Intermittent Explosive Disorder Leslie Khoo

Defusing Intermittent Explosive Disorder (IED)

In July 2016, Leslie Khoo Kwee Hock strangled Cai Yajie in his car at Gardens by the Bay East, before burning her body completely at Lim Chu Kang. He allegedly did so to silence her repeated threats of exposing his lies and confronting his family.

Defence psychiatrist Dr Ken Ung Eng Khean, diagnosed and supported the claim that Mr Khoo suffered from Intermittent Explosive Disorder (IED) at that time, which explained his impulsive aggression towards the eventual demise of Ms Cai.

More recently, a young man was charged in Court after telling his 13 year-old sister that he wanted to kill her after slapping and kicking her. He was diagnosed with conduct disorder with intermittent explosive disorder, sentenced to 18 months probation and admitted to a hostel for a year.

What is Intermittent Explosive Disorder? (IED)

According to the Diagnostic and Statistical Manual of Mental Disorders-5, Intermittent Explosive Disorder “is the failure to control impulsive aggressive behaviour” in response to a minor provocation that may typically not result in an aggressive outburst.

It may be diagnosed by either:

– Verbal or physical aggression that occur on an average of twice weekly for a period of 3 months; or

– 3 behavioural outbursts involving destruction to property or physical injury to animals or other individuals over a period of 12 months.

The outbursts of an individual with IED are “grossly out of proportion” to the stressor. In the defence case of Mr Leslie Khoo, one of the incidents used to support his diagnosis was when he flung a pen against the wall due to his anger against a colleague and caused it to break.

The outburst may provide relief to the individual with IED who has difficulty coping with his frustrations and impulses. Once the rage has dissipated, he is likely to feel regret and remorse for his behaviour. He may even feel depressed and ashamed, citing that he lost control during the angry outburst, with no premeditation to cause harm to anyone or damage a property.

What is Someone with IED Like in His/Her Daily Life?

Someone with IED may generally be irritable, restless, throw temper tantrums, engage in heated arguments, or even have a history of assault. Those around him may perceive his reaction to the stressor or trigger as being over the top or being out of control.

Loved ones or friends without caregiving training may start avoiding them in fear of the sudden extreme angry outbursts. The individual himself may even alienate himself from friends and colleagues due to embarrassment, or fear of hurting them when he is unable to control himself again.

This could be someone you know who becomes aggressive out of a sudden for no apparent reason. He may then apologise for his behaviour, and feel ashamed of being unable to control himself. In some cases, you may notice restlessness and frustration as he struggles to manage his anger, which may be signs leading to an outburst.

Some individuals with IED may also use alcohol, drugs, or engage in self-harm to manage their anger or control the impulsive aggression.

If you know of a friend or loved one who seems to display such behaviour as frequently as several times a week, you may be concerned as to whether he has IED.

How should you discuss this with someone you care about, without offending him or triggering an impulsive aggression?

Someone with IED tends to feel ashamed and regret for his uncontrollable outburst.

If you believe that a loved one is very likely to become aggressive towards you, or has done so before, it is important to get away from the situation as soon as possible, instead of confronting that person.

Someone with IED tends to feel ashamed and regret for his uncontrollable outburst.

A typical IED outburst usually lasts for less than 30 minutes. Thus, a recommended approach is to wait for him to calm down, before letting him know that you recognise his remorse for the behaviour and would like to help him prevent future outbursts.

Remind your loved one that you care, that you desire to see his point of view, and gently suggest seeking the opinion of a medical professional.

Unfortunately, broaching such a topic may be tense or even anger-inducing. Thus, it is still up to your loved one to agree that his behaviour has been causing strained relationships, affecting his job, and even his daily life.

Can IED Be Treated, and How Can I Be Supportive?

Medications such as anti-depressants or mood stabilisers may be prescribed to someone with IED, alongside with behavioural therapy and skills-training.

These may include:

  • Cognitive Behavioural Therapy (CBT) to identify triggers
  • Relaxation Techniques
  • Mindfulness
  • Self-soothing methods to cope with anger
  • Learning techniques to manage an overload of emotions

If you or your loved one with IED are able to identify potential stressors in the environment, it will also be helpful to reduce exposure to such situations whenever possible.

Remind your loved one that you are supportive of him/her seeking treatment, and learn about the coping skills taught during therapy sessions. Practice them together to support your loved one in acquiring these coping skills and techniques. With time, someone with IED can be in better control and mindful of his/her impulsive aggression.

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  1. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM-5, American Psychiatric Association, 2013
  2. Gardens by the Bay murder trial: Debate over man’s pen throwing outburst, Straits Times -
  3. How to deal with aggression, Everyday Health -
  4. Intermittent Explosive Disorder: Clinical Anger issues, Depression Alliance –
  5. Intermittent Explosive Disorder: Health Line –

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