Intermittent explosive disorder

Diagnosis

To determine a diagnosis of intermittent explosive disorder and eliminate other physical conditions or mental health disorders that may be causing your symptoms, your doctor will likely:

• Do a physical exam. Your doctor will try to rule out physical problems or substance use that could be contributing to your symptoms. Your exam may include lab tests.
• Do a psychological evaluation. Your doctor or mental health professional will talk to you about your symptoms, thoughts, feelings and behavior patterns.
• Use the criteria in the DSM-5. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, is often used by mental health professionals to diagnose mental conditions.

Treatment

There's no single treatment that's best for everyone with intermittent explosive disorder. Treatment generally includes talk therapy (psychotherapy) and medication.

Psychotherapy

Individual or group therapy sessions that focus on building skills can be helpful. A commonly used type of therapy, cognitive behavioral therapy, helps people with intermittent explosive disorder:

• Identify which situations or behaviors may trigger an aggressive response
• Learn how to manage anger and control inappropriate responses using techniques such as relaxation training, thinking differently about situations (cognitive restructuring), and applying communication and problem-solving skills

Medication

Different types of medications may help in the treatment of intermittent explosive disorder. These may include certain antidepressants — specifically selective serotonin reuptake inhibitors (SSRIs) — anticonvulsant mood stabilizers or other drugs if needed.

Coping and support

Controlling your anger

Part of your treatment may include:

• Unlearning problem behavior. Coping well with anger is a learned behavior. Practice the techniques you learn in therapy to help you recognize what triggers your outbursts and how to respond in ways that work for you instead of against you.
• Developing a plan. Work with your doctor or mental health professional to develop a plan of action for when you feel yourself getting angry. For example, if you think you might lose control, try to remove yourself from that situation. Go for a walk or call a trusted friend to try to calm down.
• Improving self-care. Getting a good night's sleep, exercising and practicing general stress management each day can help improve your frustration tolerance.
• Avoiding alcohol or recreational or illegal drugs. These substances can increase aggressiveness and the risk of explosive outbursts.

If your loved one won't get help

Unfortunately, many people with intermittent explosive disorder don't seek treatment. If you're involved in a relationship with someone who has intermittent explosive disorder, take steps to protect yourself and your children. The abuse isn't your fault. No one deserves to be abused.

Create an escape plan to stay safe from domestic violence

If you see that a situation is getting worse, and suspect your loved one may be on the verge of an explosive episode, try to safely remove yourself and your children from the scene. However, leaving someone with an explosive temper can be dangerous.

Consider taking these steps before an emergency arises:

• Call a domestic violence hotline or a women's shelter for advice, either when the abuser isn't home or from a friend's house.
• Keep all firearms locked away or hidden. Don't give the abuser the key or combination to the lock.
• Pack an emergency bag that includes items you'll need when you leave, such as extra clothes, keys, personal papers, medications and money. Hide it or leave the bag with a trusted friend or neighbor.
• Tell a trusted neighbor or friend about the violence so that he or she can call for help if concerned.
• Know where you'll go and how you'll get there if you feel threatened, even if it means you have to leave in the middle of the night. You may want to practice getting out of your home safely.
• Come up with a code word or visual signal that means you need the police and share it with friends, family and your children.

Get help to protect yourself from domestic violence

These resources can help:

• Police. In an emergency, call 911 or your local emergency number or your local law enforcement agency.
• Your doctor or the emergency room. If you're injured, doctors and nurses can treat and document your injuries and let you know what local resources can help keep you safe.
• The National Domestic Violence Hotline: 1-800-799-SAFE (1-800-799-7233). This hotline is available for crisis intervention and referrals to resources, such as women's shelters, counseling and support groups.
• A local women's shelter or crisis center. Shelters and crisis centers generally provide 24-hour emergency shelter, as well as advice on legal matters and advocacy and support services.
• A counseling or mental health center. Many communities offer counseling and support groups for people in abusive relationships.
• A local court. Your local court can help you get a restraining order that legally orders the abuser to stay away from you or face arrest. Local advocates may be available to help guide you through the process. You can also file assault or other charges when appropriate.

Preparing for your appointment

If you're concerned because you're having repeated emotional outbursts, talk with your doctor or make an appointment with a mental health professional who specializes in treating emotional disorders, such as a psychiatrist, psychologist or social worker. Here's some information to help make the most of your appointment.

What you can do

Before your appointment, make a list of:

• Symptoms you're experiencing, including any that may seem unrelated to the reason for the appointment
• Key personal information, including any major stresses, recent life changes and triggers for your outbursts
• All medications, vitamins, herbs and other supplements that you're taking, including the dosages
• Questions to ask your doctor

Some basic questions to ask your doctor include:

• Why am I having these angry outbursts?
• Do I need any tests? Do these tests require any special preparation?
• Is this condition temporary or long lasting?
• What treatments are available, and which do you recommend?
• Are there any side effects from treatment?
• Are there any alternatives to the primary approach that you're suggesting?
• I have other health conditions. How can I best manage these conditions together?
• Is there a generic alternative to the medicine you're prescribing?
• How long does therapy take to work?
• Do you have any printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

• How often do you have explosive episodes?
• What triggers your outbursts?
• Have you injured or verbally abused others?
• Have you damaged property when angry?
• Have you ever tried to hurt yourself?
• Have your outbursts negatively affected your family or work life?
• Does anything seem to make these episodes occur more often or less often?
• Is there anything that helps calm you down?
• Has anyone else in your family ever been diagnosed with a mental illness?
• Have you ever had a head injury?
• Are you currently using alcohol, drugs or other substances?

Be ready to answer these questions so you can focus on points you want to spend more time on. Preparing and anticipating questions will help you make the most of your time with the doctor.