Harvard Mental Health Letter

Intermittent explosive disorder

Everyone has heard of road rage or read newspaper stories about a usually calm and responsible person who "snaps" and commits a violent act. Some people lose their tempers in this way repeatedly and dramatically, causing serious emotional or physical harm to themselves and others. It's a pattern in which tension builds until an explosion brings relief, followed eventually by regret, embarrassment, or guilt.

Since the early 2000s, research has been shedding more light on this condition, now called intermittent explosive disorder. It is defined by attacks of impulsive rage that seem out of proportion to the immediate provocation and have serious consequences — verbal abuse, threats, property damage, assaults, and injuries. The American Psychiatric Association's definition includes all such behavior that can't be better explained by a diagnosis of antisocial or borderline personality, attention deficit disorder, conduct disorder, substance abuse, or dementia.

Research has been showing that intermittent explosive disorder is more common and more destructive than anyone had supposed. One study of several hundred people in the Baltimore area found that a surprising 11% had qualified for the diagnosis at some time in their lives, and 3% for current diagnosis. These percentages were about the same for men and women, blacks and whites. Only age made a difference: Younger people were more susceptible.

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