Re:Intermitent Explosive Disorder

We's start by doing a good evaluation, establishing a good therapeutic relationship, and developing collaborative goals for therapy, of course. Next we'd take specific occasions on which the client has an explosion one at a time and conduct a detailed examination of the chain of events, thoughts, and feelings which lead to the explosions. Our treatment plan would depend on what we discover.

The scenario which I see most frequently in my practice is: 1) Situations occur which trigger irritation/aggravation/annoyance and the individual attempts to "control" thair anger by suppressing it or denying it (rather than either dealing effectively with the situation or dealing effectively with their anger). 2) The individual's anger persists and, as other aggravating experiences occur, their anger builds. They persist in trying to "control" their anger by suppressing or denying it. 3) As they persist in suppressing anger, they become increasingly sensitive to small slights and are increasingly irritated/aggravated/resentful but persist in trying to suppress their anger. 4) Eventually they "have had all I can take" and have an intense overreaction to the next small provocation which occurs. 5) After the explosion is over the individual regrets what they have said and done, they see all the damage that their outburst has done and conclude "I have to CONTROL my temper" and redouble their efforts to suppress anger. (They lack the perspective to realize that the problem is not created by their expressing anger, but is created by their suppressing their anger until it is too intense for them to control.)

When this scenario is behind their explosions, we help them recognize the pattern and introduce the idea that they need to notice that their anger is building and find adaptive ways to handle it before they reach their "exploding point." Typically we help them identify a range of alternatives for coping with anger (perhaps physical exercise, assertion, social problem-solving, rational responses, taking time to cool off, anticipating problems and dealing with them before they become too intense, etc.) and to use adaptive alternatives before their anger becomes too intense. We may need to help the individual master the necessary skills skills (i.e. assertion training, problem-solving training, etc.) and we may need to address fears, expectations, and beliefs that block them from using the adaptive alternatives.

As we do this we will also watch for dysfunctional thoughts, cognitive distortions, beliefs/assumptions/schemas, relationship problems, etc. that contribute to the explosions and address them as necessary.

Then we'll finish by working on relapse prevention (i.e. identifying high-risk situations that may arise and planning how the client can handle them).

Feel free to ask more if you'd like, I presented on this topic for four hours this morning so obviously this is the Cliff Notes version.

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Re:Intermitent Explosive Disorder, by Nc, 07/22/02

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