Intermittent explosive disorder (IED) is the professional diagnosis given to people who have anger issues that directly impact their life, usually at home or at work. These discrete episodes of angry behavior may take many forms — aggressive behavior toward others or property, verbal assault, or physically assaulting another person. The episodes of anger must be grossly out of proportion to any provocation, and are not premeditated or caused by a specific trigger or stressor.
The individual may describe the aggressive episodes as “spells” or “attacks” in which the explosive behavior is preceded by a sense of tension or arousal and is followed immediately by a sense of relief. Later the individual may feel upset, remorseful, regretful, or embarrassed about the aggressive behavior.
Changes to this diagnostic criteria for this disorder in the DSM-5 no longer require physical aggression to be present in order to diagnose it. Either verbal aggression (e.g., yelling or loudly insulting others, using extreme profanity, etc.) or non-destructive or non-injurious physical aggression (e.g., hitting a wall with a fist) now also qualify for the disorder’s symptom criteria.
In intermittent explosive disorder, aggressive outbursts are impulsive and/or anger based in nature, and must cause marked distress, cause impairment in one’s workplace or personal functioning (such as at home or in relationships), or be associated with negative financial or legal consequences. According to the DSM-5, they must occur at least twice a week and be present for at least 3 months.
While this disorder can be diagnosed in children as young as age 6, such a diagnosis must be carefully considered and differentiated from normal temper tantrums.
A diagnosis of Intermittent Explosive Disorder is made only after other mental disorders that might account for episodes of aggressive behavior have been ruled out (e.g., Antisocial Personality Disorder, Borderline Personality Disorder, a Psychotic Disorder, a Manic Episode, Conduct Disorder, or Attention Deficit/ Hyperactivity Disorder). The aggressive episodes are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., head trauma, Alzheimer’s disease).
Aggressive behavior can occur in the context of many other mental disorders. A diagnosis of Intermittent Explosive Disorder should be considered only after all other disorders that are associated with aggressive impulses or behavior have been ruled out. For instance, when the behavior develops as part of a dementia or delirium, a diagnosis of Intermittent Explosive Disorder is generally not made.
Intermittent Explosive Disorder should be distinguished from Personality Change Due to a General Medical Condition, Aggressive Type, which is diagnosed when the pattern of aggressive episodes is judged to be due to the direct physiological effects of a diagnosable general medical condition (e.g., an individual who has suffered brain injury from an automobile accident and subsequently manifests a change in personality characterized by aggressive outbursts).
Aggressive outbursts may also occur in association with Substance Intoxication or Substance Withdrawal, particularly associated with alcohol, phencyclidine, cocaine and other stimulants, barbiturates, and inhalants. Intermittent Explosive Disorder should be distinguished from the aggressive or erratic behavior that can occur in Oppositional Defiant Disorder, Conduct Disorder, Antisocial Personality Disorder, Borderline Personality Disorder, a Manic Episode, and Schizophrenia.
Aggressive behavior may, of course, occur when no mental disorder is present. Purposeful behavior is distinguished from Intermittent Explosive Disorder by the presence of motivation and gain in the aggressive act. In forensic settings, individuals may malinger Intermittent Explosive Disorder to avoid responsibility for their behavior.
The DSM-5 diagnostic code for Intermittent Explosive Disorder is 312.34 (F63.81).