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Intermittent explosive disorder in adults: Epidemiology, clinical features, assessment, and diagnosis

Author
Emil Coccaro, MD
Section Editor
Susan McElroy, MD
Deputy Editor
David Solomon, MD

INTRODUCTION

Patients with intermittent explosive disorder are periodically unable to restrain impulses that result in verbal or physical aggression [1-3]. The aggressive behaviors are unplanned, out of proportion to the provocation, and cause subjective distress or psychosocial impairment.

This topic reviews the epidemiology, pathogenesis, clinical features, assessment, and diagnosis of intermittent explosive disorder. Treatment and prognosis are discussed separately. (See "Intermittent explosive disorder in adults: Treatment and prognosis".)

AGGRESSIVE BEHAVIOR

Aggression is defined as goal-directed behavior that is intended to harm or injure another person or object [4]. Aggressive behavior can be classified by the [5]:

Target – others, self, or property

Mode – physical or verbal

                  

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Literature review current through: Nov 2016. | This topic last updated: Fri Dec 04 00:00:00 GMT+00:00 2015.
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References
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  1. Coccaro EF. Intermittent explosive disorder: development of integrated research criteria for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Compr Psychiatry 2011; 52:119.
  2. Coccaro EF. Intermittent explosive disorder as a disorder of impulsive aggression for DSM-5. Am J Psychiatry 2012; 169:577.
  3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
  4. Jones RM, Arlidge J, Gillham R, et al. Efficacy of mood stabilisers in the treatment of impulsive or repetitive aggression: systematic review and meta-analysis. Br J Psychiatry 2011; 198:93.
  5. Siever LJ. Neurobiology of aggression and violence. Am J Psychiatry 2008; 165:429.
  6. Suris A, Coccaro E. Aggression measures. In: Handbook of Psychiatric Measures, Second Edition, Rush Jr AJ, First MB, Blacker D. (Eds), American Psychiatric Publishing, Inc, Washington, DC 2008. p.731.
  7. Yoshimasu K, Kawakami N, WMH-J 2002-2006 Survey Group. Epidemiological aspects of intermittent explosive disorder in Japan; prevalence and psychosocial comorbidity: findings from the World Mental Health Japan Survey 2002-2006. Psychiatry Res 2011; 186:384.
  8. Grant JE, Levine L, Kim D, Potenza MN. Impulse control disorders in adult psychiatric inpatients. Am J Psychiatry 2005; 162:2184.
  9. Kessler RC, Coccaro EF, Fava M, et al. The prevalence and correlates of DSM-IV intermittent explosive disorder in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2006; 63:669.
  10. Bromet EJ, Gluzman SF, Paniotto VI, et al. Epidemiology of psychiatric and alcohol disorders in Ukraine: findings from the Ukraine World Mental Health survey. Soc Psychiatry Psychiatr Epidemiol 2005; 40:681.
  11. Lee S, Tsang A, Zhang MY, et al. Lifetime prevalence and inter-cohort variation in DSM-IV disorders in metropolitan China. Psychol Med 2007; 37:61.
  12. Al-Hamzawi A, Al-Diwan JK, Al-Hasnawi SM, et al. The prevalence and correlates of intermittent explosive disorder in Iraq. Acta Psychiatr Scand 2012; 126:219.
  13. Coccaro EF, Schmidt CA, Samuels JF, Nestadt G. Lifetime and 1-month prevalence rates of intermittent explosive disorder in a community sample. J Clin Psychiatry 2004; 65:820.
  14. Fincham D, Grimsrud A, Corrigall J, et al. Intermittent explosive disorder in South Africa: prevalence, correlates and the role of traumatic exposures. Psychopathology 2009; 42:92.
  15. Shen YC, Zhang MY, Huang YQ, et al. Twelve-month prevalence, severity, and unmet need for treatment of mental disorders in metropolitan China. Psychol Med 2006; 36:257.
  16. McLaughlin KA, Green JG, Hwang I, et al. Intermittent explosive disorder in the National Comorbidity Survey Replication Adolescent Supplement. Arch Gen Psychiatry 2012; 69:1131.
  17. Coccaro EF, Posternak MA, Zimmerman M. Prevalence and features of intermittent explosive disorder in a clinical setting. J Clin Psychiatry 2005; 66:1221.
  18. Linnoila M, Virkkunen M, Scheinin M, et al. Low cerebrospinal fluid 5-hydroxyindoleacetic acid concentration differentiates impulsive from nonimpulsive violent behavior. Life Sci 1983; 33:2609.
  19. McElroy SL, Soutullo CA, Beckman DA, et al. DSM-IV intermittent explosive disorder: a report of 27 cases. J Clin Psychiatry 1998; 59:203.
  20. Bach-y-Rita G, Lion JR, Climent CE, Ervin FR. Episodic dyscontrol: a study of 130 violent patients. Am J Psychiatry 1971; 127:1473.
  21. Maletzky BM. The episodic dyscontrol syndrome. Dis Nerv Syst 1973; 34:178.
  22. Mattes JA, Fink M. A family study of patients with temper outbursts. J Psychiatr Res 1987; 21:249.
  23. Mattes JA, Fink M. A controlled family study of adopted patients with temper outbursts. J Nerv Ment Dis 1990; 178:138.
  24. Coccaro EF. A family history study of intermittent explosive disorder. J Psychiatr Res 2010; 44:1101.
  25. Miles DR, Carey G. Genetic and environmental architecture of human aggression. J Pers Soc Psychol 1997; 72:207.
  26. Coccaro EF, McCloskey MS, Fitzgerald DA, Phan KL. Amygdala and orbitofrontal reactivity to social threat in individuals with impulsive aggression. Biol Psychiatry 2007; 62:168.
  27. Siever LJ, Buchsbaum MS, New AS, et al. d,l-fenfluramine response in impulsive personality disorder assessed with [18F]fluorodeoxyglucose positron emission tomography. Neuropsychopharmacology 1999; 20:413.
  28. Berman ME, McCloskey MS, Fanning JR, et al. Serotonin augmentation reduces response to attack in aggressive individuals. Psychol Sci 2009; 20:714.
  29. Frankle WG, Lombardo I, New AS, et al. Brain serotonin transporter distribution in subjects with impulsive aggressivity: a positron emission study with [11C]McN 5652. Am J Psychiatry 2005; 162:915.
  30. Coccaro EF, Lee R, Kavoussi RJ. Inverse relationship between numbers of 5-HT transporter binding sites and life history of aggression and intermittent explosive disorder. J Psychiatr Res 2010; 44:137.
  31. Coccaro EF, Lee R, Kavoussi RJ. Aggression, suicidality, and intermittent explosive disorder: serotonergic correlates in personality disorder and healthy control subjects. Neuropsychopharmacology 2010; 35:435.
  32. Coccaro EF, Lee R, Coussons-Read M. Elevated plasma inflammatory markers in individuals with intermittent explosive disorder and correlation with aggression in humans. JAMA Psychiatry 2014; 71:158.
  33. Fanning JR, Meyerhoff J, Lee R, Coccaro EF. History of childhood maltreatment in intermittent explosive disorder and suicidal behavior. J Psychiatr Res 2014.
  34. Felthous AR, Bryant SG, Wingerter CB, Barratt E. The diagnosis of intermittent explosive disorder in violent men. Bull Am Acad Psychiatry Law 1991; 19:71.
  35. Mattes JA. Comparative effectiveness of carbamazepine and propranolol for rage outbursts. J Neuropsychiatry Clin Neurosci 1990; 2:159.
  36. Stanford MS, Helfritz LE, Conklin SM, et al. A comparison of anticonvulsants in the treatment of impulsive aggression. Exp Clin Psychopharmacol 2005; 13:72.
  37. Barratt ES, Stanford MS, Kent TA, Felthous A. Neuropsychological and cognitive psychophysiological substrates of impulsive aggression. Biol Psychiatry 1997; 41:1045.
  38. McCloskey MS, Berman ME, Noblett KL, Coccaro EF. Intermittent explosive disorder-integrated research diagnostic criteria: convergent and discriminant validity. J Psychiatr Res 2006; 40:231.
  39. Jenkins AL, McCloskey MS, Kulper D, et al. Self-harm behavior among individuals with intermittent explosive disorder and personality disorders. J Psychiatr Res 2015; 60:125.
  40. McCloskey MS, Ben-Zeev D, Lee R, Coccaro EF. Prevalence of suicidal and self-injurious behavior among subjects with intermittent explosive disorder. Psychiatry Res 2008; 158:248.
  41. Coccaro EF, Kavoussi RJ, Berman ME, Lish JD. Intermittent explosive disorder-revised: development, reliability, and validity of research criteria. Compr Psychiatry 1998; 39:368.
  42. Kessler RC, Berglund P, Demler O, et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62:593.
  43. McCloskey MS, Kleabir K, Berman ME, et al. Unhealthy aggression: intermittent explosive disorder and adverse physical health outcomes. Health Psychol 2010; 29:324.
  44. Work Group on Psychiatric Evaluation, American Psychiatric Association Steering Committee on Practice Guidlines. Psychiatric evaluation of adults. Second edition. American Psychiatric Association. Am J Psychiatry 2006; 163:3.
  45. American Psychiatric Association Practice Guideline for the Psychiatric Evaluation of Adults, Second Edition, 2006. http://www.psych.org/MainMenu/PsychiatricPractice/PracticeGuidelines_1.aspx (Accessed on July 18, 2011).
  46. Grant JE. The Minnesota Disorders Interview. In: Impulse Control Disorders: A Clinician's Guide to Understanding and Treating Behavioral Addictions, W. W. Norton & Company, New York 2008. p.187.
  47. Suris A, Coccaro EF. Aggression measures. In: Handbook of Psychiatric Measures, second edition, Rush Jr AJ, First MB, Blacker D. (Eds), American Psychiatric Publishing, Washington, DC 2008. p.731.
  48. The ICD-10 Classification of Mental and Behavioral Disorders: Clinical Descriptions and Diagnostic Guidelines. http://www.who.int/classifications/icd/en/bluebook.pdf (Accessed on September 08, 2011).
  49. Lewin J, Sumners D. Successful treatment of episodic dyscontrol with carbamazepine. Br J Psychiatry 1992; 161:261.
  50. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Second Edition (DSM-II), 1968 http://www.psychiatryonline.com/DSMPDF/dsm-ii.pdf (Accessed on September 08, 2011).
  51. American Psychiatric Association. Diagnostic and Statistical Manual: Mental Disorders, 1952. http://www.psychiatryonline.com/DSMPDF/dsm-i.pdf (Accessed on September 08, 2011).
  52. Wakefield JC. DSM-5, psychiatric epidemiology and the false positives problem. Epidemiol Psychiatr Sci 2015; 24:188.
  53. The ICD-10 Classification of Mental and Behavioral Disorders: Clinical Descriptions and Diagnostic Guidelines. http://www.who.int/classifications/icd/en/bluebook.pdf (Accessed on December 04, 2015).
  54. World Health Organization. International Classification of Diseases (ICD). ICD-10 online. ICD-10 Version: 2016. http://www.who.int/classifications/icd/en/ (Accessed on December 04, 2015).
  55. Robins E, Guze SB. Establishment of diagnostic validity in psychiatric illness: its application to schizophrenia. Am J Psychiatry 1970; 126:983.
  56. Heckers S. The Value of Psychiatric Diagnoses. JAMA Psychiatry 2015; 72:1165.
  57. Kraemer HC. Research Domain Criteria (RDoC) and the DSM--Two Methodological Approaches to Mental Health Diagnosis. JAMA Psychiatry 2015; 72:1163.