Intermittent Explosive Disorder (IED) is classified as an impulse control disorder, and the person who suffers from it usually presents recurrent rapid episodes of extreme anger, uncontrolled anger and impulsive aggression, totally disproportionate to the situation in which they occur. Regarding its prevalence, it is estimated that 4-6% of the population meets the criteria for IED at some point in life, apparently being more frequent in men. Although the disorder can begin in childhood, the onset is most common in adolescence, between the ages of 13 and 18, and it has been suggested that it is a chronic clinical entity.
Coccaro & McCloskey (2010) propose a series of diagnostic criteria from clinical observations and research in the book Impulse Control Disorders . On the one hand, recurrent episodes of uncontrolled aggressive impulses that lead to verbal or physical aggression to other people, animals or property, with a minimum of twice a week for a month. The criterion of three episodes of physical aggression towards another person or destruction of property during the course of a year can also be taken. On the other hand, aggression is disproportionate to the precipitating provocation or stimulus, and is not premeditated or with the intention of achieving a goal (money, intimidation …). The authors also emphasize in an important way, aggressive behavior produces remorse once the explosive episode is over and hinders the daily functioning of the person. Finally, they point out that it cannot be explained by other medical, mental or substance abuse disorders.
TEI has been associated with an alteration in the levels of serotonin and insulin , with a lower metabolism of the prefrontal cortex and also with a greater activity of the amygdala.
The most common treatment includes cognitive-behavioral and pharmacological psychological therapy. In these patients it is important to teach impulse control, increase awareness of anger and learn how to control it, as well as to deal with the emotional stress that occurs. Relaxation is generally part of this type of intervention . In a more novel way, the practice of cognitive training such as games of attention and inhibitory control seems to have been shown to be effective in the treatment of other impulse control disorders such as Tourette’s syndrome or Attention Deficit with Hyperactivity.
Marisa Fernández, Senior Neuropsychologist, Unobrain
