Intermittent Explosive Disorder Needs Updated Criteria

If you do more than just get angry when something doesn’t go your way, you may be suffering from a mental health disorder called intermittent explosive disorder (IED). IED is characterized by explosive rage, overreaction to stress, and an inability to handle stressful situations. While the disorder was first added to the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980, many mental health professionals want the criteria for diagnosing IED to be updated.

The DSM, which has not been updated since 1994, will have a new edition available to mental health professionals in 2013. The push for updated information for IED to be included in the book stems from two conflicting studies. A 2004 study determined that approximately 4 percent of the population suffers from IED, while a 2006 study says more than 7% of adults suffer from IED. The problem is in how IED is defined, how broadly the characteristics are applied, and the number of ambiguities that exist in the current DSM about the disorder.

Dr. Emil F. Coccaro, professor of psychiatry and behavioral neuroscience at the University of Chicago, says, “IED is a behavioral disorder that is a medical condition in the same way that depression or panic disorder is – it is not simply ‘bad behavior.’ Aggressive behavior is under genetic influence and IED runs in families.”

Coccaro believes the disorder is being under-diagnosed because of unclear information in the current issue of the DSM.  ”Looking at the criteria as written, having only three aggressive outbursts in one’s life could give you the diagnosis,” Coccaro said. “However, people with only a few aggressive outbursts in their life do not look that different from other people. You really need to see much more frequent outbursts whether they involve very severe aggression or not.”

Coccaro recommends that the new DSM set the criteria for diagnosing IED at three episodes of physical assault or destruction of property in less than one year. In addition, the behavior and reaction of the individual should be significantly out of line with the type of reaction a typical person would exhibit.

The DSM is still in production, so Coccaro and others are hopeful that IED will be one of the disorders that gets addressed in the new edition, but the task force working on the DSM were unable to confirm what changes to IED will be made as they are still accepting comments from mental health professionals.