Diagnosing Intermittent Explosive Disorder

The Diagnosis of Intermittent Explosive Disorder (DID) is based on two criteria:

1. A pattern of persistent, intense emotional reactions to stimuli lasting from several minutes up to several hours per day.

2. These reactions are not due to another medical condition or psychiatric illness and do not improve over time without treatment.

In addition, there may be other signs and symptoms which suggest DID but these must meet all the above criteria before it can be diagnosed as DID.

Intermittent Explosive Disorder Symptoms:

A. Impulsivity – Irregularly changing one’s behavior in response to new information, events or situations.

For example, the person may suddenly become angry when they read something upsetting on the Internet and then immediately calm down after reading some reassuring words online. They may also act impulsively in social settings such as talking too loudly or getting into arguments with others.

B. Disorganization – Not being able to concentrate on any task for prolonged periods of time.

For example, the person may have difficulty finishing a book or completing a project at work.

C. Affective Lability – Being easily upset, even if only slightly, and experiencing sudden mood swings from joy to sadness to anger to depression.

For example, the person may get very happy one minute and then experience extreme anxiety the next moment.

D. Elation – Often feeling happy, excited, and overly confident about no apparent reason.

E. Inappropriate Anger – Getting excessively angry, often for silly or irrational reasons.

For example, they may yell at a sales clerk for something you consider inconsequential.

F. Recklessness – Engaging in risky activities that are potentially self-damaging, such as driving too fast or fighting and hurting someone else.

G. Irritability – Easily annoyed by others.

For example, the person may perceive that others are laughing at them even if they are not.

H. Deceitfulness – Lying about or hiding important things, even when unnecessary.

For example, the person may shoplift from a store and then later lie about it.

DSM-5 criteria for diagnosing Intermittent Explosive Disorder:

A. Instances of extreme anger, often followed by destructive or violent behavior and the inability to control these outbursts.

B. The person finds it extremely difficult to control their anger around people they know.

C. The majority of the person’s angry outbursts are preceded by a triggering factor such as stress or frustration.

D. The angry outbursts are not the result of some other mental or physical condition, such as substance abuse, injury or disease.

E. The angry outbursts cause distress or have negative effects on the person’s life.

Treatment for Intermittent Explosive Disorder:

The treatment options for DID are based on individual factors and may vary from patient to patient. Some common options include:

A. Psychotherapy or “talk therapy” – This involves speaking to a psychologist, psychiatrist or other trained mental health professional on a regular basis.

B. Cognitive-behavioral therapy (CBT) – This is a form of talk therapy that focuses on the current thoughts and beliefs as well as past experiences that may be causing negative feelings and emotions.

The goal of this treatment is to help the person change their negative thoughts and feelings with more positive ones.

C. Antidepressants – These medications may help to alleviate some of the symptoms of Intermittent Explosive Disorder by altering the levels of specific chemicals and neurotransmitters in the brain.

D. Medication management – This involves periodically checking and adjusting typical prescriptions for issues such as pain, diabetes, asthma and other non-psychiatric issues.

It is important to remember that treatment for Intermittent Explosive Disorder may not be effective for everyone. Speak to your doctor or a trained mental health professional about available options that may be right for you or your loved one.

Sources & references used in this article:

Intermittent explosive disorder-integrated research diagnostic criteria: Convergent and discriminant validity by MS McCloskey, ME Berman, KL Noblett… – Journal of Psychiatric …, 2006 – Elsevier

Intermittent explosive disorder: development of integrated research criteria for Diagnostic and Statistical Manual of Mental Disorders by EF Coccaro – Comprehensive Psychiatry, 2011 – Elsevier

DSM-IV intermittent explosive disorder: a report of 27 cases. by SL McElroy, CA Soutullo, DAA Beckman… – The Journal of clinical …, 1998 – psycnet.apa.org

Intermittent explosive disorder as a disorder of impulsive aggression for DSM-5 by EF Coccaro – American Journal of Psychiatry, 2012 – Am Psychiatric Assoc