DEAR DOCTOR K:
My son’s doctor thinks he might have intermittent explosive disorder. I know my son has a bad temper, but I was surprised to hear that it might be a “disorder.” Can you tell me more about this? What can I do to help my son?
Under severe enough stress, any normally calm and collected person might become angry — and might even be provoked to the point of violence. But some people lose their temper easily and repeatedly. In these people, tension mounts until there is an explosive release.
This behavior pattern is called intermittent explosive disorder (IED). People with IED respond with strong rage that is out of proportion to the situation. They may seriously harm people and property through violent words or actions.
A survey by the National Institute of Mental Health found that at any given time, 3 percent to 4 percent of people have the disorder. It also found that people with IED were often young; the disorder often starts in the early teens. Most people in the survey identified with IED were male.
A quick aside: Although IED is typically diagnosed later, clearly some infants fly into a rage much more frequently than most infants. I am not aware of any study that has seen whether such infants go on to suffer from IED as adults, but I wouldn’t be surprised. I learned recently of a famous physicist whose rages were notorious. As a baby, his screaming rages were so extraordinary that his parents were forced to move several times because of complaints by the neighbors.
It is sometimes hard to tell the difference between IED and other disorders that feature impulsive, aggressive behavior. Examples of such disorders include personality disorders, mood disorders, anxiety disorders and substance abuse.
All behavior originates in the brain. Brain scientists have learned some interesting information about the biology behind IED. Here’s what we know so far:
- Close relatives of people with IED appear to have a significantly elevated risk of IED.
- The disorder appears to be associated with abnormal activity in parts of the brain that regulate and inhibit aggressive behavior. The chemical messenger involved is serotonin.
- Impulsive aggression is associated with low serotonin activity. Such aggression is also linked to damage to the prefrontal cortex. This part of the brain is a center of judgment and self-control.
Significant violence should be treated as a medical problem, like chest pain. But people who have trouble resisting their violent impulses are not very likely to seek treatment.
A number of medications can help to reduce aggression and prevent rage outbursts. These include:
- Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs);
- Mood stabilizers (lithium and anti-seizure drugs);
- Anti-psychotic drugs.
Another approach that looks promising for treating IED is cognitive behavioral therapy (CBT). This is a form of talk therapy that helps to reframe negative thoughts and change unwanted behavior. If your son’s pediatrician has not recommended one of these approaches, ask which of them he or she recommends.