Intermittent explosive disorder (IED) is a behavior disorder characterized by sudden episodes of explosive anger, often to the point of rage, that are extremely disproportionate to the situation. The rage events usually occur suddenly with little or no warning and may involve yelling, throwing or breaking objects or physical aggression.

The episodes may occur as often as several times a week or as seldom as once every few months. Each episode typically lasts fewer than 30 minutes. Even in cases where the worst episodes occur infrequently, the sufferer may be impulsive, angry or irritable much of the time.

Some people with the disorder experience emotional changes before an episode, such as growing agitation or irritability. As the tension and energy is released through rage, many report feeling relief or even pleasure. Once the episode is over, however, the sufferer may experience significant stress, regret and embarrassment. The disorder often takes a terrible toll on the sufferer’s relationships, self-esteem and career.

People with IED are approximately four times more likely to experience depression or anxiety, compared to the general population, and three times more likely to have a substance use disorder. Many sufferers are especially sensitive to alcohol and its use may increase aggression. According to one study, IED and bipolar disorder co-occurred 60 percent of the time. The average age of onset for IED is around five years earlier than the onset of bipolar disorder.

IED occurs in approximately 4-6 percent of the population. Treatment may involve cognitive behavioral therapy (CBT), cognitive relaxation and coping skills therapy (CRCST), or medication such as selective serotonin reuptake inhibitors (SSRI) or mood stabilizers.

Example: Joseph would feel increasingly agitated before each explosive episode in which he would yell violently and throw objects at the wall. He often felt deeply sorry and embarrassed when it was over.