DSM 5 Criteria for Intermittent Explosive Disorder

What is intermittent explosive disorder?

Intermittent explosive disorder (IED) is a mental condition characterized by sudden episodes of unwarranted, severe aggression. Individuals with this disorder may experience aggressive outbursts that are grossly out of proportion to any provocation or stressor. These outbursts can manifest as verbal aggression, such as temper tantrums and tirades, or physical aggression, including damage to property or physical assaults on others. The nature of these episodes often results in significant financial or legal consequences for the individual.

Aggressive behavior in IED sufferers stems not from premeditation but from an inability to control impulsive aggression. Such aggressive impulses can severely impair one's relationships, occupational status, and overall quality of life, making understanding and management of the condition crucial.

Classified under disruptive, impulse-control, and conduct disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), IED is considered a mental disorder. It is distinct from other personality disorders, mood disorders, or psychotic disorders that may also involve aggressive behavior.

Causes and symptoms of IED

While the exact cause of IED is unknown, a combination of biological, environmental, and psychological factors may play a role in its development. These factors may include:

• Genetics: Many individuals with IED have a family history of impulsive aggression or other mental disorders.
• Brain chemistry: Imbalances in neurotransmitters such as serotonin, which regulates mood and behavior, may contribute to impulsive aggression.
• Trauma or abuse: Experiencing physical or emotional trauma, especially at a young age, can increase the risk of developing IED.
• Stressful life events: Difficulties in personal relationships, financial problems, or significant life changes can trigger aggressive outbursts in individuals with IED.

In addition to these potential causes, individuals with IEDs may also experience symptoms such as:

• Frequent verbal or physical outbursts of aggression disproportionate to the triggering event.
• Intense anger, irritability, and frustration can be difficult to control.
• Difficulty controlling impulses leads to impulsive acts of aggression without considering consequences.
• Tension and distress leading up to the outburst, followed by a sense of relief or guilt afterward.
• Relationship problems, social isolation, and difficulties at work or school due to aggressive behavior.

As with many mental disorders, it is important to remember that every individual may experience symptoms differently.

Treatment options for IED

Treatment for IED may involve a combination of medication, therapy, and lifestyle changes. Some possible treatment options include:

Medication

Antidepressants, mood stabilizers, or anticonvulsant medications may be prescribed to help regulate brain chemistry. Individuals with IEDs may also benefit from drugs used to treat other mental health conditions, such as anxiety or depression.

Therapy

Cognitive-behavioral therapy (CBT) can help individuals with IEDs learn to recognize and manage their triggers, develop coping strategies for anger and aggression, and practice relaxation techniques. Family therapy may also be beneficial in improving communication and addressing relationship issues.

Lifestyle changes

Making lifestyle changes such as exercise, stress management techniques, and avoiding drugs and alcohol can also help individuals with IED manage their symptoms. Loved ones need to be supportive and understanding during the treatment process.

Coping strategies for IED

In addition to seeking professional help, those living with IED can also utilize coping strategies to manage their symptoms. Some helpful strategies may include:

• Identifying triggers and learning to avoid or manage them.
• Practicing relaxation techniques, such as deep breathing or meditation.
• Engaging in physical activity to release pent-up energy and tension.
• Expressing feelings through art, writing, or talking with a trusted friend or therapist.
• Making a plan for responding to anger or aggressive outbursts.
• Seeking support from friends and loved ones or joining a support group for individuals with IED.

DSM 5 Criteria for Intermittent Explosive Disorder

The Diagnostic and Statistical Manual of Mental Disorders (DSM 5) is a vital resource in diagnosing various mental health conditions. It establishes standardized criteria to aid clinicians in identifying mental disorders during thorough assessments.

The following are the diagnostic criteria for intermittent explosive disorder according to DSM 5:

• Recurrent behavioral outbursts representing a failure to control aggressive impulses as manifested by either verbal aggression or behavioral outbursts.
• The magnitude of aggressiveness expressed during the recurrent outbursts is grossly out of proportion to the provocation or to any precipitating psychosocial stressors.
• The recurrent aggressive outbursts are not premeditated (i.e. - they are impulsive and/or anger-based) and are not committed to achieve some tangible objective (e.g. - money, power, intimidation).

Download our comprehensive template for the full criteria.

Co-occurring disorders with IED

It is important to note that intermittent explosive disorder can often co-occur with other mental health conditions, including:

Mood disorders

People with IEDs may also experience mood disorders such as depression and bipolar disorder. These co-occurring conditions can significantly impact the frequency and severity of their explosive outbursts, highlighting the complex interplay between emotional regulation and explosive behavior in individuals with IEDs.

Personality disorders

Individuals with Intermittent Explosive Disorder (IED), a condition marked by sudden outbursts of anger and aggression, may also face challenges associated with personality disorders. Among these, personality disorders like borderline personality disorder, known for symptoms like impulsivity, emotional instability, and turbulent relationships, can further complicate the experiences of individuals with IEDs.

Antisocial personality disorder

IED may also co-occur with antisocial personality disorder (ASPD), a condition marked by a disregard for the rights and well-being of others. Individuals with ASPD may exhibit impulsive, aggressive behavior, which can further exacerbate their explosive outbursts.

Anxiety disorders

Anxiety disorders, characterized by excessive worry and fear, may also co-occur with IED. These conditions can further intensify the emotional volatility experienced by individuals with IEDs, making it more difficult for them to regulate their emotions and behavior.

Conduct disorder

IED is also commonly seen in individuals with conduct disorder, a childhood and adolescent mental health condition characterized by aggression towards others and violation of rules. Children and adolescents with conduct disorder are at an increased risk of developing IED later in life.

Depression

Depression may also co-occur with IED, as the intense emotional dysregulation associated with the disorder can lead to feelings of hopelessness, low self-esteem, and despair. This can further exacerbate the explosive outbursts and aggression seen in individuals with IEDs.

Oppositional defiant disorder (ODD)

Oppositional defiant disorder (ODD) is another childhood and adolescent mental health disorder that may co-occur with IED. ODD is characterized by angry, hostile, and defiant behavior towards authority figures. Children with ODD are at an increased risk of developing IED in adulthood.

Substance use disorders

Individuals with IEDs are also at an increased risk of developing substance use disorders, particularly alcohol and drug abuse. This may be due to the tendency to self-medicate with substances to cope with the intense emotions and outbursts associated with IED.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Diagnostic and Statistical Manual of Mental Disorders, 5(5). https://doi.org/10.1176/appi.books.9780890425596

Substance Abuse and Mental Health Services Administration. (2016). Table 3.18, DSM-IV to DSM-5 Intermittent Explosive Disorder Comparison. Nih.gov; Substance Abuse and Mental Health Services Administration (US). https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t18/