DSM-IV Intermittent Explosive Disorder: A Report of 27 Cases [CME]
J Clin Psychiatry 1998;59(4):203-210
© Copyright 2015 Physicians Postgraduate Press, Inc.
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Background: The authors' objective was to
provide data regarding the demographic, phenomenological, course
of illness, associated psychiatric and medical comorbidity,
family history, and psychiatric treatment response
characteristics of rigorously diagnosed subjects who met DSM-IV
criteria for intermittent explosive disorder.
Method: Twenty-seven subjects meeting DSM-IV
criteria for a current or past history of intermittent explosive
disorder were given structured diagnostic interviews. The
subjects' medical histories, family histories of psychiatric
disorders, and responses to psychiatric treatments were also
Results: Most subjects described their
intermittent explosive disorder symptoms as very distressing
and/or highly problematic. All 27 subjects described aggressive
impulses prior to their aggressive acts. Of 24 subjects who were
systematically queried, 21 (88%) experienced tension with the
impulses; 18 (75%), relief with the aggressive acts; and 11
(48%), pleasure with the acts. Most subjects stated that their
aggressive impulses and acts were also associated with affective
symptoms, particularly changes in mood and energy level.
Twenty-five (93%) subjects had lifetime DSM-IV diagnoses of mood
disorders; 13 (48%), substance use disorders; 13 (48%), anxiety
disorders; 6 (22%), eating disorders; and 12 (44%), an
impulse-control disorder other than intermittent explosive
disorder. Subjects also displayed high rates of comorbid migraine
headaches. First-degree relatives displayed high rates of mood,
substance use, and impulse-control disorders. Twelve (60%) of 20
subjects receiving monotherapy with an antidepressant or a mood
stabilizer reported moderate or marked reduction of their
aggressive impulses and/or episodes.
Conclusion: Intermittent explosive disorder
appears to be a bona fide impulse-control disorder that may be
related to mood disorder and may represent another form of
affective spectrum disorder.