Categories
Disruptive, Impulse Control and Conduct Disorders

Intermittent Explosive Disorder

You’re at your favorite coffee shop on a beautiful morning. You’re happy; your morning has gone ideally, and it’s one of the best days you’ve had in a while. They call out your name to get your favorite drink, you take a large sip and…spit it all out.

Instantly, you are filled with a blinding rage—they’ve messed up your order!

You hurl it at the counter, cursing and screaming at everyone and everything around you.

You storm out, but by the time you get to your car, immense guilt has settled in.

You feel so bad, but you can’t face going back to apologize. You drive off and never return.

For someone with intermittent explosive disorder (IED), this happens regularly. Small things, like getting stuck in traffic on their way to work, can cause episodes of rage so intense, that the individual with this disorder can pose a threat to others or to themselves. Intermittent explosive disorder is a lesser-known mental disorder marked by episodes of unwarranted anger. It is commonly described as “flying into a rage for no reason” (Cleveland Clinic). Behavioral outbursts in an individual with intermittent explosive disorder are often disproportionate to the situation and often manifests itself in what seems like “adult temper tantrums” (Cleveland Clinic). Throwing objects, fighting for no reason, road rage, and domestic abuse are examples of intermittent explosive disorder. The outbursts typically last less than 30 minutes. After an outburst, an individual may feel a sense of relief – followed by regret and embarrassment.

IED often remains undiagnosed because of the nature of the disorder. People with this disorder are often labeled as “angry” and “impulsive”. The people around them don’t think to explore the underlying causes of the behaviors. Treatment options include cognitive behavioral therapy and medications, but they aren’t always effective. IED isn’t curable. These treatments attempt to make IED manageable by identifying triggers and teaching coping methods. However, the quality of life for many individuals who suffer from IED is still very low.

Carolina, age 31, who suffers from IED on a daily basis says, “I wish almost every day I could wake up and be someone else—a bubbly, happy, laughing girl who everyone likes and no one fears.”  She would see people shrug off incidents that would trigger her and feel both amazed and jealous. IED holds her back from the life she wants saying, “…I am dying for a family of my own and fear I won’t get it. All I’ve ever wanted was to be a mother and a wife. This is such a lonely life. Why am I this way?”

In her post on a support forum, she shared that two ex-boyfriends who were close to proposing left her because of her angry outbursts. One of them told her “he didn’t want to raise children in an environment where their mother would curse, shout and break things.”

She’s been fired for throwing a plant across the room at work. She also admits to calling her parents and yelling at them to the point where her mother starts crying. She feels regret and shame once the episodes pass, but she cannot control them:

“I was arrested in January for simple assault. I was in a verbally abusive relationship and my ex knew how to push my buttons. He one day went through my phone and said a bunch of crap to a guy friend of mine and then blocked him. When I found out the next day, I became enraged and physically beat my boyfriend to the point he called the police. Not only was I arrested but I was held in jail for two days…It was the lowest point of my life.” (Moon, C)

Carolina also shared that she has been taking medications and trying to manage her disorder for the past ten years. She says the medications will help calm her nerves with minor annoyances, such as road rage incidents. But she still struggles with IED every day, and she feels it is ruining her life.

Carolina’s feelings are not uncommon among those with IED. Many people feel like their disorder is ruining their lives and there isn’t much they can do about it. They worry about hurting those around them and themselves. Carolina is able to control some of her rage because she is receiving treatment. She understands that her disorder has a lot to do with her outbursts. However, someone who never received a diagnosis may be left wondering what is wrong with them. Caring for someone with IED is also a challenge. Support groups and classes are available to help caretakers understand what their loved ones need, and the best way to support them. IED is a relatively uncommon, often undiagnosed disorder. Parents assume their child is just being ‘difficult’ and don’t express their concerns to doctors or therapists. Expressing these concerns is crucial. Living with IED is not easy on the individual with the disorder or those around them, but living with undiagnosed, untreated IED is far worse.

References:

Cleveland Clinic. (n.d.). Intermittent Explosive Disorder Management and Treatment. Retrieved February 12, 2019, from https://my.clevelandclinic.org/health/diseases/17786-intermittent-explosive-disorder

Moon, C. (2016, July 20). IED is ruining my life: Intermittent Explosive Disorder Forum. Retrieved March 3, 2019, from https://www.psychforums.com/intermittent-explosive-disorder/topic184139.html

Staff. (2018, September 19). Intermittent explosive disorder. Retrieved March 3, 2019, from https://www.mayoclinic.org/diseases-conditions/intermittent-explosive-disorder/symptoms-causes/syc-20373921

Categories
Disruptive, Impulse Control and Conduct Disorders

Disruptive Behavior Disorders: What Are They?

Most of us have witnessed a toddler throwing a temper tantrum. For parents, toddler-hood entails endless screaming and crying. Toddlers behave in this way because they are experiencing emotions, but they do not have the tools to express them the way older children and adults do. As we age, we are supposed to outgrow these behaviors. We express our anger with words instead of fists pounding on the ground, we have the ability to explain why we are sad or frustrated. When a child fails to outgrow these behaviors, when they repeatedly lash out, are defiant and incapable of controlling their tempers, it can impair performance in school and cause serious family turmoil.

It’s easy to jump to the conclusion that a child who’s pushing or hitting or throwing tantrums is angry, defiant or hostile. But in many cases disruptive, even explosive behavior stems from anxiety or frustration that may not be apparent to parents or teachers. This “emotional dysregulation,” as clinicians refer to it, can reflect a number of underlying issues within broader umbrella of disruptive behavior disorders (DBDs). A major difference between DBDs and other mental health conditions is that with DBDs, the distress is focused outwards instead of inward. The dysregulated behavior is directed towards other people and property. This outward manifestation allows these disorders to be easily identified, however, the precise cause remains unknown. Risk factors include a family member with ADHD/Oppositional Defiant Disorder (ODD), depression or an anxiety disorder and environmental factors like stress in the home from divorce, separation, abuse, parental criminality or series of conflicts within the family. The disorders are also more likely to occur along with other conditions such as ADHD.

        Disruptive behavior, impulse control, and conduct disorders refer to a group of disorders that include oppositional defiant disorder, conduct disorder, intermittent explosive disorder, kleptomania, and pyromania. An estimated 6 percent of children are affected by oppositional defiant disorder or conduct disorders, and each year an estimated 2.7 percent of children and adults in the U.S. are affected by intermittent explosive disorder. Conduct disorders tend to begin in childhood or adolescence and are more common in males than females. Kleptomania and pyromania are rare, affecting 1 percent or fewer of people in the U.S.

Disruptive behavior disorders are made up of two subtypes: Oppositional Defiant Disorder (ODD) and Conduct Disorder. ODD is the less severe of the two, and is more understood than Conduct Disorder. Both are the more common of all the DBDs. Children with ODD display a persistent pattern of angry outbursts, arguments and disobedience. While this behavior is usually directed at authority figures, like parents and teachers, siblings, classmates and other children can also turn into its target. Conduct disorder is a highly complex condition, and its causes aren’t fully understood. It can involve cruelty to animals and people, other violent behaviors and criminal activity.

Treatment is available for DBDs, most often in the form of therapy. Cognitive behavioral therapy is the most common for treating DBDs, although group therapy and family therapy has also proven quite successful especially in children. Medication may be given to treat symptoms of ODD. Parents and caregivers of children are often taught ways to cope with and manage their child’s disorder. It is important for anyone suffering from any of these disorders to get help because DBDs greatly affect quality of life. Left untreated, these disorders can cause major problems in all aspects of life, often leading to substance abuse disorders.

References

DeMaso, D. R., MD. (2011). Disruptive Behavior Disorders | Boston Children’s Hospital. Retrieved February 20, 2019, from http://www.childrenshospital.org/conditions-and-treatments/conditions/d/disruptive-behavior-disorders

Ehmke, R. (n.d.). What Is Oppositional Defiant Disorder? Retrieved February 12, 2019, from https://childmind.org/article/what-is-odd-oppositional-defiant-disorder/

Nicklaus Childrens Hospital. (n.d.). Disruptive Behavior Disorders. Retrieved February 12, 2019, from https://www.nicklauschildrens.org/conditions/disorders/disruptive-behavior-disorders

Parekh, R., M.D., M.P.H. (2018, January). What Are Disruptive, Impulse-Control and Conduct Disorders? Retrieved February 12, 2019, from https://www.psychiatry.org/patients-families/disruptive-impulse-control-and-conduct-disorders/what-are-disruptive-impulse-control-and-conduct-disorders