What is Intermittent Explosive Disorder?

A diagnosis of “intermittent explosive disorder” is given to individuals at least 6 years old who have recurrent behavioral outbursts with a failure to control aggressive impulses shown by either of the following:

• Verbal aggression (e.g., temper tantrums, tirades, verbal arguments or fights) or physical aggression toward property, animals, or other individuals. The behavior occurs at least twice weekly, on average, for a period of 3 months. They physical aggression does not result in damage or destruction of property and does not result in physical injury to animals or other individuals.
• Three behavioral outbursts involving damage or destruction of property and/or physical assault involving physical injury against animals or other individuals occurred within a 12-month period.

The magnitude of aggressiveness expressed during the outbursts is grossly out of proportion to the provocation or to any precipitating psychosocial stressors. The aggressive outbursts are not premeditated and are not committed to achieving some tangible objective (e.g., money, power, intimidation). The recurrent outbursts cause either marked distress in the individual or impairment in occupational or interpersonal functioning or are associated with financial or legal consequences. The behavior is not better explained by another mental disorder (e.g., major depressive disorder, bipolar disorder, disruptive mood dysregulation disorder, a psychotic disorder, antisocial personality disorder, borderline personality disorder) and are not attributable to another medical condition (e.g., head trauma, Alzheimer’s disease) or to the physiological effects of a substance (e.g., a drug of abuse or medication). For children ages 6-18 years, aggressive behavior that occurs as part of an adjustment disorder should not be considered for this diagnosis.

What are treatments for Intermittent Explosive Disorder?

A combination of pharmacotherapy and psychotherapy has the best chance of success in treating an individual with the intermittent explosive disorder. Group psychotherapy and family therapy may also be helpful. A goal of therapy is to have the patient recognize and verbalize the thoughts or feelings that precede the explosive outbursts instead of acting them out.

Anticonvulsants have been used with mixed results in treating explosive patients. Lithium (Eskalith) has been reported useful in generally lessening aggressive behavior. Carbamazepine, valproate (Depakene) or divalproex (Depakote) and phenytoin (Dilantin) have also proven helpful. Selective serotonin reuptake inhibitors (SSRIs), trazodone (Desyrel), and buspirone (BuSpar) are useful in reducing impulsivity and aggression. Propranolol (Inderal) and other B-adrenergic receptor antagonists and calcium channel inhibitors have also been effective in some cases.