experience sudden outbursts of anger that show aggressive or destructive behavior without specific provocation. These outbursts of anger can lead to serious injury to oneself, others, or property. In moments of anger, these people feel like they have completely lost control, and some even describe this situation as similar to epileptic attacks. Before an outburst of aggression, they have a vague and unpleasant feeling of a sudden event, similar to what people with epilepsy experience before an attack. **Disorder symptoms** Explosive **Intermittent** Explosive tantrums occur without warning and usually last less than half an hour. These outbursts may be repeated several times a week or month and have devastating effects on the life of the person and those around him. Meanwhile, verbal conflicts can also appear continuously between episodes of physical aggression. People with intermittent explosive disorder often have impulsive, irritable, and aggressive behaviors and may experience constant feelings of anger. In some cases, episodes of angry outbursts are accompanied by physical and psychological symptoms, including: - A feeling of intense anger - Body tremors - Heart palpitations - Excessive irritability - Negative or even suicidal thoughts - Feeling of pressure in the chest - Sudden increase in energy - Murmuring of the body During these outbursts, the person exhibits aggressive behaviors without considering the consequences, which include: - Conflict and fight - Shouting and misbehaving - Threatening others - Damage to property - Intense and long arguments - Physical attack on others or animals - Hitting, pushing or physically harming others After the outburst ends, the person usually feels relaxed or tired, but in many cases, they feel guilty and ashamed of their behavior. If someone realizes that they are experiencing these symptoms and their behaviors match these descriptions, it is better to consult a psychologist at Pirouzi Clinic to explore the appropriate treatment options to control this condition. **Reserve consultation appointment** Initiation and clinical course Intermittent explosive disorder most often begins in late childhood or adolescence and rarely occurs for the first time after age 40. The clinical course of this disorder may be episodic with frequent episodes of impulsive aggressive outbursts. Intermittent explosive disorder appears to have a chronic and persistent clinical course that lasts for years. It also appears to be very common regardless of the presence or absence of ADHD or other disruptive, impulse control, and conduct disorders (eg, conduct disorder, defiant/defiant disorder). (American Psychological Association, Diagnostic and Statistical Manual of Mental Disorders DSM-5-TR, Dr. Mehdi Ganji, Tehran, Savalan) Many patients with Intermittent Explosive Disorder have hyperactivity and attention deficit at the same time. To learn more about this disorder, read the article "What is Attention Deficit Hyperactivity Disorder (ADHD) and how is it treated?" read the Causes of intermittent explosive disorder ### *Psychoanalytic factors* Psychoanalysts believe that outbursts act as a defense mechanism against narcissistic threats. Outbursts of anger are seen as a means of maintaining emotional distance and preventing further damage to one's narcissism. *Psycho-social factors:* Many people with intermittent explosive disorder grew up in an unfavorable environment during childhood, which included alcohol addiction, violence and serious life threats. The underlying factors in infancy and childhood include birth injuries, childhood seizures, brain injuries, encephalitis, minor brain disorders, and hyperactivity. ### *biological factors* Physiological disorders of the brain, especially in the limbic area, cause violent attacks in many cases. Also, high concentration of testosterone in cerebrospinal fluid has been associated with aggressive behavior and interpersonal violence in men. Coexistence with other mental disorders More than 90% of people suffering from this disorder also suffer from other mental problems such as mood disorders. In addition, intermittent explosive disorder is often associated with substance abuse and anxiety disorders. During periods of aggression, these people are unable to control their impulses and their anger levels are disproportionate to stressful stimuli. However, these outbursts of anger are not associated with other mental or physical illnesses. How is impulsive-based aggression disorder (IED) diagnosed? The new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has provided updated criteria for the diagnosis of IED. These criteria distinguish between: - Repeated episodes of verbal aggression that do not physically harm people or property. - Less destructive or aggressive behaviors that do not cause serious damage to people or property. A disorder characterized by impulsive and aggressive behaviors has been mentioned in all versions of the DSM. However, this disorder was first introduced as IED in the third edition of this manual. Before then, this disorder was thought to be rare. With updated diagnostic criteria and scientific advances in the field of IED, this disorder is now recognized as a more common problem. A 2005 study showed that 6.3% of 1,300 people who had referred to treatment centers for mental health problems met the diagnostic criteria for IED at some point in their lives. Additionally, 3.1% of them now have a diagnosis of IED according to DSM-5 criteria. Another 2006 study of 9,282 people found that 7.3% of people met DSM-5 criteria for IED at some point in their lives, and 3.9% of those met criteria during the past 12 months. Treatment of intermittent explosive disorder Some clinical experts believe that due to the abnormalities in the serotonin system of the brain, drug use can help control this disorder, but drug methods alone are not enough and must be combined with psychological treatments. In psychotherapy, sufferers learn to find healthier ways to manage anger. Instead of physical and violent reactions, verbal expression of feelings can be used to reduce tension. summary According to the symptoms and effective factors in intermittent explosive disorder, it can be seen that this situation can have destructive effects on personal, family and social relationships. Knowing the methods of diagnosis and treatment of this disorder is a fundamental step in controlling aggressive behaviors and preventing further injuries. Therefore, people who feel that they may have this disorder, it is better to see a psychologist or a psychiatrist of Pirizh Group as soon as possible. Proper management and receiving appropriate treatment not only help to improve the condition of the person, but can also prevent the negative consequences of this disorder on the quality of life and personal relationships.

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