Intermittent explosive anger

Abstract

Anger is among the most basic human emotions, which is a response to physical and mental harm inflicted on an individual. Anger can take many forms including passive aggressive anger, intermittent explosive anger among many more forms of anger. Although anger is among the most powerful and vital emotions, it can at times develop to be a big problems especially when it persists and start causing challenges in our lives especially with regard to a person’s thinking, feeling, behavior as well as relationships. In general, anger is encompasses three key components which are physical, cognitive and behavioral. Physical reactions includes increase in heart rate, increase in blood pressure as well as tightening of muscles while cognitive component concerns itself with how we perceive and think of the causes of our anger. Behavioral component on the other hand is consisted of behavior that signals anger, for instance, raising voice, slamming doors among others.

In this paper, we focus on one form of anger called intermittent explosive anger. This is an extreme form of anger where an individual fails to resist aggressive impulses and end up causing serious assaults to people and animals or destroy valuable properties. The degree of aggressiveness articulated during such an episode is by far out of proportion when compared to normal provocation or situational stress. In some instances, the individual may even be angered by things, which should normally anger a normal person. To help with the discussion of this issue, a case of person called Mark is illustrated followed by discussion of symptoms, feelings and thoughts, causes and impacts of the disorder. Finally, in details the paper discusses various forms of treatment of this condition.

Mark’s case

Mark recently turned 35 and had his birthday celebration last work in a posh hotel. However, it is not the birthday celebration that took center stage but the drama that ensued with Mark at the center of it.  It all started at the time of refreshments. As you would in expect in such an event, there were many types of refreshments present including alcohol drinks. As the birthday boy, Mark and his immediate neighbors were among the first to be served and they had their glasses filled with Vodka. Before they started drinking, they did the traditional tossing and this is where it all began. As Sam tossed his glass with that of Mark, James raised his glass and a small confusion ensued that led to some alcohol pouring on Mark. Mark was outraged. He held James on the Chest and gave him a slap that left everyone in the room quiet. Before anybody could intervene, Mark was throwing all the glasses and their content on the floor causing havoc confusion that saw some people running for their safety, some of them injured. Those who tried to stop him, found themselves on the receiving end as well-built Mark, body-wise, did not want to hear from any person trying to calm him down. It only took the intervention of the restaurant’s bouncers to overcome the situation as they got hold of him and cooled him. After cooling down which took almost an hour, Mark returned to his place and was visibly embarrassed and looked remorseful.

This was just one of the incidents that Mark has caused since he moved to his new residence. Recently, he spent a night at a police cell after smashing the windscreen of a car belonging to another person after the owner “unnecessarily” hooted at him. On the same weekend, Mark had fought with one of his friend in a local pub after arguing on whether or not a player from his team needed to have been red-carded. It only took intervention of other friends to prevent the club personnel from calling the police. Nevertheless, what is common in all these provocations is that at the end of it all, Mark feels sorry for his victim and apologizes. However, his friends are getting fed up with him because the habit seems not to stop. In fact, it is rumored that he left his last residence because of losing all his friends, as they could no longer tolerate him. As a matter of fact, Mark does not only attack human but also other animals and objects. Some neighbors have threaten to report him to authorities if he do not stop his brutality towards his dog pet when in rage. Mark recently smashed the Smart Television in his house after being annoyed by an “irritating” reporter.

When asked about his condition, Mark says it started when he was young at the age of around 15 years. This is after his mother and father divorced after continuous fights and quarrels.

Internment explosive Anger Behavioral symptoms

From the case discussed above about Mark, it is evident that he is experiencing Intermittent explosive anger often referred as Intermittent Explosive Disorder (IED). This a disorder originating from impulse and is characterized by sudden episodes of unwarranted anger as it was happening with Mark in the case. The anger disorder is exemplified by hostility, impulsivity as well as recurrent aggressive anger (Czirr, 2014). There are several symptoms, which can tell a person with intermittent explosive anger. Physical aggressiveness occurs where an individual gets confrontational for no apparent reason or for simplest of irritation often leading to physical wars (Hinshaw & Melnick, 1992). An example in the case above is where Mark fight because of accidentally being hurt and does the same because of an argument about a football match. Another symptom of intermittent anger disorder is verbal aggressiveness where the person gets into unnecessary argument and gets irritated. Angry outbursts is another symptom of this disorder and this is evident in the case of Mark. People with intermittent explosive anger also physically attack people and objects as seen in the case discussed where Mark attacks his friends, his dog and also his Television. Damaging property and road rage are other symptoms that such people experiences like seen in the case of Mark where he destroys the windscreen of a car belonging to a stranger due to anger.

Physical symptoms of people with intermittent explosive anger

People with intermittent explosive anger experiences some physical symptoms including headaches, muscle tensions, chest tightness among others. Headaches occur continuously coming with some pain. Muscle tension is a condition where the body muscles remain semi contracted for long periods. Intermittent explosive anger victims also experiences chest tightness, palpitations, tingling, and feeling of pressure in the head as well as tremors (Leishman, 2013).

Relevant Feelings and thoughts related to intermittent explosive anger

People experiencing intermittent explosive anger have reported that after causing such events as described above, they normally feel tension that comes with rage go which make them relieved. Most people once the relief is gone have a feeling of remorse and embarrassment resulting from their action when in rage. For people with this condition also, a feeling of loss control over one’s thought is common (McCloskey, et al. 2008). This means the victim losses their thoughts and end up doing things they also regret later. Another feeling that people like Mark in the case have is a feeling of rage where they get highly irritated and burns with rage from inside which comes out in form of confrontations. Such people also experiences racing thoughts. They also have low frustration tolerance meaning when frustrated it is easy for them to get confrontational and even fight with the cause of the frustration even if it is an animal or an object. Intermittent explosive anger victims also experience brief period of emotional detachment where their emotions are detached from themselves. Moreover, such people are uncontrollable irritable which is beyond their control (Leishman, 2013).

Causes of Intermittent explosive anger

There are various factors that exposes one to develop the intermittent explosive disorder. Being male is a risk factor as the explosive anger disorder majorly affects the male members of the population. Another risk factor is the exposure to violence at an early age, which can contribute to a person developing this disorder in the future. In the described case, we learn that Mark had had some exposure to violence when still a child where the parents were having domestic violence. This may have contributed to him developing the intermittent explosive disorder (McCloske, et al. 2006). Another risk factor and which is related to violence at early age is exposure to explosive behaviors at home including but not limited to outburst from parents or siblings and this may also had been the cause of Mark’s problem. Having had to face physical trauma in the past is another risk factor that can cause one to experience this disorder as is experiencing emotional trauma. Others causes includes misuse of alcohol and other substances, which can overtime lead to a person developing the condition or advance it. There are also some medical conditions that act as risk factors to the condition meaning the medical condition lead to a person developing the Intermittent Explosive disorder (McCloske, et al. 2006).

Effects of intermittent explosive anger

This condition can lead to upsetting consequences for its victims though this is dependent on the specific symptoms and behaviors exhibited by the person. People with intermittent explosive anger normally end up having impaired interpersonal relationships as a result of their rage. At the extreme cases, this can lead to loss of some or all friends. In the case for example, Mark had to move to a new place after losing all his friends due to his anger. Domestic or child abuse is another effect of this intermittent explosive anger where a parent can end up hurting their children as a result of the condition. In the case discussed for instance, Mark was hurting his dog and probably if he had a child, the anger would have been directed to the child. Another impact is legal problems and this is evident in the case where Mark gets into legal tussles with people for breaking their properties including a car. Some people can try to run away from the problem by engaging in drugs or burying themselves in alcohol (Kessler, et al. 2006). In work setting, the condition can bring conflicts and spell trouble to the person experiencing it. This goes the same with home and schools. The condition can further lead to low self-esteem and self-loathing especially after reflection of a bad happening. At the worst, this can cause self-harm especially when one is alone. Lastly, the condition can lead to one having suicidal thoughts and behaviors (Kessler, et al. 2006).

Treatment of intermittent explosive anger

There are various methods that can be applied in treatment of anger and some of them are discussed under especially with the focus on the case of Mark.

Relaxation Interventions

These interventions vary in design but generally consist of a set of overlapping emergent elements. The person administering these interventions need to start by identifying the anger experienced by the patient which is normally done by descriptions given by the patient, asking the client to fill a questionnaire or self-monitoring of anger when conducting an activity such as driving. The emotional and physiological arousal is normally targeted by these interventions where the person is equipped with skills of applying relaxation coping skills, which enables him to initiate relaxation upon the coming of anger. When subjected to a repeated application of relaxation skills, it is possible to have the clients lower their baseline level of arousal. In summary relaxation interventions that can be applied in Mark’s case would include; a) Development of a relaxation response. b) development of a momentary relaxation coping skills with the ability to abruptly initiate relaxation c) educating the client on internal emotional and psychological cues of anger arousal enabling him to initiate relaxation when aroused, d) rehearsal of relation coping skills and e) development of strategies for maintenance of relaxation coping skills after termination of therapy (Fernandez, 2013).

Reappraisal

This is another form of treatment, which involves challenging the belief by the client that the anger he experiences the fault of other people, animals or objects such as friends, dog or objects like television. The procedure of “check the facts” is applied to dispute cognitions. The client need to be trained to try to establish the cause of a happening before attributing unfounded blameworthy to others. In situation where the client is somehow justified to get angry, a notion should be created in their minds that no matter how bad it may be, they should be able to overcome it (Fernandez, 2013).

Social skills training

Anger is a relational emotional and thus its reduction is dependent on how one interacts with others. It is therefore important for people with intermittent explosive anger to be trained on social skills specifically on how they interact with others. Thus, for Mark need would include teaching him how to identify emotion from facial cues and physiological sensations. This should be followed with coaching on prosocial behavior. In general social skills training calls for two important procedures, which are proper social modeling as well as adequate rehearsal. The client will therefore be equipped with social skills and will not consider confrontational as the solution to their anger (Fernandez, 2013).

The inpatient Milieu

This involves taking a client to a psychiatric health facility or a prison, which provides unique set of hurdles for management of anger. This relates largely to the coercive and aversive atmosphere that is more often than not attributable to such environment. These environments are normally associated with noise, enforced treatment in addition to have some methods of restraint. In such as setting therefore, it would be highly likely to erode therapeutic progress without containment of the routine and familiar source frustration and thus invoking the principle of stimulus control as per the behavior modification. An extension of stimulus control will be done to ensure that once the client is discharged or released, the client would not have to return to his or her own environment as well as living arrangements with their own frustrations that would set off a relapse to the dysfunctional anger (Fernandez, 2013).

Cognitive interventions

Anger can be managed through some cognitive interventions. In general, a person like Mark can be trained on several cognitive interventions. The first one is redirection of attention where one need to turn away his attention from the angering situation. Like in the case of his birthday, Mark would have concentrated on the fun as opposed to getting angry for a minor thing. Another cognitive way is letting go and ignoring where the person who is angered need to unhook and not try to get involved. Another approach that such a person can be trained of is acceptance, tolerance and realistic expectations such that he or she is aware that sometimes they may encounter difficulties when dealing with situations especially when driving and therefore the need to accept and be tolerant if when this occurs. Another important cognitive approach to anger is coaching the client to be less demanding such that they do not expect every person they meet on the way to behave like them. Cognitive change encompasses helping the client accept their personal standards but do not impose them on other people (Fernandez, 2013).

Conclusion

Anger come at times for some people gets out of proportion and lead to severe consequences. It is important to take action before it reaches such dangerous levels. For individuals suffering from anger disorders such as intermittent explosive anger, there are various interventions available, which can be applied. This is dependent on the age, personality, causes among other factors related to the person seeking treatment. Various methods are also available to gauge the identify the type of anger ranging from descriptions given by the patient, asking the client to fill a questionnaire to self-monitoring of anger when conducting an activity such as driving. Some of the treatment method which can be applied includes cognitive interventions, social skills training, Reappraisal among others.

References

Czirr, R. (2014). Hidden Syndrome. Clinical Gerontology: A Guide to Assessment and Intervention, 417.

Fernandez, E. (Ed.). (2013). Treatments for Anger in Specific Populations: Theory, Application, and Outcome. Oxford University Press.

Hinshaw, S. P., & Melnick, S. (1992). Self-management therapies and attention-deficit hyperactivity disorder Reinforced self-evaluation and anger control interventions. Behavior Modification, 16(2), 253-273.

Kessler, R. C., Coccaro, E. F., Fava, M., Jaeger, S., Jin, R., & Walters, E. (2006). The prevalence and correlates of DSM-IV intermittent explosive disorder in the National Comorbidity Survey Replication. Archives of general psychiatry, 63(6), 669-678.

Leishman, K. (2013). Graduate School of Education and Psychology(Doctoral dissertation, Pepperdine University).

McCloskey, M. S., Berman, M. E., Noblett, K. L., & Coccaro, E. F. (2006). Intermittent explosive disorder-integrated research diagnostic criteria: Convergent and discriminant validity. Journal of Psychiatric Research, 40(3), 231-242.

McCloskey, M. S., Noblett, K. L., Deffenbacher, J. L., Gollan, J. K., & Coccaro, E. F. (2008). Cognitive-behavioral therapy for intermittent explosive disorder: a pilot randomized clinical trial. Journal of consulting and clinical psychology, 76(5), 876.

 

 

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