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Dual Diagnosis: Intermittent Explosive Disorder And Addiction

Isaac Alexis, M.D., AAMA, AMP-BC

Medically reviewed by

Isaac Alexis, M.D., AAMA, AMP-BC

February 20, 2019

Addiction can aggravate the symptoms of IED, and IED can cause people with the disorder to turn to substance abuse to cope. This cycle of one disorder affecting the other is often the case with a dual diagnosis.

Struggling with addiction isn’t easy, but having a dual diagnosis (co-occurring disorders) is an even bigger struggle. Intermittent explosive disorder (IED) is a condition that causes “repeated, sudden episodes of impulsive, aggressive, violent behavior or angry verbal outbursts,” Mayo Clinic explains.

If you have IED, you may experience the following adverse behaviors:

  • Road rage
  • Domestic abuse of others
  • Breaking or throwing things
  • Temper tantrums
  • Threatening or assaulting others
  • Violent outbursts

What Are The Symptoms Of Intermittent Explosive Disorder?

“Intermittent Explosive Disorder is marked by several discrete episodes of failure to resist aggressive impulses that result in serious assaultive acts or destruction of property,” according to Psychology Today.

While this may seem like a disorder we can all relate to, IED goes beyond a few aggressive acts. A diagnosis of IED means you must have expressed verbal or physical aggression toward someone or something, at least twice a week for at least three months. You can also be diagnosed with IED if you have at least three explosive outbursts within 12 months that result in damage to something or assault that leads to injury.

It’s important to note that with IED the explosive outbursts aren’t caused by substance abuse or the result of a separate mental disorder. In fact, Psychology Today reports that many with the disorder state they feel a pressing need to be aggressive right before they act out.

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With this disorder, those affected often have outbursts or episodes which can last up to 30 minutes with little to no warning. For some, they may go weeks or months without an episode. Less aggressive verbal episodes may happen between the string of violent, physical ones.

The violent or aggressive episodes may happen along with certain symptoms:

  • Extreme depression and/or fatigue immediately after episodes
  • Increase in energy
  • Irritability
  • Rage
  • Scattered thoughts/confusion during the episodes

Some people may also have physical warning signs that happen right before an episode, such as chest tightness, heart palpitations, feeling of pressure in the head, tingling sensation, tremors, or hearing an echo sound.

What Causes IED?

There is no known exact cause of IED, but certain biological or environmental factors may contribute to it. The following factors may play a role in who is affected:


  • IED could be passed through genes from parent to child
  • Mayo Clinic states “there may be differences in the way serotonin, an important chemical messenger in the brain, works in people with intermittent explosive disorder”


  • The majority of people with this disorder had a family history of behavior similar to that of this disorder: angry, aggressive behavior, including verbal and physical abuse
  • Early exposure puts you more at risk for developing IED

Of course, not every person who grows up in a violent or aggressive household will grow up to have IED, just as not every person who is exposed to substance abuse will later struggle with addiction. Early exposure simply increases your risk, and for this reason, it’s important to understand what else may put you at risk of IED, developing addiction, and what you can do about these issues.

Who Is At Risk?

IED is most common among children ages six and above, and people under 40 years of age. However, most cases of IED show up in people under age 35. Some research also suggests men may be at higher risk of developing this disorder than women.

Further, if you experienced physical or mental abuse, you are more at risk of developing IED. If you have other certain mental disorders, you may also be at higher risk. These include antisocial personality disorder, borderline personality disorder, and attention-deficit/hyperactivity disorder (ADHD)

How Does Addiction Affect IED?

Perhaps one of the most frustrating things about having a dual diagnosis is that symptoms of one disorder might aggravate or intensify symptoms of the other. Also, having one disorder may put you at higher risk of developing a second one. For example, many of the feelings associated with and symptoms that occur with IED can lead to substance abuse.

People who have episodes due to this disorder may feel immediate guilt or regret afterward. Once they have had time to recover, they may even feel remorse or shame, or get upset by their actions. In order to cope with this angst, they might turn to substances.

But substances aren’t always a quick fix, as use of them can easily turn into habit. Habits, and the brain chemical changes that come with them, can lead to addiction. Prolonged abuse and addiction come with a whole host of side effects and consequences. Just some of these are:

  • Changes to health
  • Effects on: personal relationships, finances, family life, school, or work
  • Lack of interest in things that used to interest you
  • Shirking responsibility to seek substance use
  • Engaging in risky behavior, something you wouldn’t normally do, to seek substance use
  • Gaining a criminal record or spending time in jail or prison because of substance use

Addiction to substances is dangerous for these reasons on its own, but when you add in a mental health disorder like IED, it might just result in a recipe for disaster. Alcohol, for example, might appeal to someone with IED because of its calming and relaxing effects. In fact, alcohol is a depressant, which would intensify some of the depressing feelings you experience with IED episodes.

Other substances, like stimulants, might worsen the episodes—people with IED experience rage and increased energy, and stimulants may enhance these feelings. Since episodes often result in assault of others or destruction of property, bringing substance abuse into the mix is unhealthy.

If you know someone who struggles with IED and addiction, it’s best to seek help before the episodes, coupled with substance abuse, lead to actions that can’t be reversed.

Dual Diagnosis: The Scope

Maybe it seems that it would be rare for someone to have two disorders at the same time. In truth, one third of people with all mental illnesses and half of people with severe mental illness also abuse substances. This does not account for all the people out there who are going undiagnosed.

It’s hard to spot co-occurring disorders because the symptoms are so complex, and can overlap. In treatment, if you have co-occurring disorders and one is left undiagnosed while you get treated for the other, you may have a hard time healing. The best way to ensure people get the care they need for a dual diagnosis is to ensure comprehensive treatment or a plan that addresses both disorders.

How Can You Get Help For A Dual Diagnosis?

Private, inpatient rehab centers may offer the best care for a dual diagnosis. Private care means you’ll get a level of quality necessary for full recovery. Treatment can be a tough process, but one that can help you change your life for the better. During this difficult time, you’ll want people by your side who have experience in the field, utilize evidence-based methods, and who will help give you the best chance at recovery success.

The rehab centers we can connect you with at provide inpatient care from trained, licensed medical staff. An inpatient experience takes you away from the environment of substance abuse, allowing you to concentrate on getting better. If you’re ready to overcome addiction and manage your IED, we can help find a rehab facility and treatment plan that’s right for you.

What Treatments Are Available?

Each person comes to treatment with a set of needs that are unique to him or her. For help with your dual diagnosis, you’ll want to enter a rehab center that provides specialized care for people with co-occurring disorders. Many of our rehab centers work to treat any and all disorders so you get a comprehensive healing experience.

Depending on your disorders, symptoms, and history, you may undergo a combination of approaches during treatment. Our rehab centers offer an array of treatment modalities which include:

Find Dual Diagnosis Treatment Today

If you have suffered with addiction or IED, or both, you may have felt ashamed, isolated, or even alone in your struggles. But there are so many people out there who share your experiences, and so few of them receive the help they need to change their lives.

Our rehab centers exist to help people like you make a positive change in your life. With our help, you can stop worrying about what addiction and mental health disorders may cost you, and get back to focusing on your life. Contact us today at to learn more about dual diagnosis and the best rehab centers for treatment.

Harvard Health Publications - Treating Intermittent Explosive Disorder

Mayo Clinic - Intermittent Explosive Disorder

National Alliance On Mental Illness - Dual Diagnosis

National Institute On Drug Abuse - DrugFacts: Comorbidity: Addiction And Other Mental Disorders

Psychology Today- -Intermittent Explosive Disorder -

Substance Abuse And Mental Health Services Administration - Mental And Substance Use Disorders

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