Harvard Researchers Study “Intermittent Explosive Disorder” (IED); Aggression in Adolescents

Kermit Cole
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Harvard Medical School researchers, publishing in Archives of General Psychiatry this week, propose that Intermittent Explosive Disorder (IED), characterized by the DSM-IV as “recurrent episodes of aggression involving violence or destruction of property out of proportion to provocation or precipitating stressors,” afflicts 8% of adolescents and is “understudied and undertreated.” Allen Frances, chairman of the DSM-IV task force, called IED an “inherently unreliable category that probably shouldn’t be in the DSM at all.”

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Note from Kermit Cole, “In the News” editor:
Though “IED” also stands for “Improvised Explosive Device,” this article is not a joke.

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

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Kermit Cole
Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected]

15 COMMENTS

  1. Hmmm, sort of awkward, with this being the only comment and all. Oh, well…

    It seems lots of folks with lengthy histories spend a few years fighting explosions, which are often brought about by pharmacology and stress+trauma and loss/grief. I think it is important that we talk about what self/world destructive violence means in humans and particularly in youth, what it indicates and what can be done to help.

    I was, for a period of about 10 years, intermittently explosive to a fairly severe extent during my Prozac-adolescence. I had extreme emotional intensity and sense/stress vulnerability to begin with. Add a few years of deep and traumatizing insults and threats and…well, yeah, kids explode. The teenage brain isn’t even fully developed. The prefrontal cortex, in particular, isn’t even fully wired for another ten years or so.

    Is it a good idea to add powerful psychopharmaceuticals to tumultuous neurology-in-development? Probably not.
    They don’t even know how the drugs work. For example,I was floored when I looked at the risperdal website and it proclaimed: “The symptoms of Bipolar I Disorder and schizophrenia are thought to be caused by chemical imbalances in the brain. Although it is unclear exactly how RISPERDAL® CONSTA® works, it seems to help balance the chemicals in the brain.” http://www.risperdalconsta.com/about-risperdal-consta/how-does-risperdal-consta-work It’s right there on the website.

    It seems like the kids with IED and Oppositional Defiant/Conduct Disorder often end up on atypical antipsychotics nowadays. Frequently, where they came from are some fairly horrible experiences that they have every right to be angry about.

    A few years ago, I was a volunteer advocate for Guardian ad Litem. The kids I worked with were, specifically, adolescents in state custody that were in “Leveled” homes ~ therapeutic foster care to long-term “residential treatment.” They were all on put on Geodon. Though some were able to get off by explaining that it made it difficult for them to stay awake in school, which was true, and that this created “more problems” for them, also true.

    Anyway, I don’t talk about the explosive years much. They are a challenge to me. Even as skilled as I am at finding something salvageable in unfortunate events, it’s tough to figure out what might have been good about being so powerfully enraged that I literally broke my own bones in desperate fits of wanting to destroy something to the extent that I terrified myself, which fueled the fits even more…

    Oh, maybe that’s the good to come of it…now I can learn more and teach more about the processes that drive explosive human rage/grief/frustration destructo-nihilistics and maybe one day we’ll stop giving kids drugs that make them want to hurt people they love and themselves and the whole world. It is the worst feeling I have ever felt, what I felt as a fifteen year old on Prozac. I thought it was me. That was the worst of it, I thought it was me.

    Thanks for holding this community space where people can share science and story and perspective on what we are healing from.

    • I work with foster kids and see this all the time. SSRIs and/or stimulants evoke aggressive incidents, which are interpreted as “bipolar disorder” and lead to atypical antipsychotic “treatment” of their own drugs’ side effects. Which are never acknowledged as such, of course.

      I’m so sorry you had to go through that – well done for hanging in there and helping fight for sanity for others in a similar situation. Sometimes being really, really pissed is a NORMAL reaction to a very abnormal situation. And sometimes it’s a reaction to the drugs they give you to try and shut you up.

      —- Steve

    • so the the risperdal website proclaimes: “The symptoms of Bipolar I Disorder and schizophrenia are thought to be caused by chemical imbalances in the brain. Although it is unclear exactly how RISPERDAL® CONSTA® works, it seems to help balance the chemicals in the brain.”

      Those are lies. Or the drug company is stupid. Either interpretation disgusts me.

      Bipolar 1 and Schizophrenia are only thought of a chemical imbalances because the drugs cause chemical imbalances and post hoc reasoning has been used to justify the drugs. There is no serious evidence that I am aware of that there are chemical imbalances involved in mental distress of any kind.

      The drug companies know how their drugs work in exquisite detail. They block various nuero-transmitters, dopamine receptors in most so called anti-psychotics, but also other ones.

      Blatant lies from the drug company advertising then.

  3. “Intermittent Explosive Disorder” indeed! Sometimes it is the only way to get through to adults when you are a teenager. If you speak politely they don’t listen to you. The same goes also for authorities and so called experts. Teaching lovingly assertiveness,self respect and self-control is probably the answer here-certainly not drugs

  4. “Teaching lovingly assertiveness,self respect and self-control is probably the answer here-certainly not drugs
    ”

    Of course, this is not in the interest of medical model+pharmapsychiatrists, who profit from progressive and disabling “illness.” The diagnoses themselves are stigma-structured in such a way that people are basically presumed to not “be able to manage themselves” ~ seen as “out of control.” This deleterious perception often supports people’s control being taken away from them, the effects of which can be devastating.

    Ah, minor correction re: the writing above “…kids with IED and Oppositional Defiant/Conduct Disorder” should read “kids with (…) DIAGNOSES” ~ there is no disorder other than the poor perceptions of traumatized brains/lives further disrupted by pharmacology and the troubles caused by coercive and inhumane care.

    • A raises (and has for some time) an interesting point. What does psychiatry, social work, psychology, counseling look like without the diagnoses we currently have? Could any of these disciplines survive and if so, how? I believe three of the disciplines could roll with “problems of life” or “life challenges” as “presenting problems” There’s one discipline that I don’t think could ever make that transition.

      • Here in the UK some psychologists support the idea of a Formulation as opposed to a diagnosis.

        A Formulation arises out of a collaborative conversation between the practitioner and the client. It usually has the symptoms, the causes and some idea of what the client has found helpful. It can be a paragraph or two long.

        It pretty much sounds like the sort of conversations many of us have with friends but summarised and written down.

        Here is an example of formulation I have just made up, “Jane has panic attacks and finds it hard to get things done. It started when she was bullied at work and lost her job last year. She also has memories of being bullied at school. She finds sitting in her garden helpful when she is having a panic and talking things over with someone sympathetic.”

        • Yes, this is what I’m wondering John. So many of the diagnostic terms have become “loaded” besides the fact IMO they’re not useful, in fact, often harmful.

          This idea of a “formulation” or an agreed upon summary of what the difficulty is and an agreed upon strategy to try and lessen and/or overcome the difficulty between both parties seems reasonable to me. You’re comment about friends resonates with me, because I feel friends have probably done far more good than “professionals” in aleviating distress. Thanks again. PS Do folks in Great Britain like the show Wheeler Dealers or is it just me?

  6. This has to be the silliest and most unsupportable diagnosis in the DSM. This, I must say, is a very high bar to overtake, as it’s filled with silly and unsupportable diagnoses (like Oppositional Defiant Disorder, diagnosed when a child is, surprisingly, oppositional and defiant. Pretty creative, eh?) But IED certainly tops all. The whole basis of this disorder is that the person sometimes gets really pissed off, hence, they “explode.” There are, of course, listings of manifestations of adult temper tantrums to make it all look “scientific,” but basically, they’re diagnosing anger outbursts and calling it a “disorder.” No attempt to understand context, of course. Nothing to distinguish one’s righteous indignation from another’s selfish and intimidating rant. No attempt to ferret out what other issues may be contributing to the “explosions.” If you get pissed off a lot, you have it.

    We used to have a different name for people who get hostile and intimidating for no reason. We called them “assholes.” I personally prefer the traditional term, as I find it far more descriptive.

    — Steve

  8. IED also means improvised explosive device, at least when used in a war zone.

    Imagine what it would be like to have that as part of your self image. A robotic “thing” that explodes when set off by motion or pressure.

    Again, this is dehumanizing a person, as psychiatry is wont to do.

    “You look like a teenager, but you could explode at any time.”.

    What would a teenager do with that? Internalize it and use it when needed, perhaps, as a way to control others. Or internalize it and perceive himself as unpredictable and dangerous, and not responsible for his behavior?

    Neither of those options is positive.

  9. There is an amazing revelation from this [trolling for another psychopharm market] -er, I mean, STUDY ; it is this:

    >”The only sociodemographic correlates of lifetime IED that we were able to document are related to family structure and size. Adolescents who do not live with both biological parents and who have more siblings have elevated odds of IED. Not living with both biological parents is the most consistent sociodemographic correlate of mental disorders in the NCS-A and is likely to be a nonspecific risk marker for psychopathology, whereas having more siblings is associated in the NCS-A specifically with behavior disorders, including not only IED but also CD.” <

    NOW, if only Dr. Kessler could be coaxed to apply some of that critical thinking and enlightened education that students of the Harvard School of Public Health are pilfering , then a truly astounding breakthrough could be on the horizon. Although it appears to be an example of run of the mill common sense to link problems during adolescence that challenge and undermine [create a crisis] the development of identity, the milestone that sets the foundation for successful, happy, fulfillment in adulthood; though it is obvious that fractured family relationships that go hand in hand with all varieties of single parent households thwart the sense of security and support adolescents require to build and refine their individual identities; yes, and given that emotional intelligence, collaborative brain function that supports executive decision making — the prerequisite for impulse control, IS the very brain development that SHOULD be occurring during adolescence AND requires some support and guidance from caring, invested, adult role models… THERE IS ZERO EVIDENCE FOR LABELING MALADAPTIVE BEHAVIOR IN THE CONTEXT OF OVERWHELMING THREAT TO NORMAL DEVELOPMENT — A *MENTAL DISORDER*….

    IF Dr. Kessler… who "takes responsibility for the integrity and the accuracy of the data analysis" — of this study, were to employ critical reasoning for the sake of *analyzing* the data in the quote I posted from this article, he would be in a position to pioneer a whole new approach for understanding the etiology of adolescent emotional dysregulation…He is so-o-o-o close to getting it…

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