DSM-IV INTERMITTENT EXPLOSIVE DISORDER - A REPORT OF 27 CASES

Background: The authors' objective was to provide data regarding the d emographic, phenomenological, course of illness, associated psychiatri c and medical comorbidity, family history, and psychiatric treatment r esponse characteristics of rigorously diagnosed subjects who met DSM-I V criteria for intermittent explosive disorder. Method: Twenty-seven s ubjects meeting DSM-IV criteria for a current or past history of inter mittent explosive disorder were given structured diagnostic interviews . The subjects' medical histories, family histories of psychiatric dis orders, and responses to psychiatric treatments were also assessed. Re sults: Most subjects described their intermittent explosive disorder s ymptoms as very distressing and/or highly problematic. All 27 subjects described aggressive impulses prior to their aggressive acts. Of 24 s ubjects 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 aggressi ve impulses and acts were also associated with affective symptoms, par ticularly 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 exp losive disorder. Subjects also displayed high rates of comorbid migrai ne headaches. First-degree relatives displayed high rates of mood, sub stance use, and impulse-control disorders. Twelve (60%) of 20 subjects receiving monotherapy with an antidepressant or a mood stabilizer rep orted 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 disord er and may represent another form of affective spectrum disorder.