Impulsivity: Is it AD/HD or IED, Intermittent Explosive Disorder?

Impulsivity Redefined

[Ed Note: this post was first published here in 11/2008, today 6 years ago. See this more recent CorePsych posting on IED from 11/2014 on the Biomedical Measurement and Fresh Treatments for Intermittent Explosive Disorder]

What is Intermittent Explosive Disorder?

Markers Prevent Wrecks

Intermittent Explosive Disorder [IED] can look like ADHD – but it's more than that: Take a look at this material from the National Institute of Health that also differentiates IED from Bipolar:

Intermittent Explosive Disorder (IED) Affects up to 16 Million Americans in their lifetime

“A little-known mental disorder marked by episodes of unwarranted anger [-sounds like ADD/ADHD at first glance] is more common than previously thought, a study funded by the National Institutes of Health's (NIH) National Institute of Mental Health (NIMH) has found. Depending upon how broadly it's defined, intermittent explosive disorder (IED) affects as many as 7.3 percent of adults — 11.5-16 million Americans — in their lifetimes. The study is based on data from the National Comorbidity Survey Replication, a nationally representative, face-to-face household survey of 9,282 U.S. adults, conducted in 2001-2003.

People with IED may attack others and their possessions, causing bodily injury and property damage. Typically beginning in the early teens, the disorder often precedes — and may predispose for — later depression, anxiety and substance abuse disorders. Nearly 82 percent of those with IED also had one of these other disorders, yet only 28.8 percent ever received treatment for their anger, report Ronald Kessler, Ph.D., Harvard Medical School, and colleagues. In the June, 2006 Archives of General Psychiatry, they suggest that treating anger early might prevent some of these co-occurring disorders from developing.”

Diagnostic Criteria

-the following criteria apply, remembering this is a descriptive review, not giving us any brain functional information, as we at CorePsych find so essential [more on this later]:

“with IED, an individual must have had three episodes of impulsive
aggressiveness “grossly out of proportion to any precipitating
psychosocial stressor,” at any time in their life, according to the
standard psychiatric diagnostic manual. The person must have “all of a
sudden lost control and broke or smashed something worth more than a
few dollars, hit or tried to hurt someone, or threatened to hit or hurt
someone.”

“People who had three such episodes within the space of one year — a
more narrowly defined subgroup — were found to have a much more
persistent and severe disorder, particularly if they attacked both
people and property. The latter group caused 3.5 times more property
damage than other violent IED sub-groups. Affecting nearly 4 percent of
adults within any given year — 5.9-8.5 million Americans — the disorder
leads to a mean of 43 attacks over the course of a lifetime and is
associated with substantial functional impairment.

“Evidence suggests that IED might predispose toward depression, anxiety,
alcohol and drug abuse disorders by increasing stressful life
experiences, such as financial difficulties and divorce.

Given its earlier age-of-onset, identifying IED early — perhaps in
school-based violence prevention programs — and providing early
treatment might prevent some of the associated psychopathology, propose
the researchers. Although most study respondents with IED had seen a
professional for emotional problems at some time in their lives, only
11.7 percent had been treated for their anger in the 12 months prior to
the study interview.

Although the new prevalence estimates for IED are somewhat higher than
previous studies have found, the researchers consider them
conservative. For example, anger outbursts in people with bipolar
disorder, which often overlaps with IED, were excluded. Previous
studies have found little overlap between IED and other mental
illnesses associated with impulsive violence, such as antisocial and
borderline personality disorders.

Also participating in the study were Dr. Emil Coccaro, University of
Chicago, Dr. Maurizio Fava, Massachusetts General Hospital, and Dr.
Savina Jaeger, Robert Jin, and Ellen Walters, Harvard University.”

It's interesting how the diagnosis and discussion revolves for years based upon appearances. Other considerations today: Brain injury and biomedical imbalances as described more completely in the IED CorePsych posting link in that first paragraph above.

Look forward to your comments on this interesting tip of the iceberg!
cp
Dr Charles Parker
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