Intermittent Explosive Disorder


Intermittent explosive disorder (IED) is a little studied psychological disorder characterized by repeated violent outbursts against people or objects, which is caused by a failure to resist aggressive impulses. The violent or aggressive reaction is disproportionate to the stimulus that provokes it, and outbursts occur repeatedly. IED is considered by some to be a cause of interpersonal violence from road rage to intimate partner violence. Others consider IED’s diagnostic and definitional criteria to be too vague or too broad, calling into question its legitimacy and utility as a diag-nosable psychological disorder.

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) places IED within the larger category of impulse disorders. Impulse disorders are characterized by the failure to resist impulses despite the potential for negative consequences. The diagnostic criteria for IED are vague and include any violent or aggressive outbursts that are repetitive, out of proportion to the situation, and not accounted for by other psychological disorders, drug use, or biological disorders. Due in part to its expansive diagnostic criteria, research on IED is very limited and some psychologists question its legitimacy. Despite the dearth of scholarly consensus and evidence about IED, it has been used successfully as a defense in court cases. Defendants have attempted to use it in court in response to charges as serious as homicide, primarily in cases related to road rage or intimate partner violence.

The available research is marked by a small number of studies, research definitions that differ from the DSM diagnostic criteria, and small sample sizes. Studies claim that IED is more common in men than women by a ratio of about three to one, and that it generally manifests in adolescence. Characteristics of IED described in the literature include an irresistible violent impulse followed by pleasure or relief derived from acting on the impulse, followed by remorse for the violent outburst or its consequences. The violent outbursts last less than 30 minutes. Often, the aggression is aimed at intimate partners. It may be either a grossly disproportionate response to provocation or unprovoked. Some scholars recommend treatment using drugs that are used to treat other impulse disorders. Others recommend cognitive-behavioral therapy or a combination of the two.

Critics have noted that the diagnostic criteria for IED are so vague that they could include nonpatho-logical and instrumental violence. The criteria include no minimum number of outbursts beyond repetition, and no time period in which the outbursts must occur. This means that virtually all violence that is not specifically identified as caused by another psychological disorder, biological problem, or drug use could ostensibly be termed IED. Common abusive behaviors could fall under the diagnostic criteria for IED, and scholars caution against pathologizing violence against intimate partners. Current research on IED fails to rule out social and cultural influences on violent and aggressive behavior within and outside of the family.

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