A mental health professional will ask for a complete personal history from the patient and sometimes family members and friends before making a diagnosis of intermittent explosive disorder. She also will review medical, psychological or educational records, perform a complete mental status examination and apply criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), a clinical reference guide for mental health professionals.

Diagnostic criteria for intermittent explosive disorder include:

  • Failing to resist aggressive impulses that result in serious assault or destruction of property during several episodes.
  • Exhibiting a degree of aggressiveness grossly out of proportion to the circumstances.
  • Inability to attribute aggressive episodes to another mental disorder, medical condition or the direct effects of a substance such as alcohol or a drug.

The health professional often must get to know the patient over an extended period of time in order to make a definitive diagnosis. She will try to determine whether another medical disorder or mental condition such as antisocial personality disorder, a conduct and disruptive behavior disorder, bipolar disorder, schizophrenia or acute intoxication could be causing the behavior.

Antisocial or other personality disorders are different from impulse disorders because the impulsiveness and aggressiveness are part of a person’s character and are more constant, not just exhibited during episodes. The same applies to conduct and disruptive behavior disorders, which are characterized by repetitive and persistent patterns of inappropriate behaviors.

Manic episodes, part of bipolar disorder, also are different from impulse disorders in that impulsive, aggressive behavior is evident only during a manic state. Schizophrenia causes a debilitating disturbance of thoughts and perceptions. While some people with schizophrenia might exhibit violent behavior, it is almost always caused by psychotic symptoms such as delusions or hallucinations.

Personal history, a mental status examination and laboratory or radiology evaluations can determine whether acute alcohol or drug intoxication or a medical problem such as epilepsy or a brain tumor is responsible for the explosive behavior.