Differential Diagnosis for Aggression and Violence

The patient's symptoms of daily outbursts of aggression and violence, sometimes unprovoked and sometimes triggered by everyday things, can be approached by considering various psychiatric, neurological, and medical conditions. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis

  • Intermittent Explosive Disorder (IED): Characterized by recurrent, problematic, and impulsive aggression that is disproportionate to the provocation or stressor. The frequency and nature of the outbursts, as described, align closely with the diagnostic criteria for IED.

• Other Likely Diagnoses

  • Bipolar Disorder: Especially during manic or mixed episodes, patients can exhibit irritability and aggressive behavior.
  • Borderline Personality Disorder: Marked by intense anger and recurrent physical fights, which can be triggered by minor stressors.
  • Substance Abuse or Dependence: Certain substances can induce aggression, especially during intoxication or withdrawal phases.
  • Attention Deficit Hyperactivity Disorder (ADHD): Primarily in children and adolescents, but can also be seen in adults, where impulsivity may manifest as aggressive outbursts.

• Do Not Miss Diagnoses

  • Traumatic Brain Injury (TBI): Especially frontal lobe injuries, which can lead to significant changes in personality, including increased aggression.
  • Neurodegenerative Diseases (e.g., Frontotemporal Dementia): Can cause significant personality changes, including aggression, early in the disease course.
  • Hypoglycemia: Severe cases can lead to aggressive behavior due to the brain's lack of glucose.
  • Thyroid Storm: A life-threatening complication of untreated or undertreated hyperthyroidism, which can cause agitation and aggression.

• Rare Diagnoses

  • Kluver-Bucy Syndrome: A rare condition, usually resulting from bilateral damage to the amygdalae, characterized by a loss of fear and aggression.
  • Pseudobulbar Affect: Involves involuntary and inappropriate emotional responses, which can sometimes be misinterpreted as aggression.
  • Wilson's Disease: A genetic disorder leading to copper accumulation in the brain and liver, which can cause psychiatric symptoms, including aggression, especially in young individuals.

Each of these diagnoses requires careful consideration of the patient's full clinical picture, including history, physical examination, laboratory tests, and sometimes imaging studies, to accurately diagnose and manage the underlying condition causing aggression and violence.