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Ask the Mental Health Expert Archives 2001-2004

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Intermittent Explosive Disorder

Q. I am a graduate student researching the history of Impulse Disorders, specifically Intermittent Explosive Disorder. I need to find out when Intermittent Explosive Disorder became a diagnosable illness. Was it in the DSM-III? When did it first appear as a bonafide mental illness?

A. As you know, Intermittent Explosive Disorder (IED) is now classified in DSM-IV among the "Impulse Control Disorders Not Elsewhere Classified". This has remained essentially unchanged since DSM-III, which was published in 1980. Prior to that--in DSM-II--the nearest thing to IED was so-called Explosive Personality, which was regarded as a personality disorder.

In DSM-III, and ever since, it was recognized that some individuals have bouts of explosive behavior that are NOT part of their underlying character structure, and, indeed, are experienced as ego-alien or ego-dystonic. But, when you describe it as a bonafide mental illness, you may be going a bit further than our understanding permits.

In all likelihood, IED is a heterogeneous collection of pathophysiological and psychological conditions, rather than a single illness--that is, IED may really be a syndrome that represents the final common pathway for several etiologies. A good historical review from the 1980s is provided by Monopolis et al (Am J Psychiatry 1983;140:1200-1202). A more recent review is provided by McElroy et al in the March 1992 American Journal of Psychiatry, and in the April 1998 Journal of Clinical Psychiatry (also McElroy et al).

In the latter article, the authors found evidence that IED may be part of the affective spectrum of disorders, and might even reflect an atypical form of bipolar disorder. But, there are most likely patients who have been given the diagnosis of IED whose condition actually reflects a sub-ictal epileptiform disorder, impulse-ridden character disorders, etc. At the very least, these should be in the differential diagnosis of IED.

Good luck with your research!

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May 2002

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