Intermittent Explosive Disorder (Uncontrollable Anger/Rage)

- Psychological Disorders and Mental Health Conditions

We have all witnessed a child throw a tantrum in which they expressed anger, threw things, and maybe said some harsh words for not getting their way. They test their limits and show emotions that may not be ideal but it helps them figure out their boundaries. Usually these children will respond to discipline, with a pout of course, and can calm down to return to the activity. To an extent, this is normal behavior, but when it exceeds any “normal” tantrum there may be the chance of something more serious.

Causes

Intermittent Explosive Disorder can be suspected when behaviors become dangerous or excessive. This disorder is likely caused by some brain impairment including chemical imbalance or possibly a brain injury. There have been findings that the parts of the brain responsible for impulse control and aggression may be underdeveloped. Intermittent Explosive Disorder often occurs in homes where children are exposed to violence, substance abuse, neglect, and parental mental illness. The child may feel vulnerable, afraid, or threatened in their home environment and use the behavior as a way to protect themselves. There is also a possibility that abnormally high levels of testosterone may be involved. A child may be predisposed to this disorder if their mother used drugs or alcohol while pregnant, experienced seizures, contracted an infection of the brain, or had head trauma.
Uncontrolled anger and rage

Diagnosis

Diagnosis of Intermittent Explosive Disorder should not be made until all other disorders that include aggression have been ruled out. Although this disorder often occurs with other diagnoses it is important to find if another diagnosis better describes the behavior. A sign that a child has Intermittent Explosive Disorder is behavior that is much more intense than what the trigger should illicit. For instance, if a child is asked to finish eating dinner they may throw the plate onto the floor, kick the table, and then attempt to hit you. The child may be pleasant at other times but has very specific outbursts that are beyond normal behavior. Explosions of aggression can consist of harm to self and others, major property damage, and seemingly uncontrolled behavior that cannot be stopped easily. These behaviors may be learned from watching others in the home but not necessarily; the lack of an adult role model or good influence to teach that the behavior is wrong may also be a factor. This disorder is considered an impulse control type disorder so other disorders that deal with a lack of control may be an issue with high likelihood of substance abuse as an adult.

Treatment

It is imperative to begin treatment as soon as possible if you have a child with Intermittent Explosive Disorder. If left untreated the child may become involved in criminal activity, substance use, and could also develop major personality disorders as an adult. Treatment usually consists of some form of Cognitive Behavioral Therapy or Psychodynamic Therapy. Cognitive Behavioral Therapy will help the child and family pinpoint triggers and develop strategies to reduce the behavior. Psychodynamic Therapy will allow the child to further explore the conscious and unconscious causes for the aggression. This will help the child deal with the feelings beneath the emotions to help regulate those emotions when triggered. Intermittent Explosive Disorder affects the entire family and can cause a sense of anarchy and dysfunction. Family members may even be fearful around the child with this disorder. Because of this, it is important that the entire family attend counseling together to determine what in the home can be changed to reduce the explosive outbursts. Sometimes, for the safety of the child, family, and peers the child may need medication to help subdue the part of the brain responsible for aggression and increase impulse control.

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