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Recognition and Treatment of DSM-IV Intermittent Explosive Disorder

Susan L. McElroy, M.D.

Although models of impulsive aggression are often associated with psychiatric disorders, some individuals demonstrate violent outbursts of rage that are variously referred to in the field as rage attacks, anger attacks, episodic dyscontrol, and intermittent explosive disorder. According to DSM-IV, intermittent explosive disorder is characterized by discrete episodes of failure to resist aggressive impulses resulting in serious assaults or destruction of property. Virtually no research has been done on intermittent explosive disorder as defined by DSM-IV criteria, and this article discusses the phenomenology, comorbidity, and treatment response of 27 individuals who met the DSM-IV criteria for the disorder. The association of the explosive episodes in these subjects with maniclike affective symptoms, the high rate of lifetime comorbid bipolar disorder, and the favorable response of explosive episodes to mood-stabilizing drugs suggest that intermittent explosive disorder may be linked to bipolar disorder.

(J Clin Psychiatry 1999;60[suppl 15]:12–16)

From the Biological Psychiatry Program, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio.

Presented at the closed symposium "Phenomenology and Treatment of Aggression Across Psychiatric Illnesses," held August 31, 1998, Chicago, Illinois, and sponsored by an unrestricted educational grant from Abbott Laboratories.

Reprint requests to: Susan L. McElroy, M.D., Biological Psychiatry Program, University of Cincinnati College of Medicine, P.O. Box 670559, 231 Bethesda Ave., Cincinnati, OH 45267.