I found some interesting info on this disorder, which many may already know. Yep! Describes Isabella to a T.
Definition
Intermittent explosive disorder (IED) is a mental disturbance that is characterized by specific episodes of violent and aggressive behavior that may involve harm to others or destruction of property. IED is discussed in the Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) under the heading of "Impulse-Control Disorders Not Elsewhere Classified." As such, it is grouped together with kleptomania, pyromania, and pathological gambling.
A person must meet certain specific criteria to be diagnosed with IED:
- There must be several separate episodes of failure to restrain aggressive impulses that result in serious assaults against others or property destruction.
- The degree of aggression expressed must be out of proportion to any provocation or other stressor prior to the incidents.
- The behavior cannot be accounted for by another mental disorder, substance abuse, medication side effects, or such general medical conditions as epilepsy or head injuries.
The reader should note that DSM-IV's classification of IED is not universally accepted. Many psychiatrists do not place intermittent explosive disorder into a separate clinical category but consider it a symptom of other psychiatric and mental disorders. In many cases individuals diagnosed with IED do in fact have a dual psychiatric diagnosis. IED is frequently associated with mood and anxiety disorders, substance abuse and eating disorders, and narcissistic, paranoid, and antisocial personality disorders.
Description
People diagnosed with IED sometimes describe strong impulses to act aggressively prior to the specific incidents reported to the doctor and/or the police. They may experience racing thoughts or a heightened energy level during the aggressive episode, with fatigue and depression developing shortly afterward. Some report various physical sensations, including tightness in the chest, tingling sensations, tremor, hearing echoes, or a feeling of pressure inside the head.
Many people diagnosed with IED appear to have general problems with anger or other impulsive behaviors between explosive episodes. Some are able to control aggressive impulses without acting on them while others act out in less destructive ways, such as screaming at someone rather than attacking them physically.
Although the editors of DSM-IV stated in 2000 that IED "is apparently rare," a group of researchers in Chicago reported in 2004 that it is more common than previously thought. They estimate that 1.4 million persons in the United States currently meet the criteria for IED, with a total of 10 million meeting the lifetime criteria for the disorder.
With regard to sex and age group, 80% of individuals diagnosed with IED in the United States are adolescent and adult males. Women do experience IED, however, and have reported it as part of premenstrual syndrome (PMS).
Causes and symptoms
Causes
As with other impulse-control disorders, the cause of IED has not been determined. As of 2004, researchers disagree as to whether it is learned behavior, the result of biochemical or neurological abnormalities, or a combination of factors. Some scientists have reported abnormally low levels of serotonin, a neurotransmitter that affects mood, in the cerebrospinal fluid of some anger-prone persons, but the relationship of this finding to IED is not clear. Similarly, some individuals diagnosed with IED have a medical history that includes migraine headaches, seizures, attention-deficit hyperactivity disorder, or developmental problems of various types, but it is not clear that these cause IED, as most persons with migraines, learning problems, or other neurological disorders do not develop IED.
Some psychiatrists who take a cognitive approach to mental disorders believe that IED results from rigid beliefs and a tendency to misinterpret other people's behavior in accordance with these beliefs. According to Dr. Aaron Beck, a pioneer in the application of cognitive therapy to violence-prone individuals, most people diagnosed with IED believe that other people are basically hostile and untrustworthy, that physical force is the only way to obtain respect from others, and that life in general is a battlefield. Beck also identifies certain characteristic errors in thinking that go along with these beliefs:
- Personalizing. The person interprets others' behavior as directed specifically against him.
- Selective perception. The person notices only those features of situations or interactions that fit his negative view of the world rather than taking in all available information.
- Misinterpreting the motives of others. The person tends to see neutral or even friendly behavior as either malicious or manipulative.
- Denial. The person blames others for provoking his violence while denying or minimizing his own role in the fight or other outburst.
Symptoms
The symptoms of IED are described by the DSM-IV criteria for diagnosing the disorder.
Diagnosis
The diagnosis of IED is basically a diagnosis of exclusion, which means that the doctor will eliminate such other possibilities as neurological disorders, mood or substance abuse disorders, anxiety syndromes, and personality disorders before deciding that the patient meets the DSM-IV criteria for IED. In addition to taking a history and performing a physical examination to rule out general medical conditions, the doctor may administer one or more psychiatric inventories or screeners to determine whether the person meets the criteria for other mental disorders.
In some cases the doctor may order imaging studies or refer the person to a neurologist to rule out brain tumors, traumatic injuries of the nervous system, epilepsy, or similar physical conditions.
Treatment
Emergency room treatment
A person brought to a hospital emergency room by family members, police, or other emergency personnel after an explosive episode will be evaluated by a psychiatrist to see whether he can safely be released after any necessary medical treatment. If the patient appears to be a danger to himself or others, he may be committed against his will for further treatment. In terms of legal issues, a doctor is required by law to notify the specific individuals as well as the police if the patient threatens to harm particular persons. In most states, the doctor is also required by law to report suspected abuse of children, the elderly, or other vulnerable family members.
The doctor will perform a thorough medical examination to determine whether the explosive outburst was related to substance abuse, withdrawal from drugs, head trauma, delirium, or other physical conditions. If the patient becomes assaultive inside the hospital, he may be placed in restraints or given a tranquilizer (usually either lorazepam [Ativan] or diazepam [Valium]), most often by injection. In addition to the physical examination, the doctor will obtain as detailed a history as possible from the family members or others who accompanied the patient.
Medications
Medications that have been shown to be beneficial in treating IED in nonemergency situations include lithium, carbamazepine (Tegretol), propranolol (Inderal), and such selective serotonin reuptake inhibitors as fluoxetine (Prozac) and sertraline (Zoloft). Adolescents diagnosed with IED have been reported to respond well to clozapine (Clozaril), a drug normally used to treat schizophrenia and other psychotic disorders.
Psychotherapy
Some persons with IED benefit from cognitive therapy in addition to medications, particularly if they are concerned about the impact of their disorder on their education, employment, or interpersonal relationships. Psychoanalytic approaches are not useful in treating IED.
Prognosis
The prognosis of IED depends on several factors that include the individual's socioeconomic status, the stability of his or her family, the values of the surrounding neighborhood, and his or her motivation to change. One reason why the Chicago researchers think that IED is more common than previously thought is that most people who meet the criteria for the disorder do not seek help for the problems in their lives that result from it. The researchers found that although 88% of the 253 individuals with IED that they studied were upset by the results of their explosive outbursts, only 13% had ever asked for treatment in dealing with it.
Prevention
Since the cause(s) of IED are not fully understood as of the early 2000s, preventive strategies should focus on treatment of young children (particularly boys) who may be at risk for IED before they enter adolescence.
Key Terms
Cognitive therapy
A form of short-term psychotherapy that focuses on changing people's patterns of emotional reaction by correcting distorted patterns of thinking and perception.
Delirium
An acute but temporary disturbance of consciousness marked by confusion, difficulty paying attention, delusions, hallucinations, or restlessness. Delirium may be caused by drug intoxication, high fever related to infection, head trauma, brain tumors, kidney or liver failure, or various metabolic disturbances.
Kleptomania
A mental disorder characterized by impulsive stealing.
Neurotransmitter
Any of a group of chemicals that transmit nerve impulses across the gap (synapse) between two nerve cells.
Pyromania
A mental disorder characterized by setting fires.
Serotonin
A neurotransmitter or brain chemical that is responsible for transporting nerve impulses.
Dr. Phil continues his look at rage. When Isabella first appeared on the show, cameras installed in her home captured outrageous behavior . Has she changed? Find out how she reacts when she hears what DrPhil.com message board writers posted about her. Isabella's mom, Mary, joins the show and gives insight into Isabella's childhood. Why does she feel her daughter's anger is like a cancer that could destroy her? Then, find out why Isabella says she feels like she could actually hurt someone. Dr. Frank Lawlis, Chairman of the Dr. Phil Advisory Board and author of The Stress Answer, reveals the results of Isabella's evaluation, which he conducted at his PNP Center. Will the findings shed light on why Isabella loses control? And, Stuart says his rage is like a train on a collision course, and he's fearful for what might happen. He unleashes on everyone from his family members to strangers. How will he react when he sees what it's like to be on the receiving end of his out-of-control anger? What's at the root of Stuart's behavior? Plus, if you feel a fit of rage coming on, don't miss the exciting feature on DrPhil.com that will help mellow your mood! Join the discussion.
