Intermittent Explosive Disorder


Definition
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Intermittent Explosive Disorder falls in the category of Impulse-Control Disorders. The condition is characterized by failure to resist aggressive impulses, resulting in serious assaults or property destruction. Examples of this behavior include threatening to or actually hurting another person and purposefully breaking or damaging an object of value. The degree of aggressiveness expressed during an episode is grossly out of proportion to any provocation or situational stress. The individual may describe the episodes as "spells" or "attacks" in which the explosive behavior is preceded by a sense of tension or arousal and followed immediately by a sense of relief. Often genuine regret is expressed after the outburst. Later the individual may also feel upset, remorseful or embarrassed about the behavior. Most patients are young men and history will often involve frequent traffic accidents, moving violations and possibly sexual impulsivity. These patients may exhibit extreme sensitivity to alcohol. This disorder is a controversial category because some clinicians believe that it is only a symptom of other diagnoses rather than a disorder on its own.

Symptoms

Intermittent Explosive Disorder is marked by 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 (such as 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 (such as a medication or a drug of abuse) or a general medical condition (such as head trauma, Alzheimer's disease)

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 such as irritability or rage, increased energy, and racing thoughts during the aggressive impulses and acts, and rapid onset of depressed mood and fatigue after the acts. Some individuals may also report that their aggressive episodes are often preceded or accompanied by symptoms such as tingling, tremors, palpitations, chest tightness, head pressure, or hearing an echo. This disorder may result in job loss, school suspension, divorce, difficulties with interpersonal relationships or other impairment in social or occupational areas, accidents (such as in vehicles), hospitalization because of injuries from fights or accidents, financial problems, incarcerations or other legal problems.

Causes

The majority of cases occur when the individual is between late adolescence and late twenties. There is some evidence that the neurotransmitter serotonin may play a role in this disorder.

Although the prevalence of intermittent explosive disorder is unknown yet considered rare, the disorder is probably more common than realized and may be an important cause of violent behavior. Intermittent explosive disorder is more common in men.

Treatment

Treatment could involve medication or therapy including behavioral modification, with the best prognosis utilizing a combination of the two.

Studies suggest that patients with intermittent explosive disorder respond to treatment with antidepressants, antipsychotics, beta-blockers, alpha(2)-agonists, phenytoin and mood stabilizers.

Sources:

  • Diagnostic and Statistical Manual of Mental Disorders
  • DSM-IV™ Made Easy: The Clinician's Guide to Diagnosis
  • Olvera R. L. (2002). Intermittent explosive disorder: epidemiology, diagnosis and management. CNS Drugs. 16(8):517-26.

Last Reviewed: 24 Oct 2005
Last Reviewed By: Laura Stephens