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
Cause:
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.
Treatment:
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).
