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Intermittent Explosive Disorder

Many psychiatric disorders are associated with impulsive aggression, but some individuals demonstrate violent outbursts of rage, which are variously referred to as rage attacks, anger attacks, episodic dyscontrol, or intermittent explosive disorder. Intermittent explosive disorder was first formally conceptualized as a psychiatric disorder.

On several occasions the patient has lost control of aggressive impulses, leading to serious assault or property destruction.

The aggression is markedly out of proportion to the seriousness of any social or psychological stressors.

No other mental disorder or personality disorder better explains the symptoms.

These symptoms are not directly caused by a general medical condition or substance use, including medications and drugs of abuse.

Associated Features:

Head Trauma
Psychotic Disorder

Differential Diagnosis: 

Some disorders have similar or even the same symptoms. The clinician, therefore, in his/her diagnostic attempt has to differentiate against the following disorders which need to be ruled out to establish a precise diagnosis.

Alzheimer's Disease
Antisocial Personality Disorder
Borderline Personality Disorder
Conduct Disorder
Attention-deficit / hyperactivity disorder


Although the prevalence of intermittent explosive disorder is unknown and considered to be rare,  the disorder is probably more common than realized and may be an important cause of violent behavior. As presently defined, intermittent explosive disorder is more common in men. However, women also have problematic impulsive aggression, and some women have reported an increase in intermittent explosive symptoms when they are premenstrual.


These patients often need psychological treatment along with medication treatment, and it is often very helpful to base their psychological treatment on addiction-based models.

Counseling and Psychotherapy [ See Therapy Section ]:

Biofeedback has proven quite effective

Pharmacotherapy [ See Psychopharmacology Section ] :

Studies suggest that patients with intermittent explosive disorders respond to treatment with antidepressants such as tricyclic antidepressants and serotonin reuptake inhibitors (SRIs) and mood stabilizers such as lithium, carbamazepine, and divalproex. Psychotropic medications used with Intermittent Explosive Disorder.

Carbamazepine (Tegretol and others).
Divalproex (Depakote).
Fluoxetine (Prozac).
Gabapentin (Neurontin).
Lamotrigine (Lamictal).
P henytoin (Dilantin).
Sertraline (Zoloft).
Venlafaxine (Effexor).

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