Explosive anger disorder (or EAD, also called intermittent explosive disorder or IED) is a condition in which individuals experience ‘explosive’ fits of rage that are disproportionate to the stressor that triggered them. These outbursts will often be short in duration and will be accompanied by twitching, sweating and other bodily symptoms. Often the individual will feel a sense of relief and even pleasure after allowing themselves to vent their anger. It is suspected that this condition is highly prevalent and studies have found that roughly 16 million Americans would fit the criteria of EAD, though it is a different condition to categorise and diagnose and it is hard to draw the line between those with EAD and those who simply have a short temper. To be classified as EAD, the explosive outbursts must not be the result of other psychological or health conditions such as Alzheimer’s disease, of medication or substance abuse.
Impulsive outbursts of anger can of course be a highly unsociable behaviour, but at the same time they can be dangerous and destructive if they lead to acts of violence or other poor judgement. It is thought that EAD could cause many cases of road rage, vandalism, domestic violence and pub fights. Those with EAD might have difficulty holding down relationships and jobs and might make rash actions that they gravely regret subsequently.
Causes of Explosive Anger Disorder (EAD)
There are many potential causes of EAD and the exact mechanisms are not fully understood. It may well be that several different causes can have the same effects as EAD. Impulsive violence has been linked in some studies to a low serotonin turnover rate (serotonin being a feel good hormone and a neurotransmitter). This in turn could be caused by a low amount of 5-Hydroxyindoleacetic acid in the cerebrospinal fluid. Low 5-HIAA might be inherited.
EAD has also been linked to blood sugar levels. Increased insulin secretion for instance is correlated with EAD which would result in low blood sugar. Meanwhile lesions in the amygdala and prefrontal cortex may damage blood sugar control and have also been correlated with EAD. This might be because of low blood sugar causing decreased brain function.
Lesions in the prefrontal cortex could also affect an individual’s long-term planning abilities. This would then mean that they had less ability to predict the outcome of their behaviour and result in more destructive impulsive outbursts. This is why alcohol can cause explosive outbursts of anger – and why those with EAD should avoid consuming alcohol.
Treatment of Explosive Anger Disorder (EAD)
There are many treatments for EAD. Where the outbursts are highly antisocial and are putting the patient and others at risk then medication might be required and here a range of antidepressants such as serotonin re-uptake inhibitors can be used.
At the same time there are many therapies that are aimed at teaching individuals to manage and recognise their anger. CBT for instance (cognitive behavioural therapy) can teach individuals to identify the thoughts that might make them angry and then replace them with more calm thoughts that will extinguish the situation before it erupts.
Biofeedback may be used as part of CBT or on its own. Here the patients will be given a heart rate monitor which they will use to monitor their heart rate. As their heart rate increases they will enter a state of excitability where they will be more likely to become angry. When they notice this happening they will be instructed to try using a range of anger management techniques such as smiling, controlling their breathing, removing themselves from the situation etc, and they can then monitor the results of this on their heart rate monitor. The eventual hope then is that they begin to recognise the situations that trigger their outbursts so that they can avoid them, identify the signs that their heart rate is rising, and know the best techniques to calm themselves back down.
A range of other lifestyle changes can also help to eliminate anger in general and can be used for those with EAD or general temper problems. For instance lowering your blood pressure can help you to keep your heart rate calmer and to avoid anger outbursts and this can be achieved through improving your diet – by drinking lots of water and eating lots of fibre. Likewise exercise can also help to prevent angry outbursts, as can having an outlet where you can express yourself creatively. If you have any ongoing stressors in your life or are generally unhappy for any reason you should meanwhile try to address these and so hopefully improve your general mood.