What Is the Best Treatment for Intermittent Explosive Disorder?

This article will provide valuable insights into the best treatment approaches for intermittent explosive disorder (IED) and to offer guidance on developing a sample treatment plan tailored to individual needs.

Intermittent explosive disorder (IED) is a mental health disorder that falls under the category of disruptive, impulse-control, and conduct disorders. Individuals with IED have recurrent outbursts like verbal or physical aggression all because they cannot control their aggressive impulses. It is not uncommon for someone with IED to have recurrent outbursts that are not premeditated and for those outbursts to cause significant distress for the individual. 

For intermittent explosive disorder, an individual will be diagnosed based on the following criteria:

1. Individuals must exhibit recurrent behavioral outbursts that represent a failure to control their aggression, including either of the following:
   1. Verbal aggression, including verbal fights, tirades, or temper tantrums, as well as physical aggression toward individuals, property, or animals takes place a minimum of two times per week for an average of 3 months at a time. Physical aggression does not need to result in damage or destruction nor cause any injury to individuals or animals to qualify.
   2. Three behavioral outbursts that involve destruction or damage, including physical assault involving personal injury, within a 12-month time frame.
2. The magnitude of the aggressive nature during those outbursts must be significantly disproportionate to the provocation or stressors.
3. The recurrent aggressive outbursts cannot be premeditated, nor can they be committed to achieve an objective.
4. The recurrent aggressive outbursts must cause significant distress in interpersonal functioning or have other consequences.
5. The chronological age of the individual experiencing the outbursts must be at least six.

Given that intermittent explosive disorder has symptoms similar to other conditions, a psychiatrist will have to rule out things like

• Oppositional defiant disorder
• Autism spectrum disorder
• Conduct disorder
• ADHD

After that, they’ll be able to determine whether or not the outbursts are exclusively related to intermittent explosive disorder or whether they co-occur with other mental health issues like depression or anxiety.

These outbursts have a detrimental impact on daily life by interfering with interpersonal or occupational functions, often with legal or financial consequences. For these reasons, it is important to seek professional help and find the best treatment for intermittent explosive disorder. But what are the options out there?

Those struggling with IED have a few options for treatment. 

The primary treatment for intermittent explosive disorder is psychotherapy. Individual and group Psychotherapy can help those struggling with intermittent explosive disorder to change their thought patterns and develop new, positive ways to respond to frustration.

Some research has found that cognitive-behavioral group therapy sessions are a very successful form of psychotherapy for intermittent explosive disorder treatment. 

Cognitive behavioral therapy is more effective when it’s combined with things like anger management. Anger management can help individuals learn which situations tend to result in explosive episodes and from there, figure out ways that they can manage the way they feel in a healthier fashion that doesn’t risk the safety and well-being of themselves or others. 

So, how does cognitive behavioral therapy work with intermittent explosive disorder?

With cognitive behavioral therapy, clients participate in sessions where they have discussions about symptoms, behaviors, and thoughts that contribute to their outbursts and relapses. If an individual is under 18, it’s not uncommon for parents or other guardians to participate in these therapy sessions. Tangentially, caregivers and teachers might also participate in cognitive behavioral therapy to better understand how they can afford to trigger these outbursts in a younger child.

At present, there is no specific treatment option for intermittent explosive disorder that involves medication. However, intermittent explosive disorder medication treatment can also prove useful in controlling secondary symptoms.  

This includes things such as:

1. Antidepressant medications like SSRIs, which help to increase the amount of time that serotonin remains within the brain and, in so doing, improve mood among those who might struggle with depression leading to their rage.
2. Anticonvulsant mood stabilizers, which help to reduce mood episodes by reducing nerve impulse excitability in the brain. This means that the amount of activity in the brain gets reduced so that neurotransmitters are not negatively affecting levels of serotonin, GABA, or dopamine. 
3. Anti-anxiety medications, especially beta blockers which, are used to reduce your heart rate as well as your adrenaline. Beta-blockers are traditionally given for heart attacks or hyperthyroidism, but they also treat anxiety conditions and IED secondary symptoms by reducing the amount of adrenaline and high blood pressure that might contribute to increased outbursts and feelings of anger. This can also help to reduce violent responses and calm any verbal attacks that are otherwise commonplace with an individual.

Medication is much more successful if used in tandem with psychotherapy, particularly cognitive behavioral therapy. 

There are other alterations that can be made to better control symptoms including better diet and exercise. For example, there are many foods that have been shown to reduce feelings of anger, stress, depression, and irritability.

• Omega-3 fatty acids have been shown to better regulate serotonin, which overcomes feelings of depression or anxiety.
• Dark chocolate can stimulate the release of endorphins to overcome depression symptoms.
• Berries and bananas have high levels of vitamin C and vitamin B6, both of which can reduce anger and produce neurotransmitters like serotonin and dopamine, which have a positive effect on mood.
• Spinach and other greens contain magnesium and vitamin B6, which produce serotonin, help regulate mood, and reduce outbursts.
• Chamomile tea can promote reduced anxiety and restful sleep while also helping to do away with depression.

Exercise can help release endorphins as well while distracting those with intermittent explosive disorder from their negative thoughts and their anger. Regular exercise also lowers stress hormones like adrenaline, which is a contributing factor to emotional outbursts. When combined with certain medications like beta blockers, this can have a significantly positive effect on symptom management.

These lifestyle changes, too, should be used in conjunction with CBT and/or medication. 

Relaxation techniques like yoga, meditation, or guided breathing can help individuals control their reactions to stress or triggers. Even in situations where the outbursts are not directly caused by a specific trigger, individuals can learn to control their emotional response and prevent themselves from reacting with physical or verbal outbursts.

For someone with IED, it is important to intervene early with personalized treatment plans and ongoing support in effectively managing intermittent explosive disorder. If you are struggling with intermittent explosive disorder, seek professional help and explore various treatment options to address your unique needs and challenges.