Dr. Roach: Time and effort needed to treat intermittent explosive disorder

Keith Roach
To Your Health

Dear Dr. Roach: Recently, you wrote about intermittent explosive disorder. I have this condition and would like your help dealing with it. I can lose my self-control and get so upset that I swear. I have attempted to control myself, but if I do not watch myself, I get very angry and then feel guilty when I say things I don't mean to ones I love. I have been in counseling for several weeks without much improvement.

— E.M.C.

Dear E.M.C.: The critical first step in successful treatment, and often the hardest, is to recognize you have a problem, so I congratulate you taking it.

As with most conditions affecting the mind, treatment is with therapy, medication or both. The most well-studied treatment on the therapy side is called cognitive behavioral therapy, but it is expensive, can be hard to find and is not appropriate for everybody. It certainly takes significant and prolonged effort.

Dr. Keith Roach

Medication therapy has also been demonstrated to be effective in treating intermittent explosive disorder. The best-studied medication is fluoxetine (Prozac), which was found to have a moderate or large improvement in 66% of subjects, compared with 29% of those taking placebo.

A combination of CBT and medication is considered the best treatment, when possible. Counseling takes time. Even several weeks isn't enough sometimes to see a benefit.

Substance use is a major barrier to effective treatment. Alcohol is a trigger for many people with this condition, but any recreational drug is a potential problem and all should be avoided.

The Mayo Clinic has good information on this condition, at tinyurl.com/mayo-IED.

Dear Dr. Roach: I am a 41-year-old man. I used to do jiujitsu for three years until 6 months ago. Two weeks ago, in a stress echo (running on the machine) test, I was diagnosed with aortic root of 41 mm. Two years ago, my aortic root was 30 mm. My doctor sent me to get a CT for better measurement of the root, which indeed was 41 mm.

Can I continue practicing jiujitsu? Is my condition dangerous? What kind of sports can I do? I know weightlifting is not allowed, but why?

— U.J.

Dear U.J.: The aortic root is where the aorta starts, at the left ventricle. The aorta takes all the oxygenated blood from the heart and splits into the major arteries to deliver this blood to the muscles and organs. The normal size in men is up to 39.1 mm.

There are many causes of dilation, including high blood pressure, but in a man as young as yourself, less-common causes, such as Marfan syndrome or vascular Ehlers-Danlos should be considered. I am especially concerned given the rapid increase in size. A careful examination of your family history would be an important first step.

In general, regular, moderate exercise is safe even in people with dilations in their aortic root. Strenuous exercise should be avoided because blood pressure can increase just as it can with heavy weightlifting. You should get specific advice from your own physician. If they say it is OK, talk with your jiujitsu coach about your need to avoid overly strenuous workouts.

If you smoke, you should quit, and even moderate increases in blood pressure should by carefully considered for treatment.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.