Intermittent Explosive Disorder

Intermittent explosive disorder (IED) is a DSM-5 disorder characterized by recurrent behavioral outbursts representing a failure to control aggressive impulses. It manifests as either verbal aggression (tantrums, tirades, verbal arguments) occurring twice weekly for 3 months without property damage or physical injury, or three behavioral outbursts involving damage to property or physical assault within a 12-month period.

The aggressive outbursts are impulsive (not premeditated) and are not committed to achieve a tangible objective. They cause marked distress, occupational impairment, interpersonal problems, or financial/legal consequences. The episodes typically last less than 30 minutes and are followed by feelings of remorse, regret, or embarrassment. The diagnosis requires age of at least 6 years and exclusion of other disorders that better explain the behavior.

IED is more common than previously recognized, with lifetime prevalence around 4-7%. It typically begins in late childhood or adolescence and is more common in males. It frequently co-occurs with mood disorders, anxiety disorders, substance use disorders, and other personality disorders. Underlying neurobiological factors include serotonergic dysfunction and abnormalities in the amygdala and prefrontal cortex.