A ticking time bomb

An otherwise normal individual bursting out into severe aggression or verbal tirades against known people often takes family and society by surprise. This kind of explosive behaviour is a hint of underlying aggression and impulsion which is often curtailed or unknown. Experts state that of the 80 per cent of depression cases that they counsel at the clinical level, 10 per cent are cases of intermittent explosive disorder wherein a sense of hurt accumulates over a period of time and bursts out. Dr Daljeet Kaur, senior psychiatrist explains how this behaviour often sets in during the early teenage years and is characterised by a lack of tolerance.

Q Which category of depressive people are found to suffer from these symptoms?
Research shows an association between severity of depressive disorder and higher assault acts, which means that the more severe the hostile behaviour is, the worse will be the social adjustment.

Q It is found that the condition develops when an individual is in their teens. Is it due to biological factors, socio-economic or certain behaviours?
The teenage period is a transition period psychologically from childhood to adulthood and a very vulnerable time. The teenager is learning from family and friends. When a teenager grows in an environment where there is harsh punishment, they are likely to become more aggressive. They will react negatively to something that they encounter. The symptoms of explosive disorder often develop during these times. Evidence shows that they ape their parents as they find redemption in putting others through the same form of physical pain.

Intermittent explosive disorder is not diagnosed unless a person has displayed at least three episodes of impulsive aggressiveness. The family has to be aware and be able to identify this form of behaviour.

Q It is said that these people do not show aggression all the time, but when they do, it is very volatile. Does this mean that they have difficulty expressing themselves?
It is beyond just that. It is a failure of self-control. It is an impulsive act. Individuals with this disorder have reported that once they have released the tension that built up as a result of their rage, they feel a sense of relief. Once the relief wears off, some people report experiencing feelings of remorse or embarrassment.

Q How does one identify this kind of behaviour at the family level?
At the family level, there is a lot of distress regarding the behaviour of such an individual. The presence of distress itself is the main identification, but since it is subjective, we need some objective symptoms. It can be classified as behavioural, physical, cognitive and emotional.

Behavioral symptoms can include physical aggressiveness, verbal anger, outbursts, physically attacking people and/or objects, damaging property and road rage.

Physical symptoms can include headaches, muscle tension, chest tightness, palpitations, tingling feelings of pressure in the head and tremors.

Cognitive symptoms include low frustration tolerance, feeling a loss of control over one’s thoughts and racing thoughts.

Emotional symptoms can include rage, uncontrollable irritability and brief periods of emotional detachment.

Q What are the risk factors for the individual and to the person staying with them? Can they cause harm?
It can lead to devastating consequences for those with the disorder, but this depends upon the specific symptoms and behaviours the person exhibits. Interpersonal relationships can be impaired, low self-esteem and self-loathing, self-harm, suicidal thoughts and behaviours, drug or alcohol addiction, trouble at work, home or school, legal problems, domestic or child abuse and incarceration are just some of the consequences. Since they act on an impulse, judgment is impaired so they can cause harm to their near and dear ones.

Q How can it be treated and how long does it take to treat the condition?
Treatment involves medication or therapy, including behavioural modification, and a combination of both offers the best prognosis.

Group Therapies have been found to have good effect. Anger management sessions, especially by people who have come out of the explosive disorder, can also be helpful.

Relaxation techniques have been found to be useful in neutralising anger. Studies suggest that patients with intermittent explosive disorder respond to treatment with antidepressants, anti-anxiety agents in the benzodiazepine family, anti-convulsants, and mood stabilisers. Proper management of depressive disorder/symptoms is an important step for treatment.