Intermittent Explosive Disorder

Intermittent Explosive Disorder is defined as repeated and uncontrollable anger attacks that often become violent.

IED is different from common type of anger most people exhibit from time to time when they pout, throw a book down or walk out of the room banging door, activities that are better described as mild temper tantrums.

                                    One in 20 people may be susceptible to repeated, uncontrollable anger attacks in which they lash out in road rage, spousal abuse or other unjustifiably violent actions.

Researchers from Harvard and the University of Chicago have found that 4-5% of people in the study have physically assaulted someone, threatened bodily harm or destroyed property in a rage an average of five times a year.

Some Disturbing Trends

            IED is on the increase among teenagers and it may set the stage for the onset of other mental conditions such as depression and alcoholism.

The rage disorder typically begins at the age 12-13 in boys and 15-16 in girls, increases rapidly in the teen years, is less prevalent among respondents in 40’s and becomes even less so among people in their 60’s.

Why?

Here comes a question, why is it increasing day by day?

Is there something profoundly important about how society is changing that’s leading to this apparent increase in people not being able to control their emotions and lashing out at other people?

Is it that we are bad parents and we are creating these little monsters?

Is television doing it? Is it due to the increase in action movies or is it due to the increase in nudity & vulgarity in the movies?

Instead of being considered a mental health problem, anger was thought to be a matter of will power. But new brain imaging studies show that the people with IED have abnormal brain signaling in areas that control anger responses.

                        When people with rage disorder are shown pictures of people with angry faces, their amygdala lights up far more than is seen in healthy subjects. The amygdala, deep in the center of the brain, governs emotional responses to threats.

At the same time, the front portion of their brain, which serves as an executive control over emotional urges, is less active than in normal people, indicating that people with IED quickly lose control.

People with rage disorder often misinterpret another person’s harmless action as a personal threat and respond by slapping, hitting or threatening the other person, breaking things, punching holes in walls or even try to run the person down with a car. The large numbers of assaultive acts occur in interpersonal relationships, followed by social settings, home & work.

Relief turns to remorse.

During a rage attack people often feel a sense of relief, but they mostly feel remorse afterward. They run a high risk of getting divorced, losing friends, and getting into trouble with the law and being fired from jobs.

Anger attacks can be reduced with drug-therapy to raise the threshold at which people explode or with cognitive behavioral intervention that teaches people how to relax when they feel tense & how to recognize that another person is not trying to hurt them.

The simplest coping skill is to get out of the encounter. If you feel you are going to explode you just walk away, take a timeout.

Homoeopathic Approach

The homoeopathic understanding of health is intimately connected to its understanding of the mind in general. Homoeopathic practitioners do not distinguish the mind from the body in the usual way; these practitioners generally assume that the two are dynamically interconnected and that they directly influence one another. This concept of the interconnectedness of body and mind is not simply vague or impractical. Because some psychologic symptoms arise from physiologic processes, and vice versa, it is of value to treat patients who have such symptoms holistically and a holistic approach is inherent in homoeopathic care. Indeed, virtually every homoeopathic prescription is based on both the physical and psychologic symptoms of the patient. Psychologic symptoms often play a primary role in the selection of an appropriate homoeopathic medicine.

Rubrics to be consider: – (Kent’s Repertory-Mind)

1- Abrupt:

2- Abusive:

3- Anger, irascibility:

4- Anger, irascibility: Stabbed, so that he could have, anyone:

5- Anger, irascibility: Throws things away:

6- Anger, irascibility: Violent:

7- Break things, desire to:

8- Cruelty

9- Disturbed, averse to being:

10- Fight, wants to:

11- Impatience

12- Impertinence

13- Imprudence

14- Impulse: to kill

15- Indignation:

16- Insolent:

17- Irritability:

18- Kill: Desire to:

19- Kill: Desire to kill the person that contradicts her;

20- Kill: Sudden impulse: To

21- Kill: Sudden impulse: For a slight offense:

22- Kill: Sudden impulse: Throw child into fire:

23- Kill: Thought he ought to kill somebody:

24- Kill: Threatens to:

25- Looked at, cannot bear to be:

26- Offended, easily:

27- Quarrelsome:

28- Rage, fury:

29- Rage, fury; Insults after:

30- Rage, fury: Kill people, tries to:

31- Remorse:

32- Remorse: Repents quickly:

33- Remorse: Trifles, about:

34- Restlessness, nervousness: Rage, ending in a:

35- Rudeness:

36- Sadness, mental depression: Anger, after:

37- Sensitive, oversensitive:

38- Throws things: Away:

39- Throws things: Away: At persons: who offend:

40- Violent, vehement, etc.

Boenningheusen’s Repertory: – Mind

1- Abusive, scolding, railing etc:

2- Anger, crossness, etc.:

3- Anger, crossness, etc.: Remorse, followed by:

4- Bad part, takes everything in; easily offended:

5- Cruelty, harshness of heart etc:

6- Destructive:

7- Faultfinding, reproachful, etc:

8- Hatred and revenge:

9- Irritable, cross:

10- Irritable, cross: Alternating with wrath:

11- Knife, impulse to injure with:

12- Mania, madness, rages, etc.:

13- Profanity, cursing, etc;

14- Quarrelsome, contentious, strife:

15- Raving, raging:

16- Rude, coarse, insolent:

17- Shouting:

18- Shrieking, screams, cries out:

19- Striking (about):

20- Striking (about): The walls:

21- Trifles: Vexed over:

Boericke’s Repertory: – Mind

1- Mood, disposition: Complaining, discontented, dissatisfied

2- Mood, disposition: Fault-finding, finicky, cautious:

3- Mood, disposition: Fretful, Cross, irritable, peevish, quarrelsome, whining

4- Mood, disposition: Haughty, arrogant, prideful:

5- Mood, disposition: Hypersensitive, cannot bear contradiction, vexed at trifles;

6- Mood, disposition: Impudent, insulting, malicious, revengeful, spiteful:

7- Propensity to: Be abusive, curse, swear:

8- Propensity to: Be cruel, violent, inhuman:

9- Propensity to: Be destructive, bite, strike, tear clothes:

10- Propensity to: Kill beloved ones:

11- Propensity to: Scold:

12- Propensity to: Tear things:

Therapeutics:

Though Homoeopathy works on the Principle of Individualization i.e. the medicine can vary from person to person depending upon the onset, duration, progress, location, sensation, modalities & concomitant symptoms yet in our Materia Medica there are many remedies that can be labeled as remedies for IED. In some rubrics like: “MIND, Violent, vehement” or “MIND, Anger” or “MIND, Rage” there are more than 100 remedies. In other smaller rubrics like: “MIND, Wildness” or MIND, Violent deeds, rage, leading to” or “MIND, Anger, violent” there are less remedies and in even smaller rubrics like “MIND, violent” or “MIND, Rage, kill people, tries to” or “MIND, Rage, violent” there are only a few remedies.

     If we take into consideration the intensity of the different remedies in these rubrics we see that the remedies which appear first are the following: Hyos., Stram., Bell., Hep., Verat., Anac., Lyc., Nux vom., Aur., Nit Ac., Cham., Lach., Merc., Staph., then other less violent remedies.

     The three remedies to consider first (Hyos., Stram.,Bell..) are complementary to each other.

So let us try to understand how these remedies differ from each other with respect to Intermittent Explosive Disorder.

Hyoscyamus:

The basic disorder in this remedy is jealousy and suspiciousness. The child becomes jealous in families where the parents take more care of another child. Jealousy is so strong, that the child loses his personality, becomes introvert, with blocked sentiments. The Hyos. child comes into a situation as if it stops living. They are possessed by jealousy, they want to take revenge, but they cannot and the expression of the sentiments stops. Only jealousy is there and with the first opportunity in a quarrel, violence comes up. They strike, they want to kill and they can kill. It is very possible also that they will turn to suicide. Children can throw their brother or sister into the swimming pool because of jealousy or they try to strangle them. Finally the desire to kill arises.

     They express themselves with coldness (want of sentiments, coldness, logic). The mental disorder drives to increased sexuality, without sentiments. They lose any inhibition, expose their genitals to anyone and constantly occupy themselves with their genitals. They curse using crude words.

     Generally Hyos. is more passive, occupied with his internal situation. When they are disturbed they react violently. That is why this remedy is more often prescribed in acute situations, but it is also a useful remedy in chronic situations.

Stramonium:

This is for situations where the subconscious, that has been loaded with frights and bad experiences, erupts. They were very frightened or scared. The first symptom in children is a fear at night in bed. He tries not to express his violence because he is afraid of the intensity he feels. Stram. is the most violent remedy. They can injure, breaks things, glasses. They also have fear of being injured, of suffering. In this case he falls down and acts like if he struggles with himself.

     During rage they can bite, strike and even kill. They also have sexual aggressiveness. The little boys touch or prick the back or the breast of a woman. When they are not in a rage they look very quiet. They feel a sleepiness when they have to face difficult situations or when they speak about a bad experience which made them frightened.

Belladonna

This remedy is characterized by great intensity and vividness in the patient and in the disease process. In anger they explode, they burst out, they become violent. They pull, they bite, they strike, they knock their head. Their face becomes frightful and red. The rage is strong, but without passion and malice (like in Stram.) and stops suddenly. They feel pulsation of the arteries during rage.

    Bell. are healthy and balanced people. They have no great fears, except fear of dogs.

     In pathological situations (fever, neurologic disorders, e.t.c.), the big fantasy they have can produce delusions. In these situations they lose the sense of the environment and they become violent, nobody can stop them. They climb up, they bite like dogs or throw things away.

Hepar sulphuricum

Oversensitiveness and abusiveness are the keywords for this remedy. The patient appears as if his nerves are on edge, as if the nerve edges are raw and exposed. In this situation he feels that he cannot take the slightest physical or psychological pressure, otherwise he will break apart. So he becomes angry, nasty, vicious and abusive to other people.

     His oversensitiveness is visible in the beginning with irritability over small things. Later he becomes very hasty and angry for the slightest reason (the smallest illness or something the other says). Verbal abusiveness is very characteristic. But he could have the impulse to kill, even his child (Sep., Nux v.), especially at the sight of a knife. He might also have the desire to set things of fire.

Nitric Acid:

     These patients are always miserable and disappointed under any conditions. They therefore become critical of themselves and others. Nobody wants their company. He is irritated by faults and very obstinate denying any consolation. He never forgives. He is miserable on all levels and develops an anxiety about health, especially about cancer as this leads to death. His psychological condition leads him to depression and suicidal thoughts, but due to fear of death he cannot commit suicide. Nitric Acid is easily irritated, curses, weeps, and is easily started.

Nux Vomica.

     This person is very ambitious, intelligent and capable, with a strong sense of duty. He is very irritable and wants everything around him to be perfect and in order. He is disturbed by others around him, is impatient and cannot stand disorder or objection. He is ready to quarrel at any time for these reasons. At first he tries to suppress his anger and not to quarrel, then with next unimportant matter he bursts out shouting, cursing even throwing or tearing things. He loses his self control. They weep from irritability (Plat.).

     The second stage is characterised by destructiveness. Here the wife can hit her husband or have the impulse to throw the child into the fire or kill it, (Sulph., Thea.). In the deeper stages this impulse becomes a fear and is followed by weakness and depression. Despite feeling weak she feels she will burst out at the slightest provocation. They are very anxious with oversensitive senses (Cannot bear noise, light, touch, drafts of air and has a fear of wind). He has suicidal thoughts, by shooting, or throwing himself from a balcony. The woman is very irritable before menses, (Lac,. Lyc., Nat mur., Sepia., Caust., Cham.).Nux can be compared to Hepar in their irritability, violence and abusiveness. Nux however, has more self-control.

Veratrum:

The keyword for this remedy is restlessness on all levels and malice. The children are restless and untamable, their mind works all the time with different ideas. They can do all sorts of damage. They want to be constantly in motion. They do the opposite of what you tell them. They curse, are obstinate, hard, jealous. They want to reduce the others. You strike them and they don’t say anything or they become violent. They have the need to always be active (physically or mentally), the need to do something bad.

     In the older people, characteristic is the intensity in every symptom. They are critical and jealous, because they think they deserve more. They are quarrelsome especially in the evening when they feel worse. Intensity of emotions with malice and desire to curse, to strike. Later they can develop religious delirium and they shout in the streets “change your minds” e.t.c. and they pray. Then they are not violent.

     In rage they have the desire to kill. Also desire to tear, to cut things with scissors.