Monday, June 05, 2006

Intermittent Explosive Disorder

TeeVee blogging here.
NBC Evening News just ended with a note of trivia.

There is now a clinical category for behavior that we used to call "having a hot temper." It might include Dad's over-reaction when he came home from work because somebody didn't take out the garbage. Or road rage. Intermittent Explosive Disorder.

I remember when I first came across the term IED and had to look it up. That was the term used for 'Improvised Explosive Device," weapon of choice in Iraq. We don't hear as much about that now with the new term "roadside bomb."

Did a Google search and sure enough, Intermittent Explosive Disorder is easy to find.

Many psychiatric disorders are associated with impulsive aggression, but some individuals demonstrate violent outbursts of rage, which are variously referred to as rage attacks, anger attacks, episodic dyscontrol, or intermittent explosive disorder. Intermittent explosive disorder was first formally conceptualized as a psychiatric disorder.

»On several occasions the patient has lost control of aggressive impulses, leading to serious assault or property destruction.

»The aggression is markedly out of proportion to the seriousness of any social or psychological stressors.

»No other mental disorder or personality disorder better explains the symptoms.

»These symptoms are not directly caused by a general medical condition or substance use, including medications and drugs of abuse.

Although the prevalence of intermittent explosive disorder is unknown and considered to be rare, the disorder is probably more common than realized and may be an important cause of violent behavior. As presently defined, intermittent explosive disorder is more common in men. However, women also have problematic impulsive aggression, and some women have reported an increase in intermittent explosive symptoms when they are premenstrual.

As soon as I heard it I immediately thought about someone I know who seemed to be a textbook case. I was wrong, however. This individual was instead ruled out by a more serious constellation of behaviors known as Borderline Personality Disorder.

A professional counselor we know says these people are the most durably resistent cases known to professionals who earn their living working with behavior disorders. Borderline people are the ones most likely to be referred elsewhere for attention because the professionals know right away they are apt to be wasting time trying to lead them to a better place.

»A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

»Frantic efforts to avoid real or imagined abandonment.

»A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation

»Identity disturbance: markedly and persistently unstable self-image or sense of self

»Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating).

»Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.

»Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).

»Chronic feelings of emptiness.

»Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).

»Transient, stress-related paranoid ideation or severe dissociative symptoms.

Like all personality disorders, borderline personality disorder is intrinsically difficult to treat. Personality disorders, by definition, are long-standing ways of coping with the world, social and personal relationships, handling stress and emotions, etc. that often do not work, especially when a person is under increased stress or performance demands in their lives. Treatment, therefore, is also likely to be somewhat lengthy in duration, typically lasting at least a year for most.

Got that?

Five or more from the list is all it takes to make the team. They try to put treatment into the best possible light, but reading between the lines it looks as though the prognosis is not very good.

That's it for tonight, folks.
Reflect now on whether any of these behaviors that occur in the civilian population with identifiable regularity are somehow eliminated by military training and conditioning. Seems to me that wearing a uniform and having access to weapons might not be a good idea for these individuals.

But hey, what do I know? I'm just an old guy blogging.
Maybe we have our own IED's after all.

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