Intermittent Explosive Disorder

The diagnostic criteria for Intermittent Explosive Disorder (IED)includes the following:

• Several discrete episodes of failure to resist aggressive impulses that result in serious assaultive acts or destruction of property.

• The degree of aggressiveness expressed during the episodes is grossly out of proportion to any precipitating psychosocial stressors.

• The aggressive episodes are not better accounted for by another mental disorder (e.g., Antisocial Personality Disorder, Borderline Personality Disorder, a Psychotic Disorder, a Manic Episode, Conduct Disorder, or Attention-Deficit/Hyperactivity Disorder) and are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., head trauma, Alzheimer's disease).

Associated Features

Individuals with Intermittent Explosive Disorder sometimes describe intense impulses to be aggressive prior to their aggressive acts. Explosive episodes may be associated with affective symptoms (irritability or rage, increased energy, racing thoughts) during the aggressive impulses and acts, and rapid onset of depressed mood and fatigue after the acts.

Individuals with narcissistic, obsessive, paranoid, or schizoid traits may be especially prone to having explosive outbursts of anger when under stress. Mood Disorders, Anxiety Disorders, Eating Disorders, Substance Use Disorders, and other Impulse-Control Disorders may also be associated with Intermittent Explosive Disorder. Childhood histories may show severe temper tantrums, impaired attention, hyperactivity, and other behavioral difficulties, such as stealing and fire setting.

Course

Limited data are available on the age at onset of Intermittent Explosive Disorder, but it appears to be from childhood to the early 20s. Mode of onset may be abrupt and without a prodromal period. The course of Intermittent Explosive Disorder is variable, with the disorder having a chronic course in some individuals and a more episodic course in other individuals.

Diagnostic criteria summarized from:

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.