He Intermittent explosive disorder Is a behavioral disorder that is classified As a disorder of impulse control. It is a serious disorder that can cause multiple negative consequences for the person who suffers and usually deteriorates his life greatly Daily.
The main characteristic of this psychopathology is the presentation of episodes in which the person presents aggressive impulses without a motive Apparent as the individual is not exposed to a situation in which he is being attacked.
In these episodes, the person with intermittent explosive disorder is totally unable to control these impulses by what ends up performing acts Violence against persons or material objects.
Put another way: the person who suffers from this disorder"explodes"before any situation that can cause minimal frustration.
Likewise, there is no alteration of the State of mind That is, the person may be"completely normal"and suddenly Outbreak of unreasonable anger.
Characteristics of intermittent explosive disorder
The most common is that people with this disorder"despair"and present the outbreak of anger to a tiny detonating: an inadequate word, An ambiguous tone of voice, an object that bothers you, etc.
After these aggressive behaviors in which the individual can not Control your urge to anger , The person begins to be aware of the Consequences of their actions.
Therefore, the person suffering from intermittent explosive disorder is not aware of the consequences and significance of their violent acts while It is doing it, but it is doing it once it is concluded.
It is then that the individual realizes what he has done and the consequences and / or reprisals that his actions can have, and he experiences feelings of guilt Or self-reproach for having performed a behavior that he should not do.
It is for this reason that intermittent explosive disorder is considered a disorder of the Impulse control Because the person is unable to control a Aggressive impulse that appears suddenly.
However, it differs from other impulse control disorders such as kleptomania , the pyromania Or gambling due to the fact that, in this In this case, the impulse appears unexpectedly.
In other cases of impulse control disorders, the desire to perform a certain action (stealing in the case of kleptomania, burning things In the pyromania or play in the one of the Gambling ) Does not appear so suddenly and the impulse-inducing behavior is performed less Immediately.
For example, a gambler may have the urge to play and not do it immediately, but he does accumulate his desire to play until he finds a At which time it is impossible for him to resist doing so.
In contrast, in the case of intermittent explosive disorder, the impulses of violent action do not accumulate, they appear suddenly before a Minimum stimulus, at which time the person can not control himself and performs the aggressive behavior immediately.
It is for all this that the classification of this disorder as a mental alteration has created some controversy over time.
And is that the aggressiveness Is understood as a normal quality and shared by all human beings. All people have the ability to perform Aggressive behavior to defend their own interests.
However, what makes pathological conduct of people with intermittent explosive disorder is not the aggressiveness itself, but the Impulsivity of the aggressiveness that these individuals present.
Thus, while a person without intermittent explosive disorder is able to control his aggressiveness and make use of it when he believes it Convenient, the person with intermittent explosive disorder is not, and performs it even in those situations that would not want to do so.
Symptoms and diagnosis of Intermittent explosive disorder
Explosive episodes with this type of patient may be associated with affective symptoms such as irritability, anger, Fast thoughts.
In addition, some individuals report that their aggressive episodes are accompanied by physical symptoms such as tingling, trembling, palpitations, oppression Thoracic pressure, head pressure or feeling of an echo.
In fact, people with this disorder often define the episodes as highly unpleasant and annoying.
In the same way, during episodes epxlosivos can be observed signs of impulsivity or generalized aggressiveness, and the acts that are carried out Can cause serious bodily injury to others or property damage.
These episodes of which we are talking all the while are usually very brief, and can last between 20 and 40 seconds.
Likewise, they may appear recurrently or more sporadically, presenting episodes every several weeks or months.
Finally, once the episode has occurred, the individual may feel either a sense of relief or negative feelings of guilt and state Depressive disorders.
However, in order for all of these symptoms and behaviors to be classified as intermittent explosive disorder, the following criteria must be met:
Several isolated episodes of difficulty controlling aggressive impulses, which lead to violence or destruction of property.
The degree of aggressiveness during the episodes is disproportionate to the intensity of any precipitating psychosocial stressor. Is To say, there is never a logical factor that motivates and justifies the impulse and the aggressive behavior.
Aggressive episodes are not best explained by the presence of another mental disorder (for example Antisocial personality disorder or Manic episode) and are not due to the effects of a drug (eg alcohol or cocaine).
Course and prevalence
Not many people suffer from this intermittent explosive disorder, however, there is some ambiguity in the prevalence studies of this psychopathology.
In fact the DSM argues that there is no conclusive data on the prevalence of this disorder, although it clarifies that its occurrence is scarce.
On the other hand, a study by Monopolis and Lion showed that 2.4% of psychiatric patients were diagnosed with an explosive disorder intermittent. However, in subsequent reviews the prevalence decreased to 1.1%.
Similarly, Zimmerman performed a study that detected a prevalence of 6.5% for intermittent explosive disorder among patients Psychiatric disorders and 1.5% in the general population.
So, despite not having irrefutable data on the number of people suffering from this disorder, it is clear that not many people That suffer this alteration.
As regards the course of the disease, it usually appears during childhood and adolescence, with the average age being 14 years and the older age High recorded 20.
It usually starts abruptly, with no previous state indicating the onset of the disorder.
The evolution of this disorder is very variable and can occur both with a chronic course and with an episodic course. The average duration is In about 20 years as identified by the DMS.
Causes
As it is defended at present, the intermittent explosive disorder does not have a single cause, and is usually originated and developed by the combination Of biological and environmental factors.
There seems to be a certain genetic predisposition to suffer from this disease, since several cases have been observed in which the progenitors of the person With intermittent explosive disorder showed similar behavior patterns.
However, no gene has been detected that could be responsible for this similarity between patients with intermittent explosive disorder and their Parents, which means that environmental factors must be taken into account.
It is argued that being exposed to scenes of habitual violence during childhood and adolescence increases the likelihood of showing certain traits of This disorder in early ages and end up manifesting an intermittent explosive disorder during adolescence.
Also, people who have been abused during childhood and / or have experienced multiple traumatic events when they were young are more Susceptible to develop the disease.
The fact of being a man also constitutes a risk factor for intermittent explosive disorder since this pathology is presented with much greater Between men and women.
Finally, in investigations to discover the causes of this disease, it has been pointed out that people with intermittent explosive disorder Show a remarkable decrease in the levels of serotonin in your brain.
Treatment
To control and reverse the symptoms of intermittent explosive disorder, both pharmacological and psychological treatments can be performed.
As far as pharmacological treatments are concerned, different drugs can be used.
1. Stabilizers of the mood
Medications such as lithium , he Valproate sodium wave Carbamazepine Are used to reduce the aggressiveness and violent behavior of this type of Patients.
Although the effect of these drugs is much more effective in those cases where there is an altered affective component (a fact that does not usually happen In intermittent explosive disorder) has shown some effectiveness in reducing the aggressions of patients with this problem.
2. Antidepressants ISRSS
Medications such as Fluoxetine wave Venlafaxine Reduce irritability scores and aggressive tendencies, and improve the mood of Aggressive behaviors are less likely.
3. Antipsychotics
Finally, the Antipsychotics Have been used for the treatment of short-term aggressiveness. However, it is not recommended to use these Drugs to treat intermittent explosive disorder due to its side effects.
With regard to psychological interventions, a great number of techniques can be used that allow the person to learn to control their Impulses and their aggressive acts.
4. Behavioral therapy
The person is instructed to react appropriately in different situations so that, through practice, he / she acquires modes of response To avoid aggressive behavior.
5. Social Skills
Likewise, it is very important to carry out work designed to increase Social skills Of the patient with intermittent explosive disorder.
These sessions focus on the resolution of conflicts that cause aggressive impulses and learn to interact and communicate in a more Appropriate.
6. Relaxation
Often people who suffer from this disorder lack moments of calm and tranquility that are basic to their well-being.
Teach Relaxation techniques So that the patient can practice them daily can be a great help in learning to control their impulses.
7. Cognitive Therapy
Finally, it is possible to work so that the individual learns to identify his aggressive thoughts, to analyze them and to modify them by others more adapted and Less harmful.
The patient is trained so that whenever an impulse appears and an aggressive thought is able to change it by a neutral thought and of this Form, can control its impulse and avoid the appearance of aggressive behavior.
Thus, although intermittent explosive disorder is a serious disorder that has a major impact on the functioning of the person, Can apply treatments that can eliminate these impulses and prevent violent behaviors.
References
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- COCCARO EF: Intermittent explosive disorder as a disorder of impulsive aggression for DSM-5.
- Ellis, Albert and Grieger, Russell. Manual of Emotional Rational Therapy. Editorial DDB, Bilbao, 1981.
- Moeller FG, Barratt ES, Dougherty DM, Schmitz JM, Swann AC. Psychiatric aspects of impulsivity. Am J Psychiatry 2001; 158 (11): 1783-93.
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