Intermittent explosive disorder

Diagnosis

To diagnose intermittent explosive disorder and rule out other conditions that could be causing your symptoms, your health care professional will likely:

• Do a physical exam. This may be done to try to rule out physical problems or alcohol or drug use that could be adding to or causing your symptoms. Your exam may include lab tests.
• Do a mental health evaluation. You talk with the health care professional about your symptoms, thoughts, feelings and behavior.

Treatment

There is no single treatment that's best for everyone with intermittent explosive disorder. Treatment usually includes talk therapy, also called psychotherapy, and medicine.

Talk therapy

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 triggers. Learn which situations or behaviors may trigger an aggressive response.
• Practice relaxation techniques. Regular use of deep breathing, relaxing imagery or yoga may help you stay calm.
• Develop new ways of thinking. Also called cognitive restructuring, this involves gaining the ability to think about a frustrating situation in new or different ways. With professional help, you learn to do this by identifying thoughts and expectations that are not reasonable and changing them to be more realistic. These techniques may improve how you view and react to an event.
• Use problem-solving. Plan ways to solve a frustrating problem by being assertive rather than aggressive. Even if you cannot fix the problem right away, having a plan can refocus your energy.
• Learn ways to improve communication. Listen to the message the other person is trying to share. Then think about your best response rather than saying the first thing that comes to mind.

Between therapy sessions, regularly practice the skills you've learned.

Medicines

Different types of medicines may help in the treatment of intermittent explosive disorder. These may include certain antidepressants — usually selective serotonin reuptake inhibitors (SSRIs). Anticonvulsant mood stabilizers or other medicines may be used if needed.

Some people need to take medicine for a long time to help prevent explosive outbursts.

Coping and support

Controlling your anger

Part of your treatment may include:

• Changing learned problem behavior. Coping well with anger is a learned behavior. Practice the skills 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.
• Creating 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 stress management each day can help improve your frustration tolerance.
• Avoiding alcohol or street drugs. These can make you more aggressive and raise the risk of explosive outbursts.

If your loved one will not get help

Unfortunately, some people with intermittent explosive disorder do not seek treatment. If you're in a relationship with someone who has intermittent explosive disorder, take steps to protect yourself, your children and your pets. The abuse is not 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 that your loved one may be on the verge of an explosive episode, try to safely remove yourself and your children from the scene. But leaving someone with an explosive temper can be dangerous. It's a good idea to make a plan ahead of time.

Consider taking these steps before an emergency arises:

• Contact a domestic violence hotline or a shelter for advice. Do this either when the abuser is not home or from a friend's house.
• Keep all firearms locked away or hidden. Do not give the abuser the key or combination to the lock.
• Pack an emergency bag that includes items you'll need when you leave. Include items such as extra clothes, keys, personal papers, medicines 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 person 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.
• Create a code word or visual signal that means you need the police. 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, your local emergency number or your local law enforcement agency.
• Your health care team or the hospital emergency department. If you're injured, health care professionals can treat and document your injuries. They can 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 shelters, counseling and support groups.
• A local domestic violence shelter or crisis center. Shelters and crisis centers generally provide 24-hour emergency shelter. They also may have staff members who can offer 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 also can file assault or other charges when needed.

Preparing for your appointment

If you're concerned because you're having repeated emotional outbursts, talk with your doctor or other health care professional. 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 having, including any that may not seem related to the reason for the appointment.
• Key personal information, including any major stresses, recent life changes and triggers for your outbursts.
• All medicines, vitamins, herbs and other supplements that you're taking, including the doses.
• Questions to ask. Preparing for questions will help you make the most of your appointment time.

Some basic questions to ask include:

• Why am I having these angry outbursts?
• Do I need any tests?
• Is this condition temporary or long lasting?
• What treatments are available? Which do you recommend?
• Are there any side effects from treatment?
• Are there any options other than the main approach that you're suggesting?
• I have other health conditions. How can I best manage these conditions together?
• Is there a generic option 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?

Feel free to ask other questions during your appointment.

What to expect from your doctor

Your health care or mental health professional is likely to ask you questions, such as:

• How often do you have angry outbursts?
• 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 caused problems with your family, or at school or work?
• Does anything seem to make these bouts occur more often?
• Does anything seem to make these bouts occur less often?
• Is there anything that helps calm you down?
• Has anyone else in your family ever been diagnosed with a mental health condition?
• Have you ever had a head injury?
• Are you currently using alcohol, drugs or other substances?

Be ready to answer these questions to save time to talk about what's most important to you.