Intermittent Explosive Disorder Health Article

Definition

Intermittent explosive disorder (IED) is a mental disturbance that is characterized by specific episodes of violent and aggressive behavior that may involve harm to others or destruction of property. IED is discussed in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) under the heading of "Impulse-Control Disorders Not Elsewhere Classified." As such, it is grouped together with kleptomania, pyromania, and pathological gambling.

A person must meet certain specific criteria to be diagnosed with IED:

• There must be several separate episodes of failure to restrain aggressive impulses that result in serious assaults against others or property destruction.
• The degree of aggression expressed must be out of proportion to any provocation or other stressor prior to the incidents.
• The behavior cannot be accounted for by another mental disorder, substance abuse, medication side effects, or such general medical conditions as epilepsy or head injuries.

Description

People diagnosed with IED sometimes describe strong impulses to act aggressively prior to the specific incidents reported to the doctor and/or the police. They may experience racing thoughts or a heightened energy level during the aggressive episode, with fatigue and depression developing shortly afterward. Some report various physical sensations, including tightness in the chest, tingling sensations, tremor, hearing echoes, or a feeling of pressure inside the head.

Many people diagnosed with IED appear to have general problems with anger or other impulsive behaviors between explosive episodes. Some are able to control aggressive impulses without acting on them while others act out in less destructive ways, such as screaming at someone rather than attacking them physically.

DSM-IV's classification of IED is not universally accepted. Many psychiatrists do not place intermittent explosive disorder into a separate clinical category but consider it a symptom of other psychiatric and mental disorders. In many cases individuals diagnosed with IED do in fact have a dual psychiatric diagnosis. IED is frequently associated with mood and anxiety disorders; substance abuse; eating disorders; and narcissistic, paranoid, and antisocial personality disorders.

One culturally specific psychiatric syndrome resembling IED is amok, which was first reported in Malaysia. As the English phrase "running amok" implies, the syndrome is characterized by sudden outbursts of indiscriminate aggression or murderous rage that are completely unprovoked or that are triggered by trivial slights.