Although it is often unpremeditated, there may be affective changes prior to an outburst, such as tension, or mood changes, or bodily symptoms, such as chest tightness, sweating, twitching, or palpitations. The violent or aggressive acts are often accompanied by a sensation of relief, and in some cases, pleasure, but are invariably succeeded by remorse after the act.
Prevalence of IED is higher in men than women, and it mostly begins in teens, or early 20s. People who have a history of substance abuse have an increased risk of IED, as do those who were abused as children, or have experienced multiple traumatic events in their life.
Living in an environment of explosive behavior, and physical and verbal abuse can cause this disorder, as being exposed to violence at an early age increases the chances of children exhibiting those traits later in life. It also occurs in families that have a history of addiction and mood disorders.
Thus, explosive behavior may occur as a way of compensating insecurity or low self esteem when confronted in situations that consciously or unconsciously remind the person of his or her low self worth, or frustrating childhood experiences.
There may also be a genetic component related to IED, because some children inherit this disorder as physical or biological abnormalities from their parents, which are sometimes associated with mild neurological abnormalities.
Brain chemistry, relating to dysfunctional neurotransmitters or chemical messenger, such as serotonin, along with hormones such as testosterone and some regions of the brain such as the limbic system or the frontal lobe may also be implicated as a cause of IED.
But regardless of the cause of the disorder, aggressive episodes are more likely to occur during periods of stress. This can be seen in road rage, where a person may be stressed out by the driving habits of another driver, and respond in an aggressive way that escalates out of proportion. Intermittent explosive disorder can also be seen in domestic violence, where anger leads to assault.
(The article is a joint contribution of Anu Goel, Counselling Psychologist & Apurva Sapra)