CNS Drugs

, Volume 16, Issue 8, pp 517–526 | Cite as

Intermittent Explosive Disorder

Epidemiology, Diagnosis and Management
Therapy in Practice

Abstract

Intermittent explosive disorder (IED) is characterised by discrete episodes of aggressive impulses that result in serious assaultive acts towards people or destruction of property. IED causes severe impairments in daily function. The diagnosis of IED should be made only after a thorough medical work-up. A structured or semi-structured diagnostic interview is helpful to ensure that comorbid and pre-existing conditions are considered.

There is a lack of controlled trials of agents for the treatment of patients with IED, but there is evidence that mood stabilisers, antipsychotics, β-blockers, α2-agonists, phenytoin and antidepressants may be useful. Behavioural interventions may be valuable as part of the overall treatment of IED

References

  1. 1.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994Google Scholar
  2. 2.
    Linnoila M, Virkkunen M. Biologic correlates of suicidal risk and aggressive behavioral traits. J Clin Psychopharmacol 1992; 12: S19–20CrossRefGoogle Scholar
  3. 3.
    Barratt ES, Stanford MS, Dowdy L, et al. Impulsive and premeditated aggression: a factor analysis of self-reported acts. Psychiatry Res 1999; 86: 163–73PubMedCrossRefGoogle Scholar
  4. 4.
    Vitiello B, Stoff DM. Subtypes of aggression and their relevance to child psychiatry. J Am Acad Child Adolesc Psychiatry 1997; 36: 307–15PubMedCrossRefGoogle Scholar
  5. 5.
    Dodge KA, Harnish JD, Lochman JE, et al. Reactive and proactive aggression in school children and psychiatrically impaired chronically assaultive youth. J Abnorm Psychol 1997; 106:37–51PubMedCrossRefGoogle Scholar
  6. 6.
    McElroy SL, Soutullo CA, Beckman DA, et al. DSM-IV intermittent explosive disorder: a report of 27 cases. J Clin Psychiatry 1998; 59: 203–10PubMedCrossRefGoogle Scholar
  7. 7.
    Kaneko M, Hoshino Y, Hashimoto S, et al. Hypothalamic-pituitary-adrenal axis function in children with attention-deficit hyperactivity disorder. J Autism Dev Disord 1993; 23: 59–65PubMedCrossRefGoogle Scholar
  8. 8.
    Kavoussi R, Armstead P, Coccaro E. The neurobiology of impulsive aggression. Psychiatr Clin North Am 1997; 20: 395–403PubMedCrossRefGoogle Scholar
  9. 9.
    Coccaro EF, Harvey PD, Kupsaw-Lawrence E, et al. Development of neuropharmacologically based behavioral assessments of impulsive aggressive behavior. J Neuropsychiatry 1991; 3: 544–51Google Scholar
  10. 10.
    Traskman-Bendz L, Ailing C, Oreland L, et al. Prediction of suicidal behavior from biologic tests. J Clin Psychopharmacol 1992; 12: S21–6CrossRefGoogle Scholar
  11. 11.
    Pliszka SR. The psychobiology of oppositional defiant disorder and conduct disorder. In: Quay HC, Hogan AE, editors. Handbook of disruptive behavior disorders. New York: Kluwer Academic/Plenum Publishers, 1999: 371–395CrossRefGoogle Scholar
  12. 12.
    Haller J, Makara GB, Kruk MR. Catecholaminergic involvement in the control of aggression: hormones, the peripheral sympathetic, and central noradrenergic systems. Neurosci Biobehav Rev 1998; 22: 85–97PubMedCrossRefGoogle Scholar
  13. 13.
    Archer J. The influence of testosterone on human aggression. Br J Psychol 1991; 82: 1–28PubMedCrossRefGoogle Scholar
  14. 14.
    Virkkunen M, Rawlings R, Tokola R, et al. CSF biochemistries, glucose metabolism, and diurnal activity rhythms in alcoholic, violent offenders, fire setters, and healthy volunteers. Arch Gen Psychiatry 1994; 51: 20–7PubMedCrossRefGoogle Scholar
  15. 15.
    Dabbs JM, Jurkovic GJ, Frady RL. Salivary testosterone and cortisol among late adolescent offenders. J Abnorm Child Psychol 1991; 19:469–78PubMedCrossRefGoogle Scholar
  16. 16.
    Davidson RJ, Putnam KM, Larson JL. Dysfunction in the neural circuitry of emotion regulation — a possible prelude to violence. Science 2000; 289: 594CrossRefGoogle Scholar
  17. 17.
    Coccaro EF. Intermittent explosive disorder. Curr Psychiatry Rep 2000; 2: 67–70PubMedCrossRefGoogle Scholar
  18. 18.
    Gordon N. Episodic dyscontrol syndrome. Dev Med Child Neurol 1999; 41: 786–8PubMedCrossRefGoogle Scholar
  19. 19.
    Elliott FA. The episodic dyscontrol syndrome and aggression. Neurol Clin 1984; 2: 113–25PubMedGoogle Scholar
  20. 20.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed., text revision. Washington, DC: American Psychiatric Association, 2000Google Scholar
  21. 21.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed. Washington, DC: American Psychiatric Association, 1980Google Scholar
  22. 22.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd rev. ed. Washington, DC: American Psychiatric Association, 1987Google Scholar
  23. 23.
    Dodge KA. Social-cognitive mechanisms in the development of conduct disorders and depression. Annu Rev Psychol 1993; 44: 559–84PubMedCrossRefGoogle Scholar
  24. 24.
    Barratt ES, Stanford MS, Kent TA, et al. Neuropsychological and cognitive psychophysiological substrates of impulsive aggression. Biol Psychiatry 1997; 41: 1045–61PubMedCrossRefGoogle Scholar
  25. 25.
    Monopolis S, Lion JR. Problems in the diagnosis of intermittent explosive disorder. Am J Psychiatry 1983; 140: 1200–2PubMedGoogle Scholar
  26. 26.
    Felthous AR, Bryant SG, Wingerter CB, et al. The diagnosis of intermittent explosive disorder in violent men. Bull Am Acad Psychiatry Law 1991; 19: 71–9PubMedGoogle Scholar
  27. 27.
    Coccaro EF, Kavoussi RJ, Berman ME, et al. Intermittent explosive disorder-revised: development, reliability, and validity of research criteria. Compr Psychiatry 1998; 39: 368–76PubMedCrossRefGoogle Scholar
  28. 28.
    Lejoyeux M, Feuche N, Loi S, et al. Study of impulse-control disorders among alcohol-dependent patients. J Clin Psychiatry 1999; 60: 302–5PubMedCrossRefGoogle Scholar
  29. 29.
    Zimmerman M, Mattia JI. Principle and additional DSM-IV disorders for which outpatients seek treatment. Psychiatr Serv 2000; 51: 1299–304PubMedCrossRefGoogle Scholar
  30. 30.
    Zimmerman M, Mattia JI, Younken S, et al. The prevalence of DSM-IV impulse control disorders in psychiatric outpatients [abstract no. 265]. APA new research abstracts. 151 st Annual Meeting of the American Psychiatric Association; 1998 May 30–Jun 4; Toronto (ON)Google Scholar
  31. 31.
    Zimmerman M, Posternak M. Anger and aggression in psychiatric outpatients. J Clin Psychiatry 2002. In pressGoogle Scholar
  32. 32.
    McElroy SL, Hudson JI, Pope HG, et al. The DSM IHR impulse control disorders not elsewhere classified: clinical characteristics and relationship to other psychiatric disorders. Am J Psychiatry 1992; 149: 318–27PubMedGoogle Scholar
  33. 33.
    Robins S, Novaco RM. Systems conceptualization and treatment of anger. J Clin Psychol 1999; 55: 325–37PubMedCrossRefGoogle Scholar
  34. 34.
    Pabis DJ, Stanislav SW. Pharmacotherapy of aggressive behavior. Ann Pharmacother 1996; 30: 279–87Google Scholar
  35. 35.
    Post RM, Roy-Byrne PP, Uhde TW. Graphic representation of the life course of illness in patients with affective disorder. Am J Psychiatry 1988; 145: 844–8PubMedGoogle Scholar
  36. 36.
    Olvera RL, Pliszka SR, Konyecsni WM, et al. Validation of the interview module for intermittent explosive disorder (MIED) in children and adolescents: a pilot study. Psychiatry Res 2001; 101:259–67PubMedCrossRefGoogle Scholar
  37. 37.
    Mattes JA. Psychopharmacology of temper outbursts: a review. J Nerv Ment Dis 1986; 174: 464–71PubMedCrossRefGoogle Scholar
  38. 38.
    Connor DF, Steingard RJ. A clinical approach to the pharmacotherapy of aggression in children and adolescents. Ann N Y Acad Sci 1996; 794: 290–307PubMedCrossRefGoogle Scholar
  39. 39.
    Marini JL, Sheard MH. Antiaggressive effect of lithium ion in man. Acta Psychiatr Scand 1977; 55: 269–86PubMedCrossRefGoogle Scholar
  40. 40.
    McElroy SL. Recognition and treatment of DSM-IV intermittent explosive disorder. J Clin Psychiatry 1999; 60: 12–6PubMedCrossRefGoogle Scholar
  41. 41.
    Sheard MH, Marini JL, Bridges CI, et al. The effect of lithium on impulsive aggressive behavior in man. Am J Psychiatry 1976; 133: 1409–13PubMedGoogle Scholar
  42. 42.
    Campbell M, Small AM, Green WH, et al. Behavioral efficacy of haloperidol and lithium carbonate: a comparison in hospitalized aggressive children with conduct disorder. Arch Gen Psychiatry 1984; 41: 0Google Scholar
  43. 43.
    Campbell M, Adams PB, Small AM, et al. Lithium in hospitalized aggressive children with conduct disorder: a double blind and placebo controlled study. J Am Acad Child Adolesc Psychiatry 1995; 34: 445–53PubMedCrossRefGoogle Scholar
  44. 44.
    Malone RP, Bennett DS, Luebbert JF, et al. Aggression classification and treatment response. Psychopharmacol Bull 1998; 34: 41–5PubMedGoogle Scholar
  45. 45.
    Malone RP, Delaney MA, Luebbert JF, et al. A double-blind placebo-controlled study of lithium in hospitalized aggressive children and adolescents with conduct disorder.Arch Gen Psychiatry 2000; 57: 649–54PubMedCrossRefGoogle Scholar
  46. 46.
    Lindenmayer JP, Kotsaftis A. Use of sodium valproate in violent and aggressive behaviors: a critical review. J Clin Psychiatry 2000; 61: 123–8PubMedCrossRefGoogle Scholar
  47. 47.
    Swann AC. Treatment of aggression in patients with bipolar disorder. J Clin Psychiatry 1999; 60: 25–7PubMedGoogle Scholar
  48. 48.
    Donovan SJ, Susser ES, Nunes EV, et al. Divalproex treatment of disruptive adolescents: a report of 10 cases. J Clin Psychiatry 1997; 58: 12–5PubMedCrossRefGoogle Scholar
  49. 49.
    Donovan SJ, Stewart JW, Nunes EV, et al. Divalproex treatment for youth with explosive temper and mood lability: a double-blind, placebo-controlled crossover design. Am J Psychiatry 2000; 157: 818–20PubMedCrossRefGoogle Scholar
  50. 50.
    Young AL, Hillbrand M. Carbamazepine lowers aggression: a review. Bull Am Acad Psychiatry Law 1994; 22: 52–61Google Scholar
  51. 51.
    Patterson JF. Carbamazepine for assaultive patients with organic brain disease. Psychosomatics 1987; 28: 579–81PubMedCrossRefGoogle Scholar
  52. 52.
    Mattes JA. Carbamazepine for uncontrolled rage outbursts. Lancet 1984; II: 1164–5CrossRefGoogle Scholar
  53. 53.
    Mattes JA, Rosenberg J, Mayes D. Carbamazepine vs propranolol in patients with uncontrolled rage outbursts: a random assignment study. Psychopharmacol Bull 1984; 20: 98–100PubMedGoogle Scholar
  54. 54.
    Hakola HPA, Laulumaa VA. Carbamazepine in treatment of violent schizophrenics [letter]. Lancet 1982; I: 1358CrossRefGoogle Scholar
  55. 55.
    Neppe VM. Carbamazepine as adjunctive treatment in non-epileptic chronic inpatients with EEG temporal lobe abnormalities. J Clin Psychiatry 1983; 44: 326–31PubMedGoogle Scholar
  56. 56.
    Foster HG, Hillbrand M, Chi CC. Efficacy of carbamazepine in assaultive patients with frontal lobe dysfunction. Prog Neuropsychopharmacol Biol Psychiatry 1989; 13: 865–74PubMedCrossRefGoogle Scholar
  57. 57.
    Kafantaris V, Campbell M, Padron-Gayol MV, et al. Carbamazepine in hospitalized aggressive conduct disorder children: an open pilot study. Psychopharmacol Bull 1992; 28: 193–9PubMedGoogle Scholar
  58. 58.
    Cueva JE, Overall JE, Small AM, et al. Carbamazepine in aggressive children with conduct disorder: a double blind and placebo controlled study. J Am Acad Child Adolesc Psychiatry 1996; 35: 480–90PubMedCrossRefGoogle Scholar
  59. 59.
    Barratt ES, Stanford MS, Felthous A, et al. The effects of phenytoin on impulsive and premeditated aggression: a controlled study. J Clin Psychopharmacol 1997; 17: 341–9PubMedCrossRefGoogle Scholar
  60. 60.
    Stanford MS, Houston RJ, Mathias CW, et al. A double-blind placebo-controlled crossover study of phenytoin in individuals with impulsive aggression. Psychiatry Res 2001; 103: 193–203PubMedCrossRefGoogle Scholar
  61. 61.
    McElroy SL, Pope HG, Keck PE, et al. Are impulse-control disorders related to bipolar disorder? Compr Psychiatry 1996; 37: 229–40PubMedCrossRefGoogle Scholar
  62. 62.
    Coccaro EF, Kavoussi RJ. Fluoxetine and impulsive aggressive behavior in personality-disordered subjects. Arch Gen Psychiatry 1997; 54: 1081–8PubMedCrossRefGoogle Scholar
  63. 63.
    Feder R. Treatment of intermittent explosive disorder with sertraline in 3 patients. J Clin Psychiatry 1999; 60: 195–6PubMedCrossRefGoogle Scholar
  64. 64.
    Jenkins SC, Toshihiko M. Therapeutic use of propranolol for intermittent explosive disorder. Mayo Clin Proc 1987; 62: 204–14PubMedCrossRefGoogle Scholar
  65. 65.
    Greendyke RM, Kanter DR. Therapeutic effects of pindolol on behavioral disturbances associated with organic brain disease: a double-blind study. J Clin Psychiatry 1986; 47: 423–6PubMedGoogle Scholar
  66. 66.
    Greendyke RM, Kanter DR, Schuster DB, et al. Propranolol treatment of assaultive patients with organic brain disease. J Nerv Ment Dis 1986; 174: 290–4PubMedCrossRefGoogle Scholar
  67. 67.
    Kemph JP, DeVane CL, Levin GM, et al. Treatment of aggressive children with clonidine: results of an open pilot study. J Am Acad Child Adolesc Psychiatry 1993; 32: 577–81PubMedCrossRefGoogle Scholar
  68. 68.
    Schachar R, Tannock R, Marriot M, et al. Deficient inhibitory control in attention deficit hyperactivity disorder. J Abnorm Child Psychol 1995; 23: 411–37PubMedCrossRefGoogle Scholar
  69. 69.
    Popper CW. Combining methylphenidate and clonidine: pharmacologic questions and news reports about sudden death. J Child Adolesc Psychopharmacol 1995; 5: 157–66CrossRefGoogle Scholar
  70. 70.
    Hunt RD, Arnsten AFT, Asbell MD. An open trial of guanfacine in the treatment of attention deficit hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 1995; 34: 50–4PubMedCrossRefGoogle Scholar
  71. 71.
    Horrigan JP, Barnhill LJ. Guanfacine for the treatment of attention deficit hyperactivity disorder in boys. J Child Adolesc Psychopharmacol 1995; 5: 215–23CrossRefGoogle Scholar
  72. 72.
    Campbell M, Rapoport JL, Simpson GM. Antipsychotics in children and adolescents. J Am Acad Child Adolesc Psychiatry 1999; 38: 537–45PubMedCrossRefGoogle Scholar
  73. 73.
    Jibson MD, Tandon R. New atypical antipsychotic medications. J Psychiatr Res 1998; 32: 215–28PubMedCrossRefGoogle Scholar
  74. 74.
    Pinals DA, Buckley PF. Novel antipsychotic agents and their implications for forensic psychiatry. J Am Acad Psychiatry Law 1999; 27: 7–22PubMedGoogle Scholar
  75. 75.
    Buitelaar JK, Van der Gaag RJ, Cohen-Kettenis P, et al. A randomized controlled trial of risperidone in the treatment of aggression in hospitalized adolescents with subaverage cognitive abilities. J Clin Psychiatry 2001; 62: 239–48PubMedCrossRefGoogle Scholar
  76. 76.
    Findling RL, McNamara NK, Branicky LA, et al. A double-blind pilot study of risperidone in the treatment of conduct disorder. J Am Acad Child Adolesc Psychiatry 2001; 39:509–16CrossRefGoogle Scholar
  77. 77.
    Alpert JE, Spillman MK. Psychotherapeutic approaches to aggressive and violent patients. Psychiatric Clin North Am 1997; 20: 453–71CrossRefGoogle Scholar
  78. 78.
    Edmondson CB, Conger JC. A review of treatment efficacy for individuals with anger problems: conceptual, assessment and methodological issues. Clin Psychol Rev 1996; 16: 251–75CrossRefGoogle Scholar
  79. 79.
    Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale (NJ): Lawrence Erlbaum, 1988: 25–6Google Scholar
  80. 80.
    Lochman JE. Effects of different treatment lengths in cognitive behavioral interventions with aggressive boys. Child Psychiatry Hum Dev 1985; 16: 45–56PubMedCrossRefGoogle Scholar
  81. 81.
    Lochman JE. Cognitive-behavioral intervention with aggressive boys: three-year follow-up and preventive effects. J Consult Clin Psychol 1992; 60: 426–32PubMedCrossRefGoogle Scholar
  82. 82.
    Lochman JE, Coie JD, Underwood MK, et al. Effectiveness of a social relations intervention program for aggressive and nonaggressive, rejected children. J Consult Clin Psychol 1993; 61: 1053–8PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 2002

Authors and Affiliations

  1. 1.Division of Child and Adolescent PsychiatryThe University of Texas Health Science Center at San AntonioSan AntonioUSA

Personalised recommendations