Psychiatrist In Westlake Village: Treating IED With Empathy

As a psychiatrist in Westlake Village, I treat individuals struggling with Intermittent Explosive Disorder (IED). This condition is often misunderstood as just “anger issues,” but in reality, it is a complex mental health condition that requires thoughtful, professional care.

I can help patients understand the underlying emotional and neurological factors driving sudden outbursts, while providing evidence-based treatment in a compassionate, judgment-free environment. With the right support, patients can gain greater emotional regulation, improve relationships, and regain a sense of control over their daily lives. Let’s take a look at this disorder, its possible causes, and treatment options.

What Is Intermittent Explosive Disorder?

​IED is a mental health disorder characterized by repeated episodes of anger or aggression that are disproportionate to the situation. Let’s look at a possible example of how IED manifests.  
 
For instance, a child spills a glass of milk onto the kitchen floor. A person without IED might feel irritated or even speak sharply to the child, but they typically recognize that this is just an accident and calm down quickly with no lasting damage or emotional harm.
 
A person with IED, on the other hand, might experience a quick and intense surge of anger in response to this simple accident. They may yell loudly, slam doors, throw objects, etc, with seemingly no ability to control the anger or the aggressive behavior.
 
While the latter situation can be very traumatic, it is important to understand that the person who has the outburst typically will feel deep remorse or shame about the incident and also not understand why they had such an extreme response to a small issue. This is not simply an anger issue; this is a disorder with impaired impulse control.
 
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is published by the American Psychiatric Association, lists specific criteria that we use to diagnose all mental health conditions, including IED.  The following criteria describe the key features used to identify and diagnose IED.

A. Recurrent Aggressive Outbursts

These outbursts may follow one of two patterns. In the first pattern, we see verbal or physical aggression (or both) occurring at least twice weekly for a period of at least three months. The aggression does not result in physical injury or property damage.

In the other pattern, we see more severe angry outbursts, and the criteria include an individual having three or more outbursts that involve either damage or destruction of property and/or physical assault causing injury. These outbursts must occur within a 12-month period to fit the criteria for IED.

B. Disproportionate Reaction

To meet the criteria, the intensity of the aggression is grossly out of proportion to the stressor. For instance, a person

C. Impulsivity

Aggression is not planned, but impulsive, and the person does not seek a specific objective, such as revenge, intimidation, money, etc.

D. Functional Impairment

The outbursts cause significant distress, disrupt work or relationships, or lead to financial or legal problems.
​
E. Age Requirement

The individual must be six years of age or older, as young children are still developing emotion regulation and impulse control. Angry outbursts and temper tantrums are common in early childhood, but typically by the age of about six (or an equivalent developmental level), most children have developed the ability to better regulate their emotions. 

What Causes Intermittent Explosive Disorder?

​In general, there is usually no single reason why IED will develop in a person. Typically, there is a combination of biological, psychological, and even environmental factors that affect impulse control and emotional regulation in general.
 
Some studies suggest that people with IED may have differences in areas of the brain that control emotional regulation, particularly areas that control threat response and inhibition. In some cases, serotonin imbalances are linked to impulsivity and aggression.
 
It’s possible that there is a genetic component, and people with a family history of mood disorders, substance use disorders, and impulse control disorders seem to have a higher risk of developing IED.
 
Additionally, people with IED often have experienced early life trauma, such as abuse or neglect, or exposure to chronic conflict within their household. These experiences can increase the likelihood of aggressive and impulsive outbursts in later life.  In many cases, all of these factors will contribute to the development of IED as well as many other mental health conditions. 

Does IED Co-Occur With Other Disorders?

This is a complex issue because aggression and anger can be symptoms of other conditions, including ADHD, bipolar disorder, substance use disorders, and more. Here’s a quick look at how your local psychiatrist might determine whether or not the aggression is due to IED or another disorder.

IED vs. Bipolar Disorder

Bipolar disorder and IED certainly can co-occur, but as a bipolar psychiatrist, I find that it’s crucial to distinguish between the types of aggression common to both disorders. For instance, with IED, outbursts are short-lived and not tied to sustained mood changes.
With bipolar disorder, irritability or aggression occurs during manic or hypomanic episodes and is accompanied by other symptoms such as decreased need for sleep, increased energy, grandiosity, or risky behavior.​

IED Vs. ADHD

Aggression is quite common with Attention Deficit Hyperactivity Disorder, or ADHD. Generally, with IED, we see that the aggression is severe, emotionally driven, and episodic. With ADHD, aggression is usually less extreme and is more consistent with a person’s distractibility or frustration tolerance.
 
With IED, a person has an immediate, disproportionate response to a stressor. With ADHD, you likely will notice a person becoming more and more frustrated, while a person with IED might seem to explode out of nowhere. As an ADHD psychiatrist, I have seen patients with both IED and ADHD, and we need to provide treatment that addresses aggression stemming from both disorders. ​

IED Vs. Substance-Induced Aggression

If the aggression occurs primarily during substance use, such as a person becoming violent and aggressive while drinking, this is more likely due to a substance use disorder. With IED, aggressive outbursts will occur independently of either intoxication or withdrawal.

IED Vs. Personality Disorders

Personality disorders include conditions such as antisocial personality disorder, narcissistic personality disorder, and borderline personality disorder. With personality disorders, we may see aggression, but again, these episodes are not simply impulsive. Typically, they follow a pattern and are more intentional, and often, the individual lacks remorse for their actions. People with IED typically feel remorse and shame after an outburst.

IED Vs. Other Conduct Disorders

IED is considered an impulse control disorder and is categorized under the DSM-5 category of Disruptive, Impulse-Control, and Conduct Disorders. We typically distinguish IED by its sudden and impulsive reactions. With other conduct disorders, there is often some premeditation, and typically the person has a history of defiance and rule-breaking.
 
It is important to differentiate whether or not the aggression stems from IED because an accurate diagnosis ensures that we create the best possible treatment plan.

Why You Need A Psychiatrist For IED

​First and foremost, it is important to understand that people with IED experience a loss of control during these issues. These are not issues relating to defiance or antisocial behavior. While they can cause great distress to others as well as the individual with IED, these outbursts are not intentional or driven by a desire to harm others.
 
As a psychiatrist in Westlake Village, I know that the best way to begin is with a thorough, thoughtful diagnosis, and it’s important to find a psychiatrist who treats IED for several reasons.
 
First, we are medical doctors, so we not only treat mental health, but we also understand how medical conditions can contribute to mental health. In some cases, we may find that, in addition to treating IED, we also need to treat other types of physical disorders. For instance, a person could suffer from hormonal or metabolic imbalances that exacerbate anger responses. We need to treat this physical issue as well as treat the IED.
 
Second, a psychiatrist is the only mental health professional who can prescribe medication. There are no approved medications specifically for IED; however, we sometimes use medications that help reduce impulsivity and emotional regulation, such as selective serotonin reuptake inhibitors (SSRIs) or mood stabilizers. These need to be monitored carefully, which is why it is crucial that you find a local psychiatrist to help with any type of medication management.
 
Lastly, we can develop a comprehensive treatment plan that addresses all of the issues you are facing. Many people with IED have co-occurring disorders, and I not only treat IED, but I also work as a psychiatrist for anxiety, a psychiatrist for depression, as well as for conditions such as PTSD, bipolar disorder, ADHD, OCD, and borderline personality disorder.
 
With this level of experience, as well as a thorough knowledge of pharmacology and different treatment options, I can help develop a treatment plan that ensures the best possible outcome and reduction of symptoms for all of the conditions that a patient might have. 

Treatment Options

​As stated above, medication may be used to help with mood stabilization, impulse control, and serotonin levels, but that is just one component of treatment. Cognitive Behavioral Therapy (CBT) can help people with IED recognize triggers and learn to better handle stressful situations. CBT can be an extremely effective treatment for IED, as well as many other mental health conditions.
 
Anger management therapy and emotion regulation skills training are two other types of psychotherapy that can be highly beneficial, in addition to CBT. A therapist or psychologist can provide the services, as well as talk therapy and other types of psychotherapy for co-occurring disorders.
 
Meeting with a psychiatrist as well as a therapist or psychologist is crucial, but there are also some helpful lifestyle changes you can make that can help reduce aggression and control mood. For instance, consistently getting a good night’s sleep can be highly beneficial, as well as learning stress management techniques. Daily exercise and meditation also can help with stress reduction and mood control. 

Treating IED With Empathy

​The aggressive outbursts and violence associated with IED can be very damaging to families, friendships, and work environments. It’s important to keep in mind that a person with IED truly does not mean to be inflicting harm and generally feels tremendous shame after an episode has passed.
 
While in no way do we want to simply excuse the behavior, the ultimate goal is to find a path toward treatment. To that end, an empathetic response is usually the best way to help a person seek treatment.
 
During an outburst, stay calm and use calm, reassuring tones. However, if you feel that you or anyone in your family is in danger, leave the room or home, as your safety should be a priority.
 
Once the “storm” is over, it can help to acknowledge the person’s feelings while also expressing that the aggression is not acceptable. “I see how angry and overwhelmed this situation made you feel, but the outburst was not ok.”
 
From there, you might discuss how these outbursts seem like symptoms of IED and encourage your loved one or friend to seek help, normalizing treatment as simply a way to build skills to help them manage anger and aggression.
 
Of course, those with IED often damage relationships, and those will need to be rebuilt. Therapy, such as family or couples therapy, can help. If you are a loved one dealing with a person with IED, your safety and mental health are crucial. It is perfectly fine to create boundaries to ensure your mental and physical safety.
 
With any mental health condition, patience and empathy are key, as many people with mental illnesses feel shame about their condition and see it as a sign of failure. However, mental illness is not a weakness; it’s simply a biological disease that is often treatable. Seeking help for IED or any mental illness is no different than seeking treatment for diabetes or high blood pressure.
 
If you or a loved one is struggling with IED, please give me a call and let’s find a treatment plan that helps you reduce symptoms and live a happier life. In addition to working as a psychiatrist in Westlake Village, I also serve as a psychiatrist in Thousand Oaks, a psychiatrist in Simi Valley, and the surrounding areas.