Type: Research Essays
Sample donated: Sandy Barnes
Last updated: September 25, 2019
In conclusion, IED is an obstructive anger disorder whichhas a major effect on one’s social, financial, educational and personal life.Neurobiology certainly has an effect in comparing individuals with IED andwithout IED, drawing upon psychopathy behaviours. Exposure to trauma has alsobeen confirmed in influencing one’s development in coping and regulating emotions.IED will always involve recurrent episodes of anger attacks, in which poorhealth outcomes is something to guard against, which can be efficient throughthe utilization of previously examined treatments, such as pharmaceuticals andCBT.Cognitive Behavioural Therapy (CBT) incorporates cognitiverestructuring, coping skills and relaxation training, existing as a promisingapproach for treating IED. Findings by MICHAEL MCCLOSKEY suggest that CBT wouldbe efficient for people with IED, however, anger treatment is often not able todifferentiate between clinical anger issues with and without marked aggression.
For example, a study by MCCLOSKEY involved participants who were angrystudents, volunteers, criminals, medical patients, drivers and abusivepartners. Though some of these participants may meet the criteria of IED, theintensity of anger and aggressiveness are likely to be more severe than thosewho are merely angry students and drivers (MCCLOSKEY). Therefore, preliminaryevidence proposes that CBT can be efficacious for patients diagnosed with IED,but not as effective for people without IED (MCCLOSKEY). Further treatment forIED is needed as an area of future research, as experts and studies believeviolence is something that can be treated (HARVARD). Individuals who find it complicated to resist their violentimpulses, are not likely to seek treatment. People with IED have receivedpsychiatric treatment, however, fewer than 20% have been treated particularlyfor the outburst attacks (HARVARD MEDICAL). Research around pharmaceuticaltreatment has been limited, although, the following medications are recognizedto be minimise aggression and avoid raging episodes: antidepressants (Selectiveserotonin reuptake inhibitors – SSRIs), mood stabilizers (lithium andantiseizure drugs) and antipsychotic drugs (OLVERA).
For example, in one studyconducted by HARVARD MEDICAL SCHOOL, impulsively aggressive patients whoabsorbed SSRI fluoxetine (Prozac) exhibited increased activity in theprefrontal cortex. Another study by HARVARD MEDICAL found that those who hadtaken fluoxetine for 12 weeks experienced great falls in aggressive behaviour,in comparison to those who took a placebo. Although, experts warned that evenif the affect may appear effective, less than half of patients taking Prozacachieved a full or incomplete remission (HARVARD MEDICAL). OLVERA states thatgiven the lack of controlled trials for the management of patients with IED, itis suggested to utilize associated symptoms and comorbidity as guides towardstreatment.HEWAGE studies presented that intense anger outbursts thatoccur in response to minor triggers, that are allied with feelings of loss ofcontrol and autonomic arousal are mutual with those with depressive and anxietydisorders. Evidence from studies conducted by (KATHERINE M KEYES) alsosuggested that impulsive aggression and explosive anger are mutual with anxietydisorders. For example: IED is repeatedly linked with major depression, asindividuals who are aggressive, tend to be further depressed and anxious thanthose who are non-aggressive (FETTICH). However, the nature of possibleshortages in affective processing in IED is still not clear due to theheterogeneity in presentations in a clinical setting (AMY LOOK).
There is extensive indication that IED with its primaryfeature of anger leads to poor consequences (FERNANDEZ). An epidemiologicalsurvey observed IED to be related with 9 of 12 physical health issues,including coronary heart disease, hypertension, stroke, diabetes, arthritis,back/neck pain, ulcers, headaches and other long-lasting pain syndromes(FERNANDEZ). Enduring anger may also compromise lung functioning and intensifythe natural decrease in lung power that begins with ageing (MICHAEL MCCLOSKEY).Pain issues are also of contribution with an angry or aggressive temperament,as people with a history of tension headaches and migraines have advanced angerpoints and poorer anger control (MICHAEL MCCLOSEY).
Research proposes thatanger and hostility are interrelated with numerous physical health outcomes(EMIL COCCARO DANIEL J FRIDBERG). The use of self-report measures presentsitself as a limitation to these studies; by way of example: “Once in a while Ican’t control the urge to strike another person” (MCCLOSKEY, P325), rather thanmeasures of concrete aggressive behaviours. Therefore, MCCLOSKEY suggests thatunderstanding IED is important in further comprehending the relationshipbetween aggression and poor health outcomes, as IED is an existing disorder inthe DSM-5. However, if aggressive behaviour only exists within the setting ofchronic pain, IED cannot be diagnosed (ABIGAIL L JENKINS).
There has been a lack of research connecting IED to traumaand posttraumatic stress responses. Bearing in mind the early onset of IED, itis likely that traumatic events that take place early in life may have a severeinfluence on the development of IED (ANGELA NICKERSON). Studies conducted byANGELA NICKERSON propose that substantial childhood trauma can obstruct sufficientdevelopment of emotion regulation capabilities, with shortages resulting inexplosive anger. The experience of trauma throughout childhood prevents optimumgrowth, intervening with one’s capacity to absorb the required skills to enablepsychological health and emotional regulation in adulthood (NICKERSON). Therelationship between childhood exposure to trauma and IED may also be affectedby genetic factors (NICKERSON).
For example: a second study conducted in TimorLeste, proposed that maximum levels of exposure to trauma was the sturdiestpredictor of explosive anger outbursts amongst survivors of human rightsviolations (KALHARI HEWAGE). Therefore, KALHARI HEWAGE study conclusions areproven to be reliable with the growing body of research that advocates anger ispredominant amongst trauma survivors. However, a limitation would be that otherelements that could have influenced IED were not examined. For future research,it may be of interest to study the appropriate impact of trauma exposure atdifferent stages in childhood (NICKERSON). There is limited resources and information about the clearcauses of IED, although, experts recognize that the disorder affects people inall cultural and socioeconomic groups. Neurobiological studies present abiobehavioural connection between aggression and selected brain chemicals, suchas serotonin (EMIL COCCARO). For example: KARLA C FETTICH shows thatneuroimaging studies propose that a probable neurobiological weakness forintense emotional reactions and emotion dysregulation are due to a dysfunctionin the amygdala-orbitofrontal cortex (OFC) network with individuals diagnosedwith IED.
Individuals with IED are more vulnerable in undergoing strongnegative emotions, with the inability to regulate them, compared to healthyindividuals (KARLA FETTICH). ALEXANDER PUHALLA also confirms that individualswith IED demonstrate anomalies within this network, with hyper-reactivitywithin the amygdala, hypo-activation in the OFC and a minimized efficientcoupling between all the areas compared to those who are of healthy nature. Theamygdala is vital for emotion processing and the OFC is crucial in decisionmaking, therefore, this pattern proposes that individual with IED arevulnerable to negative emotions and have a shortage in their aptitude tocontrol their emotions (ALEXANDER PUHALLA). However, further research isrequired to scrutinize emotional clarity between individuals with IED comparedto psychologically healthy subjects (KARLA FETTICH). IED was perceived to be a rare disorder, until recent eventsproved experts otherwise. For example: in The National Comorbidity SurveyReplication (NSC-R), a face to face representative survey for over 9000 UnitedStates adults was carried out in 2001-2003 which resulted in a 12-month andlifetime prevalence estimated to be 3.9% and 7.3%, with a mean 43 lifetimeepisodes resulting in $1359 in property damage (RONALD C KESSLER).
RONALDKESSLER states that IED injuries occur 180 times per 100 cases, with the meanage onset at 14 years. IED has been faintly associated with ethnicity, educationalstatus and other sociodemographic variables (FERNANDEZ). However, FERNANDEZstates that it is more visible during adolescence, decreasing across adulthood,with a higher rate in males than females. According to the (DSM-5), the following criteria must bestrictly met to be diagnosed with IED. A) Recurrent behavioural outbursts reflectingthe inability to control aggressive impulses that are manifested as eitherverbal or physical aggression towards people, animals or property occurringtwice a week for a period of three months or three outbursts involving damageand destruction of property or physical assault over a one year period, B) thegrade of aggressiveness presented during the episodes is grossly out ofproportion to the provocation or any psychosocial stressors C) The aggressivebehaviour is not premeditated and is not committed to achieve an objective D)The aggressive behaviour causes either marked distress in the individual orimpairment in occupational or interpersonal functioning E) the aggressivebehaviour is not better accounted for by another mental disorder, a manicepisode, a general medical condition or the direct physiological effects of asubstance (DSM-5) and (EMIL F. COCCARO). Anger, like other emotions, can be distinguished by its formand intensity and can take the form of an emotion, mood or temperament(FERNANDEZ). Anger can range “in intensity from irritation or annoyance to furyor rage” (E.
FERNANDEZ, P125). Primary “red flags” (FERNANDEZ) that anger hasgrasped a pathological level are aggression that is physical and verbal, withan intent to offend and violence that results in physical injury or damage. When anger reaches consistently interferingand difficult levels, it becomes pathological and meets diagnostic criteria inthe DSM-5 (CLAIR CASSIELLO-ROBBINS). FERNANDEZ states out of all DSM-5diagnoses, IED best reflects anger. IED is defined as repeated behavioural explosionswhich reflect the inability to control aggressive impulses (RENE L OLVERA) andare disproportionate to provocation (FERNANDEZ). Anger is an existing key criterion in five diagnoses withinthe Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
This essaywill particularly focus on Intermittent Explosive Disorder (IED), its diagnosticcriteria, prevalence rates, possible causes and available treatments and interventions.The following essay will thoroughly demonstrate and examine the influences ofneurobiology, the relationship between trauma exposure and IED, IED’s poorhealth outcomes and the relationship between anxiety and aggression, drawingupon resourceful limitations and areas for future research.