Rage Disorder or Intermittent Explosive Disorder (IED)

What is Rage Disorder or Intermittent Explosive Disorder (IED).


Rage Disorder

Rage Disorder or Intermittent Explosive Disorder (IED), is characterized by disproportionate rage responses, leading to serious harm through violent words or deeds. Rage Disorder or Intermittent Explosive Disorder begin during the early teen years and evidence has suggested that it has the potential of predisposing individuals to depression, anxiety, and substance abuse disorders. People with IED essentially “explode” into a rage despite a lack of apparent provocation or reason. Individuals suffering from intermittent explosive disorder have described feeling as though they lose control of their emotions and become overcome with anger. People with IED may threaten to or actually attack objects, animals, and/or other humans. IED can be extremely disruptive to an individual’s life, as well as to the lives of those around them. People with IED were often young and that the majority are male. In the severest cases (at least three rage attacks per year), a person with IED may have dozens of episodes over time, leading to injuries requiring medical attention or causing thousands of dollars in property damage.


Diagnostic Criteria For Intermittent Explosive Disorder (IED)

Intermittent Explosive Disorder is diagnosed by following :-

  • Failure to control aggressive impulses that leads to behavioral outbursts as manifested by either of the following:

1. Verbal aggression (eg, temper tantrums, tirades, arguments, or fights) or physical aggression directed towards property, animals, or other individuals that does not result in physical damage or injury; these outbursts occur on average at least twice weekly for three months

2. Physical assaults that damage property or injure animals or other people, occurring at least 3 times in a 12 month period

  • Aggressive behavior is grossly out of proportion to the provocation or any precipitating psychosocial stressor

  • Behavioral outbursts are impulsive, unplanned, and/or a response to anger

  • Marked subjective distress or psychosocial impairment

  • Aggression is not accounted for by another disorder

Treatment of Intermittent Explosive Disorder (IED)

The disorder is usually treated with pharmacotherapy by a psychiatrist, internist, or nurse practitioner. If cognitive-behavioral therapy (CBT) is used in addition to or instead of pharmacotherapy, a psychologist generally provides the psychotherapy. However, psychiatrists, internists, and nurse practitioners can provide all of the treatment if they are trained to administer CBT; treatment by a single clinician is often preferable because it allows for a better understanding of the patient and more consistent care.

A number of medications are known to reduce aggression and prevent rage outbursts, including antidepressants (namely selective serotonin reuptake inhibitors, or SSRIs), mood stabilizers (lithium and anticonvulsants), and antipsychotic drugs. In one study, impulsively aggressive patients who took the SSRI fluoxetine (Prozac) showed increased activity in the prefrontal cortex. A 2009 study of 100 patients found that those who took fluoxetine for 12 weeks experienced statistically significant reductions in impulsive aggressive behavior compared with those who took a placebo.

Cognitive behavioral therapy (CBT) that combines cognitive restructuring, coping skills training, and relaxation training looks promising. A small randomized controlled trial by University of Chicago researchers compared group and individual CBT for the treatment of IED with a wait-list control group. After 12 weekly sessions, patients participating in either individual or group therapy were significantly less aggressive and angry, and less depressed, than those in the control group. Those who attended individual therapy sessions also reported an improvement in their overall quality of life.

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