Intermittent Explosive Disorder (I.E.M.) and Childhood Trauma.

This disorder, which is listed in DSM V (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), is a manual that is used by psychologists and psychiatrists to diagnose mental illness and provides the diagnostic criteria (i.e. relevant symptoms) by which diagnosis of the specific psychiatric condition is made, is, as the name implies, related to problems a person has with controlling his/her anger.

According to DSM V, the symptoms of intermittent explosive disorder (IED) are as follows:

1) Several episodes of being unable to suppress impulses of intense anger which leads to serious aggressive acts such as assault and destruction of property

2) The high intensity of the aggression displayed during these episodes is clearly out of proportion to the precipitating event (ie the event that triggered the aggression)

3) The episodes of aggression are not better explained by other mental conditions such as borderline personality disorder (BPD) or anti-social personality disorder.

How Common is IED?

Research into this area so far suggests that around 5% of the population may suffer from IED during some period of their lifespan. Not infrequently, the disorder first appears during adolescence but can also occur in children as young as six years old.

Often, too, the disorder will exist co-morbidly (i.e. together with/alongside) other mental health conditions: about 4 in 5 people with a diagnosis of I.E.D. also suffer from depression, anxiety, and/or substance abuse issues.

IED can very adversely affect many crucial areas of the sufferer’s life, which include: relationships with family, relationships with friends, reputation, career prospects, and even freedom (if the uncontrolled aggression results in an incident that leads to being sent to jail). Clearly, then, a person who suffers from IED urgently requires treatment in order to prevent him/her from potentially ruining his/her own life. But in order to treat it, of course, it is first necessary to understand what causes it. In relation to this quest, research has focused on childhood trauma.

Research findings:

Research indicates that the experience of childhood trauma, particularly childhood trauma connected to problematic (ie dysfunctional) relationships with parents/carers is the strongest predictor of the development of IED in adulthood. It is thought that the reason for this is that, as a result of such trauma, the affected individual does not learn how to manage his/her emotions nor how to manage the intricacies of interpersonal relationships.

Neurological issues may also be related to IED; however, I should point out that such issues may themselves have been caused by childhood trauma – further research into this is necessary.

What Are The Symptoms Of  I.E.D?

Symptoms include:

  • verbal aggression
  • shouting, screaming, and raging
  • being excessively argumentative
  • getting into physical fights
  • making extreme threats (such as death threats)
  • physically assaulting others
  • harming animals
  • road rage
  • domestic violence
  • vandalism/destroying property (e.g. throwing and smashing objects)
  • feelings of intense tension
  • racing thoughts 
  • palpitations

Other problems related to IED:

Furthermore, IED can ruin relationships, lead to legal problems, and harm work-life/school life. IED is also associated with an increased risk of various physical problems including diabetes, stroke, stomach ulcers, elevated blood pressure, and associated risk of heart disease and stroke.

‘Explosive episodes’ tend to abate within 30 minutes or so but can last longer.

I.E.D. or complex PTSD? The vital importance of considering whether IEM is linked to traumatic experiences:

I.E.D., may, in fact, be indicative of far more wide-ranging disorders, most notably PTSD (e.g as experienced by many war veterans) and complex PTSD; both can be associated with acute sensitivity to perceived threat and hypervigilance.

Complex PTSD can result from severe and chronic or repetitive interpersonal trauma in childhood. For example, an analysis carried out in 2014 found that nearly one-third of those diagnosed with IEM also had PTSD.

In other words, in such cases, IEM is likely to be a secondary condition. If IEM is focused on alone, therefore, this can lead to a failure to diagnose the underlying cause (i.e. PTSD or complex PTSD).

Therapy and coping techniques:

It is therefore imperative that those diagnosed with IEM are also assessed in terms of how they may have been affected in their lives by trauma, particularly interpersonal, ongoing trauma in early life. For this reason, effective treatments can include Dialectical Behavioural Therapy (DBT), Trauma-Focused CBT, and somatic and ‘bottom-up’ therapies.

More specifically, therapy can help the person suffering from IED with specific ways of coping including relaxation techniques, improved communication skills, altering destructive thinking patterns (cognitive restructuring), addressing alcohol and substance abuse issues, and finding ways of adjusting the individual’s environment to reduce stress and triggers such as avoiding or leaving places situations that may lead to a loss of emotional control.

 

Dissociated Rage

The rage that manifests itself in IED often takes place when the person is in a state of ‘dissociation’.  A dissociated state is defined by psychologists as one that involves the experience of disconnection and discontinuity between actions, memories, thoughts, surroundings, and identity. Behaviors carried out whilst the person is in this state and out of touch with reality are involuntary and beyond the person’s control and this is sometimes recognized in courts of law as a defense by defendants charged with serious crimes, even murder. A well-known example of this is the historic case of Candy Montgomery who was found not guilty of killing a neighbor with 41 blows of an ax after the neighbor used a word that triggered an emotional flashback connected to childhood trauma.

Needless to say, this is a most extreme example of dissociated rage and its consequences and such occurrences are exceptionally rare.

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REFERENCES:

Morris, D. J. (2014) PTSD contributes to violence. Pretending it doesn’t is no way to support the troops. Slate. Retrieved from https://slate.com/technology/2014/04/ptsd-and-violence-by-veterans-increased-murder-rates-related-to-war-experience.html

Reardon, A. F. et al.,  (2014). Intermittent explosive disorder: Associations with PTSD and other Axis I disorders in a US military veteran sample. Journal of Anxiety Disorders, 28(5), 488–494. d

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