Have you ever felt that someone was making you feel guilty without knowing exactly why? Or found yourself agreeing to things you did not really want to do simply to avoid their anger or blame? Sometimes, what is happening may be more than just a difference of opinion. It could be a form of psychological manipulation that makes a person question their decisions, feelings, and personal boundaries.A manipulative person does not always appear that way at first. They may initially seem friendly, caring, or extremely attentive, but gradually begin using tactics such as emotional pressure, guilt-tripping, distorting facts, playing the victim, or crossing personal boundaries to get what they want.In this Dalili Medical guide, we will explore the most common signs of manipulative behavior, the tactics frequently used by manipulative people, and the reasons that may lead some individuals to engage in manipulation. Most importantly, we will discuss how to deal with a manipulative person in a calm and healthy way while protecting your boundaries and self-respect without getting drawn into endless conflicts.

What Is Intermittent Explosive Disorder (IED)?

Intermittent Explosive Disorder (IED) is a mental health disorder characterized by recurrent episodes of intense anger or impulsive aggressive behavior, in which the intensity of the reaction is clearly disproportionate to the situation or provocation that triggered it. During an episode, the person may have difficulty controlling their impulses and emotional responses.

Does Being Irritable Mean That a Person Has Intermittent Explosive Disorder?

No. Anger and irritability are normal emotions that everyone may experience at times, and experiencing them does not necessarily mean that a person has Intermittent Explosive Disorder.

Diagnosis is based on a recurrent pattern of anger outbursts and impulsive aggression, as well as the negative impact these episodes have on the person’s life and relationships. Other possible causes or mental health conditions that may produce similar symptoms must also be ruled out.

How Does an Intermittent Explosive Disorder Episode Present?

An episode may appear in several forms, including:

• Yelling, raising one’s voice, or using offensive language.

• Making threats toward others.

• Engaging in sudden and intense arguments.

• Throwing objects, damaging property, or breaking things.

• Physically assaulting others.

• Engaging in impulsive verbal or behavioral actions that the person finds difficult to control.

After an episode, the person may experience regret, embarrassment, or guilt about what they said or did.

Does a Person With IED Intentionally Try to Hurt Others?

Not necessarily. One of the key features of the disorder is that aggressive outbursts are generally impulsive and not premeditated, rather than being a deliberate strategy to gain a benefit or achieve a specific goal.

However, the fact that the behavior is impulsive does not mean that it is harmless or that the person is not responsible for its consequences. Such episodes can result in significant psychological, physical, or social harm to the person and those around them.

5. Is Intermittent Explosive Disorder the Same as Extreme Anger?

No. Anger is a normal emotion that people may experience in different situations. In contrast, Intermittent Explosive Disorder is a mental health disorder characterized by recurrent episodes of intense anger and impulsive aggressive behavior that are disproportionate to the situation that triggered them.

6. Is Intermittent Explosive Disorder a Form of Narcissism?

No. Intermittent Explosive Disorder and narcissism are different concepts, although they may occur in the same person.

IED is primarily associated with impulsivity, recurrent anger outbursts, and aggressive behavior, whereas narcissism involves a different set of traits, such as an exaggerated sense of self-importance, a strong need for admiration, and a sense of entitlement, according to established diagnostic criteria.

7. What Causes Intermittent Explosive Disorder?

There is no single, clearly established cause of Intermittent Explosive Disorder. Instead, a combination of genetic, biological, psychological, and environmental factors may contribute to its development.

Certain childhood experiences, ongoing psychological stress, and patterns of dealing with anger and emotions may also contribute to an increased likelihood of developing symptoms. However, experiencing a difficult event or psychological stress does not necessarily mean that a person will develop the disorder.

8. When Does Intermittent Explosive Disorder Usually Begin?

Symptoms of Intermittent Explosive Disorder (IED) may begin during late childhood or adolescence and may continue into adulthood, particularly when the person does not receive appropriate assessment and treatment.

9. Can Intermittent Explosive Disorder Be Treated?

Yes. The symptoms can be managed, and a person can improve their ability to regulate anger and emotional reactions through appropriate treatment.

Treatment often includes psychotherapy, particularly cognitive behavioral therapy (CBT). CBT can help individuals identify the thoughts and situations that precede anger outbursts and learn healthier ways to respond to them.

In some cases, a doctor may also prescribe medication depending on the person’s symptoms, overall health, and individual treatment needs.

Treating the disorder is important because persistent anger outbursts and aggressive behavior may lead to problems in family and social relationships, difficulties at work or school, physical injuries, or legal problems.

10. Does Everyone With Intermittent Explosive Disorder Need Medication?

No. Not everyone with IED requires medication.

The decision to use medication depends on several factors, including the severity and frequency of the episodes, co-occurring mental health conditions, the person’s medical history, and their response to psychotherapy.

11. Can Intermittent Explosive Disorder Go Away on Its Own?

The severity or frequency of symptoms may change over time. However, recurrent anger outbursts and aggressive behavior can contribute to problems in family and social relationships, difficulties at work or school, and, in some cases, physical injuries or legal problems.

Therefore, it is generally better not to simply wait for the symptoms to disappear. Seeking an appropriate mental health assessment and treatment when needed can help reduce the impact of the disorder.

12. Does a Person Realize They Were Wrong After an Episode?

Many people may experience regret, guilt, or embarrassment after an episode because of what they said or did. They may also recognize that their reaction was excessive compared with the situation.

However, experiencing regret after an episode is not a requirement in every case and cannot, by itself, confirm the diagnosis.

13. Does Apologizing After an Episode Mean the Problem Is Over?

No. An apology can be a positive step, but it does not resolve the underlying problem on its own, especially when anger outbursts and aggressive behavior continue to recur.

What matters is working toward behavioral change, learning anger and emotional regulation skills, identifying triggers that precede episodes, and following an appropriate treatment plan to reduce the frequency and severity of outbursts.

14. Can Intermittent Explosive Disorder Be Diagnosed Through an Online Test?

No. Online tests cannot be used to confirm a diagnosis of IED. They may be useful for general awareness or identifying whether professional help may be appropriate, but they are not a substitute for a professional assessment.

An accurate diagnosis requires a comprehensive evaluation by a psychiatrist or qualified mental health professional, including an assessment of symptoms and medical and psychological history, while ruling out other conditions or causes that may produce similar symptoms.

15. When Should Urgent Medical Help Be Sought?

An urgent mental health assessment is recommended if anger outbursts involve:

• Self-harm or attempts to harm others.

• Serious threats toward others.

• The use of weapons or threats involving weapons.

• Severe or repeated destruction of property.

• A clear loss of control over behavior.

• Fear that the person may lose control and hurt themselves or someone else.

If there is an immediate risk of harm to the person or others, they should go to the nearest emergency department or contact local emergency services immediately.

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Stages of Manipulative Behavior in Relationships

There is no formal psychological or diagnostic classification called the “stages of a manipulative personality.” Manipulation is also not a standalone mental disorder.

However, a common pattern of manipulative behavior in some relationships can be described through a number of stages. These stages may vary from one person or relationship to another and do not necessarily occur in the same order.

Stage	What May Happen
1. Exploration	The person begins observing the other person’s strengths and vulnerabilities, learning their boundaries, emotional triggers, and what makes them respond or back down.
2. Building Trust	They may show excessive attention, kindness, or understanding in ways that help establish a strong relationship and increase trust and emotional attachment.
3. Testing Boundaries	They begin testing how much the other person will tolerate. This may start with small requests or behaviors and gradually increase if there is little resistance.
4. Emotional Pressure	They may use guilt, fear, jealousy, silence, or victimhood to influence the other person’s decisions.
5. Shifting Responsibility	When confronted about their behavior, they may shift the focus from their actions to the other person’s mistakes or reactions, causing the person who was affected to defend themselves instead of addressing the original issue.
6. Confusion and Distortion	They may deny certain events, change their version of what happened, or present events differently, potentially causing the other person to question their memory or interpretation of the situation.
7. Increasing Control	The behavior may shift from influencing a particular situation to repeatedly attempting to control the other person’s decisions, relationships, boundaries, and independence.
8. Repetition of the Pattern	After an apology, reconciliation, or concession, the same behavior may return, creating a recurring cycle that may become more intense over time in some relationships.

 

Causes of Manipulative Behavior

There is no single explanation for manipulative behavior in every person. It may develop through a combination of psychological, family, environmental, and life-experience factors.

In some cases, manipulation may be a behavior learned during childhood or developed over time as a way of dealing with personal needs, fears, and relationships with others.

Key Factors That May Contribute to Manipulative Behavior

1. Family Upbringing

If a person grows up in an environment where family members regularly use pressure, threats, lying, or emotional exploitation to get what they want, they may learn to view these behaviors as normal ways of achieving goals and interacting with others.

2. Fear of Rejection or Abandonment

Some people may resort to manipulation because of an intense fear of losing others or being abandoned. They may attempt to influence another person’s emotions or decisions in an effort to maintain the relationship.

3. Low Internal Sense of Security

Controlling others may provide a temporary sense of safety or power, particularly when a person experiences significant insecurity or fears losing control.

4. Poor Communication and Emotional Expression Skills

Some people may struggle to communicate their needs and feelings directly and in healthy ways. As a result, they may rely on indirect hints, pressure, or guilt-inducing behaviors instead.

5. Exposure to Harmful Experiences or Relationships

A person may learn manipulative behaviors after experiencing deception, control, or exploitation in previous relationships. They may later use similar behaviors as a defensive strategy or an attempt to protect themselves.

1. Excessive Need for Control

   Some people may have difficulty accepting that others have independent decisions, wishes, and boundaries. As a result, they may try to control other people’s behavior or choices.

   7. Low Tolerance for Rejection and Frustration

   When a person does not get what they want, they may struggle to accept rejection or cope with frustration. They may resort to psychological or emotional pressure instead of respecting the other person’s decision.

   8. Reinforcement of the Behavior Over Time

   If a person repeatedly succeeds in achieving their goals through manipulation, they may begin to view this approach as an effective way of getting what they want, increasing the likelihood that they will repeat it.

   9. Certain Personality Traits or Mental Disorders

   Manipulative behavior may occur as part of different patterns of psychological difficulties or mental disorders. However, using manipulative tactics by itself does not mean that a person has a specific mental disorder.

   Traits of a Manipulative Personality

   A manipulative person may display a range of behaviors intended to influence or control other people’s emotions and decisions indirectly. Common examples include:

   • Emotional manipulation: Using guilt, fear, pity, or anger to influence another person’s decisions and pressure them into doing what the person wants.

   • Distorting facts: Reinterpreting events or presenting them selectively so that the person appears to be the victim or the other person appears responsible for the problem.

   • Denial and evasiveness: Denying certain statements or actions, or changing the subject when confronted with clear evidence.

   • Inducing guilt: Using statements that imply the other person is ungrateful or failing them, such as, “After everything I’ve done for you.”

   • Playing the victim: Repeatedly portraying themselves as the wronged person in order to avoid taking responsibility for their actions.

   • Testing boundaries: Trying to discover what the other person will tolerate and then gradually crossing those boundaries if there is little resistance.

   • Using silence or ignoring as pressure: Withholding communication as a form of punishment or to force the other person to respond, rather than simply taking space to calm down.

   • Conditional affection: Showing affection and attention when they get what they want, then withdrawing or reducing it when the other person says no.

   • Withholding information or presenting it selectively: Sharing only part of the truth in a way that serves their interests or influences the other person’s decision.

   • Creating jealousy or competition: Using other people to provoke jealousy or undermine the other person’s confidence.

   • Disrespecting rejection: Continuing to pressure someone after they have clearly said “no,” rather than respecting their decision.

   Signs That You May Be Experiencing Manipulation

   A person should not be labeled as manipulative based on a single incident. It is more useful to look for a repeated pattern of behavior and its impact on you. Possible signs include:

   • You frequently feel guilty when you refuse a request or set a boundary.

   • Blame is repeatedly shifted onto you, even when the other person bears the primary responsibility.

   • The person denies what happened or makes you question your memory or interpretation despite clear evidence.

   • They repeatedly use silence or ignoring as a way to punish or pressure you.

   • They use emotionally charged statements to pressure you, such as, “If you really loved me, you would do this.”

   • They change their story or position depending on what benefits them.

   • They repeatedly portray themselves as the victim and avoid taking responsibility or apologizing.

   • They continue pressuring you after you have clearly expressed your refusal.

   • They use your vulnerabilities or secrets against you during arguments.

   • They try to isolate you from people who support you or make you constantly doubt those people’s intentions.

   • They give you attention or praise and then withdraw it when you do not comply with their wishes.

   • They leave you constantly confused and wondering, “Am I the one who is wrong?”

   • They hold you to standards that they do not follow themselves and provide different justifications for their own behavior.

   • They apologize after an argument mainly to end the conflict and then repeat the same behavior without meaningful change.

   Diagnosis of Intermittent Explosive Disorder (IED)

   The diagnosis of Intermittent Explosive Disorder (IED) is not based simply on being quick-tempered or frequently angry. Instead, it involves a recurrent pattern of angry outbursts and impulsive aggressive behavior, while other possible causes and disorders that can produce similar symptoms must also be ruled out.

   Main Diagnostic Criteria

   According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), a mental health professional evaluates several criteria, including:

   • Recurrent episodes of aggressive behavior, either verbal aggression or physical acts of aggression.

   • The intensity of the aggressive response is clearly disproportionate to the level of provocation or the situation.

   • The outbursts are impulsive and not premeditated, rather than being a deliberate strategy for achieving a specific goal, such as obtaining money or seeking revenge.

   • The episodes cause significant psychological distress or negatively affect relationships, work, or education, or result in material or physical harm.

   • The aggressive behavior is not better explained by an ongoing mood state. The person may be relatively calm between episodes, although some irritability may remain.

   • The episodes are not better explained by another mental disorder, substance use such as alcohol or drugs, medication effects, or another medical condition.

   The clinician also considers the frequency, nature, and severity of the episodes. A single angry outburst is not sufficient to diagnose IED.

   How Is IED Diagnosed in Practice?

   There is no blood test, brain scan, or single test that can confirm Intermittent Explosive Disorder. Diagnosis is primarily based on a comprehensive psychological and psychiatric assessment, which may include:

   • Taking a detailed history of the angry outbursts, including when they began, how often they occur, how long they last, and what happens during them.

   • Identifying situations or triggers that precede the episodes and determining whether the behavior is impulsive or planned.

   • Asking what happens after an episode, such as feelings of regret, guilt, or embarrassment.

   • Assessing the impact of the episodes on family and social relationships, work, and education.

   • Reviewing the person’s medical and psychiatric history, medications, and use of alcohol or other substances.

   • Looking for other disorders or conditions that can cause similar symptoms, such as bipolar disorder, depression, certain personality disorders, Attention-Deficit/Hyperactivity Disorder (ADHD), and substance use disorders.

   Illustrative Example

   An evaluation for possible IED may be considered when a person encounters a relatively minor situation, such as an ordinary disagreement, and then suddenly escalates into severe shouting, destroying property, or physically attacking others. If these incidents repeatedly occur in an impulsive manner and are disproportionate to the situation, they may warrant professional evaluation.

   On the other hand, if a person plans revenge in advance or deliberately uses anger to blackmail someone or obtain a specific benefit, this does not automatically mean that they have IED. Impulsivity and lack of premeditation are important factors in the diagnostic assessment.

   Important Note

   IED should not be diagnosed based on these signs alone or through an online test. A definitive diagnosis requires an evaluation by a psychiatrist or other qualified mental health professional to determine whether the diagnostic criteria are met and to rule out other possible causes.

   Medications for Intermittent Explosive Disorder

   Intermittent Explosive Disorder (IED) is characterized by recurrent episodes of intense anger or impulsive aggressive behavior that are disproportionate to the situation or provocation that triggered them.

   Medication may be used to help reduce the frequency and severity of outbursts, but there is currently no medication specifically approved by the U.S. Food and Drug Administration (FDA) for the treatment of IED. Evidence for medications in IED also remains more limited than the evidence available for some other psychiatric disorders.

   1. Selective Serotonin Reuptake Inhibitors (SSRIs)

   Selective serotonin reuptake inhibitors (SSRIs) are among the medications that have been studied most extensively for IED. Fluoxetine is one of the most studied medications in this context.

   One randomized, double-blind clinical trial found a significant and sustained reduction in aggression and irritability in some people taking fluoxetine compared with placebo. However, not everyone responded to treatment, meaning that effectiveness can vary from person to person.

   A doctor may, depending on the patient’s condition, consider using other medications from the SSRI group, such as:

2. Sertraline

3. Escitalopram

4. Paroxetine

5. Fluvoxamine

6. However, the fact that these medications belong to the same drug class does not mean that the scientific evidence supporting their effectiveness in treating Intermittent Explosive Disorder (IED) is equally strong.

   2. Mood Stabilizers and Some Anticonvulsants

   Some of these medications may be used in certain cases, particularly when aggressive outbursts are severe or when other symptoms or coexisting disorders make their use appropriate.

   Medications that have been studied for their potential role in controlling aggression include:

7. Oxcarbazepine

8. Valproate / Divalproex

9. Carbamazepine

10. Lithium

11. The scientific evidence for these medications is not equally strong. Some reviews have reported promising results for certain medications, while other medications have not demonstrated clear benefits for IED symptoms compared with placebo.

    Therefore, these medications should not be selected simply because a person experiences anger or aggressive outbursts. They should only be considered following a comprehensive medical and psychological evaluation.

    3. Antipsychotic Medications

    A doctor may prescribe certain antipsychotic medications in specific circumstances, particularly when there is a coexisting psychiatric condition or severe symptoms that warrant their use.

    However, antipsychotics are generally not considered a first-line treatment for IED, and they should not be used simply to control anger without careful medical evaluation, because they can have side effects that require a careful assessment of their potential benefits and risks.

    4. Other Medications

    Some other medications have been studied in the context of aggression and impulsivity, including certain beta-blockers and other medications that affect the nervous system.

    However, evidence for their specific use in treating IED is limited, so they are not considered general treatment options for all patients.

    How Does a Doctor Choose the Appropriate Medication?

    Medication selection is not based on angry outbursts alone. The doctor evaluates the person’s overall condition and may assess for:

12. Depression or anxiety disorders.

13. Bipolar disorder.

14. Personality disorders.

15. Attention-Deficit/Hyperactivity Disorder (ADHD).

16. Alcohol or substance use.

17. Sleep disorders.

18. Other medications the patient is taking.

19. Medical conditions, including liver and kidney disorders.

20. The severity of aggression and the risk of harm to oneself or others.

21. This is important because anger and aggression may be symptoms of another disorder or medical condition and are not necessarily caused by Intermittent Explosive Disorder.

    Is Medication Alone Enough?

    In many cases, relying on medication alone is not preferred. Psychotherapy, particularly Cognitive Behavioral Therapy (CBT), is an important approach that can help a person understand their anger triggers, identify the thoughts that occur before emotional outbursts, and learn more effective skills for regulating anger and controlling impulsive behavior.

    Depending on the individual’s condition, the treatment plan may look like this:

    Comprehensive psychological assessment → psychotherapy, such as CBT → medication if needed → monitoring the response and side effects → adjusting the treatment plan according to the response.

    What About Medication Dosages?

    The dose of fluoxetine, valproate, lithium, or any other medication should not be determined independently. The appropriate dose depends on factors such as:

22. Age.

23. Overall health.

24. Diagnoses and coexisting conditions.

25. Other medications being taken.

26. Severity of symptoms.

27. Response to treatment.

28. 6. Pay Attention to How You Feel After Interacting With Them

    Certain recurring feelings may be worth paying attention to, such as:

29. Persistent guilt.

30. Confusion and uncertainty.

31. Fear of the person’s reaction.

32. Feeling that you are always the one who is wrong.

33. Feeling that you have to justify every decision you make.

34. These feelings alone do not prove that manipulation is occurring, but they may be worth considering when evaluating the nature of the relationship and its boundaries.

    7. Maintain Your Relationships and Independence

    Try to maintain healthy relationships with family members, friends, and people you trust. Avoid allowing one person to become your only source of support.

    Communicating with trusted people can help you see situations more objectively, especially when you feel confused or under pressure.

    8. Do Not Try to Force the Person to Change

    You cannot control another person’s behavior, but you can control your own boundaries, decisions, and responses.

    Therefore, focus on protecting yourself rather than exhausting yourself trying to change the other person.

    9. Use a Calm and Consistent Response

    Remain calm and repeat your position without entering into a confrontation. For example:

    “I understand that you’re angry, but my decision hasn’t changed.”

    Or:

    “I won’t discuss this in this way. We can talk when we’re both calm.”

    This approach can reduce the likelihood of the conversation turning into a prolonged emotional confrontation.

    10. Seek Professional Support When Necessary

    If a relationship becomes psychologically harmful or involves threats, blackmail, severe control, or abuse, it is important to seek help from a mental health professional or a trusted support service.

    In situations involving immediate danger, personal safety should take priority. Seek urgent help rather than trying to handle the situation alone.

    Some medications may also require regular medical tests and monitoring to ensure that they are being used safely.

    Ways to Protect Yourself From the Effects of a Manipulative Person

    Dealing with a manipulative person does not mean entering into constant conflict with them. Instead, the goal is to protect your personal boundaries and independence and maintain your ability to make decisions without psychological or emotional pressure.

    Some approaches that may help reduce the impact of manipulation include:

    1. Set Clear and Consistent Boundaries

    Express your boundaries directly and calmly, for example:

    “I can’t do that.”

    “This is not acceptable to me.”

    You do not need to feel obligated to provide lengthy explanations every time you refuse a request that does not work for you.

    2. Avoid Making Decisions Under Pressure

    If someone tries to rush you or push you into making an immediate decision, give yourself enough time to think. You can say:

    “I’ll think about it and let you know later.”

    Having time and space to think can help you make a decision without being influenced by emotional pressure or the intensity of the moment.

    3. Avoid Getting Into Endless Arguments

    Sometimes a discussion can shift from the original issue into an attempt to force you to continually defend yourself. Try to stay focused on the main issue and calmly repeat your position rather than entering into a long cycle of explanations and self-defense.

    4. Learn to Say “No” Without Excessive Guilt

    Refusing someone’s request does not mean that you are selfish or a bad person. Likewise, respecting other people’s needs does not mean abandoning your own needs and boundaries.

    It is important to remember that you are not entirely responsible for other people’s feelings and decisions.

    5. Rely on Facts

    If someone repeatedly changes their version of events or denies what was agreed upon, it can be useful to keep important messages or agreements, particularly when dealing with financial, professional, or legal matters.

6. Pay Attention to How You Feel After Interacting With Them

Certain recurring feelings may be worth paying attention to, such as:

• Persistent guilt.

• Confusion and uncertainty.

• Fear of the person’s reaction.

• Feeling that you are always the one who is wrong.

• Feeling that you have to justify every decision you make.

These feelings alone do not prove that manipulation is occurring, but they may be worth considering when evaluating the nature of the relationship and its boundaries.

7. Maintain Your Relationships and Independence

Try to maintain healthy relationships with family members, friends, and people you trust. Avoid allowing one person to become your only source of support.

Communicating with trusted people can help you see situations more objectively, especially when you feel confused or under pressure.

8. Do Not Try to Force the Person to Change

You cannot control another person’s behavior, but you can control your own boundaries, decisions, and responses.

Therefore, focus on protecting yourself rather than exhausting yourself trying to change the other person.

9. Use a Calm and Consistent Response

Remain calm and repeat your position without entering into a confrontation. For example:

“I understand that you’re angry, but my decision hasn’t changed.”

Or:

“I won’t discuss this in this way. We can talk when we’re both calm.”

This approach can reduce the likelihood of the conversation turning into a prolonged emotional confrontation.

10. Seek Professional Support When Necessary

If a relationship becomes psychologically harmful or involves threats, blackmail, severe control, or abuse, it is important to seek help from a mental health professional or a trusted support service.

In situations involving immediate danger, personal safety should take priority. Seek urgent help rather than trying to handle the situation alone.