From the Guidelines
Intermittent Explosive Disorder (IED) is characterized by repeated brief episodes of verbal or physical aggression or destruction of property representing a failure to control aggressive impulses. The diagnostic criteria for IED, as described in the study 1, involve recurrent episodes of aggression that are out of proportion to the triggering stressor. According to the study, IED is characterized by:
- Repeated brief episodes of verbal or physical aggression
- Destruction of property
- Representing a failure to control aggressive impulses These criteria are essential in diagnosing IED, and it is crucial to distinguish it from other mental disorders, medical conditions, or substance use that may exhibit similar symptoms. The study 1 provides a comprehensive overview of the changes from ICD-10 to ICD-11 and future directions in psychiatric classification, including the diagnostic criteria for IED.
Key points to consider in the diagnosis of IED include:
- The aggressive response must be grossly disproportionate to the provocation or any precipitating psychosocial stressors
- The outbursts are impulsive and/or anger-based rather than premeditated or serving a specific purpose
- They cause marked distress, impair occupational or interpersonal functioning, or result in financial or legal consequences
- The person must be at least six years old or at an equivalent developmental level
- The outbursts cannot be better explained by another mental disorder, medical condition, or substance use.
It is essential to note that the study 1 provides the most recent and highest quality evidence on the diagnostic criteria for IED, and its findings should be prioritized in clinical practice.
From the Research
Diagnostic Criteria for Intermittent Explosive Disorder (IED)
The diagnostic criteria for IED have undergone development and refinement over the years. According to 2, IED is characterized by recurrent, problematic impulsive aggressive behavior. The study highlights the importance of new research criteria in facilitating empirical work on IED.
Key Criteria
- Discrete episodes of aggressive impulses resulting in serious assaultive acts towards people or destruction of property 3
- High frequency/low intensity aggressive outbursts (A1) and low frequency/high intensity outbursts (A2) 4
- Signs of tension preceding the assaults and signs of release or pleasure after performing the act 5
Considerations for Diagnosis
- A thorough medical work-up is necessary to rule out other conditions 3
- A structured or semi-structured diagnostic interview can help identify comorbid and pre-existing conditions 3
- Exclusion of certain personality disorders (e.g., antisocial and borderline personalities) is being discussed, but some argue that IED can co-occur with these conditions 5