As humans it is perfectly normal to experience an array of emotions and behaviours. It would not be considered unusual if we, from time to time, become irritable, frustrated, or grumpy.
But it can be uncomfortable (and even scary) to witness a friend, colleague, or family member, fly off the handle from a minor provocation. Aggressive behaviour from our fellow humans can feel threatening, especially when physical violence towards objects or people is in the mix. In ‘normal’ outbursts, most will be short lived and relatively harmless and will even be perceived as a temper tantrum, mood strop or blow out. It will be rationalised by excuses and apologies are usually forthcoming. Thankfully normality resumes and incidences are rare. But what if incidences occur at work, with some frequency, or have an explosive and unpredictable element to them?
IED is a mental health condition characterised by recurrent behavioural outbursts with high rates of anger and serious impulsive aggression toward others. Along with increasing claims from employers for people with mental health conditions, we are now seeing new issues like this emerge. People with IED disorder cannot control their aggressive outbursts, which usually come on suddenly and target someone close to them. The outbursts usually last about 30 minutes and are typically followed by remorse, embarrassment, and distress. IED is thought to be diagnosable in 1-4 percent of the general UK population.
It is accepted that individuals with clinically significant anxiety and depression are more likely to experience IED. People who struggle with substance misuse are also more at risk.
So, what is the difference between IED and just getting angry? Some would say that this diagnosis is somewhat controversial and just “validates” bad and unacceptable behaviour. Researchers and clinicians have differentiated between anger outbursts and IED by looking at frequency, severity and impact, it was concluded that in the situation of IED there is repeated, (often daily), sudden episodes of impulsive, aggression, (physical and psychological), which is disproportionate to the situation.
Like many psychiatric conditions, intermittent explosive disorder has no conclusive cause, however it is thought to originate from a combination of factors including neurological, genetic, and environmental factors. It usually manifests itself in early childhood, but diagnosis generally occurs in adulthood.
Symptoms include intense emotions, immature defence mechanisms (like projection and denial), poor reality testing and explosive volatile behaviour.
Unfortunately, only a minority of people with IED receive treatment, mainly due to resource provision and skills shortage of practitioners. The basis of the treatment is focused on medication such as antidepressants, anxiolytics, and mood regulators. In addition to this cognitive behavioural therapy, (CBT), and diversional therapy is offered.
A financial services company recently came to me for support with an employee. Liam, (name changed), is a 32-year-old who had been notably angry when I reached out to him. He initially presented as volatile, hostile and was aggrieved that others considered him to have an ‘anger issue’. Over the period of a few months, I was able to build a rapport with him, set boundaries in relation to acceptable behaviours and help him engage in relevant counselling. I developed a level of trust to the extent that I could work with Liam and his employers to help recognise triggers, develop coping strategies and reduce risk of outbursts. There were some adjustments and modifications to Liam’s role.
So what does all this mean for insurers and employers? IED is a complex behavioural rather than medical condition, it can lead individuals to become dysfunctional or absent from their place of employment meaning that employers are likely to reach out for help under income protection schemes. Insurers, through their rehab teams, may be able to offer guidance to HR or team leaders through their rehabilitation services and or provide education via webinars, guide notes and opportunity to discuss issues through rehab access clinics.
Intermittent explosive disorder is a condition that is managed rather than cured. The diagnosis has credence and endorsement and is recognised by the medical fraternity, but due to the manifestation and impact, it also raises controversy and uncertainty and as a result is often misunderstood or rejected by some.