F. The recurrent aggressive outbursts are not better explained by another mental disor- der (e.g., major depressive disorder, bipolar disorder, disruptive mood dysregulation disorder, a psychotic disorder, antisocial personality disorder, borderline personality disorder) and are not attributable to another medical condition (e.g., head trauma. Alz- heimer's disease) or to the physiological effects of a substance (e.g.. a drug of abuse, a medication). For children ages 6—18 years. aggressive behavior that occurs as part of an adjustment disorder should not be considered for this diagnosis.
Note: This diagnosis can be made in addition to the diagnosis of attention-deficit/hyper- activity disorder, conduct disorder, oppositional defiant disorder, or autism spectrum dis- order when recurrent impulsive aggressive outbursts are in excess of those usually seen in these disorders and warrant independent clinical attention.
The impulsive (or anger-based) aggressive outbursts in intermittent explosive disorder have a rapid onset and, typically, little or no prodromal period. Outbursts typically last for less than 30 minutes and commonly occur in response to a minor provocation by a close intimate or associate. Individuals with intermittent explosive disorder often have less severe epi- sodes of verbal and / or nondamaging, nondestructive, or noninjurious physical assault (Cri- terion A1) in between more severe destructive /assault1ve episodes (Criterion A2). Criterion
A1 defines frequent (i.e., twice weekly, on average, for a period of 3 months) aggressive out- bursts characterized by temper tantrums, tirades, verbal arguments or fights, or assault without damage to objects or without injury to animals or other individuals. Criterion A2 defines infrequent (i.e., three in a 1-year period) impulsive aggressive outbursts character- ized by damaging or destroying an object, regardless of its tangible value, or by assaulting/ striking or otherwise causing physical injury to an animal or to another individual. Regard- less of the nature of the impulsive aggressive outburst, the core feature of intermittent explosive disorder is failure to control impulsive aggressive behavior in response to subjec- tively experienced provocation (i.e., psychosocial stressor) that would not typically result in an aggressive outburst (Criterion B). The aggressive outbursts are generally impulsive and/ or anger-based, rather than premeditated or instrumental (Criterion C) and are associated with significant distress or impairment in psychosocial function (Criterion D). A diagnosis of intermittent explosive disorder should not be given to individuals younger than 6 years, or the equivalent developmental level (Criterion E), or to individuals whose aggressive out- bursts are better explained by another mental disorder (Criterion F). A diagnosis of intermit- tent explosive disorder should not be given to individuals with disruptive mood dysregulation disorder or to individuals whose impulsive aggressive outbursts are attribut- able to another medical condition or to the physiological effects of a substance (Criterion F).
In addition, children ages 6—18 years should not receive this diagnosis when impulsive ag- gressive outbursts occur in the context of an adjustment disorder (Criterion F).
Mood disorders (unipolar), anxiety disorders, and substance use disorders are associated with intermittent explosive disorder, although onset of these disorders is typically later than that of intermittent explosive disorder.
One-year prevalence data for intermittent explosive disorder in the United States is about 2.7% (narrow definition). Intermittent explosive disorder is more prevalent among younger individuals (e.g., younger than 35—40 years), compared with older individuals (older than 50 years), and in individuals with a high school education or less.