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)
