The intermittent explosive disorder is a behavioral disorder that is classified as an impulse control disorder. It is a serious disorder that can cause multiple negative consequences for the person who suffers and often greatly deteriorate their daily lives .
The main characteristic of this psychopathology is the presentation of episodes in which the person witnesses aggressive impulses without an apparent reason since the individual is not exposed to a situation in which he is being attacked.
Intermittent Explosive Disorder Treatment
In these episodes, the person with intermittent explosive disorder is totally unable to control these impulses and ends up doing violent acts against people or material objects.
Put another way: the person suffering from this disorder “explodes” in any situation that can cause minimal frustration.
Likewise, there is no alteration of the previous state of mind, that is, the person can be “completely normal” and suddenly present an outbreak of excessive anger.
Characteristics of intermittent explosive disorder
The most common is that people with this type of disorder “despair” and present this outbreak of anger before a tiny trigger: an inadequate word, an ambiguous tone of voice, an object that bothers you, etc.
After these aggressive behaviors in which the individual can not control his impulse of anger, the person begins to be aware of the consequences of their actions.
Therefore, the person suffering from intermittent explosive disorder is not aware of the consequences and the meaning of his violent acts while he is performing them, but he is aware of it once he has finished.
It is then when the individual realizes what he has done and the consequences and / or reprisals that his actions can have, and experiences feelings of guilt or self-reproach for having performed a behavior that he should not do.
It is for this reason that intermittent explosive disorder is considered a disorder of impulse control since the person is unable to control an aggressive impulse that appears suddenly.
However, it differs from other impulse control disorders such as kleptomania, pyromania or pathological gambling by the fact that, in this case, the impulse appears unexpectedly.
In the other cases of impulse control disorders, the desire to perform a certain action (stealing in the case of kleptomania, burning things in the pyromaniac or playing in the game of gambling ) does not appear so suddenly and the behavior that prompts the impulse is done less immediately.
For example, a gambler may have the impulse to play and not do so immediately, but he may accumulate his desire to play until he finds a moment when he can not resist doing so.
On the other hand, in the case of intermittent explosive disorder, the impulses to perform a violent action do not accumulate, they appear suddenly before a minimum stimulus, at which time the person can not control himself and performs the aggressive behavior immediately.
It is for all this that the classification of this disorder as a mental disorder has created some controversy over time.
And is that aggressiveness is understood as a normal quality and shared by all human beings. All people have the ability to perform aggressive behavior to defend their own interests.
However, what makes pathological the behavior carried out by people with intermittent explosive disorder is not the aggressiveness itself, but the impulsivity of the aggressiveness that these individuals present.
Thus, while a person without intermittent explosive disorder is able to control his aggressiveness and use it when he sees fit, the person with intermittent explosive disorder is not, and he does it even in those situations that he would not want to do.
Symptoms and diagnosis of intermittent explosive disorder
The explosive episodes that present this type of patients can be associated with symptoms of affective type, such as irritability, anger, increased energy or accelerated thoughts.
In addition, some individuals report that their aggressive episodes are accompanied by physical symptoms such as tingling, tremor, palpitations, chest tightness , pressure of the head or sensation of perceiving an echo.
In fact, people with this disorder often define episodes as highly unpleasant and annoying.
Similarly, during impulsive episodes, signs of impulsivity or generalized aggressiveness may be observed, and the acts carried out may cause serious bodily injury to other persons or material damage.
These episodes that we are talking about all the time are usually very brief, and can last between 20 and 40 seconds.
Likewise, they can appear recurrently or more sporadically, presenting episodes every several weeks or months.
Finally, once the episode has occurred, the individual may feel either a sense of relief or negative feelings of guilt and depressive states .
However, for all of these symptoms and behaviors to be classified as intermittent explosive disorder, the following criteria must be met:
Several isolated episodes of difficulty in controlling aggressive impulses, which result in violence or destruction of property.
The degree of aggressiveness during the episodes is disproportionate to the intensity of any precipitating psychosocial stressor. That is, there is never a logical factor that motivates and justifies the impulse and aggressive behavior.
Aggressive episodes are not better explained by the presence of another mental disorder (for example, antisocial personality disorder or manic episode) and are not due to the effects of a drug (for example alcohol or cocaine).
Course and prevalence
Not many people suffer from this intermittent explosive disorder, however, there is some ambiguity in the prevalence studies of this psychopathology.
In fact, the DSM argues that there is no conclusive data on the prevalence of this disorder, although it clarifies that its appearance is scarce.
For its part, a study conducted by Monopolis and Lion showed that 2.4% of psychiatric patients were diagnosed with intermittent explosive disorder . However, in subsequent reviews the prevalence decreased to 1.1%.
Likewise, Zimmerman carried out a study in which a prevalence of 6.5% was detected for the intermittent explosive disorder among psychiatric patients and of 1.5% in the general population.
Thus, despite not having irrefutable data on the number of people suffering from this disorder, it is clear that not many people suffer from this disorder.
As regards the course of the disease, it usually appears during childhood and adolescence, with an average age of 14 years and the highest age recorded. 20
It usually begins abruptly, without any previous state that indicates the onset of the disorder.
The evolution of this disorder is very variable and can occur with both a chronic course and an episodic course. The average duration is about 20 years as identified by the DMS.
As currently advocated, intermittent explosive disorder does not have a unique cause, and is usually originated and developed by the combination of biological and environmental factors.
There seems to be a certain genetic predisposition to suffer from this disease, since several cases have been observed in which the parents of the person with intermittent explosive disorder showed similar types of behavior.
However, no gene that could be responsible for this similarity between patients with intermittent explosive disorder and their parents has been detected , which means that environmental factors must be taken into account.
It is argued that being exposed to scenes of habitual violence during childhood and adolescence increase the likelihood of showing certain features of this disorder at an early age and end up manifesting an intermittent explosive disorder during adolescence.
Likewise, people who have been victims of abuse during childhood and / or have experienced multiple traumatic events when they were small are more susceptible to developing the disease.
The fact of being a man also constitutes a risk factor for intermittent explosive disorder since this pathology occurs much more frequently among males than among females.
Finally, in research aimed at discovering the causes of this disease, it has been connoted that people with intermittent explosive disorder have a marked decrease in the levels of serotonin in their brain.
To control and reverse the symptoms of intermittent explosive disorder, both pharmacological and psychological treatments can be performed.
As regards the pharmacological treatments, different medications can be used.
1. Mood stabilizers
Medications such as lithium, sodium valproate or carbamezapine are used to reduce the aggressiveness and violent behavior of this type of patients.
Although the effect of these drugs is much more effective in those cases in which there is an altered affective component (a fact that does not usually occur in intermittent explosive disorder), it has shown some efficacy to reduce the aggressions of patients with this problem.
2. ISRSS antidepressants
Medications such as fluoxetine or venlafaxine reduce irritability scores and aggressive tendencies, they also improve mood in a general way and make aggressive behaviors less likely.
Finally, antipsychotics have been used for the treatment of short-term aggression. However, it is not recommended to use these drugs for a long time to treat intermittent explosive disorder due to its side effects.
With regard to psychological interventions, a large number of techniques can be used that allow the person to learn to control their impulses and their aggressive acts.
4. Behavioral therapy
The person is instructed to react appropriately in different situations so that, through practice, he acquires alternative response modes to avoid aggressive behavior.
5. Social skills
Likewise, it is very important to carry out a work aimed at increasing the social skills of the patient with intermittent explosive disorder.
These sessions focus on the resolution of conflicts that cause aggressive impulses and learn to interact and communicate in a more appropriate way.
Often people suffering from this disorder lack moments of calm and tranquility basic to their well-being.
Teaching relaxation techniques so that the patient can practice them daily can be a great help to learn to control their impulses.
7. Cognitive therapy
Finally, you can work so that the individual learns to identify their aggressive thoughts, analyze them and modify them for others more adapted and less harmful.
The patient is trained so that whenever an impulse and an aggressive thought appear, he is able to change it by a neutral thought and in this way, he can control his impulse and avoid the appearance of the aggressive behavior.
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Thus, despite the fact that the intermittent explosive disorder is a serious disorder that greatly affects the functioning of the person, treatments can be applied that eliminate these impulses and prevent violent behavior.