Antisocial personality disorder or borderline personality disorder. Individuals with an- tisocial personality disorder or borderline personality disorder often display recurrent, problematic impulsive aggressive outbursts. However, the level of impulsive aggression in individuals with antisocial personality disorder or borderline personality disorder is lower than that in individuals with intermittent explosive disorder.
Delirium, major neurocognitive disorder, and personality change due to another med- ical condition, aggressive type. A diagnosis of intermittent explosive disorder should not be made when aggressive outbursts are judged to result from the physiological effects of an- other diagnosable medical condition (e.g., brain injury associated with a change in personality
Characterized by aggressive outbursts; complex partial epilepsy). Nonspecific abnormalities on neurological examination (e.g., ”soft signs") and nonspecific electroencephalographic changes are compatible with a diagnosis of intermittent explosive disorder unless there is a di- agnosable medical condition that better explains the impulsive aggressive outbursts.
Substance intoxication or substance withdrawal. A diagnosis of intermittent explosive disorder should not be made when impulsive aggressive outbursts are nearly always as- sociated with intoxication with or withdrawal from substances (e.g., alcohol, phencyclidine, cocaine and other stimulants, barbiturates, inhalants). However, when a sufficient number of impulsive aggressive outbursts also occur in the absence of substance intoxication or withdrawal, and these warrant independent clinical attention, a diagnosis of intermittent explosive disorder may be given.
Attention-deficit/hyperactivity disorder, conduct disorder, oppositional defiant disor- der, or autism spectrum disorder. Individuals with any of these childhood-onset dis- orders may exhibit impulsive aggressive outbursts. Individuals with ADHD are typically impulsive and, as a result, may also exhibit impulsive aggressive outbursts. While indi- viduals with conduct disorder can exhibit impulsive aggressive outbursts, the form of ag- gression characterized by the diagnostic criteria is proactive and predatory. Aggression in oppositional defiant disorder is typically characterized by temper tantrums and verbal ar- guments with authority figures, whereas impulsive aggressive outbursts in intermittent explosive disorder are in response to a broader array of provocation and include physical assault. The level of impulsive aggression in individuals with a history of one or more of these disorders has been reported as lower than that in comparable individuals whose symptoms also meet intermittent explosive disorder Criteria A through E. Accordingly, if
Criteria A through E are also met, and the impulsive aggressive outbursts warrant inde- pendent clinical attention, a diagnosis of intermittent explosive disorder may be given.
Depressive disorders, anxiety disorders, and substance use disorders are most commonly comorbid with intermittent explosive disorder. In addition, individuals with antisocial personality disorder or borderline personality disorder, and individuals with a history of disorders with disruptive behaviors (e.g., ADHD, conduct disorder, oppositional defiant disorder), are at greater risk for comorbid intermittent explosive disorder.
A. A repetitive and persistent pattern of behavior in which the basic rights of others or ma- jor age—appropriate societal norms or rules are violated, as manifested by the presence of at least three of the following 15 criteria in the past 12 months from any of the cate- gories below, with at least one criterion present in the past 6 months:
Aggression to People and Animals 1. Often bullies, threatens, or intimidates others.
2. Often initiates physical fights.
3. Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).
470 Disruptive, lmpulse-Control, and Conduct Disorders 4. Has been physically cruel to people.