Condition

Intermittent explosive disorder

also known as IED

Medically reviewed by the Shrinkopedia editorial team, led by Shariq Refai, MD, MBA, FAPA.

7 min read · 1,652 words

Medically reviewed . Reviewed by a board-certified psychiatrist before publication.
Sourced from primary literature . DSM-5-TR, NICE, the American Psychiatric Association, the NIMH, Cochrane, peer-reviewed research.
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Quick answer

> "Intermittent explosive disorder involves repeated, sudden outbursts of aggression or anger that are out of proportion to what set them off. It's a recognized DSM-5-TR diagnosis." (Shrinktionary's definition)

People with intermittent explosive disorder (IED) know the pattern well. Something small happens, a slow driver or a comment from a partner, and within seconds they're shouting, slamming, or throwing things. It's over fast. Then comes the shame. The outbursts aren't planned or used to get something. They're impulsive, and they hurt relationships, jobs, and sometimes people. IED is far more common than it was once thought to be, most people never get treated for it, and cognitive behavioral therapy has promising early evidence.

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Symptoms and key features

Under DSM-5-TR, IED involves either of these patterns:

frequent lower-level outbursts: verbal aggression (tantrums, tirades, heated arguments) or physical aggression that doesn't damage property or injure anyone, averaging twice a week for three months
or three outbursts in 12 months that damage property or injure a person or animal

And:

the aggression is far out of proportion to the trigger
it's impulsive or anger-driven, not planned to get something
it causes real distress or trouble at work, in relationships, legally, or financially
the person is at least 6 years old
it isn't better explained by another condition, a medical problem, or a substance

What it looks like

A 28-year-old warehouse supervisor has cracked two phone screens this year by throwing them. Last month, when a coworker moved his clipboard, he screamed at her in front of the team and punched a locker. He got a written warning. At home, his girlfriend says the fights come out of nowhere, over dishes or a late text, and he's frightening for five minutes and apologetic for the next two days. He describes it as "going from zero to a hundred" and hating himself afterward.

That cycle is typical: a trigger, a surge of rage that feels uncontrollable, a fast release, then relief mixed with guilt and embarrassment.

What people often confuse this with

Borderline personality disorder. Borderline personality disorder includes intense anger, but it comes with unstable relationships, fear of abandonment, and a shifting sense of self. IED is narrower.

Antisocial personality disorder. In antisocial personality disorder, aggression is often calculated or used to get something. In IED, it's impulsive and followed by regret.

PTSD. Irritability and angry outbursts are part of PTSD. When they're driven by trauma reminders and hyperarousal, PTSD is the main diagnosis.

Mood disorders. Irritability during depression or mania is part of the mood episode, not a separate disorder.

DMDD in children. In kids under 18, DMDD adds a constantly irritable mood between outbursts. DSM-5-TR doesn't allow both diagnoses at once.

Substances. Alcohol, stimulants, and withdrawal can all trigger aggression. If outbursts only happen while using, that's the problem to treat.

Reality check

Myth: They're just a jerk with a temper.

IED is a recognized condition, and most people with it feel real shame and want to stop. That doesn't excuse harm, but it means treatment is worth trying.

Myth: Letting anger out is healthy.

Venting by yelling or hitting things tends to rehearse the pattern. Learning to notice and slow the surge works better.

Myth: It's rare.

Large surveys suggest it's as common as many better-known conditions.

What research says

It's common. In the National Comorbidity Survey Replication, estimated lifetime and 12-month prevalence of DSM-IV IED were 7.3 and 3.9 percent. The average age at onset was 14.
Most people don't get treated for it. In that survey, 60 percent of people with IED had received professional help for some emotional or substance problem, but only about 29 percent had ever been treated for their anger.
The costs are real. The same study counted a mean of 43 lifetime attacks per person, with property damage and injuries.
Treatment trials are small. The main CBT trial had 45 adults, and the fluoxetine trial had 100. The results are encouraging but need replication.

When to seek care, and when it's urgent

Get help when outbursts are damaging relationships, costing you work, frightening the people around you, or leading to legal trouble. A primary care clinician, psychologist, or psychiatrist can start the evaluation, and anger-focused CBT is widely available.

It's urgent if someone is being hurt, if there are weapons involved, or if you're afraid of what you might do. Call 911 in an emergency. If you're thinking about harming yourself, call or text 988 in the US. If you're living with someone whose outbursts frighten you, the National Domestic Violence Hotline is 1-800-799-7233.

What we know and what we don't know

What we know

IED is common, usually starts in adolescence, and is rarely treated directly.
CBT for anger reduced aggression in a small randomized trial.
Fluoxetine reduced aggression in a randomized trial, though fewer than half of people reached remission.

What we don't know

Exactly what causes it and how much is inherited.
Which treatment works best for whom. There are very few trials.
How best to reach the many people who never seek help for anger.

Questions people ask

Is IED just anger management issues?

It's more specific than that. IED means repeated, impulsive outbursts that are wildly out of proportion to the trigger and cause real harm. Anger management programs can be part of the treatment.

Can IED be cured?

Many people get much better. CBT and medication can reduce how often outbursts happen and how bad they get. Some people describe it as learning to catch the wave earlier.

Why do I feel so bad afterward?

Because the outburst isn't what you wanted. The regret is common in IED, and it's one reason people seek help. It's also a sign the behavior isn't in line with who you want to be.

Does alcohol make it worse?

It can. Alcohol lowers the brakes on impulses, which is why a clinician will ask about drinking. If outbursts tend to happen when you've been drinking, cutting back becomes part of the plan.

Can children have IED?

It can be diagnosed from age 6. In children and teens, clinicians also think about ADHD, DMDD, oppositional defiant disorder, and what's happening at home and school.

How it's diagnosed

A clinician takes a detailed history of the outbursts: how often, how severe, what sets them off, and what happens afterward. Hearing from a partner or family member helps, since people often minimize or forget details. The clinician checks for other explanations, because aggression shows up in many conditions. A physical exam may matter too, since head injuries, seizures, and some medical problems can change impulse control.

Why it happens

The causes aren't fully known. In Coccaro's 2012 review, people meeting research criteria for IED showed elevated impulsivity, a family history of aggression, and differences in biological markers of aggression. Researchers have also focused on the brain's serotonin system, which helps regulate impulses, and that's part of why SSRIs were tested.

Treatment

Cognitive behavioral therapy. CBT for anger teaches people to catch early warning signs (heat in the face, a clenched jaw), challenge hostile interpretations ("he did that on purpose"), relax, and practice responding differently. A small randomized trial by McCloskey and colleagues found 12 weeks of individual or group CBT reduced aggression, anger, and hostile thinking compared with a waitlist, with large effects that lasted at least three months.

Skills from DBT. Emotion regulation and distress tolerance skills from DBT help some people ride out the surge without acting on it.

Medication. No medication is approved specifically for IED. In a randomized trial of 100 people, the SSRI fluoxetine reduced aggression and irritability starting in the second week, but full or partial remission happened in fewer than half. Mood stabilizers and other medications are sometimes used, with less evidence. The PsychiatryRx guide to SSRIs covers how the class works.

Treating what comes with it. IED often travels with depression, anxiety, and substance use. If outbursts cluster around drinking, that's worth addressing directly.

Sources

Read how Shrinkopedia builds and reviews its content.

How to cite this page

Short: Intermittent explosive disorder. Shrinkopedia, medically reviewed by Shariq Refai, MD, MBA. https://shrinkopedia.com/conditions/intermittent-explosive-disorder/
APA: Shrinkopedia. (2026, September 24). Intermittent explosive disorder. Medically reviewed by Shariq Refai, MD, MBA. https://shrinkopedia.com/conditions/intermittent-explosive-disorder/
MLA: "Intermittent explosive disorder." Shrinkopedia, 24 Sept. 2026, https://shrinkopedia.com/conditions/intermittent-explosive-disorder/.

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Medical disclaimer

Shrinkopedia is for education, not medical advice. It can't diagnose you, and it isn't a substitute for care from a licensed clinician.

If you're in crisis or thinking about harming yourself, call or text 988 in the US to reach the Suicide and Crisis Lifeline, or call 911.

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Editorial guidance

When evaluation may help

Reading a reference is not the same thing as being evaluated. If what you just read matches your own experience closely, if the pattern has been getting in the way of work, relationships, or daily life, or if you have questions that only a clinician who knows your situation can answer, a professional evaluation is a reasonable next step. Reading forward without seeking evaluation is also a reasonable choice for many people. There isn't one right answer.

A few honest options, presented in no particular order:

Your primary care doctor. Often the fastest way to begin. A family doctor or internist can do an initial screen, rule out medical contributors, and refer you to a psychiatrist or therapist if that's the right next step. This is the entry point most people already have.
A therapist through Psychology Today or your insurance panel. Search Psychology Today by location and specialty, or call the member services number on your insurance card and ask for the in-network therapists near you. Look for someone trained in the treatments Shrinkopedia describes for intermittent explosive disorder.
A psychiatrist. If medication is likely to be part of the picture, or the situation is complex, a psychiatrist is the clinician to see. Wait times are often long, so book earlier rather than later. Ask about telepsychiatry if in-person options are limited where you live.
shrinkMD if telepsychiatry fits. Disclosure: shrinkMD is an independent multistate telepsychiatry practice founded by Shariq Refai, MD, MBA, who is also the medical editor of Shrinkopedia. Shrinkopedia takes no referral or affiliate commission for care. We name shrinkMD here because it is transparently one option, not because we recommend it above other qualified clinicians. shrinkMD provides adult outpatient psychiatric evaluation, medication management, and follow-up care through secure virtual appointments. If it fits your situation, you can start care at shrinkMD. Other qualified psychiatrists in your area or through your health plan will do this same work.
If you are in crisis or thinking about harming yourself. Call or text 988 in the US, 24 hours a day, to reach the Suicide and Crisis Lifeline. Call 911 or go to an emergency room for immediate danger. This is not the moment to search for a new psychiatrist.

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