Intermittent Explosive Disorder: Causes, Symptoms, and Treatment

Intermittent explosive disorder, or IED, is a mental health condition that causes sudden, intense outbursts of anger that are out of proportion to the situation. These outbursts may involve physical violence or verbal threats.

People with IED usually cannot control their anger, and episodes can occur at any time, without warning. As a result, IEDs can interfere with daily life and cause significant distress to people and their friends and family.

Although there is no single treatment for IEDs, doctors can recommend effective therapies and medications to manage symptoms and improve quality of life.

This article takes a closer look at intermittent explosive disorder, including its causes, diagnosis, and treatment.

IED is a mental health problem, the characteristics of which include short periods of unexpected and intense aggression, rage or violence. These strong feelings often arise spontaneously and are usually more intense than the situation warrants.

IED often appears in late childhood or early adolescence, with affected individuals often feeling like they have no control over their anger.

Children with IED may have less severe temper tantrums, fights, or outbursts. However, they can also have severe anger that leads to physical violence towards people, animals or objects.

Because of these reactions, IED frequently affects a child’s academic performance and causes problems in relationships with family and friends.

Individuals with IEDs may experience different forms of aggressive episodes, which may include:

  • an inability to control sudden outbursts of anger
  • frequent outbursts in the form of arguments, tantrums, and fights
  • occasionally have more intense moments of anger and violence
  • explosive outbursts lasting less than 30 minutes
  • aggressive explosions in case of frustration

Doctors remain unsure of the exact causes of IEDs, but believe many factors play a role.

Environmental factors encompass behaviors that a person experienced in childhood. These include trauma and growing up in a physically, sexually or verbally abusive home.

Other expert rating that the repeated aggressive and impulsive behavior characteristic of IED is correlated with low levels of serotonin in the brain. Therefore, brain chemistry could also contribute to the development of IEDs.

Some to research shows that the people most at risk of developing an IED are those who:

  • are men
  • are between the ages of 13 and 23
  • are unemployed
  • are divorced or separated
  • suffered multiple traumatic events as a child
  • grew up in a physically, verbally, or sexually abusive home

In addition, people with other mental health problems have a increases risk of developing an IED. These conditions include those with symptoms of problematic or impulsive behaviors, such as attention deficit hyperactivity disorder (ADHD), conduct disorder, and oppositional defiant disorder (ODD).

Having an IED does not necessarily mean that a person is more likely to receive another mental health diagnosis and vice versa. However, the comorbidity rate is high. Causality can work both ways, and the correlation between IEDs and other mental health conditions is still a matter of debate.

People with IED are also more likely to develop a substance use disorder or to consider self-harm or suicide.

Doctors often begin the process of diagnosing IED by ruling out other potential causes for the individual’s behavior.

Other conditions that could cause similar behaviors include:

  • other mental health disorders
  • drug or alcohol use disorder
  • physical causes, such as a head injury

Once a doctor has ruled out the above, they can diagnose a person with IED if they:

  • can’t control his anger
  • often argue or have tantrums
  • sometimes have destructive outbursts of violence and rage that do not accurately reflect the seriousness of the situation

The first-line treatment for IEDs is usually a combination of medication and therapy.


Although there is no specific medicine for IED, there are still many effective options, such as:

  • anti-anxiety medications, including beta-blockers such as propranolol (Inderal) and nadolol (Corgard)
  • antidepressants, including fluoxetine (Prozac), fluvoxamine (Luvox), and citalopram (Celexa), which are selective serotonin reuptake inhibitors
  • anticonvulsant mood stabilizers, including valproic acid (Depakote) and topiramate (Topamax)

It is important to note that medications for mental health can take as long as 2 months to produce their full effect. Also, people may need a long-term prescription.


Doctors may recommend cognitive behavioral therapy (CBT) for people with IED. CBT allows people to understand and recognize the situations that trigger their severe outbursts.

CBT offers people with IEDs a way to deal with their anger in healthy ways rather than with violent, verbal outbursts. This practice not only ensures that no one else gets hurt in an explosion, but it also helps people feel better about their situation by giving them a level of control they didn’t have before.

With CBT, the individual’s caregivers can also work with the therapist. CBT can help them understand the triggers for angry outbursts and how they can navigate the situation.

Learn more about types of therapy.

Some other mental health conditions can have similar symptoms to IEDs, but there are also key differences.

Bipolar disorder

Bipolar disorder is a mental illness that leads to unusual changes in mood, activity levels, energy, concentration, and the ability to perform regular daily tasks.

These mood swings often cause a person to go from high energy states, such as motivation, elation, or irritability, to low energy states of sadness, indifference, and despair.

These low moods are not characteristic of IEDs. Additionally, manic periods in bipolar disorder typically last at least 7 days, whereas an episode of IED typically lasts Less than 30 minutes.

Oppositional Defiant Disorder (ODD)

Doctors can diagnose ODD in children who have temper tantrums, are abnormally angry, don’t follow rules, or hurt others on purpose. Odd children exhibit this extreme behavior for at least 6 months.

Usually ODD affects children before the age of 8 and no later than 12 years old, which is younger than the typical age for IEDs.

Children can outgrow OPT, but early treatment helps family life and can improve the child’s future.

Intermittent explosive disorder is a mental health condition that often manifests as sudden anger and violent outbursts. It usually appears in early adolescence and can cause problems with relationships and school performance.

Doctors aren’t sure of the specific causes, but brain chemistry and exposure to childhood trauma likely play a role.

To diagnose IEDs, doctors first rule out other possible causes of anger and irritability. These include other mental health issues, substance abuse, and head injuries.

Treatment options for IEDs include CBT and medications such as mood stabilizers, anti-anxiety medications, and antidepressants.

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