Associated physical examination findings and general medical conditions. The individual has persistent symptoms of anxiety or increased arousal that were not present before the trauma. Studies have found that intermittent explosive disorder is particularly prevalent among the military population. Within the general population, the prevalence rate is less than one percent, yet within the clinical population, this number rises to about 2 to 16 percent. Persistent symptoms of increased arousal not present before the trauma , as indicated by two or more of the following: 1 difficulty falling or staying asleep 2 irritability or outbursts of anger 3 difficulty concentrating 4 hypervigilance 5 exaggerated startle response E.
Acute Stress Disorder is distinguished from Posttraumatic Stress Disorder because the symptom pattern in Acute Stress Disorder must occur within 4 weeks of the traumatic event and resolve within that 4-week period. These maladaptive coping mechanisms can result in issues in the work place or in school, or unemployment. This disorder can develop in individuals without any predisposing conditions, particularly if the stressor is especially extreme. These symptoms are present for at least one month and the disorder is usually long-term. The most effective psychotherapy intervention for intermittent explosive disorder is cognitive behavioral therapy that focuses on the direct treatment of anger. Malingering should be ruled out in those situations in which financial remuneration, benefit eligibility, and forensic determinations play a role.
Combat training places heavy emphasis on aggression, while traits such as fear or compassion can lead or distraction or even death. The traumatic events can be reexperienced in various ways. The person has been exposed to a traumatic event in which both of the following were present: 1 the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others 2 the person's response involved intense fear, helplessness, or horror. To qualify for diagnosis, outbursts must occur about twice a week for at least three months American Psychiatric Association, 2013. Traumatic events that are experienced directly include, but are not limited to, military combat, violent personal assault sexual assault, physical attack, robbery, mugging , being kidnapped, being taken hostage, terrorist attack, torture, incarceration as a prisoner of war or in a concentration camp, natural or manmade disasters, severe automobile accidents, or being diagnosed with a life-threatening illness. Intermittent explosive disorder is extremely common, as more than half of youth and young adults have experienced at least one angry outburst.
Causes and Course of Intermittent Explosive Disorder Onset of intermittent explosive disorder usually begins around age 12 McLaughlin, et al. The individual may have a sense of a foreshortened future e. This is called talk therapy. This approach is helpful because it addresses the affective, cognitive, and behavioral components of violent outbursts. Symptoms interfere with day-to-day living and include reliving the event in nightmares or flashbacks; avoiding people, places, and things connected to the event; feeling alone and losing interest in daily activities; and having trouble concentrating and sleeping. There may be increased risk of Panic Disorder, Agoraphobia, Obsessive-Compulsive Disorder, Social Phobia, Specific Phobia, Major Depressive Disorder, Somatization Disorder, and Substance-Related Disorders. Differential Diagnosis In Posttraumatic Stress Disorder, the stressor must be of extreme i.
Engaging in combat requires some level of aggression or hostility to be effective. Patients learn anger management skills, deal with underlying concerns, learn to manage stress, and build positive coping skills Morland, et al. This specifier indicates that at least 6 months have passed between the traumatic event and the onset of symptoms. If the outbursts occur at work, the patient may be faced with employment. Note: In children, this may be expressed instead by disorganized or agitated behavior. Flashbacks in Posttraumatic Stress Disorder must be distinguished from illusions, hallucinations, and other perceptual disturbances that may occur in Schizophrenia, other Psychotic Disorders, Mood Disorder with Psychotic Features, a delirium, Substance-Induced Disorders, and Psychotic Disorders Due to a General Medical Condition. Augmenting cognitive behaviour therapy for post-traumatic stress disorder with emotion tolerance training: a randomized controlled trial.
Psychological therapies for the treatment of post-traumatic stress disorder in children and adolescents. As a result of this study, it suggests that computer-aided therapies are proving to be as effective as face-to-face therapies while saving time and providing faster access to care. Here is the complete list of Diagnostic and Statistical Manual of Mental Disorders codes, organized by disorder category. Narcissistic Personality Disorder: Progress in Recognition and Treatment. Note: In young chil- dren, repetitive play may occur in which themes or aspects of the trauma are expressed.
Intermittent explosive disorder, which can be diagnosed in children as young as six, is characterized by a wide variety of aggressive outbursts. In children, the sense of a foreshortened future may be evidenced by the belief that life will be too short to include becoming an adult. Associations between post-traumatic stress disorder symptoms and alcohol and other drug problems: Implications for social work practice. The diagnostic thresholds are lowered for children and adolescents. In Obsessive-Compulsive Disorder, there are recurrent intrusive thoughts, but these are experienced as inappropriate and are not related to an experienced traumatic event. Persistent of increased arousal not present before the trauma , as indicated by two or more of the following: 1 difficulty falling or staying asleep 2 or outbursts of anger 3 difficulty concentrating 4 5 exaggerated E.
Symptoms usually begin within the first three months after the trauma, although there may be a delay of months, or even years, before symptoms appear. The person commonly makes deliberate efforts to avoid thoughts, feelings, or conversations about the traumatic event Criterion C1 and to avoid activities, situations, or people who arouse recollections of it Criterion C2. Anxiety and fear related to the negative events are reduced over time. Even with inpatient care, it is best to opt for shorter hospital times, as extended stays have not been reported to transform the course of the illness. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed. Young children usually do not have the sense that they are reliving the past; rather, the reliving of the trauma may occur through repetitive play e. Increased arousal may be measured through studies of autonomic functioning e.
Because of this, intermittent explosive disorder is typically treated with medications such as antidepressants or mood stabilizers. Note: In young children, trauma-specific reenactment may occur. Patients also tend to see the therapist as an enemy. These traits are necessary in combat, but are maladaptive in the civilian world Morland, et al. Children may also exhibit various physical symptoms, such as stomachaches and headaches.
Remission is achieved when only one or two symptoms persist Coccaro, 2012. Phobic avoidance of situations or activities that resemble or symbolize the original trauma may interfere with interpersonal relationships and lead to marital conflict, divorce, or loss of job. Note: In children older than 6 years old, repetitive play or games may involve themes of the traumatic event s they experienced. Refugees and emergency service workers are also at higher risk Nickerson, et al. The highest rates are found among survivors of rape, captivity, military combat, and genocide.