DSM-IV Intermittent Explosive Disorder: A Report of 27 Cases

Background: The authors’ objective was toprovide data regarding the demographic, phenomenological, courseof illness, associated psychiatric and medical comorbidity,family history, and psychiatric treatment responsecharacteristics of rigorously diagnosed subjects who met DSM-IVcriteria for intermittent explosive disorder.

Method: Twenty-seven subjects meeting DSM-IVcriteria for a current or past history of intermittent explosivedisorder were given structured diagnostic interviews. Thesubjects’ medical histories, family histories of psychiatricdisorders, and responses to psychiatric treatments were alsoassessed.

Results: Most subjects described theirintermittent explosive disorder symptoms as very distressingand/or highly problematic. All 27 subjects described aggressiveimpulses prior to their aggressive acts. Of 24 subjects who weresystematically queried, 21 (88%) experienced tension with theimpulses; 18 (75%), relief with the aggressive acts; and 11(48%), pleasure with the acts. Most subjects stated that theiraggressive impulses and acts were also associated with affectivesymptoms, particularly changes in mood and energy level.Twenty-five (93%) subjects had lifetime DSM-IV diagnoses of mooddisorders; 13 (48%), substance use disorders; 13 (48%), anxietydisorders; 6 (22%), eating disorders; and 12 (44%), animpulse-control disorder other than intermittent explosivedisorder. Subjects also displayed high rates of comorbid migraineheadaches. First-degree relatives displayed high rates of mood,substance use, and impulse-control disorders. Twelve (60%) of 20subjects receiving monotherapy with an antidepressant or a moodstabilizer reported moderate or marked reduction of theiraggressive impulses and/or episodes.

Conclusion: Intermittent explosive disorderappears to be a bona fide impulse-control disorder that may berelated to mood disorder and may represent another form ofaffective spectrum disorder.