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So You Know a Rage-aholic? Dealing with Intermittent Explosive Disorder

Contrary to popular belief, “rage-aholic” is an actual disorder that affects up to 16 million Americans, although the Diagnostic and Statistical Manual of Mental Disorders -IV refers to it as the descriptive term “intermittent explosive disorder.” People diagnosed with intermittent explosive disorder, or IED, experience sudden attacks of rage, often for no reason. In some cases, specific triggers cause the onset of an explosive attack, but in many cases, there is no real source of the anger. It can be normal and even healthy for the average person to lose his or her temper after having to stay restrained for long enough, but for a person with IED, there is no restraint, only rage.

Understanding Intermittent Explosive Disorder: Its Diagnosis, Risks and Prognosis

A diagnosis of intermittent explosive disorder requires a history of at least three episodes of rage, or impulsive aggression, which is out of proportion to the stressor that precipitated the attack, if any. During such an episode, an affected person may lash out at loved ones for no reason, threaten to attack nearby persons, actually attack a nearby person, or break expensive possessions. According to the National Institute of Mental Health, people who experience three or more such attacks within the course of a year are likely to have the disorder to a significantly more severe degree. Additionally, people with IED are at risk of developing disorders such as major depressive disorder, generalized anxiety disorder, and drug or alcohol abuse disorders in conjunction with IED. This may be a product of the overall stressful life experiences of a person experiencing intermittent explosive disorder—people who repeatedly lash out at their support system are less likely to maintain a strong support system, and are more likely to lose a job or suffer in school because of their disorder. These struggles can make it likely that other disorders will develop as a result, exacerbating treatment. Cognitive behavioral therapy is a common treatment for people with IED, with the goal of educating the patient about how to recognize the behaviors associated with their aggressive attacks and to curb the behaviors using proven strategies. Treatment with psychotropic medications has been limited, but sometimes involves the use of antidepressants, mood stabilizers and antipsychotics. Because IED is an early-onset disorder in most cases, behavioral treatment early may be most appropriate and the most effective at curbing severe symptoms later.

Supporting a Person With Intermittent Explosive Disorder

Living in the same household with a person who has IED can be challenging, particularly when other disorders—such as depression and anxiety disorders—are at play. As with many mental disorders, supporting intermittent explosive disorder involves a tricky mix of balancing factors including biological, social and psychological. You can take a number of actions to help support a loved one, whether he or she is actively symptomatic or not. First, identify what triggers the aggressive episodes, if any trigger exists. Your loved one may benefit from increased, gradual exposure to the triggering stimulus, which will eventually make it easier to endure exposure without experiencing a reaction. If no trigger exists, which is often the case, cognitive behavioral therapy can make it possible for the individual to recognize indicators that precede an episode and avoid escalation through practicing strategies. Barring therapy, even gentle guidance from a member of a support group or family can be helpful. The most important part of symptom management is making sure that the individual can manage his or her own symptoms and that surrounding members of the household know how to identify warning signs and take action accordingly. Although intermittent explosive disorder is a complex disorder with many complications and risk factors, it is possible to deal with it in a healthy way with the right resources at hand. In many cases, persistent therapy on its own is effective enough to manage symptoms. In other cases, a combination of psychotropic drug therapy and cognitive behavioral therapy will help reduce symptomatic presentation and limit the incidence of episodes. The disorder can be scary and overwhelming to family members who don’t know how to deal with it, but for household members who stay prepared and involved, it can become manageable and even just another part of the individual living with IED. Staff, Mayo Clinic. “Intermittent Explosive Disorder.” Mayo Clinic. Mayo Foundation for Medical Education and Research, 18 Sept. 2012. Web. 18 Dec. 2012. “Treating Intermittent Explosive Disorder.” Harvard Health Publications. N.p., n.d. Web. 18 Dec. 2012.

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