Intermittent Explosive Disorder and Substance Abuse

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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
  • Injuries

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.

Treatment Timing

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.

Often, that problem persists for years. Harvard suggests that people with IED often wait 10 years or even more before they ask for help. That’s a decade in which the behaviors surrounding anger grow more and more entrenched, and it’s a decade in which an addiction can grow stronger. That can come with very serious consequences.
Mayo Clinic says that people with intermittent explosive disorder who add in substances of abuse are at a greater risk of self-harm, when compared to people with IEDs who don’t use drugs or alcohol. These substances seem to worsen an already weak link between higher thought and the impulse to do harm. Untreated IED can come with such severe consequences that self-harm may seem like a great idea, and drugs can make that self-harm easy to accomplish.

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
  • Sweating
  • 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.

A study in the Journal of Consulting and Clinical Psychology suggests that this talk therapy helps people with IED to feel less angry, hostile, aggressive, and depressed while it helps them to deal with any angry feelings that do appear. The treatment works for long periods of time. When the therapy stopped and researchers checked in three months later, many still were improved. By coaching, talking and learning, people can get better.
Medications may also play a role, as intermittent explosive disorder does seem to stem from chemical imbalances in delicate brain cells. By providing antidepressant medications, doctors can correct that imbalance, and that chemical change could make controlling temper just a little easier. In one study of the issue, researchers found that the drug fluoxetine helped to reduce impulsive aggressive episodes and impulsivity.

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.


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