Dear Dr. Roach: I have a relative who fits the description of intermittent explosive disorder, which I recently read about. Could you please tell me what kind of therapy a person would need if diagnosed with this problem? — T.M.
Answer: Intermittent explosive disorder is an impulse control disorder: an inability to restrain behaviors related to emotions. As the name suggests, people with intermittent explosive disorder have periodic bursts of aggressive behavior. The behavior can be verbal or physical, and is grossly out of proportion to the situation. The outbursts are impulsive and unplanned, and importantly, cause distress to the person. I suspect most readers will not find it hard to think of someone who has had these kinds of outbursts, but the formal diagnosis requires the person to meet strict criteria. The diagnosis is usually made by a mental health professional.
There are many risk factors, including family history and prior history of abuse or neglect. Genetics is suspected to cause about half the risk for developing this condition. It is more common in men.
Treatment may be with medication such as the SSRI fluoxetine (Prozac), with cognitive behavioral therapy or both. Cognitive behavioral therapy encompasses 12-20 one-hour sessions. Alternative medications are available for those who do not do well with Prozac.
While I have heard friends and family members excuse such behavior, people with intermittent explosive disorder may cause injury to people or animals, cause property damage and get in legal trouble. Most importantly, treatment is usually effective.
