Intermittent explosive disorder
Intermittent explosive is serious and treatable. Learn more about its underlying causes and explore strategies for managing and improving outcomes for individuals affected by this condition.
What is Intermittent Explosive Disorder?
Intermittent explosive disorder (IED) is a disorder of aggression that can occur in children, teenagers, or adults. People who have intermittent explosive disorder show sudden and extreme anger when they are provoked or frustrated. During these bouts of anger they may throw a tantrum, yell, hurt people, or destroy things. The angry response is out of proportion to the incident that provoked it. People with intermittent explosive disorder are aware their anger is not appropriate but feel like they can’t control themselves when they are angry.
Scientists believe that about 1-3% of people have intermittent explosive disorder. Intermittent explosive disorder occurs in children and adults of both genders, but it is more common in boys and men.
Intermittent explosive disorder is not diagnosed in children under 6 years of age. Tantrums and anger are very common in even healthy toddlers and preschool-aged children. Intermittent explosive disorder is most likely to first emerge in older children and teenagers. Adults who are diagnosed are usually younger than 40.
Learn the Signs of Intermittent Explosive Disorder
A sign is an objective, observable behavior or trait that can be recognized by other people. Signs of intermittent explosive disorder include:
- Frequent outbursts of anger
- Injuring others, throwing things, or destroying things when angry
- Anger out of proportion to the incident that provoked it
- Outbursts are not planned and serve no purpose
What Causes Intermittent Explosive Disorder?
The causes of intermittent explosive disorder are complex. People who are at risk for intermittent explosive disorder are more easily frustrated than other people, and are less tolerant of feeling frustrated. When they feel frustrated or are provoked, they overreact impulsively. This may result from differences in their brain that cause them to have stronger emotional responses or more difficulty controlling emotions.
Like other mental disorders, intermittent explosive disorder results from a combination of both genetic and environmental factors (“nature” and “nurture”).
Genetic Risk Factors
Genetic factors account for about half (50%) of the risk that a person will develop intermittent explosive disorder. This means a person is more likely to develop intermittent explosive disorder if they have one or more biological relatives who also had this disorder (or another disorder of aggression).
There is no “intermittent explosive disorder gene.” Many thousands of genes affect human brain functioning. People with intermittent explosive disorder may carry an unusually high number of genetic variants that increase their risk of developing the disorder. Some of these genes may affect the way the person responds to specific events like being frustrated or provoked.
Environmental Risk Factors
Some environmental risk factors for intermittent explosive disorder affect how the brain develops, or how a person learns to behave during childhood.They include:
- Poverty or low socio-economic status
- Being abused or neglected
- Witnessing violence in the household
Environmental risk factors in adulthood that are associated with risk for intermittent explosive disorder include:
- Being male
- Being young
- Unemployment
- Being divorced or separated
- Having less education
Risk factor or cause?
A risk factor is not the same as a cause. Some people may have environmental risk factors for intermittent explosive disorder but not develop the disorder. Some people with intermittent explosive disorder do not have any environmental risk factors.
Untangling whether a risk factor causes a disorder or is caused by the disorder (or neither) can be challenging. For example, a child who witnessed a parent being violent might be at risk for intermittent explosive disorder because they share genes with the violent parent, because they learned violence by observing it, or a combination of both. Another example is that unemployment can cause stress, which increases the risk for intermittent explosive disorder. However, intermittent explosive disorder may also cause unemployment if a person has angry outbursts at work.
How is Intermittent Explosive Disorder Diagnosed?
If you are concerned that you or someone you know may have intermittent explosive disorder, ask your doctor for a referral to a psychologist or psychiatrist. These are experts in diagnosing disorders such as intermittent explosive disorder.
They will try to make sure that the outbursts of anger do not have a cause other than intermittent explosive disorder. Certain drugs and illnesses like bipolar disorder can mimic intermittent explosive disorder. This is because they can cause paranoia, hallucinations, and other distorted thoughts. People with these disorders sometimes falsely believe they are being threatened and can react violently as a perceived form of self-defense. When these disorders are successfully treated with medications and/or therapy, the outbursts often stop.
A psychologist or psychiatrist will also screen for other mental health conditions like anxiety, attention deficit hyperactivity disorder (ADHD), and personality disorders that are common in people who have intermittent explosive disorder.
Sometimes mental health professionals avoid giving someone a diagnosis of intermittent explosive disorder because they are worried the patient will be unhappy about the diagnosis. But receiving an accurate diagnosis is important for selecting the best treatment.
If you are having trouble finding a psychologist or psychiatrist, please see our provider list.
How is Intermittent Explosive Disorder Treated?
Intermittent explosive disorder is treatable. This means that there are therapies and medications that can reduce symptoms of intermittent explosive disorder. In some cases, symptoms improve so much that the person no longer qualifies as having the disorder.
Psychotherapy
The most recommended treatment for intermittent explosive disorder is a type of psychotherapy called cognitive-behavioral therapy. This type of therapy can be used in both adults and children. Cognitive behavioral therapy is a structured, goal-oriented form of talk therapy. It is like physical therapy for the mind. Physical therapy teaches people strategies for handling physical stress (for example, how to lift heavy things) to reduce pain and injury. Similarly, cognitive behavior therapy teaches people better strategies for responding to emotional stress to reduce pain and suffering.
One cognitive-behavioral therapy technique that may be used in treating intermittent explosive disorder is cognitive restructuring. This involves learning to change assumptions, beliefs, and unhelpful thoughts when frustrated or provoked.
Medication
Some medications may help people with intermittent explosive disorder react less strongly when they are frustrated or provoked. These include:
- Antidepressants
- Anti-anxiety medications
- Mood stabilizers such as lithium
References
For more information about intermittent explosive disorder, please see these references:
- Barron (2025). Losing it: A deeper look at intermittent explosive disorder and what can be done to help
- Mayo Clinic (2024). Intermittent explosive disorder
- Olvera (2012). Intermittent explosive disorder: Epidemiology, diagnosis, and management