This disorder is based on aggressive attitudes. Let’s see exactly what it consists of.
However, there are cases in which it escapes from any adaptive purpose, and becomes the sad protagonist of life. By extension, obviously, it ends up having incalculable resonances on the environment and on the way in which everyday life unfolds.
In this article we will expand on intermittent explosive disorder , which has been the subject of controversy since its conception back in the 1980s. Here we will discuss how it expresses itself at a clinical level, what its etiology is and the therapeutic arsenal currently available.
- It may interest you: “The 10 most common psychological disorders”
intermittent explosive disorder
Intermittent explosive disorder is, with complete certainty, one of the most controversial diagnostic entities. And it is that, as occurs in so many other pictures applicable to childhood (such as the defiant negativist), a categorical “cut” is made for the complex phenomenon of human aggressiveness, whose nature is considered dimensional and subject to the culture of the expressing subject.
The main criticism of this health problem is precisely that its axis of rotation is not an extraordinary fact, but behaviors that in some situations can be considered adaptive (at least to a certain degree).
The diagnostic label as such was born with the third edition of the DSM-III manual, although on that occasion it still lacked an operational structure and was included in a different category than the one it belongs to today, more specifically in “control of impulses” (along with pyromania, gambling or kleptomania). When the revision of the fourth edition of this same manual arrived, the problem was relocated and specific criteria were added so that it was included in axis I of the multiaxial system. Currently, following the DSM-5 manual, it is subsumed in the category of “destructive disorders, impulse control and behavior”.
In order to make the diagnosis, it is necessary that the person be at least six years old, and that they meet a series of criteria or requirements that we proceed to point out. Some studies set its prevalence at 4% of the total population , although there are discrepancies in its categorization that may be behind the enormous variability observed for this specific figure.
Characteristics and signals
Intermittent explosive disorder is currently considered a “problem” that extends to childhood , adolescence, and adulthood; since there is a considerable volume of research on this point.
For this reason, the criteria that form it come from empirical evidence in the experimental field, but have been able to demonstrate their adjustment with clinical experience (in terms of their sensitivity and specificity). Let us now see what its characteristics are.
1. Verbal and physical aggression
The most important symptom of the disorder that concerns us is the clear presence of aggressive behavior in its physical and verbal aspects. The most common is that both occur at the same time, within the same acute and unstoppable episode, but we will distinguish between them for expository purposes. In any case, they are triggered at least twice a week for three months or more, and sometimes their frequency is so high that it is difficult to distinguish if there are phases free of violence or if it is rather a behavioral continuum.
Among the episodes of verbal aggression that characterize it can be found fights, insults, tantrums and even threats to harm third parties or their possessions. Such types of behaviors often emerge as a more or less predictable pattern of action, expressed during moments of frustration or disappointment, often anticipating the escalation of the conflict into its physical dimensions. They also cloud the way the child relates to her peers.
Physical violence, meanwhile, is directed at people or their property. Sometimes it can be projected towards animals or other children of a similar or younger age. However, and since this diagnosis is usually made in the early stages of life, the attack does not usually have permanent and/or irreversible consequences on the integrity of those who are the object of it.
Despite this, it should never be perceived as a tantrum or encouraged or reinforced by care figures, as its continuity would be encouraged until adolescence or beyond.
2. Outbursts in behavior
In intermittent explosive disorder there is hardly any planning for the aggressiveness that unfolds, rather it emerges impulsively and as a result of emotions that cannot be adequately managed.
For this reason, it is very common that the trigger is a completely insubstantial event (or even that there is no apparent cause), which is why it is often perceived as disproportionate and disconcerting. These acts, lacking the slightest thought, must be presented at least three times in the year prior to the evaluation date.
A molecular view of the matter reveals that children who act in this way are intoxicated by anger or fear, which motivates precipitous behavior of violent fight or flight. That is why no material or interpersonal goal is pursued, but instead seeks to relieve an affection whose intensity overwhelms the scarce resources that human beings usually have at this age. In any case, most of those affected describe an increase in energy at this time, as well as great irritability.
Although these episodes rarely last more than thirty minutes, they are more than enough to generate a very important deterioration of academic and domestic life, which is why they severely affect the daily lives of those who experience them and their environment. . All this is much more relevant when reaching adult life, where the potential consequences on third parties can be very serious, and give rise to legal consequences that often even translate into deprivation of liberty.
3. Poor impulse control
One of the most defining characteristics of intermittent explosive disorder is impulsive behavior, from which poor control of emotion can be inferred. Although this is so, it is also important to point out that this issue only occurs during acute episodes of aggressiveness, and not in the period of time between them.
For this reason, those who present it can correctly manage their inner life when it is not compromised by anger or fear.
In the event that impulsive acts have been developed, and therefore any containment resource would have been futile, a feeling of guilt or remorse consistently arises. This differentiates it from other pathologies, such as dissocial disorder, for which an analysis of one’s own behavior and its consequences in the lives of others is rarely reproduced. This emotional mess is one of the main sources of discomfort for those who suffer from the disorder, along with its impact on key areas of life (academic, work, etc.).
Finally, some of those affected say they can anticipate when one of the episodes of aggressiveness is going to unfold, through their own bodily sensation (which acquires a discriminating property): fear, tension, headaches or nausea are some of the most frequently recognized signals.
4. Not related to other disorders
The symptoms that are indicated, characteristic of intermittent explosive disorder, should never occur within the context of other mental (or neurodevelopmental) disorders in which acts derived from agitation or impulsivity could be reproduced. For this reason, a differential diagnosis is required regarding attention deficit hyperactivity disorder (or ADHD) and childhood depression, since the latter can present with irritability.
In the case of adults, at least schizophrenia must be ruled out (aggression during an acute episode in which another person becomes incorporated as a constitutive element of a delusion), manic episodes typical of bipolar disorder (in which impulsive acts and potentially dangerous for one’s own physical integrity or that of third parties) and substance dependence (especially during the acute phase of intoxication or withdrawal syndrome).
What are your causes?
There are many causes that contribute to the occurrence of the disorder that concerns us , and they can be both organic and social and psychological. In this section we will try to give a good account of the most important ones.
1. Stressful events
The experience of stressful events is one of the best known causes. They are often events that occurred during childhood or adolescence (moments of special growth in the evolutionary sense). The disorder is known to be more common in those who have suffered some form of abuse (physical, emotional, or sexual), and/or in those who have forged weak bonds with their primary attachment figure, especially when affectionate exchanges with them have been lacking.
A high prevalence has also been observed in victims of armed conflicts, or other experiential crises in which the human hand was the main responsible (kidnapping, robbery, etc.). The experience of natural disasters, such as earthquakes or floods, has also been related to it (although in a much less forceful way).
2. Cognitive Impulsivity
Problem-solving patterns in which impulsiveness predominates are closely associated with intermittent explosive disorder, especially when coexisting with poor social processing of the emotional “cues” that guide relationships between human beings.
Thus, for example, many works suggest that those who suffer from this problem tend to interpret the intentions of others in a hostile way, and glimpse anger in gestural configurations that most people judge as neutral.
3. Neurophysiology
Regarding what is known about the functioning of the brain in this disorder, with information coming mainly from neuroimaging studies, it has been determined that there are alterations in two structures: the orbitofrontal cortex (associated with executive-type functions such as problem solving and self-control) and the amygdala itself (limbic structure that contributes to the processing of emotional information).
Some studies detect an asymmetry in the orbitofrontal cortex, when comparing the right hemisphere with the left, and a reduction in the total volume of regional gray matter. As far as the amygdala is concerned, the data are more of a functional type, and highlight a kind of hyperactivation when the person visualizes faces with the gestural composition associated with anger.
Thus, an alteration could be noticed in the circuits responsible for the regulation of affects, which would be particularly strong and would lack the necessary resources for their containment.
4. Genetics
Finally, it has been documented that there is a remarkable genetic background for this disorder, since first-degree relatives of an affected person have a higher probability of suffering from it as well.
Since in these cases it is difficult to discriminate the relative contribution of learning and inheritance, studies have been carried out with monozygotic twins raised in different families and it has been estimated that both variables explain an equivalent variance (50% in each case). That is, they are equally important.
Treatment
Psychotherapy has proven to be very effective for the adequate therapeutic approach to this disorder, together with antidepressant drugs (among which the SSRIs or selective serotonin reuptake inhibitors stand out), and especially the modality that combines the two procedures. In this article we will only focus on psychological treatments, which are many and varied, all of them with empirical evidence in their favor.
The program that is usually provided to these patients is mixed, and includes modules aimed at cognitive restructuring (especially of ideas related to hostile or harmful intentions), activation control techniques (Jacobson’s progressive muscle relaxation and diaphragmatic breathing) and decision-making strategies (which make it possible to stop and think in moments of ambiguity in order to facilitate a measured problem-solving process that avoids impulsiveness).
Play therapies (through which the child develops emotional/social skills through playful activities) have also been used with great success; and those that make use of introspection as a safe-conduct towards a better identification, attention, distinction and regulation of affections.
Bibliographic references
- Mccloskey, M., Waldo, K., Berman, M., Chen, E. y Coccaro, E. (2010). Unhealthy Aggression: Intermittent Explosive Disorder and Adverse Physical Health Outcomes. * Health psychology : official journal of the Division of Health Psychology, American Psychological Association, 29, 324-332.
- Silka, V.R. y Hurley, A. (2000). Intermittent explosive disorder (IED). Mental Health Aspects of Developmental Disabilities, 3, 149-152.
To the classic question “what do you do?” I always answer “basically I am a psychologist”. In fact, my academic training has revolved around the psychology of development, education and community, a field of study influenced my volunteer activities, as well as my first work experiences in personal services.