Intermittent Explosive Disorder

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. Usually, these episodes follow minor incidents and are out of proportion to the trigger.

Description

The Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) decribes intermittent explosive disorder as one of several impulse-control disorders, including kleptomania (impulsive stealing), pathological gambling, and pyromania (setting fires). There must be several instances of failure to resist aggressive or violent behaviors that result in harm to others or destruction of property. Spurred by a minor incident, these acts are grossly out of proportion to the stressor. To meet the criteria for IED, these behaviors are not caused by another mental disorder (e.g. antisocial personality disorder, bipolar disorder, borderline personality disorder, or attention-deficit/hyperactivity disorder). These impulsive acts are not caused by substance abuse or medical condition (head trauma or Alzheimer's disease.

Many psychiatrists do not place intermittent explosive disorder into a separate clinical category but consider it a symptom of other psychiatric and mental disorders. Future acts of violence may escalate, despite how it is defined, and treatment is essential.

IED occurs more often in men. Women do experience it and have reported it as part of premenstrual syndrome (PMS).

Causes and symptoms

Causes

As with other impulse-control disorders, the cause of IED has not been determined.

Symptoms

IED causes such violent behavior as physical assault, destruction of property, and homicide or violent suicide. Violent, destructive behaviors often begin in childhood and escalate in adult life.

Diagnosis

A thorough case history of behavior and medical problems is taken. A diagnosis is made by a psychiatrist or psychologist after interviews and psychological testing. Since IED is a behavioral illness, no medical tests have been able as yet to find an organic cause. Treatment options with certain drugs may point to a relationship with bipolar disorder and serotonin (a brain chemical) conditions.

Treatment

Treatment for IED usually involves psychotherapy of some type, drugs, or biofeedback. Usually, a regime of therapy (behavior modification, among others) and drugs is most common. Good success has occurred with mood stabilizers and antidepressants like selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants. Among these drugs are Prozac, Zoloft, Neurontin, and Dilantin.

Prognosis

The outlook for IED is good with proper diagnosis, medications, and therapy. Still, more research is needed to determine the mechanisms involved in this disorder.

Prevention

There is no know way to prevent this disorder and no clinical way to diagnose it until behaviors appear.