MENTAL HEALTH Mental Disorders • Compulsive sexual behavior • Schizophrenia • Bipolar disorder • Borderline personality disorder • Compulsive gambling • Body dysmorphic disorder • Personality disorders • Dissociative disorders • Narcissistic personality disorder • Cyclothymia • Intermittent explosive disorder • Self-injury/cutting • Antisocial personality disorder • Schizotypal personality disorder

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Road rage. Domestic abuse. Angry outbursts or temper tantrums that involve throwing or breaking objects. Sometimes such erratic eruptions can be caused by a condition known as intermittent explosive disorder.

Intermittent explosive disorder (IED) is characterized by repeated episodes of aggressive, violent behavior that are grossly out of proportion to the situation. And, according to a June 2006 study funded by the National Institute of Mental Health, intermittent explosive disorder is more common than once thought. Intermittent explosive disorder occurs most often in young men and may affect as many as 7.3 percent of adults in the United States.

Individuals with intermittent explosive disorder may attack others and their possessions, causing bodily injury and property damage. Later, they may feel remorse, regret or embarrassment about the aggression.

The cause of intermittent explosive disorder appears to be a combination of biological and environmental factors. Lives have been torn apart by this disorder, but medications can help control you or your loved one's aggressive impulses.

Explosive eruptions, usually lasting 10 to 20 minutes, often result in injuries and the deliberate destruction of property. These episodes may occur in clusters or be separated by weeks or months of nonaggression.

Aggressive episodes may be preceded or accompanied by:

• Tingling
• Tremor
• Palpitations
• Chest tightness
• Head pressure
• Hearing an echo

Most people with this disorder grew up in families where explosive behavior and verbal and physical abuse were common. Being exposed to this type of violence at an early age makes it more likely for these children to exhibit these same traits as they mature.

There may also be a genetic component, causing the disorder to be passed down from parents to children.

People with other mental health problems — such as mood disorders, anxiety disorders and eating disorders — may be more likely to also have intermittent explosive disorder. Substance abuse is another risk factor.

Individuals with narcissistic, obsessive, paranoid or schizoid traits may be especially prone to intermittent explosive disorder. As children, they may have exhibited severe temper tantrums and other behavioral problems, such as stealing and fire setting.

The diagnosis is based on these criteria:

• Multiple incidents in which the person failed to resist aggressive impulses that resulted in deliberate destruction of property or assault of another person.
• The degree of aggressiveness expressed during the incidents is completely out of proportion with the precipitating event.
• The aggressive episodes aren't accounted for by another mental disorder, and are not due to the effects of a drug or a general medical condition.

Other conditions that must be ruled out before making a diagnosis of intermittent explosive disorder include delirium, dementia, oppositional defiant disorder, antisocial personality disorder, schizophrenia, panic attacks, and substance withdrawal or intoxication.

People with intermittent explosive disorder may have an imbalance in the amount of serotonin and testosterone in their brains. They may also show some minor irregularities in neurological signs and electroencephalograms (EEGs).

This disorder may result in job loss, school suspension, divorce, auto accidents or incarceration.

Many different types of drugs are used to help control intermittent explosive disorder, including:

• Anticonvulsants, such as carbamazepine (Tegretol), phenytoin (Dilantin), gabapentin (Neurontin) and lamotrigine (Lamictal).
• Anti-anxiety agents in the benzodiazepine family, such as diazepam (Valium), lorazepam (Ativan) and alprazolam (Xanax).
• Mood regulators like lithium and propranolol (Inderal).
• Antidepressants, such as fluoxetine (Prozac) and paroxetine (Paxil).

Group counseling sessions, focused on rage management, also have proved helpful. Some people have found relaxation techniques useful in neutralizing anger.