What Is Intermittent Explosive Disorder?

Medically Reviewed by Zilpah Sheikh, MD on January 21, 2024
9 min read

Intermittent explosive disorder (IED) is a mental disorder that causes people to have periods of intense anger and sudden outbursts without any reason. It can make you aggressive and even violent. You might yell, get in fights, throw or break things, abuse others, and have road rage. This behavior stresses you out and affects your everyday activities and relationships. It can also cause you to have financial and legal trouble.

Research says that as much as 7% of people have IED. It usually begins in childhood or teenage years. Most people continue to experience it later in their life, although it can get better as you get older. Treatment usually involves therapy and medication.

Is IED a form of bipolar?

Though they may be related, the two are separate disorders. But they are often what experts call "comorbid conditions." That means that if you have IED, you also can have bipolar disorder. According to recent research, if you have IED, you're almost seven times more likely to have bipolar disorder than people without IED. In fact, bipolar is one of the five most common mental health disorders that is connected to IED. The others are:


  • Generalized anxiety disorder
  • Conduct disorder
  • Oppositional defiant disorder
  • Alcohol dependence

Experts don’t yet know what causes IED. But a few things may increase your chances of having the disorder, such as:

  • Your genes. IED tends to run in families, so you could have inherited a gene that makes you more likely to have the disorder. As much as 72% of IED diagnoses are tied to a family history.

  • Your environment. If you grew up in a household where IED behaviors, such as violent outbursts and physical and verbal abuse, were common, you are more likely to behave in a similar way. Traumatic experiences in childhood also may increase your risk.

  • Your brain. Your brain structure and chemistry, as well as how your brain functions, may be different than that of someone who does not have IED. Research shows that people with IED have lower levels of a neurotransmitter hormone called serotonin.

Having another mental disorder also increases your risk of developing IED. For example, if you have:

  • Attention deficit hyperactivity disorder (ADHD)
  • Antisocial personality disorder 
  • Borderline personality disorder 
  • Depression 
  • Anxiety
  • Substance abuse disorder

An IED episode can happen at any time. A typical episode lasts for less than 30 minutes.

Common IED symptoms are:

  • Sudden rage
  • Frustration
  • Irritability with human contact
  • Scattered thoughts
  • High energy levels
  • Tightness in the chest
  • Tingling feelings
  • Shaking
  • Racing thoughts
  • Fast heartbeat

During an episode, you might:

  • Shout and use abusive words
  • Start heated arguments
  • Slap or push people
  • Start physical fights
  • Damage your or someone else's property
  • Threaten to harm people or animals

The intensity of your symptoms might be different from someone else's. You might show verbal aggression but not physical aggression, while someone else might be very physically aggressive. 

When you have IED, you're aware of what you are doing, but you're unable to control it. After an episode, you may feel very bad and guilty.

These episodes can happen daily, or you might not have them for weeks and months. During that time, you might still feel angry, aggressive, irritable, and impulsive.

There aren't any tests to diagnose IED. A licensed mental health professional, such as a psychiatrist, psychologist, or social worker, will ask you questions about your and your family's physical and mental health history, your relationships, school or work, and impulse control. They might also ask your family and friends to gather more information about your behavior and history.

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5)says that a person has to have shown a failure to control their aggressive impulses in one of two ways in order to be diagnosed with IED:

High-frequency/low-intensity episodes: This means that you have episodes frequently, but they might not be as severe. You must have shown physically or verbally aggressive behavior toward people, animals, or property at least two times a week during the past three months.

Low-frequency/high-intensity episodes: This means your episodes don't happen often, but when they do, they are very severe. You must have had three episodes in which you damaged property or physically harmed people or animals during the past year.

With both diagnoses, the episodes must have been out of proportion to the situation, and obviously impulsive and unplanned.

IED is treated with a combination of therapy, medication, and lifestyle changes.

Therapy: Cognitive behavioral therapy (CBT) can help you find out why you have episodes and what you can do to prevent them. It can also help you with anger management and finding healthier ways to deal with things that bother you. Relaxation training, such as deep breathing and muscle relaxation, is another therapy that can help you develop more control over your impulses.

Medicines: Your doctor might prescribe selective serotonin reuptake inhibitors (SSRIs) or mood stabilizer medicines to help balance your brain chemicals. Antipsychotics, anticonvulsants, and antianxiety medications are also used.

Lifestyle changes that can help include:

  • Stress management
  • Exercise
  • Healthy sleep
  • Nutritious diet
  • Developing a support system

IED can make your life and the lives of those around you very difficult.

Relationships. IED causes angry outbursts that can lead to verbal and physical abuse. That, in turn, can lead to divorce, stress in the family, and other relationship problems. Some research has found that people with IED are nearly four times more likely to be divorced or separated than those without IED.

Work and school. You can imagine how IED-associated behaviors would affect an individual in a school or workplace setting. IED ups your odds of being unemployed and fired from your job. That can lead to money problems, another complication of IED. At school, kids with IED risk suspension for their behavior. They are more likely than others to fight with their classmates and feel rejected by their peers. Research shows they also have more difficulty learning and are at higher risk of being held back a grade.

Mood problems and other mental disorders. About 80% of people with IED also have at least one other disorder, such as anxiety or bipolar disorder. One study found that depression was the least common disorder among people with IED. But people with IED had a nearly three times greater risk of depression than those who don’t have IED. IED also raises your risk of substance use disorders.

Suicide and self-harm. Up to 25% of people with IED attempt suicide. Self-harm, meaning you hurt yourself physically but not as part of a suicide attempt, is also common in IED. As much as one-third of people with the disorder say they have done things such as cutting themselves with razor blades or burning themselves with cigarettes.

Physical health problems. There’s a long list of physical health problems that have been linked to IED. They include:

  • Coronary heart disease
  • High blood pressure
  • Stroke
  • Diabetes
  • Arthritis
  • Back and neck pain as well as other chronic pain
  • Headaches
  • Ulcers

It's important that you seek mental health treatment for IED. It's not something you can fix on your own. And, you have to stay in treatment and on your medications for as long as your doctor tells you to.

You can also do some things in your day-to-day life to make living with the disorder easier:

  • Practice self-care. Eating a nutritious diet, exercising, and getting a good night's sleep are all forms of self-care, which can help keep your mood stable and your body and mind healthy.
  • Change learned behaviors: Change is hard, but by practicing the skills you learn in therapy, you can learn new healthy behaviors and coping skills.
  • Work on your communication skills. Try to listen to the other person's reason before reacting impulsively.
  • Practice relaxation techniques. Include breathing exercises in your routine and meditate regularly.
  • Stick to a routine. Having a daily routine gives you structure, which can help you feel more emotionally stable. Wake up and go to sleep at the same time every day. Plan out other activities at the beginning of the week, or at least the evening before.
  • Avoid stressful situations. Stress worsens mental health disorders. Keep your work and social schedule light; avoid people and situations that you know stress you out; and practice stress-relieving techniques, such as breathing exercises and meditation, every day.
  • Avoid mood-altering substances. Alcohol and recreational drugs have a significant impact on your mood and impulse control.

Untreated IED can be dangerous. People with the disorder may become violent. Your safety and the safety of your family are your priority. Have a plan in place to protect yourself and your loved ones, including pets. Make sure to:

Know the warning signs. Take note of what happens before your loved one's outbursts so that you can recognize it in the future and be ready.

Prepare a quick getaway. If you have a driveway, back your car into it when coming home. Keep all the doors locked except for the driver’s door.

Pick a safe place to go and decide how you’ll get there. Have a believable excuse ready to explain why you need to leave if you are confronted. Practice getting out in advance of any need to do so. If you have children, practice with them so they’re prepared as well.

Get advice from a domestic abuse hotline or shelter. You should do this when your partner’s not at home or when you are at a friend’s house, the library, work, or elsewhere.

Get rid of or lock up any firearms. Whether it's your partner or child who has IED, it's important to keep any dangerous weapons out of sight and secure.

Confide in a neighbor or friend. Let someone you trust know about the abuse and call on them if you need help.

Make up a code word, hand signal, or other sign that you can use to indicate to others that you’re being threatened. Share it with trusted friends, neighbors, and your children, if appropriate.

Keep your phone close. Know the numbers of your friends, family, and others who can help, such as domestic violence hotlines or shelters. 800.799.SAFE (7233) will reach the National Domestic Violence Hotline.

Helpful resources include:

Your local hospital or health care provider. If you get hurt, medical professionals can treat your injuries and document them as well. They also can provide info on safe places to seek further help.

Domestic violence shelters and crisis centers. These often provide shelter at all hours for those who need help.

Community counseling services and mental health centers. These can provide help to those in abusive relationships.

IED causes sudden anger and violent outbursts for no obvious reason. In addition to threatening others, this behavior harms you as well. Fortunately, treatment can help you better control yourself. It's important to get professional help as soon as possible.

What are the signs of IED?

Signs include sudden fits of rage for no obvious reason. People with IED lose control and become verbally and physically abusive. Physical signs of IED include tightness in your chest, a tingling feeling, shaking, and a fast heartbeat.

What is the cause of IED?

No one knows the answer to that. However, there are some risk factors that make it more likely to develop. It runs in families, for example, so if a sibling or parent has it, you might as well. It can also be caused by growing up in an environment with physical and verbal abuse or going through a very traumatic experience as a child.

Is IED a form of bipolar?

No, but the two disorders often exist together. If you have one disorder, you also have a higher risk of having the other.

Is IED a mental illness?

Yes. It’s included in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), the American Psychiatric Association’s guide on mental health conditions for mental health professionals.