A new study from the National Institute of Mental Health (NIMH) suggests that Intermittent Explosive Disorder (IED) is more common than previously thought.
The key phrase in the NIMH press release is, “Depending upon how broadly it’s defined…”
The DSM IV gives only two criteria and two qualifiers for making this diagnosis:
1. On several occasions the patient has lost control of aggressive impulses, leading to serious assault or property destruction.
2. The aggression is markedly out of proportion to the seriousness of any social or psychological stressors.
Qualifier # 1: No other mental disorder or personality disorder better explains the symptoms.
Qualifier # 2: These symptoms are not directly caused by a general medical condition or by their use of substances, including medications.
The NIMH press release states the study was “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.”
Just so we’re clear on what this study really was, people asked respondents if they have had “three or more” incidents of disproportionate anger. And then, presumably, went on to ask them questions that would rule out alcohol abuse, substance abuse, depression, etc.
So here is what we don’t know (I’ve only read the press release):
Who actually conducted the interviews? Were the interviewers trained in diagnosing chemical dependency, mood disorders, or other mental health issues? Or, did they simply ask, have you ever been treated for these things?
We never know if people are being completely honest in self reports.
What was the definition of “grossly out of proportion to any precipitating psychosocial stressor”?
My reference books tell me IED is “very rare”. My experience suggests that people with IED have trouble with anger in all aspects of their life. If explosive anger only manifests itself in one area of life, and not other areas, I would have a hard time diagnosing someone with IED. If you can control yourself at work and home but experience road rage, I don’t think you’ve met the criteria for losing control of angry impulses.
I find it curious that many of my clients over the years have managed to control their anger in situations where it might harm them (at work, in a bar, or with very large friends) but “impulsively” lose control in situations where their is little risk to themselves; at home with their wife or children or on the road behind the wheel of a very large vehicle.
I’m not convinced NIMH is on the right track. I just don’t see how one can capture the nuances of relational dynamics in a survey.
If you would like to make a comment, please fill out the form below.
Hi
I feel that my husband has this disorder. At anytime ( especially when drinking) he can erupt. He has broken a glass door, pushed me a few times, abused friends, workmates and family, slammed doors and has terrible road rage.
It scares me and I am not sure how to handle it when it manifests. If you could possibly help me it would be appreciated.
Thank you
Lee,
Please read my post on Domestic Violence ; and contact one of the agencies listed.
There is no excuse for the behavior you have described.