Intermittent Explosive Disorder and Substance Abuse
In 1985, an Illinois man heard a rumor that his wife was staying out late. He became convinced that his wife was having an affair, so he confronted her and stabbed her 23 times. She didn’t survive the attack, per an account in the Chicago Tribune.
In a similar case, a young New York man admitted that he caused a young woman to miscarry when he punched her in the stomach in a fit of anger. That same man was on trial years later for an attack on his girlfriend, per the ABA Journal.
What do these two cases have in common? The perpetrator in both attacks claimed that the violence was due to a mental illness: intermittent explosive disorder (IED). This illness caused them to do the terrible things they did, these men claimed, and the people they loved paid the price for this very serious illness.
Whether or not you believe than the men had IED or something else altogether, these stories should give you pause if someone you love is struggling to keep a serious temper under control. Without help, things could grow dangerous very quickly, but there are a number of therapies that can provide very real and important help.
A Formal Definition
People who have IED have anger reactions that are completely and totally out of proportion to the issue at hand. These are the sorts of people that can blow up with anger in response to something very small, including:
- Fender benders
- Overheard conversations
- Misheard jokes
- News reports
- Minor arguments
Where a healthy person might grow irritated or even upset in response to things like this, a person with an IED can absolutely explode with rage, putting the people nearby at very serious risk of physical or mental harm.
Mayo Clinic says an episode of IED could manifest as a road rage incident, as domestic violence, or as a temper tantrum that involves throwing or breaking objects. These are episodes in which the person has set aside all matters concerning good health and proper manners. These are people that are absolutely consumed by the angry feelings inside them.
When an episode does fade away, people with IED can feel intense remorse and regret. Some can even be embarrassed by the things they did and said, but those feelings don’t help to prevent the next episode. When the next trigger comes along, the person will react again.
People with IED may not seem angry or upset all of the time. In fact, between episodes, people with IED might not seem any more or less irritable than the next person, but when the right trigger comes and the anger begins to flow, people with IED will overreact. If they do so more than three times in the space of one year, per the National Institute of Mental Health, they’re almost sure to get a formal IED diagnosis that could spur them to get help.
People with IED certainly need help, too, because research suggests that this disorder often manifests alongside other disorders that can make day-to-day life difficult. For example, Psychology Today suggests that about 82 percent of those with IED also have another mental health disorder.
In a way, that makes sense. Some mental illnesses, including depression, come about through a brain wiring issue paired with an outside trigger. If a person with IED does have a brain chemistry issue that stands behind the anger difficulties, and acts out and harms others due to the mental health issue, that person could be at deep risk for depression. Losing a home, a spouse, or a child due to an anger outburst could be enough to tip these people into depression.
The same goes for anxiety disorders. If people with IED know they can’t control temper issues, and they know they tend to get angry over things they can’t predict, they can grow fearful of the onset of the next attack, which is almost certainly around the corner. That anxiety disorder might start with brain chemistry, but the IED makes it worse.
Addiction is a very real concern for anyone with intermittent explosive disorder. In some cases, people attempt to blunt angry feelings with drugs, hoping they’ll be so sedated that they just can’t react when the feelings start to crop up. Others use alcohol or drugs to calm down after an episode, so they can limit the amount of damage they do while they’re in the moment of feeling angry.
People may turn to drugs and alcohol simply because they’ve been dealing with IED since youth. For example, in a study of close to 6,500 teens, researchers found that about two-thirds admitted that they’d had angry episodes involving threatening someone, growing violent, or destroying property. Of those teens, about 6.2 percent met the criteria for IED, and the researchers note that the average age of onset of the disorder was 12.
Young people often don’t have the capacity to deal with anger. The portions of the brain that deal with impulse control and decision-making are still under development during adolescence, so teens are much more likely to be impulsive. A teen with intermittent explosive disorder could use that impulsivity and make a poor decision about drugs. Since teen brains are more sensitive to the damage drugs can cause, an impulsive teen that medicates IED with drugs can become an adult with IED and an addiction.
Stopping the Cycle
While people in the midst of an anger episode are difficult or impossible to talk to, people with IED need to do a great deal more talking in order to get better, and they need to do that talking with a trained professional.
Psychotherapy techniques can help people with IED learn how to spot the signs of anger before they have a chance to grow and spread. Rather than being swept away by their feelings, which seem to come out of nowhere, they’ll learn that anger comes with physical signs they can watch for, including:
- Sped-up pulse
- Diminished ability to hear
- Blushing or flushing
- Muscle clenching
When people can read the signs of anger in their bodies, they can learn new techniques that can help them to cope. Rather than lashing out, they might walk away from the situation, meditate, or visualize a better outcome. They might learn to express their anger with words, not with violence. They might care for their overall mental health, so they’ll be less vulnerable to attacks in the first place.
For people with IED and substance abuse concerns, therapy focuses on craving control. Drugs of abuse spark their own chemical changes in brain tissue, making it much more difficult to resist the allure of the drugs. People think they need these drugs, and they’re willing to do almost anything to get them. With the help of therapy, they might be able to use the power of thought to overcome an urge to use.
Therapists might also help people with addictions to restructure their lives, so they’ll be less likely to put their sobriety at risk. For some, that means learning how to choose a community in which to live. Some neighborhoods offer easier access to drug use, and people with a history of drug abuse may have deep-set memories of good sensations that were brought about by drugs purchased in those neighborhoods. By choosing a home in a different neighborhood that urge to use may fade.
Family therapy may also be a key part of recovery. People with IED and substance abuse may have a long history of terrorizing their families, and they might be surrounded by people who jump and cower at every word they say. That behavior works a little like a relapse trigger, as people with these concerns might wonder why their families won’t just trust them and stop being afraid of them. In therapy, the whole family can discuss the behavior caused by IED and the addiction, and they can work through the trauma an explosive episode of anger can cause. In time, they’ll build up new habits and new ways of relating to one another, and that could help everyone to live together in a much more natural, more healthful manner.
People with intermittent explosive disorder might need to be on alert the rest of their lives, as a poor decision could make the issues come roaring right back, but support group work can help. People in recovery have the opportunity to stay in touch with the treatment community, and they can keep learning and growing in sobriety and mental health. A weekly meeting could be just the thing to keep a relapse from taking hold.
If you’re ready to work on IED and help your family to heal, we’d like to help. We can put you in touch with the right treatment facility, and we can help to expedite your enrollment. Just call and we’ll tell you more about how we can help.