Here is an incident about Intermittent Explosive Disorder and its treatment.
– (patient making an angry face) before we start this I want to know if this session will finish soon and if I can go home today.
*“Can’t guarantee that. Let’s have a talk first”

– It has just been a week that I started a new job. I cannot afford to lose it. If you don’t let me out, I might go on my own. No one can stop me.

* Don’t put yourself in more trouble. You know very well that this is a lock down unit. It isn’t easy to escape from here. If you even try to escape, you may be put in State Run Institute and treated there. I am here to help you, to understand your situation. Please don’t blow up your opportunity. I do understand your problem about your new job. But let’s have a talk first. Well if you want to talk with a calm mind, you can stay here for sometime while I deal with other patient.

(He looks a bit calm)

– No. Ask me questions now……Forgive me. I was rude to you without any reason. This habit of getting angry quickly has been a great obstacle in my life.

* How did you get admitted here? Explain me briefly.

– I had a slight problem in my cable connection. I had no access to TV or internet. The cable company made me wait whole day yesterday. But it was already 4 in the evening and no one had arrived. I didn’t have phone too. I went out for a while to go to a shop, bring cigarettes and talk to the cable operator but within that short period of time the cable company sent its worker to my home and since no one was there, he left.

I couldn’t control my anger after that. I decided to visit the cable company by myself and talk to the manager. Manager was in meeting so they asked me to wait for about an hour. I really couldn’t control myself and I took the vase of the waiting room and broke it. After that I can’t quiet remember anything. I broke the windows and even gave death threat to few people. Fortunately cable company made me admitted here and get my treatment done and dropped its case.

* From when did this disorder start? Have you taken any medicine or done any sort of treatment?

– I had this problem since my childhood and I took lots of medicines; nothing really helped. Breathing, exercise, meditation; I did everything….even teachers were scared of me while I was in school. I always got involved in some sort of fight once a week. I have beaten many people. In reality I am a very cheerful person, I love being around people and having fun but if I have slight problem with something, my anger gets bigger and bigger and I lose control of it. I sometimes become unconscious due to my temper. I come to know about stuffs I broke people I beat and things I said when I was angry only after a second person comes and tell me. I had a sense that my habit would disappear slowly as I get matured but this habit is going nowhere. I can’t get rid of my short temper instead it’s being tougher. I ruined many relationships of my life due to this anger. I had been arrested and thrown to jail for 3 long years for beating my pregnant wife. I haven’t seen my daughter’s face till today. I feel like I am a devil who has thrown his future into darkness. I am fed up with myself.

We all get angry sometimes. You might have been in a difficult situation for 3-4 times because of getting extremely angry. Being angry or not being satisfied is essential for human life. It has a great importance in your life. I will explain about the importance of anger later but today let’s focus on the bad side.

People with Intermittent Explosive Disorder get angry twice or thrice as much as normal people even on small things. They get in a big fight 4-5 times every month. I will write in brief about the treatment of this disorder. Psychiatric Practitioners have different methods of treating their patients. My method is presented below-

Initial Evaluation (for an hour)
– This is often done by taking appointment. (The above mentioned incident was taken place in Crisis Center due to emergency)
-The main aim of this evaluation is to find the reason for their disorder. Sometimes illegal drugs, mental illness, family problem, economic crisis can also be a reason.
– In this meeting, I try understanding the main problem of my patient and try answering all their queries. Most of the times the queries of patients are, “why did I become this short tempered?”, “Will I keep being like this my entire life?” etc. If I have enough time I try explaining the reason of their anger through Virtual Brain Model. By doing this the patient understands that he is not that bad person, his biological/ hereditary/ genetic/ neurochemical are the reasons for this disorder and they grow a slight hope of being normal.

What we can’t miss in first meeting is to ask the patient’s close relatives about their behavior. Because the real analysis of our behavior can only be done by the people whom we are very close with. If the patient comes to the clinic alone, their relatives are interacted through phone.

– If the patient has the possibility of taking medicine, s/he should be given medicine only when needed. Some patients need to take regularly

– The patient will be fixed an appointment with psychotherapist. Psychotherapists have idea about almost all kinds of mental disorder and they have a different “Talk Therapy” (psychotherapy) for different disorders. Those therapists are at least Master degree holder in psychology. For the patient’s treatment or to keep track of his improvement, regular interaction with Psychotherapist or Psychiatric Practitioner is important.

Follow up (at least 25- 30 minutes)
– Second meeting happens within a month. The therapy session with therapist, effects of medicine etc are discussed.
– If the patient has not met the therapist or is not willing to talk to anyone else, psychotherapy is provided by Psychiatric Practitioner.

Other follow ups:
– If the patient has started a new medicine or any new event has taken place in his life meeting is held within one month or else we meet every 3 months.

– Every clinic and hospital has its own policy. My clinic has a policy of discharging or dismissing the patient if not visited the doctor or Psychiatric Practitioner anytime within 3 months.

– After reading my article don’t bring any changes to your lifestyle without consulting your  Psychiatrist, Neurologist, Family Medical Doctor (Psychiatric Mental Health Nurse Practitioner if you are in Western Country) the main aim of my post is public awareness not treatment.

Written by : Dr. Kalyan Subedi

Translated by: Archeesa Aryal

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