Explosiveness–the Mental Health Disorder and Addiction

Explosiveness occurs as impulsive and aggressive outbursts, and can be a pattern of behavior that warrants psychiatric diagnosis and treatment. The Diagnostic and Statistical Manual (DSM-V), used by medical professionals to diagnose mental conditions, states that a pattern of explosive behavior can be Intermittent Explosive Disorder or IED. It is estimated that about 16 million Americans have IED, a number greater than those affected by Bipolar Disorder and Schizophrenia together.

Symptoms of IED

Overall, IED is characterized by a pattern of impulsive aggression that may be verbal or physical. The impulsive nature of outbursts reflects a lack of planning or premeditation. The episodes of aggression are difficult to predict for the person who has them and for others affected by them. In fact, the outbursts are reactions that are out of proportion to any trigger or stress that is experienced.  The outbursts can also occur without a recognizable trigger or identifiable stressor.

To be diagnosed with IED, the following symptoms must be identified (adapted from the DSM-V):

  • There is a failure to control aggressive impulses and this leads to behavioral outbursts as manifested by either of the following:
    • Verbal aggression (eg, temper tantrums, tirades, arguments, or fights) or physical aggression directed towards property, animals, or other individuals that does not result in physical damage or injury; these outbursts occur on average at least twice weekly for three months
    • Physical assaults that damage property or injure animals or other people, occurring at least 3 times in a 12 month period
  • Aggressive behavior is grossly out of proportion to any provocation or any stressor
  • Behavioral outbursts are impulsive, unplanned, and/or a response to anger
  • There is marked personal and/or social distress
  • Symptoms are not caused by any other mental condition

IED and Substance Use

There is a significant correlation between having IED and using substances. For example, people with IED are 5 times more likely to abuse substances than those who do not have it. Among the most commonly abused substances among those with IED  are alcohol, tobacco and marijuana. Also, the severity of IED and the severity of substance use increase together (1).

There is also a strong indication that early life experiences in which there is a pattern of aggressive behavior is a risk factor for problematic substance use in later life. Recognizing a pattern of explosiveness in youth as a medical problem rather than simply ‘bad behavior’ can help at risk youth prevent problems later in life with continuing explosiveness and substance use. While substance use certainly aggravates explosiveness, it is thought that the majority of people who have both IED and substance problems began with IED.

Reference

  1. Emil F. Coccaro, Jennifer R. Fanning, Royce Lee. Intermittent Explosive Disorder and Substance Use Disorder. The Journal of Clinical Psychiatry, 2017.